Recently, mindfulness meditation and mindfulness-based stress reduction has relieved significant attention as methods to relieve pain without resorting to pain killers. Now, a new study compared mindfulness-based stress reduction to cognitive behavioral therapy or usual care on back pain and limitation of motion among adults with chronic low back pain. The findings were published on March 22 in the Journal of the American Medical Association(JAMA) by researchers at the University of Washington, Seattle.
The study authors note that low back pain is a major cause of disability in the US. Despite numerous treatment options and markedly increased medical care resources focused on this problem, the functional status of persons with back pain in the US has worsened. Thus, there is a need for treatments with demonstrated effectiveness that are low risk and have the potential for widespread application.
The authors explain that psychosocial factors play important roles in pain and associated physical and psychosocial disability. Four of the eight nonpharmacologic (non-drug) treatments recommended for chronic back pain include mind-body components. One of these, cognitive behavioral therapy, has demonstrated effectiveness for a variety of chronic pain conditions and is commonly recommended for patients with chronic low back pain. However, patient access to cognitive behavioral therapy is limited. Mindfulness-based stress reduction is another mind-body approach; it focuses on increasing awareness and acceptance of moment-to-moment experiences including physical discomfort and difficult emotions. Mindfulness-based stress reduction is becoming increasingly popular and available in the US; thus, if it is found to be beneficial for chronic low back pain, it could offer another psychosocial treatment option for the large number of Americans residents with this condition.
The researchers note that mindfulness-based stress reduction has not been fully evaluated for young and middle-aged adults with chronic low back pain. Therefore, the objective of the study was to evaluate its effectiveness for chronic low back pain compared to behavioral therapy or usual care.
The study group comprised 342 adults aged 20 to 70 years with chronic low back pain who were enrolled in an integrated healthcare system in Washington State from September 2012 through April 2014. The subjects were randomly assigned to receive mindfulness-based stress reduction (116 subjects), cognitive behavioral therapy (113 subjects), or usual care (113 subjects).
Mindfulness-based stress reduction and cognitive behavioral therapy were delivered in eight weekly two-hour groups. Usual care included whatever care the participants received. Clinical improvement in pain and function was measured by the modified Roland Disability Questionnaire (RDQ) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks. There were 224 (65.7%) women and the average duration of back pain was 7.3 years (range: 3 months to50 years); 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks.
At 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received mindfulness-based stress reduction (60.5%) and cognitive behavioral therapy (57.7%) than for usual care (44.1%). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the mindfulness-based stress reduction group and 44.9% in the cognitive behavioral therapy group, vs 26.6% in the usual care group. The findings for mindfulness-based stress reduction persisted with little change at 52 weeks.
The authors concluded that, among adults with chronic low back pain, treatment with mindfulness-based stress reduction or cognitive behavioral therapy, compared to usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between the two groups. They noted that their findings suggest that mindfulness-based stress reduction may be an effective treatment option for patients with chronic low back pain.