Improve Opiate Relief of Low Back Pain with Mindfulness
By John M. de Castro, Ph.D.
“I’ve been doing research on back pain for 30 years. The biggest revolution has been the understanding that it’s not just a physical problem with physical solutions. It’s a biopsychosocial problem.” – Daniel Cherkin
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. The pain interferes with daily living and with work, interfering with productivity and creating absences. 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.
Pain involves both physical and psychological issues. Physically, exercise can be helpful in strengthening the back to prevent or relieve pain. Psychologically, 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 are effective in treating pain and have been shown to be safe and effective in the management of low back pain.
There have been few attempts to study the combination of opiate treatment with mindfulness training for the treatment of chronic low back pain. In today’s Research News article “Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991566/, Zgierska and colleagues examine their combination. They recruited patients with chronic low back pain who have been taking daily opiates for at least 3 months and randomly assigned them to either continue opiate treatment or to continue it in combination with mindfulness training. Mindfulness training consisted of once a week for 8 weeks, 2-hour sessions with training in breath meditation, walking meditation, loving kindness meditation, and body scan. Participants were also required to practice at home. Before and after treatment and 18 weeks later the patients were measured for pain severity, physical function (disability), and opioid intake and side effects. After treatment, they also completed measures of adherence to the treatment protocol and satisfaction with the treatment.
They found that there were significant decreases in pain severity and pain sensitivity in the mindfulness treatment group at the 18-week follow-up. No adverse events were reported and opioid use declined slightly albeit not significantly. None of the participants withdrew from the study and there was a 91% adherence to treatment protocol rate. Additionally, participants were satisfied with the intervention and generally planned to continue practice.
These results are very exciting and suggest that mindfulness training is an acceptable, safe, and effective supplement to opioid treatment for pain relief in chronic back pain patients. Given that the patients were already on pain killers, this was a remarkable effect of mindfulness training. It is thought that mindfulness training reduces pain by interrupting the patients’ psychological reactions to pain. Mindfulness is known to improve emotion regulation, and reduce stress effects, fear, worry, and anxiety all of which can amplify pain. By eliminating these factors that magnify the pain, mindfulness practice reduces the patients’ overall pain level.
So, improve opiate relief of low back pain with mindfulness.
“We are accumulating evidence that meditation’s effects on pain can be realized with very short training. A fast-acting, non-pharmacological, inexpensive treatment for chronic pain? That might be a pill everyone can swallow.” – Stephani Sutherland
CMCS – Center for Mindfulness and Contemplative Studies
This and other Contemplative Studies posts arealso available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch
Zgierska, A. E., Burzinski, C. A., Cox, J., Kloke, J., Singles, J., Mirgain, S., … Bačkonja, M. (2016). Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy. Journal of Alternative and Complementary Medicine, 22(8), 610–620. http://doi.org/10.1089/acm.2015.0314
Objective: Although mindfulness meditation (MM) is increasingly used for chronic pain treatment, limited evidence supports its clinical application for opioid-treated chronic low back pain (CLBP). The goal of this study was to determine feasibility, acceptability, and safety of an MM-based intervention in patients with CLBP requiring daily opioid therapy.
Design: 26-week pilot randomized controlled trial comparing MM-based intervention, combined with usual care, to usual care alone.
Patients: Adults with CLBP treated with ≥30 mg of morphine-equivalent dose (MED) per day for 3 months or longer.
Interventions: Targeted MM-based intervention consisted of eight weekly 2-hour group sessions and home practice (30 minutes/d, 6 days/wk) during the study. “Usual care” for opioid-treated CLBP was provided to participants by their regular clinicians.
Outcome measures: Feasibility and acceptability of the MM intervention were assessed by adherence to intervention protocol and treatment satisfaction among experimental participants. Safety was evaluated by inquiry about side effects/adverse events and opioid dose among all study participants.
Results: Thirty-five participants enrolled during the 10-week recruitment period. The mean age (±standard deviation) was 51.8 ± 9.7 years; the patients were predominantly female, with substantial CLBP-related pain and disability, and treated with 148.3 ± 129.2 mg of MED per day. All participants completed baseline assessments; none missed both follow-up assessments or withdrew. Among experimental participants (n = 21), 19 attended 1 or more intervention sessions and 14 attended 4 or more. They reported, on average, 164.0 ± 122.1 minutes of formal practice per week during the 26-week study and 103.5 ± 111.5 minutes of brief, informal practice per week. Seventeen patients evaluated the intervention, indicating satisfaction; their qualitative responses described the course as useful for pain management (n = 10) and for improving pain coping skills (n = 8). No serious adverse events or safety concerns occurred among the study participants.