Healthcare (Commonwealth Union) – There are countless treatments available for low back pain, yet few provide lasting relief for the one in four Americans living with this ongoing condition, which is also a top cause of disability worldwide. Over 80% of individuals dealing with chronic low back pain express a desire for more effective treatment options. In the absence of adequate pain relief, many resort to opioids—drugs that carry a high risk of addiction.
A collaborative team of researchers from Penn State College of Medicine and the University of Wisconsin-Madison discovered that just eight weeks of mindfulness or cognitive behavioral therapy (CBT) led to significant improvements in adults with chronic low back pain who were already using opioids and had not benefited from previous treatments. These psychological approaches enhanced physical function, improved quality of life, eased pain, and even reduced opioid use in a randomized clinical trial. The positive effects were still evident up to a year later.
The study was published on April 7 in JAMA Network Open. It represents the largest clinical trial so far to compare mindfulness and CBT for opioid-managed chronic pain, and it also included a longer follow-up period than most earlier mindfulness studies.
“Both mindfulness and cognitive behavioral therapy were shown to be safe, effective treatments, providing lasting benefits for people with opioid-treated chronic back pain,” explained Aleksandra Zgierska, Jeanne L. and Thomas L. Leaman, MD, endowed professor and vice chair of research of family and community medicine and professor of anesthesiology and perioperative medicine and of public health sciences at the Penn State College of Medicine, who had led the research. “These evidence-based behavioral therapies should be standard of care available to our patients.”
Researchers of the study stated that pain is complex, particularly when it becomes chronic and persists for months or even years. Among the various types of chronic non-cancer pain, chronic lower back pain is the most frequently treated with opioid medications. Although earlier studies have suggested that behavioral therapies may be helpful for adults dealing with long-term pain—by helping them shift their mindset and how they relate to pain—this area has not been thoroughly explored, according to the researchers. Many of the existing studies have involved small participant groups and have only measured short-term outcomes.
Eric Garland, a distinguished professor of health sciences and psychology at the University of California, San Diego, and the study’s senior author indicated that many people view chronic pain purely as a physical issue that needs a physical solution.
The research team aimed to assess the effectiveness of mindfulness compared to cognitive-behavioral therapy (CBT) as treatments for chronic low back pain managed with opioids, along with their long-term effects. While CBT is the established psychotherapy for chronic pain, its long-term benefits remain underexplored. So far, only 17 studies have investigated mindfulness for chronic low back pain, and just three have compared mindfulness with CBT.
This study was developed in collaboration with an advisory panel made up of clinicians, as well as representatives from community and advocacy organizations that support individuals with chronic pain. The panel, which also included adults with opioid-treated chronic low back pain and their caregivers, provided valuable input throughout the research process. Their feedback helped shape the study’s design and ensure that the results would be meaningful and practical for both patients and healthcare providers.
A total of 770 adults participated in a randomized clinical trial held at three different locations—Madison, Wisconsin; Boston, Massachusetts; and Salt Lake City, Utah. On average, participants suffered from moderate-to-severe pain, significant functional limitations, and a reduced quality of life, having undergone numerous previous treatments for chronic low back pain. All participants had been using daily opioid medications for at least three months.
