24 March 2016

Michael Woodhead

Meditation and yoga offer as much benefit for people with chronic low back pain as their usual care which could include NSAIDs (non-steroidal anti-inflammatory drugs, e.g. ibuprofen), a US trial suggests.

Patients who practised mindfulness-based stress reduction therapy for 8 weeks showed clinically meaningful reductions in low back pain and disability that lasted for at least a year, according to findings published in JAMA (Journal of the American Medical Association).

In a trial involving 342 adults who had had low back pain for an average of 7 years, those who took the mindfulness group classes showed similar improvements to those assigned to CBT (cognitive behavioural therapy), and significantly better improvement than those who received usual care form their doctor.

The mindfulness therapy involved attending a group class for training in meditation and yoga each week for 2 months.

After 6 months, clinically meaningful improvement in low back pain disability scores were seen in 61% of patients who underwent mindfulness classes, compared with 58% of those assigned to the CBT intervention and 44% in the control group.

Likewise, 44% of patients undergoing mindfulness training had clinically meaningful reductions in pain bothersomeness, compared with 45% of the CBT group and 27% of the usual care group.

The study authors said the improvements in low back pain were still there at 52 weeks.

“Our findings are important because they add to the growing evidence that pain and other forms of suffering involve the mind as well as the body,” said lead author Dr Daniel Cherkin (PhD), from the Group Health Research Institute in Seattle, Washington.

“The research suggests that training the brain to respond differently to pain signals may be more effective — and last longer — than traditional physical therapy and medication,” he said.

“Greater understanding and acceptance of the mind-body connection will provide patients and clinicians with new opportunities for improving the lives of persons with chronic back pain and other challenging conditions that are not always effectively managed with physical treatments alone.”

The findings were welcomed by Professor Peter O’Sullivan, a physiotherapist at Curtin University, WA, who has been researching chronic low back pain.

“[The study] supports the growing evidence that self-management approaches to manage pain are more effective than usual care, which often focus more on symptom reduction,” he said.

“It’s likely that the effects of the intervention are mediated through things like a reduction in pain related distress, fear reduction and improved self efficacy — which are known to be associated with pain bothersomeness and disability.”

“This is a great message to get out. It de-threatens pain and shifts the focus away from beliefs that back pain is linked to structural damage towards a contemporary understanding of pain — where our thoughts and behaviours influence our pain experience.”

Last Reviewed: 24/03/2016

Reproduced with kind permission from Australian Doctor


JAMA 2016; online.