A group of scholars believed that "mindfulness" meditation, practiced as a way to calm the mind,
could be a non-drug alternative to help decrease chronic low back pain that is psychosomatic, and set out to show it. 

Claims of chronic low back pain are a costly condition that plagues eight in 10 Americans at some point in their lives. A team at Group Health Research Institute compared a specific kind of meditation called mindfulness-based stress reduction (MBSR) along with cognitive behavioral therapy, a kind of talk therapy, to see if these interventions might alleviate pain.

The results were encouraging, said study leader Daniel Cherkin, PhD, a senior investigator at Group Health Research Institute. Training in MBSR led to meaningful improvements in functioning and chronic low back pain at six months and one year in Mind-Body Approaches to Pain, a randomized controlled trial involving nearly 350 patients at Group Health.

"The research suggests that training the brain to respond differently to pain signals may be more effective--and last longer--than traditional physical therapy and medication," Cherkin said. 

MBSR is booming in the United States and claims to solve almost anything. It involves training in observing, acknowledging, and accepting thoughts and feelings - including pain. The training also includes some easy yoga poses to help participants become more aware of their bodies. 

Randomized controlled trial

The trial enrolled 342 Group Health patients aged 20 to 70. Their low back pain had lasted at least three months and could not be attributed to a specific cause. The trial participants were randomly assigned to one of three groups. The first two groups received training in eight weekly two-hour group sessions in addition to whatever care they chose to seek independent of the study. One of these groups received training in MBSR and the other in cognitive behavioral therapy (CBT). The third group received only their usual care.

Compared to the group receiving usual care, participants in both the MBSR and CBT groups were significantly more likely to experience clinically meaningful (at least 30 percent) improvements from baseline in functional limitations and in self-reports of how much back pain bothered them. The proportion of participants with these improvements was similar, with no significant differences, between the mindfulness and CBT groups at each time point: one, two, and six months--and at one year--after enrolling in the study. Usual care is whatever patients would be doing for their back pain if they weren't in the study, including medications and physical therapy--but not mindfulness meditation or cognitive behavioral therapy.

Mindfulness and CBT

Before this trial, other research had shown mindfulness helped back pain in older adults--but it had never been tested in young or middle-aged adults. CBT, which was developed to treat depression, also had been previously proven effective for back pain in a variety of age groups. CBT is training to help people reframe how they think about pain so that they can manage it more successfully and change their behaviors, such as lack of exercise, that contribute to continued pain.

"We are not saying 'It's all in your mind,'" Dr. Cherkin said. "Rather, as recent brain research has shown, the mind and the body are intimately intertwined, including in how they sense and respond to pain. Both mindfulness and CBT involve the brain as well as the body. We found that these approaches were as helpful for people with chronic back pain as are other effective treatments for back pain." They also had longer-lasting benefits and were safer than many other treatment options.

"Our findings are important because they add to the growing evidence that pain and other forms of suffering involve the mind as well as the body," he added. "Greater understanding and acceptance of the mind-body connection will provide patients and clinicians with new opportunities for improving the lives of persons with chronic back pain and other challenging conditions that are not always effectively managed with physical treatments alone."

Article: "Effects of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy and Usual Care on Back Pain and Functional Limitations among Adults with Chronic Low Back Pain: A Randomized Clinical Trial" in the Journal of the American Medical Association.