(9) Low Back Pain and the Practice of Mindfulness

Millions of Americans suffer from chronic back pain… and the numbers are only on the rise. Over a 14-year period, the percentage of Americans suffering from chronic, impairing low back pain rose from 3.9% in 1992 to 10.2% in 2006.   The Centers for Disease Control and Prevention (CDC) recently advised that those suffering from chronic pain should seek the use of therapies, such as exercise or cognitive-behavioral therapy, before resorting to the use of opioids.

One week after the CDC's report, an article was published in The Journal of the American Medical Association (one of the most prestigious journals in the world) exploring mindfulness for treating individuals suffering from chronic low back pain. The study compared a mindfulness-based intervention with cognitive-behavioral therapy and usual medical care.

Cognitive-behavioral therapy (CBT), which has been demonstrated as an effective treatment for a wide variety of chronic pain conditions, focuses on training people to change the way they relate to pain. In CBT patients learn to challenge and reframe their negative pain-related thoughts. It encourages them to employ relaxation techniques, such as guided imagery, and emphasizes pain management skills – like planning activities that do not aggravate their pain.

Mindfulness-based interventions, on the other hand, focus on ways to be aware of and embrace “the now” in it’s entirety, including their pain. Mindfulness training encourages people to acknowledge their pain, their discomfort, and their emotional responses to their condition – and to embrace the experience of pain as it is. This is accomplished through the use of tools such as mindfulness meditation, yoga, as well as the continual cultivation of present-moment awareness.

So while cognitive-behavioral therapy focuses on change, mindfulness-based stress reduction focuses on awareness and acceptance.

What were the results?
At the end of the 8-week intervention period, both Mindfulness and CBT experienced clinically meaningful improvement in functional disability and pain at a rate that was much more significant than those who continued on with their usual care. Importantly, results were sustained for both treatments for an additional 4.5 months.

Astonishingly, those who participated in mindfulness-based stress reduction continued to reduce their functional disability and pain bothersomeness as time went on.

At the end of the mindfulness-based intervention, 47.4% experienced a clinically significant reduction in functional disability. Four and a half months later, that number jumped up to 60.5%. At 11-months post-intervention, that number reached 68.6%. The same pattern occurred with the participants’ self-rating of their pain bothersomeness – continual improvement as time progressed.

For those who participated in cognitive-behavioral therapy, while significant improvement occurred over the 4.5 months after therapy ended, the benefit plateaued at the 11-month follow-up.

On the contrary, the mindfulness-based intervention that was tested provided long-term pain relief, remaining significantly more effective than usual care 11-months post-intervention.

This important study put Mindfulness Training in the frontline as an effective treatment option for individuals with chronic low back pain, which affect the lives of many people worldwide.