By Andrew M. Seaman
Reuters Health - Mind-based therapy programs may help ease chronic back pain, new research suggests.
Patients who took part in such programs were more likely to have noticeable and lasting improvements in back pain than those who stuck to their usual routines, investigators found.
Both of the approaches tested in the study - mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT) - can be helpful for people who haven’t benefited from other therapies, said lead author Daniel Cherkin, of the Group Health Research Institute in Seattle.
“Maybe it’ll make a difference for them,” he told Reuters Health.
MBSR attempts to increase a person’s attention to thoughts, emotions and sensations in the moment through yoga and meditation, the researchers explain in in the Journal of the American Medical Association. CBT educates people about pain and its relation to reactions and activities. CBT also provides instructions and tools to cope with pain.
While CBT is known to be effective for chronic pain and is recommended for lower back pain, before now only one other study had looked at MBSR for chronic low back pain, the researchers say.
Cherkin and colleagues randomly assigned 342 adults with chronic low back pain to one of three groups. The pain had no known cause and had lasted for at least three months.
One group continued whatever they were doing to manage their pain. A second group also received MBSR and a third took part in CBT.
Participants in the two mind-body therapy groups were offered eight weekly two-hour group sessions. The MBSR group was also offered a six-hour retreat.
Overall, about 54 percent attended six or more sessions.
After six months, there was “meaningful improvement” in about 61 percent of the MBSR group, 58 percent of the CBT group and 44 percent of the usual care group. Patients with meaningful improvement were noticeably less disabled, the report suggests.
Likewise, about 44 percent of the MBSR group and 45 percent of the CBT group ended up with noticeable reductions in the bothersomeness of their pain, compared to 27 percent of the usual care group.
After one year, MBSR and CBT continued to outperform usual care on both measures.
“That’s a good chunk of the population with chronic low back pain that could have a meaningful improvement,” said Dr. Madhav Goyal, who co-wrote an editorial accompanying the new study.
About 30 percent of people in the MBSR group and about 10 percent in the CBT group reported adverse events, which were usually temporary increases in pain.
Patients with chronic low back pain may have trouble finding people qualified to administer CBT or MBSR, said Goyal, of the NorthBay Center for Primary Care in Vacaville, California.
Even if they can track down practitioners, people may have to pay out of pocket for the programs, he said.
“I’m not sure how well CBT is covered by insurance, but MBSR certainly is not,” said Goyal, who is also affiliated with Johns Hopkins University School of Medicine.
An eight-week MBSR program can cost about $500, he said.
“The current treatments we have are not as effective as we believe them to be and these alternatives that we think of as simple or what we usually typically brush off are highly effective,” said Dr. Jatin Joshi, a pain specialist at Weill Cornell Medicine in New York.
“If you have a physician conscientious enough to bring these tools to you, have an open mind,” said Joshi, who was not involved with the new study.