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 These programs combine meditation while sitting and walking, yoga,
focusing attention on different parts of the body, and incorporation
of mindfulness/awareness into everyday life. Earlier studies found
MBSR to be helpful for a variety of chronic pain conditions.
But for low back pain, "it was surprising that we could not identify
any difference between MBSR, usual care, or other psychological
interventions on ‘mindfulness’ and acceptance of pain in the short
and long term,” Dennis Anheyer of University of Duisburg-Essen,
Germany, told Reuters Health by email.
Anheyer and colleagues looked at data from seven previously
published studies involving 864 patients altogether.
The studies that looked at pain intensity and pain-related
disability found small improvements with MBSR only over the short
term, and even these improvements were of questionable significance,
they report in Annals of Internal Medicine.
Some studies showed meaningful improvements in physical functioning
in the short term but the improvements not sustained in the long
term.
“Our review also showed that studies using MBSR programs that
included yoga had better effects on disability and physical
functioning than studies using MBSR programs without yoga,” Anheyer
said. “Physical activity might therefore be important for these
factors.”
Surprisingly, MBSR was not associated with improvements in
mindfulness.
The inconsistent findings point to a need for larger, carefully
designed studies of MBSR and its various components in patients with
low back pain, the researchers say.
In the meantime, patients with low back pain can safely attend MBSR
courses, Anheyer said. “However,” he added, “they should not neglect
the physical activity. (And) if you practice meditation or any kind
of physical activity, do it regularly and continuously.”
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Dr. Judith A. Turner from the University of Washington in Seattle,
who has studied MBSR and cognitive behavioral therapy for chronic
low back pain, told Reuters Health by email, "People with low back
pain may find MBSR to be helpful, not only for their pain but also
for managing stress and other problems. The risks are minimal,
especially when compared to some other treatments for low back pain,
such as surgery and opioid medication. Benefits for pain may be
modest, but this is true for most treatments for chronic low back
pain.”
“It is interesting that interventions that included a yoga component
reduced disability, whereas those that did not include yoga did not
reduce disability,” she said. “This suggests that MBSR programs
might be most helpful for back pain when they include yoga, although
more research is needed to confirm this suggestion.”
“This review was of only a small number of studies and some of the
studies included had methodological problems that limit confidence
in the results,” Turner said. “Nonetheless, patients with chronic
low back pain and their health care providers are looking for
effective treatments that are alternatives to opioid medication, and
MBSR is one such option. Another such option is cognitive-behavioral
therapy, which has been demonstrated effective in the short- and
long-term for chronic low back pain.”
SOURCE: http://bit.ly/2fazTFW Annals of Internal Medicine, online
April 25, 2017.
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