Assessment of Mindfulness-Based Stress Reduction, Cognitive Behavioral Therapy or Usual Care in Adults with Chronic Low Back Pain

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Assessment of Mindfulness-Based Stress Reduction, Cognitive Behavioral Therapy or Usual Care in Adults with Chronic Low Back Pain

Mindfulness-based stress reduction (MBSR) has not been rigorously estimated for young and middle-aged adults with chronic low back pain. Hence, a study was implemented to draw the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care.

A trial was carried out in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain registered between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113). 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 encompassed whatever care participants received. Co-primary consequences were the percentages of participants with clinically significant (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. The outcomes were also analyzed at 4, 8, and 52 weeks.

As per results, there were 342 randomized participants with mean (SD) [range] age being 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 years), 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed study at 26 weeks, and 290 (84.8%) accomplished study at 52 weeks. At 26 weeks, intent-to-treat analyses depicted that percentage of participants with clinically meaningful improvement on RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overall P = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]).

At 26 weeks, participant percentage with clinically meaningful improvement in pain bothersomeness was 43.6% in MBSR group and 44.9% in CBT group, vs 26.6% in usual care group (overall P = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). The findings for MBSR continued with little change at 52 weeks for both primary outcomes.

The treatment with MBSR or CBT as compared with usual care among adults with chronic low back pain revealed greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings propose that MBSR may be an effective treatment option for patients with chronic low back pain.

JAMA
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