Cognitive Behavioral, Mindfulness Therapies Reduce Daily Dosage of Opioid Use for Chronic Back Pain
There were no statistically significant differences between cognitive behavioral therapy and mindfulness-based therapy in reducing the dosage for chronic lower back pain.
Chronic pain is considered one of the costliest health issues in the United States, according to Johns Hopkins Medicine, and low back pain is one of the most significant health issues, limiting activity for patients. For more severe pain, health care providers could prescribe opioids, but these have high abuse potential.1 In a new study published in JAMA Network Open, investigators found that cognitive behavioral therapy (CBT) and mindfulness-based therapy (MBT) decreased the opioid dosage for chronic low back pain at 6 and 12 months.2 Pain can be challenging to treat as it is very personalized to the patient.
There were no statistically significant differences between cognitive behavioral therapy and mindfulness-based therapy in reducing the dosage for chronic lower back pain. | Image Credit: SasinParaksa - stock.adobe.com
"The treatment of painful conditions can be very challenging,” Jeffrey Gudin, MD, faculty in the department of anesthesiology and pain management at the University of Miami, said in an interview.3 “We have different types of pain, acute pain and chronic pain, and different causes for pain, musculoskeletal injuries and nerve injuries of the sort, and it's very difficult for patients because we're very limited for the number of [OTC] therapies that we have.”
CBT is the standard psychological treatment for chronic pain, according to the study author, but it has not been well-studied in patients receiving opioid treatment. MBT has been used as complementary and integrative therapies for chronic pain and related comorbidities. Investigators conducted a study to compare the long-term impact of both therapies for opioid-treated chronic low back pain.1
The study included a partially masked 2-arm multisite randomized control trial comparing the effectiveness of both therapies with the usual care. The first patient was enrolled on July 1, 2017, and the last on August 4, 2021. Patients received random treatment 1:1, according to the study investigators. MBT included applying mindfulness before deciding whether to take an as-needed opioid medication, and CBT included cognitive-behavioral strategies, including cognitive restructuring of maladaptive pain-related beliefs, coping skills, relaxation training, and behavioral activation.1
The coprimary outcomes included the past week’s average pain severity and back pain-related limitations. Secondary end points included mental and physical health-related quality of life and daily opioid dose.1
Investigators included 770 patients, with 385 in the MBT group and 385 in the CBT group. Approximately 70.4% were included in the primary outcomes data at 6 months and 65.2% at 12 months. Patients reported moderate average pain scores and functional limitations, without significant differences between the groups. Approximately one-third of patients were treated with a dosage of at least 90 milligrams of morphine equivalents (MME) per day.1
Both therapies improved the primary and secondary outcomes at 6 and 12 months compared with the baseline scores. The change in Brief Pain Inventory score for MBT was –0.35 at 6 months and –0.45 at 12 months compared with baseline, and in the CBT group, the changes were –0.57 and –0.59, respectively. For functional limitations, the change in ODI score was –2.15 and –3.19, respectively, for the MBT group and –2.24 and –3.49, respectively, for the CBT group.1
In the LMEM analysis, investigators did not find significant differences between the groups for change in primary and secondary outcomes.1
“I think we will never be able to get rid of pain long term. If we're 65, 75, 85, our body is continuing [to] deteriorate. There's a degenerative process occurring,” Chris Robinson, MD, PhD, clinical fellow in anesthesia at Brigham and Women’s Hospital, said in an interview.4 “I think in order for us to really, truly get the maximal impact with our current treatments is to incorporate both mental health and pain treatment.”
READ MORE: Nonopioid Pain Management Resource Center
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