Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical...

Area of Science:

• Clinical Psychology
• Pain Management
• Behavioral Medicine

Background:

• Chronic low back pain (CLBP) often requires opioid therapy, necessitating effective strategies to mitigate symptoms and opioid-related harms.
• Cognitive behavioral therapy (CBT) and mindfulness-based therapy (MBT) are potential interventions, but their efficacy in opioid-treated CLBP populations is not well-established.

Purpose of the Study:

• To compare the effectiveness of MBT versus CBT for individuals with CLBP undergoing opioid therapy.
• To hypothesize the superiority of MBT over CBT in improving pain and function.

Main Methods:

• A 12-month, multisite, randomized clinical trial involving 770 adults with moderate-to-severe CLBP on opioid therapy.
• Participants were assigned to either manual-based MBT or CBT, comprising 8 weekly group sessions and at-home practice.
• Coprimary outcomes included average pain severity (Brief Pain Inventory) and functional limitations (Oswestry Disability Index) assessed at 6 and 12 months.

Main Results:

• Both MBT and CBT groups demonstrated significant improvements in pain severity and functional limitations over 12 months.
• No significant between-group differences were detected for primary outcomes (pain and function) at 6 or 12 months.
• The analysis indicated MBT's noninferiority to CBT for the primary outcomes in this opioid-treated CLBP cohort.

Conclusions:

• This large trial demonstrated that both MBT and CBT are effective in reducing CLBP symptoms and opioid dosage.
• The findings suggest that MBT is noninferior to CBT for managing opioid-treated CLBP.
• Increased availability of these safe psychological therapies can help alleviate the burden of refractory CLBP.