Mindfulness-based cognitive therapy (MBCT) may represent a feasible and efficacious treatment for chronic low back pain (CLBP), and MBCT and CT may exceed group-delivered mindfulness meditation (MM) for improving long-term CLBP outcomes, according to a pilot trial published in Pain Medicine.
A total of 69 adults with CLBP were recruited from physician referral or self-identification for this study conducted at the University of Queensland Psychology Clinic. Patients were randomly assigned to receive CT, group MM, or MBCT (n=23 for each group). Posttreatment pain interference, as assessed with the 4-item Pain Interference scale from the Patient-Reported Outcomes Measurement Information System item banks, was the study’s primary outcome. Secondary outcomes included pain intensity, physical function, depression, and opioid medication use. Primary and secondary outcomes were assessed at 3 and 6 months.
Study participants rated high benefits associated with group MM (all on a 0 to 6 scale): treatment adherence (5.85), appropriateness (5.94), and quality (5.82). Similar ratings were reported for CT (adherence, 5.93; appropriateness, 5.95; quality, 5.82), and for MBCT (adherence, 5.90; appropriateness, 5.90; quality, 5.79). Acceptability of approaches on treatment initiation was high for group MM (M, 6.50), CT (M, 6.30), and MBCT (M, 7.01).
In the intention-to-treat analysis, following the intervention, all groups indicated improvements in pain interference (P <.001 for all), in pain intensity (P <.001), in physical function (P <.001), and in depression (P =.002). Study participants who had undergone MBCT vs group MM indicated greater improvements in pain interference (P =.014), physical function (P =.013), and depression (P =.007), and patients who were treated with CT vs group MM indicated greater improvements in physical function (P =.012).
Study limitations include a predominantly white and well-educated patient population, a lack of power for detecting small effect sizes, and the small sample size in the follow-up data set.
“It is…critical to continue the search for treatment mechanisms and moderators of MBCT and other evidence-based CLBP treatments. This endeavor would afford the capacity to potentially streamline these treatments and to develop patient treatment-matching algorithms that maximize the use of limited health care resources and lead to optimized outcomes,” concluded the study authors.
Day MA, Ward LC, Ehde DM, et al. A pilot randomized controlled trial comparing mindfulness meditation, cognitive therapy, and mindfulness-based cognitive therapy for chronic low back pain [published online January 3, 2019]. Pain Med. doi: 10.1093/pm/pny273