Effect of Anapana, Body scan and Metta meditation techniques on pain and disability of adult patients affected with chronic neck and shoulder region pain

INTERVENTION: This trial will be conducted in a clinic in Colombo Sri Lanka. This clinic has four rheumatology clinics held on four different days of the week. Each clinic will be considered as a cluster. One cluster will be the control group. The other three clusters will be the three intervention groups: Anapana, Metta and Body Scan. Patients eligible to be included in the study will be allocated into one of the intervention arms (Anapana, Metta and Body scan) or control arm using previously generated random number groups. Patients in the three intervention arms will take part in weekly meditation training sessions (30‐45 minutes) for 8 weeks. In addition, they will be asked to practice meditation at home daily for 15 minutes/day and maintain entries in a logbook with regard to the amount of meditation done per day. The control group will not receive any intervention. They will receive only the usual care treatment which includes medication and physiotherapy. Patients in all four groups will be asked to maintain entries in a logbook with regard to their level of pain (assessed three times/day) and the amount of medication taken daily and they will be assessed at baseline and 4, 8 and 12 weeks follow‐up. The 4th and 8th weeks of follow up will take place while the intervention is going on. The 12th week of assessment will take place after the intervention. Data will be collected using validated questionnaires, clinical examinations and focus groups. A numerical pain rating scale will be used to assess the level of pain. Oswestry neck disability questionnaire, disability of shoulder arm and hand questionnaire (DASH), and clinical assessment of neck and shoulder joint CONDITION: Neck and shoulder region pain due to mechanical causes such as cervical spondylosis, muscle strain, ligamental sprain and facet joint osteoarthritis ; Signs and Symptoms PRIMARY OUTCOME: Pain in the neck and shoulder region assessed using the numerical pain rating scale at 8 weeks follow up INCLUSION CRITERIA: 1. Patients in the age range 18‐65 years and affected with chronic (>12 weeks) neck and shoulder region pain attending the four clinics managed by the same physician and physiotherapist 2. Patients affected with mechanical causes such as degenerative changes of the spine, muscle strain, ligament sprain, and facet joint osteoarthritis 3. Patients who can understand and communicate in Sinhala SECONDARY OUTCOME: ; 1. Pain in the neck and shoulder region assessed using the numerical pain rating scale at 4 and 12 weeks follow up; 2. The range of movement in the neck and shoulder region, assessed clinically by measuring the active and passive movements of the neck and shoulder joint using a goniometer at 4, 8 and 12 weeks follow‐up; 3. Physical and social disability with regard to activities of daily living, occupation and social activities (with family, friends, neighbours and/or groups) assessed using validated questionnaires (Neck Disability Index, Disability of Shoulder Arm and Hand and the SF‐36 Short Form) at 4, 8 and 12 weeks follow‐up; 4. How patients in the three intervention groups feel about the effects of meditation on pain, physical and social disability with regard to activities of daily living, occupation and social activities (with family, friends, neighbours and/or groups) and the acceptability and feasibility of the different types of meditation training and practice for the participants will be assessed using semi‐structured interviews/focus groups at 8 weeks follow‐up;