Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

Abstract

Objective: Although mindfulness meditation (MM) is increasingly used for chronic pain treatment, limited evidence supports its clinical application for opioid-treated chronic low back pain (CLBP). The goal of this study was to determine feasibility, acceptability, and safety of an MM-based intervention in patients with CLBP requiring daily opioid therapy. Design: 26-week pilot randomized controlled trial comparing MM-based intervention, combined with usual care, to usual care alone. Setting: Outpatient. Patients: Adults with CLBP treated with ‡30 mg of morphine-equivalent dose (MED) per day for 3 months or longer. Interventions: Targeted MM-based intervention consisted of eight weekly 2-hour group sessions and home practice (30 minutes/d, 6 days/wk) during the study. ''Usual care'' for opioid-treated CLBP was provided to participants by their regular clinicians. Outcome measures: Feasibility and acceptability of the MM intervention were assessed by adherence to intervention protocol and treatment satisfaction among experimental participants. Safety was evaluated by inquiry about side effects/adverse events and opioid dose among all study participants. Results: Thirty-five participants enrolled during the 10-week recruitment period. The mean age (-standard deviation) was 51.8 -9.7 years; the patients were predominantly female, with substantial CLBP-related pain and disability, and treated with 148.3 -129.2 mg of MED per day. All participants completed baseline assessments; none missed both follow-up assessments or withdrew. Among experimental participants (n = 21), 19 attended 1 or more intervention sessions and 14 attended 4 or more. They reported, on average, 164.0 -122.1 minutes of formal practice per week during the 26-week study and 103.5 -111.5 minutes of brief, informal practice per week. Seventeen patients evaluated the intervention, indicating satisfaction; their qualitative responses described the course as useful for pain management (n = 10) and for improving pain coping skills (n = 8). No serious adverse events or safety concerns occurred among the study participants. Conclusions: MM-based intervention is feasible, acceptable, and safe in opioid-treated CLBP.

Cost of opioid-treated chronic low back pain: Findings from a pilot randomized controlled trial of mindfulness meditation-based intervention

“…In addition, the MM group received the MM intervention (eight weekly 2-hour group sessions, led by two trained and experienced therapists, and at-home MM practice at least 6 days/week during the whole study), described elsewhere. 15,16 The MM intervention was patterned after established curricula 23–25 and tailored to meet the psychophysical needs of patients with opioid-treated CLBP.…”

“…11–16 Our 26-week pilot randomized-controlled trial (RCT, N=35) showed that MM was associated with reduced pain severity (p<0.05) and decreased sensitivity to heat-pain stimuli (p<0.05) among adults with disabling CLBP treated, on average, with a high-dose opioid therapy. 15 In addition, the MM intervention was found to be safe, feasible, and highly acceptable.…”

“…Therefore, we performed a secondary cost-analysis of data from our pilot RCT, which focused on the acceptability, feasibility and efficacy assessment of the MM intervention. 15,16 We hypothesized that MM, in addition to safely improving health outcomes, can also reduce costs in opioid-treated CLBP.…”

Psychological methods in the treatment of chronic nonspecific low back pain

“…Результаты клинических исследований демонстрируют, что добавление майндфулнесс к стандартной терапии хронической неспецифической БНЧС повышает эффективность лечения [44,45]. Применение майндфулнесс эффективно для уменьшения интенсивности боли у пациентов, принимающих слабые опиодные препараты [46,47], а также у пациентов старшей возрастной группы [48,49].…”

Sahaj Samadhi Meditation versus a Health Enhancement Program for depression in chronic pain: protocol for a randomized controlled trial and implementation evaluation

“…Several systematic reviews examining meditation interventions specifically in the chronic pain population have reported small but consistent improvements in pain, function and depression [18][19][20][21]. Meditation is commonly sought out by diverse people living with depression and chronic pain and the intervention is well received in these populations [22][23][24]. Sahaj Samadhi Meditation (SSM), a type of automatic self-transcending meditation, is easy to learn and master [25] and its processes can lead to stress reduction and deep relaxation [26].…”