Positive Health Online

Abstract

PASCHALIA and COLLEAGUES,  (1)Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital.; (2)Fielding Graduate University, Santa Barbara, CA.;(3)Center on Mindfulness and Integrative Health Intervention Development.; (4)College of Social Work, University of Utah, Salt Lake City, UT.;(5)Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA conducted a systematic review with the goal to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain

Background

This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the United States each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized.

Methodology

Design: Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs), pilot RCTs, and single-arm studies that explored the effectiveness of MBIs in CLBP.  Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7.

Results

Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included mindfulness meditation, mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-oriented recovery enhancement, acceptance and commitment therapy, dialectical behavioral therapy, meditation-cognitive behavioral therapy, mindfulness-based care for chronic pain, self-compassion course, and loving-kindness course. Pain intensity scores were reported using a numerical rating scale (0 to 10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP.

Conclusion

MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data the high variability in study methodologies, small sample sizes, inclusion of studies with high risk of bias, and reliance on pre-post treatment differences with no attention to maintenance of effects. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. Conflict of interest statement: E.L.G. has received royalties from BehaVR LLC and honoraria for training clinicians in mindfulness. The remaining authors declare no conflict of interest.

References

Paschali M(1), Lazaridou A(1)(2), Sadora J(2), Papianou L(1), Garland EL(3)(4),

Zgierska AE(5), Edwards RR(1). Mindfulness-based Interventions for Chronic Low Back Pain: A Systematic Review and Meta-analysis. Clin J Pain; 2):105-113. DOI: 10.1097/AJP.0000000000001173 . Feb 1 2024.

Comment

Mindfulness-based interventions (MBIs) appear to have a beneficial effect on pain intensity large-sized effect in adults with chronic low back pain (CLBP). However these findings need to be carefully interpreted due to the limited data, high variability in study methodologies, small sample sizes, inclusion of studies with high risk of bias, and reliance on pre-post treatment differences with no attention to maintenance of effects. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.