Mindfulness meditation improves chronic low back pain

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Thomas G. Ciccone, Practical Pain Management: Mindfulness meditation may offer the drug-free key to pain-free living for patients aged 65 and older, according to the results of new research. The study, recently published in JAMA,1 found when patients meditated for 90 minutes a week over the course of 8 weeks, their pain symptoms, including their most severe pain, decreased significantly—a robust trend that continued for up to 6 months.

“Preserving physical function with aging is critical to maintaining independence, because loss of independence is arguably one of the most feared consequences of aging,” the authors wrote.

The primary aim of the study was to determine the effectiveness of the mind-body program at increasing function and reducing pain in adults 65 years or older with chronic LBP.”

Mindfulness meditation is a relatively popular alternative form of medicine in the U.S. Some 18 million Americans tried meditation in 2012, alone.² A recent meta-analysis has found the practice can have moderate benefits for a number of symptoms, including pain, anxiety, and depression.³ However, up to this point, it appeared meditation’s pain-relieving benefits related to an analgesic effect on visceral pain, not necessarily musculoskeletal—a notion that could be challenged, now.

The Study

In the study, 282 community-dwelling adult patients (mean [SD] age, 74.5 [6.6] years), who were recruited from the metropolitan Pittsburgh area, either enrolled in a mindfulness meditation program (n=140) or an education program on healthy aging (n=142).

Patients in the meditation group convened for weekly sessions modeled on the Mindfulness-Based Stress Reduction Program (MBSR),⁴ which is designed to cultivate a better awareness of the body and mind in order to reduce stress, recognize negative cognitions, and positively influence autonomic physiological processes, including blood pressure and overall reactivity.⁵

The control group of patients instead received an education course on the “10 Keys” to Healthy Ageing, a prevention program on key health topics like hypertension management.⁶ Interestingly, one particular chair exercise introduced in the control group also was utilized in the meditation program. However, the control group’s program did not include information on pain management.

Meditation Provides Short-term Pain Benefits

Patients that practiced meditation significantly improved their current and most severe Numeric Pain Rating Scale (NRS) scores, showing additional -1.8 and -1.0 improvements over the control group, respectively. A noticeably higher percentage of patients doing meditation (56.8%) were able to achieve a 2.5-point clinically significant improvement after the 8-week course, compared to the control group (44.9%).

In fact, compared to the control group, noticeably more patients in the MBSR program were able to achieve a clinically meaningful 30% improvement both in NRS pain scores for current (54 of 132 [40.9%] vs 34 of 138 [24.6%]; P = 0.004) and most severe pain (48 of 132 [36.4%] vs 30 of 138 [21.7%]; P = 0.008). Even when evaluating patients for a more stringent 50% improvement, the meditation group also outperformed the control group for average (21 of 132 [15.9%] vs 14 of 138 [10.1%]; P = 0.16), current (43 of 132 [32.6%] vs 22 of 138 [15.9%]; P = 0.001), and most severe (21 of 132 [15.9%] vs 12 of 138 [8.7%]; P = 0.07) pain.

Caveats to Consider

However, other outcome measurements did not show robust differences between the groups, particularly at the 6-month follow-up. Pain self-efficacy, pain catastrophizing, depressive symptoms, quality of life, and even self-reported mindfulness—while any noticeable benefits for the meditation group were recorded at the 8-week mark, they were nullified after 6 months. Furthermore, significant differences in functional improvements were not sustained at 6 months, either.

This suggests the meditation, while not a game-changer in functional improvements over a longer period, may have significantly helped patients perceive improvements in their pain. Regardless of unremarkable differences in self-efficacy or catastrophizing scores, meditation patients reported more improvement in their back pain symptoms than control participants (P < .001), with a majority (80.3%) of meditation patients reporting at least minimal improvement at 8 weeks compared to the control group (37.0%).

Not only did this difference persist up to the 6-month mark, but a greater number of patients in the control group began reporting worsening symptoms, by contrast.

Limitations to Consider

The improvements in pain that mindfulness meditation appeared to offer patients was consistent with a patient-centered view of successful pain relief,⁷ something that other therapies are not able to achieve, the authors noted. The short term benefits of increased self-efficacy also can help decrease impairment, distress, pain severity for patients in pain,⁸ and while the difference in self-efficacy improvement between the study groups was not maintained at 6 months, there may be some limitations of the study to consider.

At baseline, patients already showed robust psychological profiles, with low occurrence of depressive symptoms. This could be explained by the fact the researchers excluded patients that had reported moderate to severe depressive symptoms in the past. Past studies have shown meditation to improve psychological disorders, like depression and anxiety.³

And even though the researchers excluded patients who were familiar with mindfulness meditation programs, baseline mindfulness scores for all participating subjects noticeably were strong. So despite the fact that qualitative reports showed patients experience increased mindfulness upon learning how to meditate, the quantitative scores did not reflect this. Also, participation rates were not very high for the 6 monthly booster sessions following the initial 8-week course, which may have dulled the measurements, as well.

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