Treatment with mindfulness-based stress reduction (MBSR) or cognitive behavioral therapy (CBT) resulted in greater improvement in back pain and functional limitations among adults with chronic back pain at 26 weeks, compared with usual care. This according to a study of 342 participants (mean age 49 years), with a mean duration of back pain for 7.3 years, and randomized to receive MBSR (n=116), CBT (n=113), or usual care (n=113). Researchers found:

• In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ (Roland Disability Questionnaire) was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (RR for MBSR vs usual care, 1.37; RR for CBT vs usual care, 1.31).

• The percentage of participants with clinically meaningful improvement in pain annoyance at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group vs 26.6% in the usual care group (RR for MBSR vs usual care, 1.64; RR for MBSR vs CBT, 1.03; RR for CBT vs usual care, 1.69).

• Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.

Citation: 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. JAMA. 2016;315(12):1240-1249. doi:10.1001/jama.2016.2323.

Commentary: The results of this study, showing sustained improvement up to 52 weeks when compared with usual care, are both impressive and important. It is worth noting that the control group was not randomized to no care, but rather to the usual care they received, including the prescription of medications for pain. The programs consisted of 2 hour-long group visits for 8 weeks, during which participants where trained in CBT or MBSR. Even in the context of the control group still receiving care for their back pain, both the CBT and the MBSR groups did significantly better with regard to decreased disability and decreased pain with the assigned therapy. The implications of this are obvious in an age where concerns about pain medication side-effects with both opioid analgesics and with NSAIDs continue to make treatment of chronic low back pain a challenging clinical entity. What now remains is for programs like the ones that carried out this study to become available in the communities in which we practice. —Neil Skolnik, MD