Wednesday, March 30, 2016:
Here I am on my morning run, half-listening my favorite medical podcasts, half-wondering what to write about for my column this week. (Yes, my attention skills need work, but honestly, a lot of these medical journal summaries are mind-numbingly dull. I mean, how many varieties of prostate screening do I want to learn about when I don't even have one?)
But then, something captures my attention. First Johns Hopkins babbles through my headphones about this one back pain study. Then the Lancet. Finally JAMA. It feels like a Big Hint.
Everyone is talking about mindfulness therapy for chronic lower back pain this week.
I decide to pay attention.
Seattle-based Group Health Research Institute's Daniel Cherkin and colleagues enlisted over 340 adults with chronic low back pain in this study. Participants had to have endured at least 3 months of pain, but some of them had pain lasting over 50 years.
They randomly placed this unhappy lot into three groups. One group just got standard medical care as a control.
The second group received MBSR or Mindfulness Based Stress Reduction, for 2 hours a week, for 8 weeks. MBSR was administered by professionals trained in this technique. MBSR features meditation, body scan, and simple yoga positions designed to help participants become more aware of their bodies.
The third group received CBT, or Cognitive Behavioral Therapy, also from trained professionals. Like the MBSR group, it was also administered 2 hours a week, for 8 weeks.
I have a special fondness for CBT (do not confuse with pot-derived CBD, which has a side effect of causing me to roll my eyes). A previous post mentioned CBT for panic disorder. I like to say CBT works as long as your cognition is online, since it requires periods of cool-headed logic and motivation. But I'd mostly associated CBT for use with phobias, anxiety and depression; mood disorders. I had not known of its use in chronic pain.
Put simply, CBT helps people reframe how they think about things, uncovering habitual illogical thought patterns in particular. In this case, CBT was used to reframe how the patients thought about their back pain, suggesting ways to change their behaviors to manage it more effectively.
Both CBT and MBSR groups received workbooks, audio CDs, and instructions for home practice.
For example, they were given Dennis Turk's The Pain Survival Guide: How to Reclaim Your Life, which I have not read, so I can't judge it, but there you go.
Notice this isn't one of those placebo-based trials, the teacher's pet darling of the research classroom. There are just some things in life that you can't blind. People have this way of knowing whether they or not they are getting therapy, for example. It's hard to hide that.
At 26 and 52 weeks, they were assessed for "pain bothersomeness" and daily function using a variety of physical tests and questionnaires. After all this, it is exciting to read that the effects of both MBSR and CBT, though "moderate in size", were considered clinically significant in both outcomes, and persisted well beyond the 8 weeks of therapy.
The main author, Cherkin, wrote:
“The research suggests that training the brain to respond differently to pain signals may be more effective — and last longer — than traditional physical therapy and medication.”
I like to put this in the category of can't hurt, might help.
Here are some more resources, which I have not reviewed. Other people have, and they seem to like these:
You Are Not Your Pain: Using Mindfulness to Relieve Pain, Reduce Stress, and Restore Well-Being by Vidyamala Burch and Danny Penman
Mindfulness Meditation for Pain Relief by Jon Kabat-Zinn, (who is just an awesome writer and worth reading for that alone)
My last article focused on the brain-boosting benefits you get from diversifying your writing postures, from sitting to standing to walking. If back pain is your unwanted guest, who shows up at the worst times and just won't leave, demanding cushions, hot pads and medications, I hope that you may find that article helpful as well.