How Do Mindfulness‐Based and Cognitive Behavioral Therapies Help Adults With Opioid‐Treated Chronic Low Back Pain? A Qualitative Study

Background: Chronic low back pain (CLBP) is common and often refractory to existing treatments, necessitating long-term opioid therapy, which has substantial risks. Mindfulness-based (MBT) and cognitive behavioral (CBT) therapies are safe and can be effective for CLBP.

Aims: To better understand how MBT and CBT may help improve opioid-treated CLBP:

Methods: This qualitative study involved a subgroup of participants with opioid-treated CLBP who completed a 12-month randomized clinical trial comparing the effects of MBT versus CBT. Participants who reported improvements at 12 months, compared to baseline, in main outcomes (assessed with validated "quantitative" questionnaires) and experience with the study intervention, and who attended the intervention sessions were invited to in-depth exit interviews. The interviews achieved thematic saturation. Thematic analysis of transcribed interviews summarized qualitative findings.

Results: Fifty participants (26 MBT, 24 CBT) were interviewed. They were, on average, 58.5 (SD = 10.0) years old. Most were female (60.0%), non-Hispanic (94.0%), and White (82.0%). At baseline, both groups were, on average, moderately-to-severely impacted by CLBP and treated with moderate-to-high daily opioid doses; at 12 months, they quantitatively reported improved pain, function and QoL scores and reduced daily opioid dose. In their qualitative responses, these participants corroborated the quantitative findings, reporting reductions in back pain (98.0% of interviewed participants), functional limitations (100.0%), and opioid dose (98.0%), with the majority attributing these changes to the study intervention they had received (98.0%, 94.0%, and 90.0%, respectively). Participants also reported the interventions helped them cope with emotional challenges and life stressors, and opioid-related adverse effects. Participants did not raise concerns about interventions' safety. Qualitative themes identified intervention-taught techniques participants most frequently used to manage their symptoms.

Conclusion: MBT and CBT can improve health and QoL and reduce opioid dose in adults with opioid-treated refractory CLBP, calling for improved access to these safe treatments.