A recent study published in JAMA Network Open examines the long-term effectiveness of mindfulness-based therapy (MBT) and cognitive behavioral therapy (CBT) for adults with opioid-treated chronic low back pain (CLBP). Chronic pain, particularly CLBP, affects millions of adults worldwide, significantly impairing quality of life (QOL) and often resulting in opioid dependency for pain management. This study compares the outcomes of MBT and CBT, two psychological interventions that have been shown to help manage chronic pain but have not been directly compared in long-term studies until now.
Current Treatments for Chronic Low Back Pain
Chronic non-cancer pain, affecting over 50 million adults in the United States, remains one of the leading causes of disability. CLBP, in particular, often results in prolonged opioid use, despite the numerous adverse effects and the limited effectiveness of opioids in alleviating pain long-term. Given the widespread issues surrounding opioid dependency, new treatment modalities are essential. While psychological treatments such as CBT and MBT have shown promise, access and insurance limitations prevent their broader use.
CBT is a widely accepted psychological intervention that helps patients develop coping strategies by changing maladaptive thoughts and behaviors related to pain. MBT, on the other hand, focuses on mindfulness practices, encouraging individuals to accept pain through non-judgmental awareness and detachment from their pain experience. While both approaches are beneficial, no study has yet compared their long-term effectiveness in patients who are being treated with opioids for CLBP.
About the Study
The Strategies to Assist with Management of Pain (STAMP) study is a two-arm, multisite randomized clinical trial designed to compare MBT and CBT in opioid-treated CLBP patients. The researchers hypothesized that MBT would be more effective than CBT in reducing pain and improving function, and would also lead to a reduction in opioid use over six and 12 months post-treatment.
Participants were aged 21 years or older, experiencing daily CLBP or sciatica, and treated with at least 15 morphine milligram equivalents (MME) daily for three months or more. They were randomly assigned to either the MBT or CBT group, receiving eight weekly two-hour therapist-led group sessions. Participants in both groups were encouraged to practice daily, with MBT participants encouraged to practice mindfulness before resorting to opioid medication.
Key Findings
At the six- and 12-month follow-up, both MBT and CBT groups showed significant improvements in pain, function, and quality of life compared to baseline. For instance, both groups experienced reductions in pain as measured by the Brief Pain Inventory (BPI), with improvements in functional limitations and health-related quality of life. However, no significant differences were found between the two therapies in terms of pain relief, functional outcomes, or opioid use reduction.
Notably, the MBT group reported greater improvements in mental health-related quality of life at six months compared to the CBT group. Both therapies resulted in comparable reductions in opioid dosage, highlighting the potential for these treatments to support opioid tapering and pain management without the risks associated with long-term opioid use.
Conclusions
The study concludes that both MBT and CBT offer effective, long-term relief for chronic low back pain, with sustained improvements in pain management and reductions in opioid use for up to 12 months. Importantly, these therapies provide a non-pharmacological alternative to opioids, which is crucial given the ongoing opioid crisis. While no significant differences were found between the two therapies in terms of pain relief, the greater improvement in mental health-related QOL with MBT suggests it may have additional benefits in addressing the psychological components of chronic pain.
Overall, the findings support the incorporation of both MBT and CBT into the treatment plans for individuals suffering from chronic low back pain, providing them with lasting relief and a reduction in dependency on opioid medications.
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