Mindfulness And Cognitive Behavioral Therapy Improve Chronic Back Pain

The list of treatments for back pain is endless, but few offer relief. More than 80% of people with chronic lower back pain want better treatment options. However, without adequate pain relief, many people have to take opioids, which can be addictive. What’s more, back problems become more common with age.

The good news? A team from several institutions led by researchers at Penn State College of Medicine and the University of Wisconsin-Madison found that eight weeks of mindfulness or cognitive behavioral therapy (CBT) resulted in significant improvements in adults with chronic low back pain who are currently being treated with opioids and have not responded to previous treatments. These behavioral therapies helped improve physical functioning and quality of life and reduce pain and opioid dosage in a randomized clinical trial. The positive effects lasted up to 12 months. The results were published in JAMA Network Open.

How Mindfulness and Cognitive Behavioral Therapy Minimize Back Pain

This is the largest study to date comparing mindfulness with cognitive behavioral therapy as a treatment for chronic pain treated with opioids. The research team followed participants for a longer period of time than in many previous mindfulness studies. “Both mindfulness and cognitive behavioral therapy have been shown to be safe and effective treatments that provide lasting relief to people with chronic back pain who are treated with opioids,” said Aleksandra Zgierska, Jeanne L. and Thomas L. Leaman, MD, endowed professor and associate chief of research for family and community medicine, and professor of anesthesiology and perioperative medicine and public health sciences at Penn State College of Medicine, who led the study. “These evidence-based behavioral therapies should be part of standard care for our patients.”

Pain is complex, especially chronic pain, which can last for months or years. Chronic low back pain is the most common form of chronic non-cancer pain treated with opioids. Previous research has shown that adults with chronic pain can benefit from behavioral therapies that help people change their thoughts about and relationship with pain, but this has not been adequately studied, the researchers said. Studies of behavioral therapies have typically been small and evaluated benefits only in the short term.

The research team set out to evaluate the effectiveness of mindfulness compared to CBT as a treatment for chronic opioid-treated low back pain and its long-term effects. CBT is considered the standard psychotherapy for chronic pain, but its long-term benefits have not been adequately studied. This study was planned in collaboration with an advisory board composed of clinicians and representatives from community and advocacy organizations who work with people with chronic pain, as well as adults with chronic low back pain treated with opioids and their caregivers. Feedback from the panel, which was incorporated throughout the study, helped the researchers design and conduct the study and better implement the study results so that they are meaningful and useful to patients and clinicians.

Reduction in Pain and Daily Opioid Dose

The team enrolled 770 adults in a randomized clinical trial conducted at three sites: Madison, Wisconsin; Boston, Massachusetts; and Salt Lake City, Utah. Participants had moderate to severe pain, functional limitations, impaired quality of life, and a history of multiple previous treatments for their chronic low back pain, and had been treated with opioids daily for at least three months. Participants were then assigned to either mindfulness-based therapy or cognitive behavioral therapy, which were conducted in therapist-led two-hour group sessions over an eight-week period. The mindfulness group learned to notice the sensations they were experiencing, which gave them more control over how they dealt with and responded to pain and other symptoms. The CBT group learned coping skills and strategies to change their negative thinking patterns. Participants were instructed to practice on their own for 30 minutes a day, six days a week, during the 12-month study and to continue their routine treatment. They were not instructed to reduce their opioid dose.

They reported on their pain levels, ability to perform daily activities, mental and physical health-related quality of life, and daily opioid use at the beginning of the study and after three, six, nine, and 12 months. At the end of the study, participants in both groups reported significant and long-lasting benefits, including a reduction in pain and daily opioid dose. They also reported improved functioning and quality of life over a 12-month period. Both mindfulness and CBT tools were found to be effective and safe for long-term use, according to the researchers. The research team explained that people living with chronic pain put together a toolkit of different self-help techniques and self-care methods to manage their pain. They may use these tools at different times and in different ways.

Developing Skills to Better Manage Chronic Pain

While participants were instructed to continue their usual treatment, including pain medication recommended by their treating physicians, opioid doses decreased in both groups within 12 months of the intervention. Participants learned skills such as conscious breathing before taking medication. According to the research team, the improvements were a byproduct of people learning to manage pain better and deciding on their own to reduce their opioid use. These therapies do not promise a complete cure, but they teach people how to develop the inner resources they need to cope with chronic pain and live better lives.