A recent study published in JAMA Network Open compares the long-term effectiveness of mindfulness-based therapy (MBT) and cognitive behavioral therapy (CBT) in treating adults with opioid-treated chronic low back pain (CLBP). Both therapies are psychologically oriented treatments designed to offer relief for individuals suffering from this debilitating condition.
Understanding Chronic Low Back Pain and Current Treatments
Chronic low back pain is a significant health concern that affects over 50 million adults in the United States. It is one of the leading causes of disability and a major contributor to reduced quality of life (QOL). Many individuals with CLBP rely on opioids for pain management, but long-term opioid use comes with numerous side effects and is often ineffective in providing lasting relief. This has led to a pressing need for alternative treatments, including psychological interventions like CBT and MBT.
Cognitive Behavioral Therapy (CBT)
CBT is a well-established psychological treatment that helps individuals with chronic pain cope by changing maladaptive thought patterns and behaviors. It empowers patients to manage their pain by modifying their responses and behaviors related to pain. However, while CBT has shown marginal benefits in managing CLBP, its efficacy can vary among individuals, and access to therapy remains a barrier for many.
Mindfulness-Based Therapy (MBT)
MBT, on the other hand, encourages individuals to accept their chronic pain through mindful awareness. This therapy teaches patients how to be non-judgmentally aware of their pain without reacting to it, cultivating a sense of calm and acceptance. While there is growing evidence supporting the efficacy of MBT, there have been no direct comparisons of its long-term effectiveness with CBT, particularly among opioid-treated CLBP patients.
Study Overview: Comparing MBT and CBT
The Strategies to Assist with Management of Pain (STAMP) study is a randomized clinical trial (RCT) that compares the effects of MBT and CBT for opioid-treated CLBP patients. This two-arm, multisite study enrolled participants who experienced daily low back pain and were treated with high doses of opioids (15 or more morphine milligram equivalents per day) for at least three months.
The researchers hypothesized that MBT would provide better outcomes than CBT, especially in terms of pain relief, improved function, and reduced opioid use. The study also aimed to examine whether MBT could help reduce opioid dosages six and 12 months after therapy initiation.
Study Methods
Participants aged 21 and older were randomly assigned to either the MBT or CBT group. Both groups underwent eight weekly, two-hour group therapy sessions, and participants were encouraged to practice mindfulness or cognitive-behavioral techniques for at least 30 minutes daily, six days per week.
The study assessed outcomes at baseline, as well as at three, six, nine, and 12 months after treatment. Key outcomes included pain intensity, functional limitations, health-related quality of life (QOL), and opioid use. Data were analyzed using a linear mixed-effects model to compare the effectiveness of the two therapies.
Results: Impact of MBT and CBT on CLBP
Both therapies showed significant improvements in pain intensity, functional limitations, and opioid reduction compared to baseline. However, the results revealed no significant differences between MBT and CBT in terms of primary and secondary outcomes at six and 12 months. Both therapies were associated with comparable improvements in pain relief and reductions in opioid usage, suggesting that both MBT and CBT are effective in managing CLBP over the long term.
Key Findings:
Pain Reduction: The change in pain intensity (measured on the Brief Pain Inventory scale) was slightly greater in the CBT group, but both therapies resulted in meaningful reductions in pain at six and 12 months.
Functional Improvement: Both MBT and CBT led to improvements in functional limitations, with no significant difference between the two groups.
Opioid Reduction: Both MBT and CBT contributed to significant reductions in opioid use, with no major differences between the two treatments.
Quality of Life: MBT was associated with greater improvements in mental health-related QOL at six months, but no significant differences were observed at 12 months.
Conclusions
This study demonstrates that both mindfulness-based therapy and cognitive behavioral therapy offer lasting benefits for individuals with chronic low back pain. Both therapies lead to significant improvements in pain intensity, function, and opioid reduction, and these effects are sustained for up to 12 months after the intervention.
Importantly, the results suggest that MBT may offer superior mental health-related benefits in the short term, while CBT appears equally effective in addressing pain and functional limitations. These findings underscore the value of incorporating both MBT and CBT into the treatment regimen for individuals with CLBP, particularly in the context of the opioid crisis.
The study supports the use of these psychological interventions as part of a comprehensive pain management plan, offering patients a way to manage their pain without the need for long-term opioid use. Given the ongoing challenges posed by chronic low back pain and opioid dependence, these therapies provide a promising alternative for individuals seeking more sustainable pain management options.
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