Magazine article Clinical Psychiatry News

Mindfulness-Based Approaches Best for Low Back Pain

Magazine article Clinical Psychiatry News

Mindfulness-Based Approaches Best for Low Back Pain

Article excerpt

FROM JAMA

Adults suffering from chronic lower back pain may be better off pursuing mindfulness-based stress reduction or cognitive-behavioral therapy rather than more standard, conventional treatments for pain alleviation, a new study shows.

However, the relatively limited availability of cognitive and mindfulness-based approaches to stress reduction in many parts of the country, coupled with the uncertainty about insurance providers covering such treatments, put the viability of such treatments receiving widespread acceptance and use in question.

"Low back pain is a leading cause of disability in the United States, [and] psychosocial factors play important roles in pain and associated physical and psychosocial disability," said Daniel C. Cherkin, Ph.D., of the Group Health Research Institute in Seattle, and his associates. "Cognitive-behavioral therapy [CBT] has demonstrated effectiveness for various chronic pain conditions and is widely recommended for patients with chronic low back pain, [but] patient access to CBT is limited."

Dr. Cherkin and his coinvestigators recruited subjects from Group Health, an integrated health care system in Washington state, looking for patients between the ages of 20 years and 70 years with low back pain persisting for at least 3 months that was both nonspecific and had not been given a specific diagnosis (JAMA. 2016 Mar;315[12]:1240-9).

Of 1,767 patients evaluated, 342 patients were enrolled and randomized into one of three cohorts: those receiving mindfulness-based stress reduction (MBSR) (116 patients), those receiving CBT (113 patients), and those receiving "usual care," defined as "whatever care participants received" prior to enrollment (113 patients).

Those randomized to receive usual care received $50 toward whichever pain management option they chose to receive. Those receiving MBSR or CBT were not aware of which they were receiving until they attended the first group session.

A total of 8 sessions, each 2 hours long and offered weekly, were conducted for patients in each cohort, although attendance at each session was not mandatory. Follow-up with patients in each cohort was conducted at 4 weeks (halfway through treatment), 8 weeks (post-treatment), 26 weeks (primary endpoint of the study), and 52 weeks, with the number of patients in each cohort varying at each follow-up; patients who attended follow-up interviews were compensated $20.

Improvements in functional limitations of at least 30% and intensity of back pain were the primary outcomes measured. The former was measured via a modified Roland Disability Questionnaire (RDQ), which assessed patients' physical limitations brought on by low back pain on a scale of 0-23, with 0 being the least intense and 23 being the most intense. The latter outcome was measured on a simple scale of 0-10, 0 being the least intense and 10 being the most intense.

At 26 weeks, RDQ scores for MBSR and CBT patients were significantly higher than for those patients receiving usual-care treatment options. Mean percentage improvement in the MBSR cohort was 60.5% and 57.7% in the CBT cohort. Comparatively, patients receiving usual care improved by an average of 44. …

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