Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain

Tom Magutu, Mercer University College of Pharmacy

 

Mindfulness-based stress reduction (MBSR) is a practice that leads to spontaneous uncoupling of the sensory component of pain from the cognitive and emotional components to reduce the amount of suffering caused by pain. [1]

 

A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society states that clinicians should consider the addition of nonpharmacologic therapy due to benefits for acute low back pain in patients that do not show improvement from self-care options. [2]

Title: Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. [3]
Design Randomized, interviewer-blind, clinical trial; N= 342
Objective To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care
Study Groups MBSR (n = 116), CBT (n = 113), or usual care (n = 113)
Methods Trained interviewers masked to treatment groups collected

data by telephone at baseline (before randomization) and after

randomization at weeks four, eight, twenty six, and fifty two.

Duration September 2012 and April 2014
Primary Outcome Measure Clinically meaningful improvement (≥ 30% improvement from baseline at week twenty six) as assessed by the Roland Disability Questionnaire (RDQ)
Baseline Characteristics   Number (%)
All Usual care MBSR CBT
Age, mean (SD) 49.3 (12.30) 48.9 (12.5) 50.0 (11.9) 49.1 (12.6)
Women 224 (65.7) 87 (77.0) 71 (61.2) 66 (58.9)
White 278 (82.5) 88 (80.0) 97 (84.4) 93 (83.0)
Asian 12 (3.9) 3 (2.7) 4 (3.5) 6 (5.4)
African American 11 (3.3) 3 (2.7) 4 (3.5) 4 (3.6)
Other 35 (10.4) 16 (14.6) 10 (8.7) 9 (8.0)
Hispanic 23 (6.8) 8 (7.1) 5 (4.3) 10 (8.9)
RDQ, mean(SD) 11.4 (4.8) 10.9 (4.8) 11.8 (4.7) 11.5 (5.0)
Results                                        RDQ results
          % (95% CI) With Clinically Meaningful Improvement
Follow up week Usual care MBSR CBT p value
26 44.1 (35.9-54.2) 60.5 (52.0-70.3) 57.7 (49.2-67.6 0.04
Adverse Events Common Adverse Events: pain in at least one session (29% in MBSR group,10% in CBT group)
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions 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.

 

 

The study shows that among adults with chronic low back pain, MBSR and CBT plus usual care resulted in greater improvement in back pain and functional limitations in comparison to usual care, which is consistent with the findings of other studies comparing either CBT or MBSR to usual care. A limitation to the study is that participants were enrolled from a single health care system and generalizability of findings to other settings and populations is unknown.

 

References

  1. Reiner K, Tibi L, Lipsitz JD. Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Med. 2013;14(2):230-42.
  2. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, 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;147:478-491. doi:10.7326/0003-4819-147-7-200710020-00006.
  3. Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA. 2016;315(12):1240-9.

 

 

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