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The Somatic Connection  |   July 2016
Mindfulness-Based Stress Reduction Improves Outcomes in Adults With Chronic Low Back Pain
Author Notes
  • Western University of Health Science College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon 
Article Information
The Somatic Connection   |   July 2016
Mindfulness-Based Stress Reduction Improves Outcomes in Adults With Chronic Low Back Pain
The Journal of the American Osteopathic Association, July 2016, Vol. 116, 485-486. doi:10.7556/jaoa.2016.094
The Journal of the American Osteopathic Association, July 2016, Vol. 116, 485-486. doi:10.7556/jaoa.2016.094
Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial. JAMA. 2016;315(12):1240-1249. doi:10.1001/jama.2016.2323. 
Low back pain (LBP) is a clinically significant problem in the United States. As the leading cause of disability,1 the social and economic impact of LBP is staggering. Standard treatments rarely address the underlying cause of pain and have done little to slow this growing problem.2,3 Manual manipulation addresses structural dysfunction and is a recommended treatment for patients with LBP.4 However, psychosocial factors also play an important role in pain. Researchers from the Group Health Research Institute in Seattle, Washington, recently studied the effectiveness of mindfulness-based stress reduction (MBSR), a therapy that aims to increase one’s “awareness and acceptance of moment-to-moment experiences,” in managing chronic LBP. In this study, MBSR was compared with cognitive behavioral therapy (CBT) and usual patient care to assess whether MBSR is superior for improving pain and functional limitation. 
Participants aged 20 to 70 years with 3 months or more of nonspecific LBP were recruited for this interviewer-blinded, randomized clinical trial. Exclusion criteria included LBP for less than 3 months, difficulty participating in classes, activity interference less than 3 (0-10 scale), pain bothersomeness less than 4 (0-10 scale), workers’ compensation or legal issues, and other specific diagnosis. The participants (N=342) were randomly assigned into the MBSR (n=116), CBT (n=113), or usual care groups (n=113). The MBSR (ie, yoga and mindfulness exercises) and CBT (ie, therapy focused on changing the patients’ relationship with pain) interventions had similar standardized formats, which included one 2-hour session per week for 8 weeks. Primary outcomes included the modified Roland Disability Questionnaire (RDQ; 0-23 scale), which measured functional limitation, and LBP bothersomeness in the past week (0-10 scale). Intention-to-treat analysis was used to assess primary outcomes at baseline and at 4, 8, 26 (primary end point), and 52 weeks. 
Results revealed a clinically meaningful improvement in RDQ scores that was significantly different between groups at 26 weeks (P=.04). The MBSR (60.5%) and CBT (57.7%) groups showed significantly greater improvement on the RDQ over the usual care group (44.1%) (relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77] and CBT vs usual care, 1.31 [95% CI, 1.01-1.69]) with no statistically significant difference between MBSR and CBT groups. Clinically meaningful improvement of LBP bothersomeness was also notably different between groups at 26 weeks (P=.01). Participants in the MBSR (43.6%) and CBT (44.9%) groups demonstrated greater improvements in LBP bothersomeness than the usual care group (26.6%) (RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34] and CBT vs usual care, 1.69 [95% CI, 1.18-2.41]), with no statistically significant difference between intervention groups. At 52 weeks, MBSR continued to have a statistically significant improvement in RDQ scores and LBP compared with usual care. 
This clinical trial reveals that MBSR and CBT may be effective for managing chronic LBP and the associated functional limitations. Osteopathic medicine recognizes the value in addressing both mind and body when providing holistic patient care. This study provides evidence supporting the role of mind-body therapies in the treatment of patients with chronic pain. 
References
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Chou R, Qaseem A, Snow V, et al.  ; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society [published correction appears in Ann Intern Med. 20018;148(3):247-248]. Ann Intern Med. 2007;147(7):478-491. [CrossRef] [PubMed]