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.
OBJECTIVE To assess benefits of mindfulness meditation and cognitive behavioral therapy (CBT) based intervention for opioid treated chronic low back pain (CLBP) 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. METHODS The intervention comprised eight weekly group sessions (meditation and CLBP specific CBT components) and 30 minutes/day, 6 days/week of at home practice. 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 g; Tumor Necrosis Factor a; 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. CONCLUSIONS Meditation CBT intervention reduced pain severity and sensitivity to experimental thermal pain stimuli in patients with opioid treated CLBP.
Pain medicine