Mindfulness program may ease chronic low back pain

(Reuters Health) – An eight-week group program focused on mindfulness-based stress reduction may help with short-term function and long-term pain for people with chronic low back problems, according to a new study.

“Most people would think mindfulness meditation would help stress,” said lead author Dr. Natalia Morone of the University of Pittsburgh. “They would not typically think it could actually lead to reduced pain or lead them to have less pain interference during their day to day activities.”

The researchers studied 282 older adults, with an average age of 74, in the Pittsburgh area with functional limitations due to chronic low back pain between 2011 and 2014.

The participants were randomly separated into two groups. Both groups entered into an eight-week program followed by monthly sessions for an additional six months.

In the mindfulness group, participants were taught four methods of meditation, using directed breathing and mindful awareness of thoughts and sensations in sitting, walking or lying down positions. They also learned mindful stretching during the initial eight weeks.

During the six months of booster sessions, participants met to meditate and discuss themes of the mindfulness program.

Those in the comparison group met for the same amount of time in groups of the same size with the same amount of “homework” and time with a facilitator, but instead focused on education based on the 10 Keys to Healthy Aging, which does not address pain. They learned about managing high blood pressure and did the same chair stretches as the mindfulness group.

The participants had monthly 15-minute phone interviews about the back pain, function, mindfulness, and doctor or hospital visits.

Based on disability questionnaires, the people in the mindfulness group had improved more after eight weeks than the control group, though disability scores were again similar by the six-month point.

The mindfulness group also had more improved current and most severe pain scores at the six-month point, as reported in JAMA Internal Medicine.

“In terms of mechanism for pain reduction, the study gives us a clue as patients in the mind-body program reported more self-efficacy toward pain - they were able to better cope with their pain,” Morone told Reuters Health by email.

She and her coauthors did not compare the mindfulness program to other back pain treatments, but it should be seen as an option for some patients that does not involve medication or surgery, she said.

The authors did not report how consistently the treatments were delivered or how faithfully participants practiced outside of their sessions, which would be important information, Dr. M. Carrington Reid of Weill Cornell Medical Center in New York and coauthors wrote in a commentary alongside the paper.

But “chronic pain is one of the most common conditions encountered by health care professionals, particularly among patients 65 years and older,” and barriers often prevent treating it with medication, so studies on non-medication options like mindfulness are important, they wrote.

“The mind-body program teaches patients how to be more aware of their thoughts, emotions, sensations and behaviors,” Morone said. “As the patient learns to do this, they can become more aware of behaviors or even thoughts or feelings about pain that make it worse, or make it difficult for them to do activities.”

At the six-month point, almost half of people in both groups had improved physical function, specifically with less pain interference due to their back when they did physical activity such as putting on socks, Morone said.

“To sustain the effects on physical function the person with chronic low back pain could consider adding a brisk daily walking program since we know this also helps patients with chronic pain,” she said.

The Mindfulness-Based Stress Reduction Program is offered in many medical centers, communities and online, she said.

SOURCE: JAMA Internal Medicine, online February 22, 2016.