Improve Chronic Back Pain with Mindfulness and Cognitive Therapy
By John M. de Castro, Ph.D.
“Mindful mediation is an appealing option for treating your pain because it has an unusual benefit; it places you in a position of control. Unlike pain medications or surgical procedures, meditation is not done to you—but rather it is something you 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. 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.
In today’s Research News article “Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069124/ ), Turner and colleagues recruited adults suffering from chronic low back pain and randomly assigned them to either receive usual care, or 8 weeks, 2 hours per day, of Mindfulness-Based Stress Reduction (MBSR), or Cognitive Behavioral Therapy (CBT). The therapies were supplemented with home practice. They were measured before and after treatment and at 26 and 52 weeks later, for mindfulness, back pain bothersomeness, pain duration, pain frequency, pain catastrophizing, pain acceptance, and pain self-efficacy.
They found that before treatment the higher the levels of pain catastrophizing the lower the levels of mindfulness, pain acceptance, and pain self-efficacy. Following treatment both MBSR and CBT produced significant decreases in pain catastrophizing and increases in mindfulness, pain self-efficacy and pain acceptance that remained significant a year later. Hence, both Mindfulness-Based Stress Reduction (MBSR), or Cognitive Behavioral Therapy (CBT) produced significant improvements in the ability of the patients to adjust and cope with low back pain.
These results are interesting as MBSR and CBT are quite different treatments. MBSR consists of a combination of meditation, yoga, and body scan practices that are designed to improve mindfulness and reduce stress On the other hand, CBT is designed to assess and alter aberrant thought process that underlie catastrophizing and pain amplification. So, it would seem that the two therapies may work by different mechanisms but end up producing the same result. This would predict that their combination would be even more effective. On the other hand, it is also possible that they both improve mindfulness and this in turn produces the improvements. In which case their combination would only be as effective as each alone. It remains to be seen if Mindfulness-Based Cognitive Therapy (MBCT) would be even more effective for treating chronic low back pain.
Regardless, both MBSR and CBT appear to help relieve the suffering of patients with chronic low back pain. So, improve chronic back pain with mindfulness and cognitive therapy.
“Mindfulness-based stress reduction (MBSR) practices like yoga and meditation have also been found to improve chronic lower back pain and its physical limitations and can provide patients with ongoing pain management skills,” – Susan McQuillan
CMCS – Center for Mindfulness and Contemplative Studies
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Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C. (2016). Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain, 157(11), 2434–2444. http://doi.org/10.1097/j.pain.0000000000000635
Cognitive-behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit chronic pain patients by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR versus CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20-70 years with chronic low back pain (CLBP) (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness; and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (non-reactivity, non-judging, and acting with awareness; all P-values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P-values < 0.05) measures. Catastrophizing decreased slightly more post-treatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the sub-sample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness, and similar effects of MBSR and CBT on these measures among individuals with CLBP.