Back Pain: Little Benefit With Mindfulness Stress Reduction

Diana Phillips

April 24, 2017

Mindfulness-based stress reduction (MBSR) may produce some short-term relief and functional improvement in patients with chronic low-back pain, but compared with outcomes achieved through usual care, the improvements are not clinically meaningful, nor are they sustained over time, a meta-analysis has shown.

Previous studies have demonstrated positive results for MBSR interventions in patients with various chronic pain conditions, but few have looked at the safety and efficacy of these techniques in patients with low back pain in particular.

To address this question, Dennis Anheyer, MA, from the University of Duisburg-Essen in Germany, and colleagues conducted a systematic review and meta-analysis of seven randomized controlled trials that compared MBSR with usual care or an active comparator intervention (such as health education or cognitive behavioral therapy). The findings were published online today in the Annals of Internal Medicine.

The trials included in the review involved 864 patients with low back pain of any cause, duration, or intensity and assessed pain intensity or pain-related disability as primary outcomes at short-term (approximately 8 weeks postintervention) or long-term (approximately 6 months after randomization) follow-up.

The mindfulness interventions that were used in all of the trials were adapted from the original MBSR program developed at the University of Massachusetts by Jon Kabat-Zinn in 1979. The original 8-week program is delivered in weekly 2.5-hour sessions and a single, all-day silent retreat. It uses a combination of mindfulness meditation, body awareness, and yoga to help individuals focus their attention and become more mindful. One of the 7 studies included in the review used the adapted MBSR program in conjunction with cognitive behavior therapy.

Compared with usual care, MSBR interventions were associated with statistically significant improvement in pain intensity in the short term compared with usual care. However, the clinical benefit of MBSR remains unclear because the point estimate for that outcome fell below the threshold for minimal clinically important difference, the authors report.

In the trials that included long-term follow-up, MBSR interventions did not produce statistically significant or clinically important group differences in pain intensity between the intervention and control groups. Similarly, comparisons with MSBR and active comparator interventions showed no between-group differences, either in the short term or long term, the authors note.

Secondary study outcomes included the effects of MSBR interventions on physical functioning, mindfulness, mental health–related quality of life, and pain acceptance. As with the effects on pain intensity, MBSR was associated with a statistically significant improvement in physical functioning in the short term when compared with usual care, but the improvements were not sustained in the long term.

Compared with usual care or active comparators, MSBR did not result in significant or clinically meaningful short- or long-term improvements in mental health quality of life, mindfulness, or pain acceptance.

Looking at the individual trial outcomes, those that included yoga as part of the MSBR intervention showed relative improvements in physical function and decreased disability, whereas those that did not include yoga were not associated with between-group differences in these outcomes.

"Other studies have reported that yoga can increase function and decrease disability in patients with low back pain," the authors write, noting that future studies "should examine the effects of components of MBSR interventions, such as mindful meditation and yoga, on low back pain."

The authors acknowledge that the findings of the study are limited by the small number of randomized controlled trials, "with some meta-analyses including only 2 trials." For this reason, they state, "the conclusions drawn from the resulting pooled analyses should be considered preliminary."

In addition, the studies themselves were small and the trials were not consistent in terms of their patient populations, interventions, or comparison treatments. Further, three of the studies were deemed to be high-risk for bias, the authors explain.

"Rigorously designed, large [randomized controlled trials] are needed in order to understand the effectiveness and safety of MBSR interventions for the management of patients with low back pain," they conclude.

The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online April 24, 2017. Article

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