Research: ZGIERSKA and COLLEAGUES,

Listed in Issue 253

Abstract

ZGIERSKA and COLLEAGUES, 1. Department of *Family Medicine and Community Health, aleksandra.zgierska@fammed.wisc.edu ; 2. Department of *Family Medicine and Community Health; 3. Department of Biostatistics and Medical Informatics; 4. Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin; 5. Department of Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, Wisconsin; 6. Department of Orthopedics and Rehabilitation; 7. Department of Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison, Wisconsin; 8. Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin; 9. Department of **PRAHS Clinical Research Company Lifetree, Salt Lake City, Utah, USA conducted a parallel-arm pilot randomized controlled trial to evaluate the benefits of mindfulness meditation and cognitive behavioural therapy (CBT)-based intervention for opioid-treated chronic low back pain (CLBP)

Background

The authors set out to assess benefits of mindfulness meditation and cognitive behavioural therapy (CBT)-based intervention for opioid-treated chronic low back pain (CLBP).

Methodology

The intervention comprised eight weekly group sessions (meditation and CLBP-specific CBT components) and 30 minutes/day, 6 days/week of at-home practice. Design: 26-week parallel-arm pilot randomized controlled trial (Intervention and Usual Care versus Usual Care alone). Setting: Outpatient. Subjects: Adults with CLBP, prescribed ≥30 mg/day of morphine-equivalent dose (MED) for at least 3 months. Outcome measures were collected at baseline, 8, and 26 weeks: primary-pain severity (Brief Pain Inventory) and function/disability (Oswestry Disability Index); secondary-pain acceptance, opioid dose, pain sensitivity to thermal stimuli, and serum pain-sensitive biomarkers (Interferon-γ; Tumor Necrosis Factor-α; Interleukins 1ß and 6; C-reactive Protein).

Results

Thirty-five (21 experimental, 14 control) participants were enrolled and completed the study. They were 51.8 ± 9.7 years old, 80% female, with severe CLBP-related disability (66.7 ± 11.4), moderate pain severity (5.8 ± 1.4), and taking 148.3 ± 129.2 mg/day of MED. Results of the intention-to-treat analysis showed that, compared with controls, the meditation-CBT group reduced pain severity ratings during the study (P = 0.045), with between-group difference in score change reaching 1 point at 26 weeks (95% Confidence Interval: 0.2,1.9; Cohen's d = 0.86), and decreased pain sensitivity to thermal stimuli (P < 0.05), without adverse events. Exploratory analyses suggested a relationship between the extent of meditation practice and the magnitude of intervention benefits.

Conclusion

Meditation-CBT intervention reduced pain severity and sensitivity to experimental thermal pain stimuli in patients with opioid-treated CLBP. Trial Registration: ClinicalTrials.gov NCT01775995. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com .

References

Zgierska AE1, Burzinski CA2, Cox J2, Kloke J3, Stegner A4,5, Cook DB4,5, Singles J6, Mirgain S6, Coe CL7, Bačkonja M8,9. Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial. Pain Med. 17(10): 1865-1881. Oct  2016. Epub Mar 10 2016.

Comment

The above research demonstrated that meditation and cognitive behavioural therapy (CBT) reduced pain in patients with opioid-treated chronic low back pain (CLBP) and thus is an argument for the introduction of these interventions into clinical practice.

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