Introduction
Pain is an unpleasant sensation and a warning sign that is often triggered by severe or noxious stimuli. Pain can cause mental pressures in people [1] that forces them to seek healthcare and treatment. It can not only cause discomfort, but also can lead to severe and painful consequences and affect a person’s life. For this reason, relief and pain control measures are the most important priorities for these people [2, 3]. Non-pharmacological methods such as mindfulness intervention can make the pain bearable for these people. The pains with psychological origin are: tension-type headaches, migraine, neck pain, and even high blood pressure and diabetes; i.e., all types of pain that cannot be treated with medication [4]. pharmacological treatments for pain include the use of drugs such as painkillers, narcotics, corticosteroids, and muscle relaxants. Non-pharmacological methods have less cost and side effects compared to pharmacological methods [5]. In recent years, non-pharmacological methods of pain reduction have been emphasized [6, 7] such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), and acceptance and commitment therapy known as the third wave therapies. Mindfulness refers to being aware in the present moment, on purpose and non-judgmentally [8]. It is considered as one of the types of meditation [9]. A study showed that mindfulness-based therapy can increase the feeling of control over pain and the use of positive coping strategies, and reduce anxiety and psychological stress in patients [10]. Since the inappropriate treatment of pain has biological and psychological consequences for the patients, their families, and society, safer and less complicated methods should be used. This study aims to review the studies on the mindfulness-based therapies used separately or in combination with other medical methods for treating chronic pain.

Materials and Methods
This is a narrative review study from February to June 2023 on the related articles by searching in databases such as MagIran, SID, Google Scholar, and PubMed using the keywords pain, pain disorders, and mindfulness. Among the found articles, 32 were included in the study, of which 13 were in Farsi and 2 in English. They were selected based on the inclusion criteria and removing duplicates. The process is illustrated in Figure 1.
Results
Out of 15 studies, 13 studies were conducted in Iran, of which 2 were qualitative studies (Table 1).




The findings showed that interventions by mindfulness exercises are effective in reducing pain intensity and improving pain management in people with pain disorders.

Discussion
The purpose of the current study was to review Mindfulness-based methods used alone or in combination with other medical methods for the treatment of chronic pain. Mindfulness training can lead to reduction of pain, anxiety [26] and psychological distress and improvement of emotion regulation [27]. MBCT is an effort to maintain the effects of behavior modification and the integration of cognitive activities to create therapeutic changes. A study showed that mindfulness therapy can increase the feeling of control over pain and the use of positive coping strategies and reduce anxiety and psychological stress in patients [10]. Few studies have been conducted on the psychosomatic problems of patients. Abdollahi et al.’s study [11] showed that mindfulness intervention leads to improvement in the quality of life and pain of patients with carcinoma. Haghdoost et al. [12] showed that MBSR had a significant effect on death anxiety, pain catastrophizing, pain acceptance and pain intensity in patients with prostate cancer. The use of relaxation techniques in mindfulness intervention, returns the flow of oxygen burning in the body to a normal state, and as a result, increases comfort and reduces the feeling of pain [20]. Mindfulness helps a person to take care of her/his mental health and enjoy life more by being aware of her/his behaviors, emotions, and thoughts by concentration and using meditation exercises. Mindfulness therapy is based on managing thoughts and feelings and being in the present moment non-judgmentally. According to Asadollahi et al. [28], regular mindfulness exercises could increase the awareness of the body, feelings and thoughts, and ultimately increases the quality of life in women with chronic back pain. Also, mindfulness training along with relaxation normalizes breathing and reduces the external symptoms of anxiety (heart palpitations, worry, pressure drop, sweating and difficulty breathing). According to a study, mindfulness training can lead to a change in our attitude towards pain and causes a person not suffer from pain [29]. Mindfulness programs can be combined with cognitive therapy to target the processes that are under the attack of depressive episodes. Mindfulness training helps patients with chronic pain interrupt the activation of depressive patterns in response to pain and physical dysfunction, and they probably learn to connect to their problems with automatic thoughts, acceptance, and in a non-judgmental manner, which is very effective in reducing depression and pain. Mindfulness increases physical monitoring and body awareness, which probably leads to the improvement of body mechanisms and self-care. The combination of medication techniques with mindfulness is associated with an increase in parasympathetic activity, which can lead to deep muscle relaxation and reduction of tension and arousal, and as a result, reduce the symptoms of stress and anxiety. This, in turn, can lead to a reduction in chronic pain.

Conclusion
Therapists should not use medication alone for treatment of chronic pain. Considering the shortage of medications in Iran, it is cost-effective to use mindfulness-based interventions for patients with chronic pain, although these interventions, like other interventions, have some limitations and is not long-lasting. More studies should be done in this field. According to the effectiveness of mindfulness-based interventions in reduction of pain disorders, it is recommended for all people with chronic pain to learn mindfulness techniques to reduce negative thoughts and emotions such as fear, anxiety and worry.

Ethical Considerations
Compliance with ethical guidelines
This is a review study with no experiments on human or animal models. Therefore, there was no ethical principles to be considered.

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

Authors' contributions
Supervision: Farangis Demehri and Mohsen Saeidmanesh; investigation, initial draft preparation, review & editing: Asal Tabatabaee Irani.

Conflict of interest
The authors declare no conflict of intervention

Acknowledgments
Thanks other professors who helped us in conducting this research.


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