Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for the treatment of chronic pain: randomized controlled trial

Abstract

Trials of cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) suggest that all 3 treatments produce reductions in pain and improvements in physical function, mood, and sleep disturbance in people with chronic pain conditions. Fewer studies have compared the relative efficacies of these treatments. In this randomized controlled study, we compared CT, MBSR, BT, and treatment as usual (TAU) in a sample of people with chronic low back pain (N 5 521). Eight individual sessions were administered with weekly assessments of outcomes. Consistent with the prior work, we found that CT, MBSR, and BT produced similar pretreatment to posttreatment effects on all outcomes and revealed similar levels of maintenance of treatment gains at 6-month followup. All 3 active treatments produced greater improvements than TAU. Weekly assessments allowed us to assess rates of change; ie, how quickly a given treatment produced significant differences, compared with TAU, on a given outcome. The 3 treatments differed significantly from TAU on average by session 6, and this rate of treatment effect was consistent across all treatments. Results suggest the possibility that the specific techniques included in CT, MBSR, and BT may be less important for producing benefits than people participating in any techniques rooted in these evidence-based psychosocial treatments for chronic pain.

Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for people with chronic low back pain: A comparative mechanisms study.

“…For full details regarding participants, including the Consolidated Standards of Reporting of Trials flowchart, see the report by Burns et al (2022) regarding different outcomes across treatments. In brief, participants were recruited through referrals from staff at the Rush University Pain Center, Midwest Orthopedic Clinic and Neurosurgery Clinic at Rush University, and at Clinics at the Duke University Medical Center (e.g., Duke Pain Clinic, Spine Clinic, Neurosurgery Clinic, and Orthopedic Clinic).…”

“…We evaluated effects of treatments on three outcome domains: pain interference (primary outcome), pain intensity, and depressive symptoms (secondary outcomes). See Burns et al (2022) for details. The Pain Interference Subscale of the Multidimensional Pain inventory (Kerns et al, 1985) assessed interference with general functioning due to pain.…”

“…The present project compared CT, MBSR, and BT to treatment as usual (TAU) among a sample of people with chronic low back pain to examine the relative validity of specific versus shared mechanism models. Our prior study involving these data (Burns et al, 2022) compared the four conditions with respect to their effects on five outcome domains—pain interference, intensity, depressive symptoms, physical activity, and sleep quality. All measures were assessed weekly during the eight session treatments.…”

Zur Praxis der Achtsamkeit in Prophylaxe und Therapie chronischer Schmerzen

“…Fallbeispiel profitierte zwar von ihrem Kurs und auch von der regelmäßigen Übungspraxis, ist jedoch durch ihre schweren, teils degenerativ bedingten Beschwerden und private Belastungen so deutlich eingeschränkt, dass Effekte eher begrenzt bleiben. Diese „Begrenztheit“ der Methoden ist oft das Ergebnis von Studien 5 , 8 , 16 und wurde im Rahmen der Aktualisierung der Fibromyalgie-S3-Leitlinie im Jahr 2017 kritisch beleuchtet 17 , 18 . Die 2.…”

The effect of mindfulness on the inflammatory, psychological and biomechanical domains of adult patients with low back pain: A randomized controlled clinical trial

“…Participation in such programs has shown to be effective to improve anxiety, depression and pain [24][25][26]. Burns et al have shown in patients with chronic pain that MBSR has produced significant differences to the "usual care alone" on average by session 6 [27]. The positive effect of the MBSR program on depression symptoms could be mediated by the reduction in rumination [25].…”