Meditation and cognitive behavioral therapy ease low back pain

Most people experience low back pain at some point in their lives. Treatment choices include over-the-counter and prescription drugs, cold and hot compresses, exercise, and in some cases, surgery. Some complementary health practices—such as spinal manipulation, acupuncture, massage, and yoga—may also be helpful in relieving chronic low back pain. A team led by Dr. Daniel Cherkin at Group Health Research Institute in Seattle compared different approaches to treating chronic low back pain. They enrolled 342 people, ages 20 to 70 years, who had back pain for more than 3 months that couldn’t be attributed to a specific cause. Participants were randomly assigned to 1 of 3 treatments groups: cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), or usual care. CBT is a form of psychotherapy that trains people to modify specific thoughts and behaviors. It’s previously been shown to be effective for alleviating back pain in a variety of age groups. CBT group participants focused on changing dysfunctional thoughts, setting and working toward behavioral goals, relaxation skills, and pain-coping strategies. MBSR focuses on increasing awareness and acceptance of moment-to-moment experiences—including physical discomfort and difficult emotions—without trying to change them. MBSR group members engaged in mindfulness practices that included yoga and both sitting and walking meditation. The CBT and MBSR groups attended weekly 2-hour sessions for 8 weeks. They received workbooks and audio CDs for home practice. The usual care group could seek whatever treatment, if any, they wanted. At 6 months, functional improvement—measured with an established questionnaire—was higher for 61% of those in the MBSR group and 58% of those in CBT group, compared to 44% of those in the usual care group. The percentage of those with improvement in self-reported back pain was also greater with MBSR (44%) and CBT (45%) than usual care (27%). Both treatments continued to show moderate benefits after 1 year. “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 says. Further research will be needed to determine whether the treatment benefits extend beyond a year, to identify mechanisms that underlie their effectiveness, and to assess their cost effectiveness.