Photo credit: www.sciencedaily.com

Innovative Therapies Show Promise for Chronic Low Back Pain Management

Chronic low back pain is a significant health concern, affecting one in four Americans and serving as a leading cause of disability worldwide. Nearly 80% of individuals dealing with chronic pain express a desire for more effective treatment options. Unfortunately, many turn to opioids in search of relief, which carries the risk of addiction.

A new study conducted by researchers from the Penn State College of Medicine and the University of Wisconsin-Madison presents encouraging findings. The research indicates that eight weeks of mindfulness training or cognitive behavioral therapy (CBT) can lead to substantial improvements in adults suffering from chronic low back pain, particularly those already relying on opioids without success from earlier treatments. This clinical trial demonstrated enhancements in physical function, quality of life, and reductions in pain and opioid use, with benefits sustained for up to a year post-treatment.

Published in JAMA Network Open, this research stands out as the largest trial to explore the effects of mindfulness compared to CBT in individuals undergoing opioid treatment for chronic pain, with a follow-up period extending longer than many similar studies.

According to Aleksandra Zgierska, the study’s lead author and an endowed professor at Penn State, “Both mindfulness and cognitive behavioral therapy were demonstrated to be safe and effective treatments, offering lasting benefits for those managing opioid-treated chronic back pain.” She emphasized the need for these evidence-based therapies to be adopted as standard care for patients.

Chronic low back pain is complex, often resulting from a confluence of factors, and is the most prevalent type of chronic non-cancer pain treated with opioids. While previous studies suggested that behavioral therapies can positively impact chronic pain by altering how individuals relate to their pain, systematic exploration has been limited. Most prior studies have been small-scale and predominantly focused on short-term outcomes.

“Chronic pain is often perceived as a strictly physical issue that necessitates physical intervention,” remarked Eric Garland, a senior author of the study and a professor at the University of California, San Diego.

To assess the long-term efficacy of mindfulness versus CBT for chronic opioid-managed low back pain, the research team enrolled 770 participants in a clinical trial across three sites: Madison, Wisconsin; Boston, Massachusetts; and Salt Lake City, Utah. Many participants reported moderate to severe pain, significant functional impairments, and a history of various treatments, including daily opioid medications for an extended period.

Bruce Barrett, co-lead of the study and a professor at the University of Wisconsin-Madison, commented, “Participants were facing severe back pain that significantly disrupted their lives and necessitated opioid treatment. Typically, individuals in such circumstances do not experience natural improvement over time.”

The trial’s participants were assigned to either mindfulness therapy or CBT, with both therapies delivered through two-hour group sessions over eight weeks. Participants in the mindfulness group focused on acknowledging their physical sensations, enhancing their capacity to manage their pain and related symptoms, while those in the CBT group learned techniques to shift negative thought patterns. They were advised to practice independently for 30 minutes daily and continue their regular treatment plan without specific instructions to reduce opioid dosage. Throughout the study, participants reported on pain levels, daily functioning, mental and physical health quality, and opioid usage at various intervals.

At the conclusion of the trial, both groups exhibited significant and enduring improvements, including decreased pain and overall opioid usage. Participants also experienced enhanced functionality and quality of life over the year following the intervention. The researchers confirmed that the tools provided through mindfulness and CBT could be applied safely and effectively over the long term.

Penney Cowan, founder of the American Chronic Pain Association and co-author of the study, reflected on the findings, stating, “The ultimate goal of pain management is enhancing quality of life, increasing functional capacity, and alleviating suffering. The interventions likely contributed to a reduction in participants’ perceptions of suffering, thus allowing for improved functionality. This study inspires hope, showing that individuals can learn to manage their pain and enhance their quality of life.”

The research team highlighted that individuals living with chronic pain often develop a toolkit of various self-care strategies to manage their discomfort. Mindfulness and CBT represent additional methods that can enrich this toolkit and enhance coping capabilities.

“Mindfulness and CBT serve as valuable components to enrich your pain management strategy, applicable across various pain conditions and severities,” noted Christin Veasley, founder of the Chronic Pain Research Alliance and a co-author of the study.

Interestingly, while participants were encouraged to maintain their existing treatment regimens, both groups demonstrated a decreased reliance on opioids over the following year. Zgierska pointed out that participants learned skills, such as mindful breathing before medication intake, which likely contributed to their proactive choices in managing opioid usage. The research team suggested that these improvements stemmed from participants gaining new coping mechanisms and deciding to reduce their opioid consumption voluntarily.

“These therapies aren’t a definitive cure, but they empower individuals to harness their inner resources for managing chronic pain and leading fulfilling lives,” Garland emphasized. “Mindfulness, unlike surgical or medicated interventions, is a self-directed tool that patients can develop from within, fostering long-lasting benefits.”

This study benefits from the collaboration of a diverse range of scholars and professionals from various institutions, reflecting a comprehensive approach to addressing chronic pain management. Funding support from the Patient-Centered Outcomes Research Institute (PCORI), alongside contributions from several esteemed medical schools and healthcare institutions, underscores the importance of this research in contemporary health care.

Source
www.sciencedaily.com