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.
Daniel C Cherkin, Karen J Sherman, Benjamin H Balderson, Andrea J Cook, Melissa L Anderson, Rene J Hawkes, Kelly E Hansen, Judith A Turner
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 342 |
| Population | Adults aged 20 to 70 years with chronic low back pain in an integrated health care system in Washington State |
| Interventions | Mindfulness-based stress reduction (MBSR) cognitive behavioral therapy (CBT) |
| Duration | 8 weekly 2-hour group sessions; outcomes assessed at 4, 8, 26, and 52 weeks |
| Measures | modified Roland Disability Questionnaire (RDQ), back pain bothersomeness scale |
| Topics | Meditation |
| Registration | NCT01467843 |
| Key findings | MBSR and CBT each produced greater improvement in functional limitations and pain bothersomeness at 26 weeks than usual care, with no significant difference between MBSR and CBT; MBSR benefits persisted with little change at 52 weeks. The authors suggest MBSR may be an effective treatment option for chronic low back pain. |
Abstract
Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care. Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled 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 included whatever care participants received. Coprimary outcomes were the percentages of participants with clinically meaningful (≥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. Outcomes were also assessed at 4, 8, and 52 weeks. There were 342 randomized participants, the mean (SD) [range] age was 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 the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the 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]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the 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]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes. 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. clinicaltrials.gov Identifier: NCT01467843.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 143
- Mindfulness Interventions Annual Review of Psychology September 30, 2016
- Mindfulness meditation–based pain relief: a mechanistic account Annals of the New York Academy of Sciences June 1, 2016
- Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients Drug and Alcohol Dependence March 29, 2017
- Intervenciones psicológicas basadas en mindfulness y sus beneficios: estado actual de la cuestión Clínica y Salud October 10, 2016
- Disentangling self from pain: mindfulness meditation–induced pain relief is driven by thalamic–default mode network decoupling Pain July 7, 2022
and 138 more in the library
Cites 6
- Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy – a systematic review of randomized controlled trials Acta Psychiatrica Scandinavica April 28, 2011
- Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy The Oxford Handbook of Stress and Mental Health February 17, 2020
- A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Internal Medicine March 1, 2016
- Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Medicine February 2013
- Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complementary and Alternative Medicine September 25, 2012
and 1 more in the library