Author affiliations Information
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| In the lab or on campus I have to dress like this, but at home I'm nude in full lotus. |
Abstract
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| This is gov't science, so it's OK. |
Importance Mindfulness-based stress reduction (MBSR) has [previously] 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.
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.
Trial Registration clinicaltrials.gov Identifier: NCT01467843
Introduction
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| Ahhh, my back hurts, stupid science! |
Psychosocial factors play important roles in pain and associated physical and psychosocial disability.4 In fact, 4 of the 8 nonpharmacologic treatments recommended for persistent back pain include mind-body components.4 One of these, cognitive behavioral therapy (CBT), has demonstrated effectiveness for various chronic pain conditions5- 8 and is widely recommended for patients with chronic low back pain.
However, patient access to CBT is limited. Mindfulness-based stress reduction (MBSR),9 another mind-body approach, focuses on increasing awareness and acceptance of moment-to-moment experiences including physical discomfort and difficult emotions.
MBSR is becoming increasingly popular and available in the United States. Thus, if demonstrated as beneficial for chronic low back pain, MBSR could offer another psychosocial treatment option for the large number of US residents with this condition.
MBSR and other mindfulness-based interventions have been recognized as helpful for a range of conditions including chronic pain.10- 12 However, only 1 large randomized clinical trial (RCT) has evaluated MBSR for chronic low back pain,13 and that trial was limited to older adults.
However, patient access to CBT is limited. Mindfulness-based stress reduction (MBSR),9 another mind-body approach, focuses on increasing awareness and acceptance of moment-to-moment experiences including physical discomfort and difficult emotions.
MBSR is becoming increasingly popular and available in the United States. Thus, if demonstrated as beneficial for chronic low back pain, MBSR could offer another psychosocial treatment option for the large number of US residents with this condition.
MBSR and other mindfulness-based interventions have been recognized as helpful for a range of conditions including chronic pain.10- 12 However, only 1 large randomized clinical trial (RCT) has evaluated MBSR for chronic low back pain,13 and that trial was limited to older adults.
This RCT compared MBSR with CBT and with usual care. We hypothesized that adults with chronic low back pain randomized to receive MBSR would show greater short- and long-term improvement in back pain–related functional limitations, back pain bothersomeness, and other outcomes as compared with those randomized to usual care.
We also hypothesized that MBSR would be superior to CBT because it includes yoga, which has been found to be effective in treating chronic low back pain.14 More
We also hypothesized that MBSR would be superior to CBT because it includes yoga, which has been found to be effective in treating chronic low back pain.14 More
- Editorial: Mind-Body Approaches for Chronic Low Back Pain (Madhav Goyal, MD, MPH; Jennifer A. Haythornthwaite, PhD)
- Comment & Response: Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy for Chronic Low Back Pain—Reply
- Comment & Response: Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy for Chronic Low Back Pain (Robert J. Gatchel, PhD, ABPP; John C. Licciardone, DO, MS, MBA; Daniel C. Cherkin, PhD; Karen J. Sherman, PhD; Judith A. Turner, PhD
- Author Video Interviews (3:50) Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy for Chronic Low Back Pain
- Author Interviews (03:29) Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy for Chronic Low Back Pain
- JAMA Report Video (2:26) Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy for Chronic Low Back Pain
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