Two Techniques Improve Chronic Back Pain

Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. It can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. It becomes chronic if it lasts for more than three months.

Interesting facts about back pain:

  • Low back pain is the single leading cause of disability worldwide, according to the Global Burden of Disease 2010.
  • Back pain is one of the most common reasons for missed work.  In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.
  • One-half of all working Americans admit to having back pain symptoms each year.
  • Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.
  • Americans spend at least $50 billion each year on back pain—and that’s just for the more easily identified costs.

For adults with chronic low-back pain, two mind and body practices resulted in greater improvement in pain reduction and physical functioning. The randomized study, which was funded by NCCIH and conducted in the Group Health Cooperative system in Washington State and the University of Washington, appears in the Journal of the American Medical Associationfond two therapies―mindfulness based stress reduction (MBSR) and cognitive-behavioral therapy―caused greater clinical improvements when compared to standard treatment.

The researchers tested MBSR (described as training in mindfulness meditation and yoga) against cognitive-behavioral therapy (training to change pain-related thoughts and behaviors) and usual care. Participants randomized to the usual care group received a nominal payment but no MBSR or cognitive-behavioral therapy, and were free to seek whatever other treatment they desired. The participants were 342 adults aged 20 to 70 who had chronic low-back pain not associated with a specific diagnosis such as spinal stenosis.

After initial assessment, participants were randomized to MBSR, cognitive-behavioral therapy, or usual care. In the two mind and body groups, treatments consisted of one 2-hour session per week for 8 weeks, plus home practice with workbooks and CDs.

The researchers found that participants in the MBSR and cognitive-behavioral therapy groups had greater improvement in functional limitation and back pain at 26 and 52 weeks compared with those who had usual care. There were no significant differences in outcomes between MBSR and cognitive-behavioral therapy. The moderately-sized treatment effects were apparent even though participants in the mind and body groups did not attend all of the sessions. In addition, the researchers observed that participants in the MSBR and cognitive-behavioral therapy groups improved more than those in the usual care group on pain intensity and some mental-health measures, although for the latter, improvement did not extend beyond 26 weeks.

Of the several limitations of this study, the researchers noted that about 20 percent of participants randomized to MBSR and cognitive behavioral therapy were lost to follow-up; the researchers used statistical imputations to address the missing data. The researchers concluded that MBSR may be an effective treatment option for people with chronic low-back pain. They also suggested that, based upon an array of evidence, such mind and body practices may give people ongoing skills to help them manage their pain. Areas for further study include MBSR’s cost-effectiveness, the mechanisms by which it exerts its effects, whether those effects persist beyond a year, and the optimal number of sessions.

Sources:

https://nccih.nih.gov/research/results/spotlight/better-low-back-pain_2016

http://www.acatoday.org/Patients/Health-Wellness-Information/Back-Pain-Facts-and-Statistics

Cherkin DC, Sherman KJ, Balderson BH, et al. 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. JAMA. March 22, 2016. Epub ahead of print.

Mind-Body Therapy Bests Usual Care for Back Pain | Medpage Today

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Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.

Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.

In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD.

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