Mind-Body Intervention for Low Back Pain

iStock_000059837422_MediumLow back pain is both chronic and debilitating in many people, and methods to alleviate it have often proven disappointing.  Now comes a study in JAMA Rick and I discuss on PodMed this week suggesting that both CBT, cognitive behavioral therapy, and MBSR, the authors'  acronym for 'mindfulness-based stress reduction,' are equally effective at helping those with the condition manage it.  And btw, that's significantly effective, reducing pain 'bothersomeness' by almost 50% in those who underwent either CBT or MBSR, compared with almost a 27% reduction in those who received usual care.

This study was impressively long term as well: 342 participants were randomized to one of the three treatments.  They ranged in age from 20 to 70 years, and some of them had been struggling with low back pain for fifty years!  After a treatment period of 8 weekly group sessions lasting two hours or usual care, the subjects were followed for a year. Almost 85% of the entire group completed the study, and the benefits of CBT and MBSR persisted at the 6 month interval.  At one year the MBSR effects were about the same as the six month interval.  Rick suggests that perhaps the ability of those who were in this arm of the study to practice both yoga and meditation at home, with the help of a study-provided CD, may account for this outcome. In any case it seems clear that such interventions are worth attempting, especially in light of recent CDC guidelines on prescription of opioid medications for pain.

Other topics this week include two techniques for ventilator weaning following abdominal surgery, also in JAMA, the best time to introduce parenteral nutrition in critically ill children in NEJM, and use of complementary and alternative medicines and how often allopathic physicians hear about that in JAMA Internal Medicine.  Until next week, y'all live well.

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