By John M. de Castro, Ph.D.
“For some people with chronic pain, mindful meditation is an appealing pain management option because it has an unusual benefit; it is something that you personally control. Unlike pain medications or medical procedures, meditation is not done to you, it is something you can do for yourself.” – Stephanie Burke
Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.
Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices have been shown to be safe and beneficial in pain management in general and yoga and mindfulness has been shown to specifically improve back pain. Mindfulness Based Stress Reductions (MBSR) programs contain both yoga and mindfulness practices. So, it would seem reasonable to project that MBSR practice would improve emotion regulation and thereby be beneficial for back pain.
In today’s Research News article “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: A Randomized Clinical Trial.” See:
or see summary below or view the full text of the study at:
http://jama.jamanetwork.com/article.aspx?articleid=2504811
Cherkin and colleagues recruited a large sample of adults suffering with low back pain. They were then randomly assigned to a treatment as usual group or to groups which received treatment as usual plus 2 hours per week for 8-weeks of either Mindfulness Based Stress Reduction (MBSR) treatment or Cognitive Behavioral Therapy (CBT). Participants were measured before, 4-weeks into, and after treatment at 8, 26, and 52 weeks for back pain, functional related limitations, bothersomeness, depression, anxiety, pain intensity, pain improvement, general physical health, and general mental health.
They found that at the primary endpoint of 26 weeks both the MBSR and CBT groups showed statistically significant better clinically meaningful improvements in pain bothersomeness and functional related limitations than the treatment as usual group and these improvements were still present at one-year follow-up. They also found that at 8 and 26 weeks both the MBSR and CBT groups showed statistically significant improvements in depression, anxiety, pain intensity, and global mental health than the treatment as usual group and the improvement in pain intensity was still present at one-year follow-up.
These results are excellent and conclusively demonstrate that both Mindfulness Based Stress Reduction (MBSR) treatment and Cognitive Behavioral Therapy (CBT) are far superior to the usual treatment in the improvement of low back pain physical and psychological symptoms. These improvements occurred without any significant adverse effects. The fact that many of the effects were still present a year later is particularly significant and indicate the treatments have lasting effects. Hence, both MBSR and CBT are safe and effective treatments for chronic low back pain.
So, reduce back pain with mindfulness.
“mindfulness-based stress reduction may be particularly helpful for people because even if their use lapses, they develop a skill they can draw on later when they need it. That suggests that training the mind has potential to change people on a more lasting basis than doing a manipulation of the spine or massage of the back, techniques that may be effective in the short term but lose effects over time. You can practice it by waiting at the bus stop and just breathing.” – Daniel Cherkin
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Daniel C. Cherkin, Karen J. Sherman, Benjamin H. Balderson, Andrea J. Cook, Melissa L. Anderson, Rene J. Hawkes, Kelly E. Hansen, Judith A. Turner. 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: A Randomized Clinical Trial. JAMA. 2016;315(12):1240-1249. doi:10.1001/jama.2016.2323.
Abstract
Importance: Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain.
Objective: To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care.
Design, Setting, and Participants Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113).
Interventions: CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received.
Main Outcomes and Measures: Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks.
Results: There were 342 randomized participants, the mean (SD) [range] age was 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 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. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overall P = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group (overall P = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.
Conclusions and Relevance: Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.
http://jama.jamanetwork.com/article.aspx?articleid=2504811