Relieving chronic low back pain could be a practice of mind over matter. Current estimates suggest that on any given day, about 25 million people in the U.S. suffer with chronic low back pain. When low back pain entrenches, doctors will usually prescribe pain medications as treatment. Unfortunately, medications simply treat the symptom of pain without resolving the cause and because pain medication use is typically long term, taking these medications can also come with risk of addiction. But what if you could use non-drug therapies to manage chronic pain? A new study suggests that mindfulness based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) may offer not only relief but may also prove more effective than standard treatment in managing chronic low back pain**.
If you’ve been following recent health news then it’s no surprise that we have an opioid epidemic in the United States. The major uptick in prescribing rates of opioid pain medications, has led to escalating rates of addiction and abuse of prescription opioids, as well as heroin and morphine. New York City is battling the opioid epidemic by requiring electronic prescribing, following in the footsteps of Minnesota which mandated e-prescribing a couple of years ago. That effort is aimed at reducing forged prescriptions, a huge problem that dominates painkiller drug use. So any therapeutic alternative that is low risk, affordable and that reduces or eliminates the ongoing need for pain medication would be a welcome addition to the world of chronic pain management. One large, randomized past study evaluated MBSR in older adults with chronic low back pain with good results. More research to look at a broader age group and to assess other similar therapies was still needed.
What is MBSR?
Mindfulness based stress reduction helps individuals to increase awareness and accept moment-to-moment unpleasant experiences like pain and emotional discomfort. It is often paired with mindfulness-based cognitive therapy. These therapies appear to have a role in the treatment of pain related to chronic conditions like cancer pain, fibromyalgia, rheumatoid arthritis and of course, chronic low back pain. The goal of these therapeutic modalities is to make the patient feel that though their symptoms may be incredibly uncomfortable, they have the control to create a mindset of tolerance which ultimately liberates them from ongoing suffering.
During treatment, the therapist helps the individuals to learn formal meditation but the technique also helps the individual to shift attitude and perspective, so the patient sees their illness and pain literally in a whole new light. One final goal is to minimize and eliminate fear of the pain so that the fear no longer consumes them. Pain may remain, but the stress and overwhelming psychological misery that typically accompanies a chronic pain situation, is alleviated. You are left feeling in control.
Researchers randomly assigned 342 subjects ages 20 to 70 years of age, all diagnosed with chronic lower back pain, to either receive MBSR and CBT or usual care. The average age of the subject was 49 years old. The average duration of the chronic back pain was just over seven years. CBT was used to help change pain-related thoughts and behaviors, and MBSR techniques included meditation and yoga. MBSR and CBT were delivered twice a week for eight weeks. Subjects continued to be monitored after the therapy was completed.
At the twenty sixth week, the percentage of patients that showed “clinically meaningful improvement” based on measurements of functional limitations was higher in those who received MSRB (61 percent) and CBT (58 percent) compared to those who stayed on their usual therapies (44 percent). When it came to an assessment of “pain bothersomeness,” the MBSR and CBT groups also had better results significantly, compared to the control group. All the subjects were monitored until the 52nd week and the researchers noted that their findings persisted. The MBSR and CBT subjects were still successfully managing their chronic pain without pain medications.
The researchers were impressed with the results, calling them remarkable given the fact that only 51 percent of the subjects randomized to receive MBSR and only 57 percent of those randomized to receive CBT attended at least six of the total eight weeks of therapy. They concluded that MBSR with CBT is a viable option for patients with persistent chronic lower back pain.
In light of the high potential of opioid misuse and abuse, the addictive nature of many pain medications and the need for affordable therapies that are accessible to large numbers of people, this research offers great hope to the millions suffering with chronic pain, and especially chronic low back pain. Mind-body techniques have been available for centuries, but science does require research-based investigations into these therapeutic options so they are held to the same standards as traditional medical therapies and drug agents.
Patients who suffer with ongoing, unrelenting pain also can find themselves so dependent on pain medications that they are resistant to even trying to wean off the pain pills to try this kind of mind-body intervention. So you need to have patients who are early in the pain cycle or patients willing to “give it a try,” but the research does offer incredibly encouraging findings and a way to limit the need for long term use of pain medications and the danger of opioid addiction or dependency. MBSR and CBT also put control to manage a chronic condition in the grasp of the patient, which is quite empowering!
National Council on Alcoholism and Drug Dependence
National Institute of Health