Effectiveness of focused meditation for patients with chronic low back pain—A randomized controlled clinical trial

https://doi.org/10.1016/j.ctim.2016.03.010Get rights and content

Highlights

  • Focused meditation and exercise relieve chronic low back pain to a comparable extent.

  • Perceived stress is better improved by meditation than exercise.

  • Adherence with meditation is limited and should be improved in future trials.

Abstract

Objectives

We aimed to evaluate the effectiveness of an 8-week meditation program (focused meditation) in patients with chronic low-back pain.

Design

A randomized clinical trial was conducted on 68 patients (55 years;75% female) with chronic low-back pain who scored >40 mm on a 100 mm Visual-Analogue-Scale. Subjects were allocated to an 8-week meditation program (focused meditation) with weekly 75 min classes or to a self-care exercise program with a wait-list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed baseline and after 4 and 8 weeks. The primary outcome measure was the change in mean back pain at rest after 8 weeks. Secondary outcomes included function, pain-related bothersomeness, perceived stress, quality-of-life (QOL), and psychological outcomes.

Results

Twelve (meditation) and 4 (exercise) patients were lost to follow-up. The primary outcome, pain at rest after 8 weeks, was reduced from 59.3 ± 13.9 mm to 40.8 ± 21.8 mm with meditation vs. 52.9 ± 11.8 mm to 37.3 ± 18.2 mm with exercise (adjusted group difference: −1.4 (95%CI:11.6;8.8;p = n.s.) Perceived stress was significantly more reduced with meditation (p = 0.011). No significant treatment effects were found for other secondary outcomes as pain-related bothersomeness, function, quality-of-life and psychological scores, although the meditation group consistently showed non-significant better improvements compared to the exercise group.

Conclusions

Focused meditation and self-care exercise lead to comparable, symptomatic improvements in patients with chronic low back pain. Future studies should include longer-term follow-ups and develop guided meditation programs to support compliance.

Introduction

Low back pain is a major public health problem, with more than 70% of the population in Western societies experiencing low back pain in a given year.1 Chronic low back pain can seriously affect quality of life and has a high comorbidity with impaired psychological well-being and depression. Furthermore, it is the most costly ailment of working age with an estimated € 10 billion spent annually on medical cost in Germany and more than 30 billion USD spent in the USA.2, 3 A wide variety of treatments for back pain exist including education, analgesic and anti-inflammatory medication, exercise, injections, manual therapies, acupuncture and further complementary therapies, surgery and minimally invasive treatments. However, there is still unsatisfactory evidence to support most of these treatments. Because patients with low back pain are frequently dissatisfied with their medical care, they commonly seek out Complementary and Alternative Medicine (CAM) methods for treatment.4, 5 Several methods of Mind-Body Medicine have found to be effective in chronic pain conditions. For example, Hatha Yoga in low back and neck pain6, 7, 8 and Tai chi in fibromyalgia9 have demonstrated clinically relevant effects in randomized trials.

Meditation has been increasingly used in the adjunctive treatment of chronic disease conditions. Several experimental studies revealed decreased central pain responsiveness in long-term meditation practitioners, and, meditation as a neuromodulatory interventions may modify cortical structures and processes involved in attention and the emotional responding to.10

Programs of eight-week mindfulness meditation or mindfulness-based stress reduction (MBSR) have been introduced for early supportive treatment of chronic pain patients.11, 12, 13 Mindfulness meditation has demonstrated beneficial clinical effects for various health problems, including anxiety disorders,14 mood and quality of life in cancer patients,15 and the prevention of relapse of depression16 among others. However, to date, only a few controlled studies investigating chronic pain patients 17, 18, 19 and two RCTs investigating the effects of a meditation program in a population of elderly patients with chronic back pain exist to.20, 21

In this study, we aimed to evaluate the effectiveness of meditation in patients with low back pain by means of a randomized trial.

Section snippets

Methods

This study was designed as a randomized controlled clinical trial. All study participants gave their informed consent. The study protocol was reviewed and approved by the Ethics committee of the Charité-University Medical Center, Berlin, Germany. Patients were enrolled between October 2009 and June 2010; interventions and follow-up were completed by February, 2011. All study procedures and data collection were carried out at the outpatient department of the Immanuel Krankenhaus Berlin,

Results

Telephone screening yielded 170 calls from subjects interested in study participation. After enrolling the first 40 patients in the study, the drop-out rate was higher than anticipated and the sample size was increased to 68 study patients. Of the 68 enrolled patients, 32 patients were randomly allocated to the meditation group, and 36 to the exercise group. 16 subjects withdrew from the study over the 8 week period, resulting in completed data sets for 20 patients in the meditation group and

Discussion

This study compared the effects of an 8-week meditation course to a self-care exercise program in patients with chronic low back pain by means of a randomized clinical trial. We found comparable pain reduction in both groups. We also found comparable improvements in pain-related bothersomeness, function and quality of life in both groups. Although the improvements in the meditation group were consistently greater than in the exercise group, the differences did not reach statistical

Conflict of interest

There are no conflicts of interest related to the study for all authors.

Acknowledgement

The study was supported by a grant of the Else Kröner-Fresenius-Stiftung, Germany.

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