Effectiveness of focused meditation for patients with chronic low back pain—A randomized controlled clinical trial☆
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.
References (29)
- et al.
The economic burden of back pain in the UK
Pain
(2000) - et al.
Effects of yoga interventions on pain and pain-associated disability: a meta-analysis
J Pain
(2012) - et al.
Yoga for chronic neck pain: a pilot randomized controlled clinical trial
J Pain
(2012) An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results
Gen Hosp Psychiatry
(1982)- et al.
Mindfulness-based cognitive therapy for generalized anxiety disorder
J Anxiety Disord
(2008) - et al.
Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial
Pain
(2011) - et al.
Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study
Pain
(2008) International experiences with the hospital anxiety and depression scale—a review of validation data and clinical results
J Psychosom Res
(1997)German translation and psychometric testing of the SF-36 health survey: preliminary results from the IQOLA project. International Quality of Life Assessment
Soc Sci Med
(1995)- et al.
Mindfulness-based stress reduction and health benefits. A meta-analysis
J Psychosom Res
(2004)
Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey
Spine (Phila Pa 1976)
Expenditures and health status among adults with back and neck problems
JAMA
Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey
JAMA
Patterns and perceptions of care for treatment of back and neck pain: results of a national survey
Spine (Phila Pa 1976)
Cited by (30)
Effects of meditation on pain intensity, physical function, quality of life and depression in adults with low back pain – A systematic review with meta-analysis
2023, Complementary Therapies in MedicineThe effectiveness of mindfulness meditation for nurses and nursing students: An integrated literature review
2018, Nurse Education TodayCitation Excerpt :Physiological changes, including reduction in cortisol levels, improved immune response and reduced blood pressure have been reported (Creswell et al., 2009; Fang et al., 2010). Chronic pain, and in particular back pain, has also improved from the regular practice of MM (Michalsen et al., 2016). There are also psychological benefits from MM reported such as reduced anxiety, stress, depression, (Escuriex and Labbé, 2011; Kiken and Shook, 2012; Platt et al., 2016; Yazdanimehr et al., 2016), improved mood regulation, and sense of well-being (Sears et al., 2011; Shapiro et al., 2008).
The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the Fear-Avoidance Model of Chronic Pain
2017, Scandinavian Journal of PainCitation Excerpt :These findings support H1. The positive correlation between anxiety and pain is supported by the literature [2,22,30–32], as well as the negative correlations between anxiety and mindfulness [4–6,8] and mindfulness and pain components [22,33]. Additionally, results indicating that mindfulness was negatively related to specific components of the Fear-Avoidance Model of Chronic Pain were consistent with previous research [3,16,34].
Mindfulness-based Interventions for Chronic Low Back Pain A Systematic Review and Meta-analysis
2024, Clinical Journal of Pain
- ☆
German Clinical Trials Register: DRKS00000373.