A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial

Sol Ahn, Mercer University College of Pharmacy

A 2007 Joint Clinical Practice Guideline from the American College of Physicians (ACP) and the American Pain Society (APS) recommends that clinicians should consider the addition of nonpharmacologic therapy for chronic low pack pain in patients who do not improve with self-care options. [1]

According to a meta-analysis of randomized controlled trials assessing the effectiveness of psychological interventions for chronic low back pain, positive effects of psychological interventions, compared to various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. [2]

A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial [3]
Design Single-blind, randomized clinical trial; N= 282
Objective To determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic low back pain (CLBP)
Study Groups A mind-body program (n= 140); a health education program (n= 142)
Methods Community-dwelling older adults 65 years or older with functional limitations owing to their CLBP (≥ 11 points on the Roland and Morris Disability Questionnaire) and chronic back pain (duration ≥ three months) were recruited within the Pittsburgh metropolitan area. Participants in the mind-body group received the group intervention of 8 weekly 90-minute mindfulness meditation sessions modeled on the Mindfulness-Based Stress Reduction program. Controls received an 8-week group health education program based on the “10 Keys” to Healthy Aging. At baseline, after the 8-week program, and 6 months after the program completion, outcome measures were obtained and analyzed.
Duration February 14, 2011 to April 9, 2015
Primary Outcome Measure The score on the Roland and Morris Disability Questionnaire (RMDQ) and pain (current, mean, and most severe in the past week) on the Numeric Pain Rating Scale (NRS)
Baseline Characteristics Of 282 participants enrolled in the study, 95 were men (33.7%) and 187 were women (66.3%) with mean age of 74.5 years. The baseline mean RMDQ scores for the intervention and control groups were 15.6 and 15.4, respectively.
Results No. (%) of Participants
8 weeks 6 months
Measure Intervention (n= 132) Control (n= 138) p-value Intervention (n= 117) Control (n= 135) p-value
RMDQ 75 (56.8) 62 (44.9) 0.051 58 (49.2) 66 (48.9) 0.97
NRS, Average 50 (37.9) 40 (29) 0.12 43 (36.7) 36 (26.7) 0.09
NRS, Current 54 (40.9) 34 (24.6) 0.004 52 (44.4) 34 (25.2) 0.001
NRS, Most severe 48 (36.4) 30 (21.7) 0.008 42 (35.9) 30 (22.2) 0.02
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions Mindfulness has a role in the treatment of CLBP in the older adult. Refinement of the mindfulness program could focus on enhancing the durability of functional improvement.

This study shows that a mind-body program, such as mindfulness meditation, for chronic low back pain in older adults improved short-term physical function and long-term severe pain. A major limitation of the study is that only intervention participants received information on a mind-body approach to pain reduction, whereas the comparison group did not receive education about pain. Also, a greater proportion of the study participants were women, which may limit the generalizability of the findings.

References

  1. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91.
  1. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1-9.
  1. Morone NE, Greco CM, Moore CG, et al. A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med. 2016;176(3):329-37.

 

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