JAMA: Mindfulness-based Therapies, Yoga, May Offer Alternative to Painkillers for Low Back Pain

If you struggle with chronic low back pain, here’s some good news: Programs that combine yoga, meditation, and breathing exercises may be just as effective as painkillers in reducing the symptoms of chronic low back pain—and without the troubling side effects that often come with the use of painkillers.

This is the conclusion of a  new study published in the prestigious medical journal JAMA (the Journal of the American Medical Association).  The study compared the effects of mindfulness-based stress reduction (MBSR), a mindfulness program that includes a combination of meditation, breathing exercises, and yoga, cognitive behavioral therapy, and usual treatment for chronic low back pain.

The study is particularly significant in light of the fact that opioid overuse is a becoming a significant problem in the U.S. The Centers for Disease Control (CDC) recently cautioned against the use of opioids in the treatment of chronic pain, and urged the use of non-opioid treatment and alternative therapies.

In the study, researchers randomly assigned 342 (mean age =49.3 years, SD =12.3 years, range 20-70 years) men and women (34.3% and 65.7% respectively), with a history of chronic back pain (mean duration 7.3 years, range 3 months to 50 years) to either group-based mindfulness-based stress reduction training, a cognitive behavioral therapy group, or to a “usual care” control group.

Experienced trainers facilitated the mindfulness-based stress reduction and cognitive behavioral therapy groups according to manualized protocols. Members of these two groups also received workbooks, audio CDs, and instructions for meditation, body scan and yoga in the mindfulness-based stress reduction group, and imagery in the cognitive behavioral therapy group.

Participants in the mindfulness-based stress reduction group (n=116) received 8, 2-hour, weekly training sessions that were modeled closely after the original mindfulness program developed by Jon Kabat-Zinn. Classes included instruction and mindfulness practices (body scan, yoga, and meditation).

Individuals in the cognitive behavioral therapy group (n  =112) received 8 weeks (2 hours per week) of instruction in techniques for the relief of chronic low back pain. These included education about chronic pain, information about the link between thoughts, emotions and physical reactions, and instructions for sleep hygiene and relapse prevention, as well as skills for changing dysfunctional thoughts, setting goals, relaxation and pain-coping strategies. Control group participants (n =113) received usual care, which may or may not have included pain medication.

Interviewers who were unaware of participant group status conducted telephone interviews at baseline, at 4 weeks (midtreatment), 8 weeks (post-treatment), and again at 26 and 52 weeks.

Programs That Combine Yoga, Meditation and Cognitive Behavioral Therapy Are Effective For Relieving Pain

The results of the study suggest that mindfulness-based stress reduction, which incorporates yoga, meditation, and mindfulness practices, may be as effective as cognitive behavioral therapy, or opioid medication for relieving chronic back pain.

Individuals in both the mindfulness-based stress reduction and cognitive behavioral therapy groups showed comparable, statistically significant improvements in self-reported back pain compared to those in the usual care group after 26 weeks. Improvements were noted in 43.6% of participants in the mindfulness-based stress reduction group, 44.9% in the cognitive behavioral therapy group, versus only 26.6% in the usual care group.

Low back pain is the leading cause of disability in the U.S. Although reviews of the efficacy of opioids for back pain are scant, they continue to be the most commonly prescribed treatment for chronic pain in the U.S. and Canada – 2-3 times greater than most European countries.

Complications of opioid use, which include addiction and overdose-related mortality, physical dependence, sedation, depression and nausea, have risen comparably with prescription rates during the past decade.  In spite of numerous strategies for reducing opioid misuse, at least 40 people in the U.S. die each day from an opioid overdose.

Although adverse events were reported by 29% of participants who attended at least one, mindfulness-based stress reduction session, these symptoms were typically short-lived, and related to increased pain with yoga. It is possible that these effects might be reduced when a therapeutic yoga practice that specifically targets low back pain is used. Of those who attended the cognitive behavioral therapy session, 10% of adults reported an adverse event, which typically involved intermittent increased pain with progressive muscle relaxation.

These findings suggest that adults may have a safe alternative to opioid medication for the treatment of chronic back pain. Although further research is needed to better understand why and how mindfulness therapies like mindfulness-based stress reduction and traditional psychotherapeutic approaches for pain management like cognitive behavioral therapy are similarly effective, this is good news for the millions of individuals who are seeking an alternative to opioid medication.

B Grace Bullock, PhD, E-RYT 500 is a psychologist, research scientist, educator, yoga and mindfulness expert and author of Mindful Relationships: 7 Skills for Social Change. Her mission is to reduce stress, increase health and well-being and improve the quality of relationships. She offers classes, workshops, writing and research that combine the wisdom of applied neuroscience, psychophysiology, psychology and contemplative science and practice. Her goal is to empower individuals, groups, leaders and organizations to reduce chronic stress and increase awareness, attention, compassion, mindfulness and effective communication to strengthen relationships, release dysfunctional patterns and unlock new and healthy ways of being. Dr. Bullock is also the Founding Director and Principal Consultant of the International Science & Education Alliance, an organization devoted to exceptional research, program evaluation, assessment design, strategic planning and capacity building to support equity, programmatic diversity and scientific integrity, and promote effective leadership, decision-making and social change. Bullock is a Certified Viniyoga Therapist and Faculty at the Integrated Health Yoga Therapy (IHYT) Training program. She is the former Senior Research Scientist at the Mind & Life Institute and former Editor-in-Chief of the International Journal of Yoga Therapy. For more information see www.bgracebullock.com.

Sources

Cherkin, D.C., Sherman, K.J., Balderson, B.H., Cook, A.J., Anderson, M.L., Hawkes, R.J. et al. (2016). Effect of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy of Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA, 315(12):1240-1249. doi:10.1001/jama.2016.2323

Deyo, R.A. Von Korff, V. Duhrkoop, D. Opiods for Low Back Pain (2015). BMJ, 350 doi: http://dx.doi.org/10.1136/bmj.g6380