Mindfulness-based Interventions for Chronic Low Back Pain: A Systematic Review and Meta-analysis.
Myrella Paschali, Asimina Lazaridou, Jason Sadora, Lauren Papianou, Eric L Garland, Aleksandra E Zgierska, Robert R Edwards
The Clinical journal of pain February 1, 2024 DOI: 10.1097/AJP.0000000000001173
Summary
Mindfulness-based interventions (MBIs) significantly reduce pain intensity in adults with chronic low back pain (CLBP), showing a large effect size. An analysis of 18 studies, encompassing diverse techniques like mindfulness meditation and acceptance therapy, revealed that participants reported notable improvements on pain scales. Despite the promising findings, issues such as small sample sizes and variability in methodologies highlight the need for larger, more rigorous trials to better understand the long-term benefits of MBIs for CLBP management.
Abstract
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. 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. 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. 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.