Mindfulness, CBT can reduce chronic low back pain

Mindfulness and CBT are superior to usual care in reducing low back pain.
Mindfulness and CBT are superior to usual care in reducing low back pain.

Mindfulness meditation and cognitive behavioral therapy (CBT) may be more effective than conventional treatments for reducing chronic lower back pain, according to a study published in the Journal of the American Medical Association.

Mindfulness-based stress reduction (MBSR) and CBT showed similar improvements in functional limitations and how much the pain bothered patients with chronic low back pain, and both of these interventions resulted in significantly greater improvements than usual care.

"We're constantly looking for new and innovative ways to help our patients," said Daniel Cherkin, PhD, a senior investigator at Group Health Research Institute. "The research suggests that training the brain to respond differently to pain signals may be more effective – and last longer – than traditional physical therapy and medication."

The study included 342 participants aged 20 to 70 years with chronic low back pain who were randomly assigned to 1 of 3 interventions: MBSR (n=116), CBT (n=113), or usual care (n=113). The study had two primary outcomes, compared with baseline and assessed at 4, 8, 26, and 52 weeks: percentage of participants with clinically meaningful (≥30%) improvement in functional limitations (as measured by the modified Roland Disability Questionnaire [RDQ], scored on a range of 0-23), and self-reported back pain bothersomeness (on a scale of 1-10) at 26 weeks.

The interventions were delivered to patients in 8 weekly, 2-hour group sessions. CBT trained patients to change pain-related thoughts and behaviors, and MBSR trained patients in mindfulness meditation and yoga.

At week 26, clinically meaningful improvement on the RDQ scale was seen in 60.5% of the MBSR group, 57.7% of the CBT group, and 44.1% of the usual care group. Clinically meaningful improvement in pain bothersomeness was seen in 43.6% of the MBSR group, 44.9% in the CBT group, and 26.6% of the usual care group.

For MBSR, the improvement in functional limitations and pain levels remained relatively unchanged at week 52. However, the researchers found that the effects of CBT were not better than usual care at 52 weeks.

“We are not saying 'It's all in your mind,'” Dr Cherkin said. “Rather, as recent brain research has shown, the mind and the body are intimately intertwined, including in how they sense and respond to pain.”

Reference

  1. Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain. JAMA. 2016;315(12):1240-1249.
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