Meditation Provides Short-Term Relief of Back Pain in Seniors

Jennifer Garcia

February 23, 2016

A mind–body program focused on mindfulness meditation may improve short-term physical function among senor adults with chronic lower back pain, but the results are not long-lasting, according to a new randomized clinical trial. Results of this study were published online February 22 in JAMA Internal Medicine.

Treatment for pain among older adults is often unsatisfactory because of the risk for adverse effects of nonsteroidal anti-inflammatory drugs or opioids, highlighting the need for nonpharmacologic interventions. The current study compared the effects of a mind–body intervention vs a traditional health education program for the management of lower back pain among community-dwelling adults older than 65 years.

"We found that the intervention group significantly improved in short-term function at 8 weeks, but the functional improvement was not sustained," write Natalia E. Morone, MD, from the University of Pittsburgh School of Medicine, Pennsylvania, and colleagues. Further, although some improvement in secondary measures such as pain self-efficacy were noted among the intervention group, the researchers found that these improvements also occurred in the control group by 6 months, so the difference in improvement between the groups was not durable.

In an accompanying invited commentary, M. Carrington Reid, MD, PhD, from the Weill Cornell Medical Center, New York City, and colleagues note that although the study was well-conducted, variables such as social support for the intervention, the number of sessions attended, or whether the use of pharmacotherapies to manage pain declined with the intervention make interpretation of these results difficult.

"Attention to underlying mechanisms of behavioral change (ie, how or why the treatment leads to change) will be key, as will efforts directed at identifying what treatment components and/or specific combinations might be particularly influential in treatment outcomes," Dr Reid and colleagues write.

Dr Morone and colleagues enrolled 282 adults with functional limitations resulting from chronic lower back pain, defined as a score of 11 or higher on the Roland and Morris Disability Questionnaire. Participants were randomly assigned to either an intervention group (n = 140), which received eight weekly 90-minute mindfulness meditation sessions, or a control group (n = 142), in which participants received an 8-week group health education program. Monthly follow-up visits (booster sessions) were performed for all participants in the 6 months after conclusion of the program. Both groups had similar baseline values and levels of participation during treatment and booster sessions.

The researchers found that compared with the control group, participants in the intervention group improved an additional −1.1 points on the Roland and Morris Disability Questionnaire at 8 weeks and −0.04 points at 6 months (effect sizes, −0.23 and −0.08, respectively). The study authors also found that by 6 months, participants in the intervention group improved an additional −1.8 points and −1.0 points on the Numeric Pain Rating Scale for current and most severe pain measures, respectively. This corresponded to an effect size between the groups at 8 weeks and 6 months of −0.33 and −0.19, respectively.

More than 80% of participants also reported a perceived improvement in pain immediately after the 8-week intervention compared with 37.0% in the control group; by 6 months, 76.1% of those in the intervention group and 42.2% of those in the control group reported at least minimal improvement.

Participants were recruited between February 14, 2011, and June 30, 2014, and the mean age of all participants was 74.5 years. In addition to a Roland and Morris Disability Questionnaire score of 11 or higher, inclusion required intact cognition and self-reported moderate chronic pain levels occurring daily or almost every day for at least the previous 3 months. Exclusion criteria included, but were not limited to, the presence of serious underlying conditions, severely impaired mobility, or moderate to severe depressive symptoms.

Dr Morone and colleagues note that although improvements in short-term function and long-term current and most severe pain measures were seen, "functional improvement was not sustained, suggesting that future development of the intervention could focus on durability."

The editorialists go on to note that "Given the dearth of health care professionals currently trained to deliver nonpharmacologic interventions, attention should also be placed on effectiveness studies that identify groups of health care professionals (eg, social workers, physical therapists, and nurses) who are willing and able (with appropriate training) to extend treatment trials to diverse clinical settings."

Funding for this study was provided through a grant from the National Institutes of Health. The authors and the editorialist have disclosed no relevant financial relationships.

JAMA Intern Med. Published online February 22, 2016. Article abstract, Commentary extract

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