Mindfulness-based stress reduction only slightly improves low back pain

Mindfulness-based stress reduction programmes (MSBR) appear to improve low back pain only slightly, and only temporarily, a review of previous research suggests.

These programmes combine meditation while sitting and walking, yoga, focusing attention on different parts of the body, and incorporation of mindfulness/awareness into everyday life. Earlier studies found MBSR to be helpful for a variety of chronic pain conditions.

But for low back pain, “it was surprising that we could not identify any difference between MBSR, usual care, or other psychological interventions on ‘mindfulnes’ and acceptance of pain in the short and long term,” Dennis Anheyer of University of Duisburg-Essen, Germany, told Reuters Health by e-mail.

Anheyer and colleagues looked at data from seven previously published studies involving 864 patients altogether.

The studies that looked at pain intensity and pain-related disability found small improvements with MBSR only over the short term, and even these improvements were of questionable significance, they report in Annals of Internal Medicine.

Some studies showed meaningful improvements in physical functioning in the short term but the improvements not sustained in the long term.

“Our review also showed that studies using MBSR programmes that included yoga had better effects on disability and physical functioning than studies using MBSR programmes without yoga,” Anheyer said. “Physical activity might therefore be important for these factors.”

Surprisingly, MBSR was not associated with improvements in mindfulness.

The inconsistent findings point to a need for larger, carefully designed studies of MBSR and its various components in patients with low back pain, the researchers say.

In the meantime, patients with low back pain can safely attend MBSR courses, Anheyer said. “However”, he added, “they should not neglect the physical activity. [And] if you practise meditation or any kind of physical activity, do it regularly and continuously.”

Dr Judith A. Turner from the University of Washington in Seattle, who has studied MBSR and cognitive behavioral therapy for chronic low back pain, told Reuters Health by e-mail, “People with low back pain may find MBSR to be helpful, not only for their pain but also for managing stress and other problems. The risks are minimal, especially when compared to some other treatments for low back pain, such as surgery and opioid medication. Benefits for pain may be modest, but this is true for most treatments for chronic low back pain.”

“It is interesting that interventions that included a yoga component reduced disability, whereas those that did not include yoga did not reduce disability,” she said. “This suggests that MBSR programmes might be most helpful for back pain when they include yoga, although more research is needed to confirm this suggestion.”

“This review was of only a small number of studies and some of the studies included had methodological problems that limit confidence in the results,” Turner said. “Nonetheless, patients with chronic low back pain and their health care providers are looking for effective treatments that are alternatives to opioid medication, and MBSR is one such option. Another such option is cognitive-behavioral therapy, which has been demonstrated effective in the short- and long-term for chronic low back pain.”