Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Meta-analysis
Dennis Anheyer1, Heidemarie Haller1, Jürgen Barth1
1From Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany; University Hospital Zurich and University of Zurich, Zurich, Switzerland; and University of Technology Sydney, Ultimo, New South Wales, Australia.
Background:
Mindfulness-based stress reduction (MBSR) is frequently used to treat pain-related conditions, but its effects on low back pain are uncertain.
Purpose:
To assess the efficacy and safety of MBSR in patients with low back pain.
Data Sources:
Searches of MEDLINE/PubMed, Scopus, the Cochrane Library, and PsycINFO to 15 June 2016.
Study Selection:
Randomized controlled trials (RCTs) that compared MBSR with usual care or an active comparator and assessed pain intensity or pain-related disability as a primary outcome in patients with low back pain.
Data Extraction:
Two reviewers independently extracted data on study characteristics, patients, interventions, outcome measures, and results at short- and long-term follow-up. Risk of bias was assessed using the Cochrane risk-of-bias tool.
Data Synthesis:
Seven RCTs involving 864 patients with low back pain were eligible for review. Compared with usual care, MBSR was associated with short-term improvements in pain intensity (4 RCTs; mean difference [MD], -0.96 point on a numerical rating scale [95% CI, -1.64 to -0.34 point]; standardized mean difference [SMD], -0.48 point [CI, -0.82 to -0.14 point]) and physical functioning (2 RCTs; MD, 2.50 [CI, 0.90 to 4.10 point]; SMD, 0.25 [CI, 0.09 to 0.41 point]) that were not sustained in the long term. Between-group differences in disability, mental health, pain acceptance, and mindfulness were not significant at short- or long-term follow-up. Compared with an active comparator, MBSR was not associated with significant differences in short- or long-term outcomes. No serious adverse events were reported.
Limitation:
The number of eligible RCTs was limited; only 3 evaluated MBSR against an active comparator.
Conclusion:
Mindfulness-based stress reduction may be associated with short-term effects on pain intensity and physical functioning. Long-term RCTs that compare MBSR versus active treatments are needed in order to best understand the role of MBSR in the management of low back pain.
Primary Funding Source:
None.
