Lola Gayle, STEAM Register
About 80 percent of adults experience low back pain at some point in their lifetimes, but for some that pain can become chronic and last for weeks and even months.
There are a variety of treatments for chronic low back pain. These include medications, physical activity, strengthening exercises, physical therapy, spinal manipulation, injections, and more. In some cases, these treatments can successfully relieve chronic low back pain, but in other cases pain persists despite medical and surgical treatment.
Now, research conducted by Group Health Research Institute shows that mindfulness meditation and cognitive behavioral therapy (CBT) may be potential alternatives to help decrease this debilitating pain.
Meditation has long been practiced as a way to calm the mind, and possibly achieve enlightenment. Mindfulness-based stress reduction (MBSR) focuses on increasing awareness and acceptance of moment-to-moment experiences including physical discomfort and difficult emotions.
Randomized controlled trial
For the study, Daniel C. Cherkin, Ph.D., of Group Health Research Institute, Seattle, and colleagues randomly assigned 342 adults age 20 to 70 years with chronic low back pain to receive MBSR, CBT, or usual care. 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 other treatment, if any, the participants received. The average age of the participants was 49 years; the average duration of back pain was 7.3 years.
The researchers found that at 26 weeks, the percentage of participants with clinically meaningful improvement on a measure of functional limitations was higher for those who received MBSR (61 percent) and CBT (58 percent) than for usual care (44 percent). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 44 percent in the MBSR group and 45 percent in the CBT group, vs 27 percent in the usual care group. Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.
“The effects were moderate in size, which has been typical of evidence-based treatments recommended for chronic low back pain. These benefits are remarkable given that only 51 percent of those randomized to receive MBSR and 57 percent of those randomized to receive CBT attended at least 6 of the 8 sessions,” the authors write. “These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.”
Mind over matter
“We’re constantly looking for new and innovative ways to help our patients,” Dr. Cherkin explained. “The research suggests that training the brain to respond differently to pain signals may be more effective — and last longer — than traditional physical therapy and medication.”
MBSR is becoming increasingly popular and available in the United States. It involves training in observing, acknowledging, and accepting thoughts and feelings including pain. The training also includes some easy yoga poses to help participants become more aware of their bodies.
“We are not saying ‘It’s all in your mind,'” Dr. Cherkin said. “Rather, as recent brain research has shown, the mind and the body are intimately intertwined, including in how they sense and respond to pain. Both mindfulness and CBT involve the brain as well as the body. We found that these approaches were as helpful for people with chronic back pain as are other effective treatments for back pain.” They also had longer-lasting benefits and were safer than many other treatment options.
Results of this randomized controlled trial are published in the journal JAMA.
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