In the JournalsPerspective

Mindfulness briefly, but insignificantly, relieves low back pain

Mindfulness-based stress reduction practices offer short-term improvements in pain and function for patients with low back pain; however, these improvements were not clinically significant compared with usual care, according to findings published in Annals of Internal Medicine.

“Low back pain is a major public health problem,” Dennis Anheyer, MA, from the University of Duisburg-Essen in Germany, and colleagues wrote. “Approximately 12% to 30% of the population has such pain annually, and lifetime prevalence is approximately 75%. In the past decade, it has become a leading cause of disability worldwide, placing a major burden on individuals and health care systems. Because an optimal clinical treatment has yet to be identified for this condition, patients often seek complementary therapies.”

Mindfulness-based stress reduction is one common complementary therapy; however, its effects are uncertain for low back pain, according to the researchers.

Anheyer and colleagues evaluated the efficacy and safety of mindfulness-based stress reduction for low back pain. They searched several databases for randomized controlled trials that compared mindfulness-based stress reduction with usual care or an active comparator and evaluated pain intensity or pain-related disability in patients with low back pain. Data on study characteristics, patients, interventions, outcome measures and results at short- and long-term follow-up were extracted. Seven eligible randomized controlled trials (RCTs) involving 864 patients with low back pain were identified.

Six of the seven trials analyzed implemented interventions based on a mindfulness-based stress reduction program developed by the University of Massachusetts, consisting of an 8-week structured program of weekly 2.5-hour group sessions and a 7- to 8-hour silent retreat. Other important factors of the intervention included sitting meditation, walking meditation, hatha yoga and body scan and a sustained mindfulness practice.

Data indicated that only short-term and clinically nonmeaningful improvements in pain intensity (4 RCTs; mean difference [MD], -0.96 point [95% CI, –1.64 to –0.34 point]; standardized MD, -0.48 point [95% CI, –0.82 to –0.14]) and physical functioning (2 RCTs; MD, 2.5 [95% CI, 0.9 to 4.1]; standardized MD, 0.25 [CI, 0.09 to 0.41]) were observed in patients undergoing mindfulness-based stress reduction compared with those treated with usual care. There were no significant between-group differences in disability, mental health, pain acceptance and mindfulness at short- or long-term follow-up. In addition, there were no significant differences in short- or long-term outcomes between mindfulness-based stress reduction and an active comparator. There were no reports of serious adverse events.

Not every intervention included yoga, which has shown benefits for function and disability in patients suffering from low back pain, Anheyer and colleagues noted.

“Future studies should examine the effects of components of [mindfulness-based stress reduction] interventions, such as mindful meditation and yoga, on low back pain,” they concluded.

The ACP recently recommended drug-free treatment, including superficial heat, massage, acupuncture, spinal manipulation or yoga, for low back pain. Other research has found that massage therapy alleviates chronic back pain in the “real world,” single glucocorticoid injection relieves chronic low back pain short-term, and naproxen plus diazepam did not improve functional outcomes or pain compared with naproxen plus placebo. – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.

Mindfulness-based stress reduction practices offer short-term improvements in pain and function for patients with low back pain; however, these improvements were not clinically significant compared with usual care, according to findings published in Annals of Internal Medicine.

“Low back pain is a major public health problem,” Dennis Anheyer, MA, from the University of Duisburg-Essen in Germany, and colleagues wrote. “Approximately 12% to 30% of the population has such pain annually, and lifetime prevalence is approximately 75%. In the past decade, it has become a leading cause of disability worldwide, placing a major burden on individuals and health care systems. Because an optimal clinical treatment has yet to be identified for this condition, patients often seek complementary therapies.”

Mindfulness-based stress reduction is one common complementary therapy; however, its effects are uncertain for low back pain, according to the researchers.

Anheyer and colleagues evaluated the efficacy and safety of mindfulness-based stress reduction for low back pain. They searched several databases for randomized controlled trials that compared mindfulness-based stress reduction with usual care or an active comparator and evaluated pain intensity or pain-related disability in patients with low back pain. Data on study characteristics, patients, interventions, outcome measures and results at short- and long-term follow-up were extracted. Seven eligible randomized controlled trials (RCTs) involving 864 patients with low back pain were identified.

Six of the seven trials analyzed implemented interventions based on a mindfulness-based stress reduction program developed by the University of Massachusetts, consisting of an 8-week structured program of weekly 2.5-hour group sessions and a 7- to 8-hour silent retreat. Other important factors of the intervention included sitting meditation, walking meditation, hatha yoga and body scan and a sustained mindfulness practice.

Data indicated that only short-term and clinically nonmeaningful improvements in pain intensity (4 RCTs; mean difference [MD], -0.96 point [95% CI, –1.64 to –0.34 point]; standardized MD, -0.48 point [95% CI, –0.82 to –0.14]) and physical functioning (2 RCTs; MD, 2.5 [95% CI, 0.9 to 4.1]; standardized MD, 0.25 [CI, 0.09 to 0.41]) were observed in patients undergoing mindfulness-based stress reduction compared with those treated with usual care. There were no significant between-group differences in disability, mental health, pain acceptance and mindfulness at short- or long-term follow-up. In addition, there were no significant differences in short- or long-term outcomes between mindfulness-based stress reduction and an active comparator. There were no reports of serious adverse events.

Not every intervention included yoga, which has shown benefits for function and disability in patients suffering from low back pain, Anheyer and colleagues noted.

“Future studies should examine the effects of components of [mindfulness-based stress reduction] interventions, such as mindful meditation and yoga, on low back pain,” they concluded.

The ACP recently recommended drug-free treatment, including superficial heat, massage, acupuncture, spinal manipulation or yoga, for low back pain. Other research has found that massage therapy alleviates chronic back pain in the “real world,” single glucocorticoid injection relieves chronic low back pain short-term, and naproxen plus diazepam did not improve functional outcomes or pain compared with naproxen plus placebo. – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.

    Perspective

    This study appears to report essentially negative effects of mindfulness-based stress reduction, except for short-term improvements in pain and physical functioning. This is not surprising, since mindfulness-based stress reduction is more about enabling patients to adjust to illness. Thus, it has been shown to work well in patients with chronic diseases, but it does not address physical problems such as decreased range of motion, balance and strength often seen in chronic pain. Consistent with this notion, those studies in the meta-analysis that included yoga as part of the intervention had better outcomes. In addition, this meta-analysis did not consider patient adherence to the mostly daily meditation practice assignments. Such practice is central to the mindfulness-based stress reduction intervention and could have greatly affected the results negatively. In summary, health care providers may want to consider mindfulness-based stress reduction for patients who are having trouble making a healthy adjustment to chronic illnesses. For chronic pain, best evidence would support cognitive behavioral therapy to challenge dysfunctional pain beliefs and to address depression, often present with persistent pain. For patients for whom conditioning appears to be a factor, yoga, massage therapy or a careful retrial of physical therapy are likely to be more beneficial.  

    • William Elder, PhD
    • Director of Behavioral Health Professor of Family and Community Medicine University of Kentucky College of Medicine

    Disclosures: Elder reports receiving recent funding from Pfizer Foundation for an unrestricted education grant.