Chronic Back Pain? These 2 Therapies Helped People Feel Better and Cut Back on Painkillers

It can be difficult to find relief for chronic back pain—but new research found two methods may be able to help.

The research, published on April 7 in JAMA Network Open, found that mindfulness-based therapy and cognitive behavioral therapy improved quality of life for people who had been taking opioids to manage their chronic low back pain. The participants experienced less pain and reduced their drug dosages in the months after starting these therapies.

“Everyone in the study had been living with moderate or severe back pain for a long time—most for over five years—and had tried many treatments,” study author Aleksandra Zgierska, MD, PhD, professor of anesthesiology, family and community medicine, and public health sciences at Penn State University, told Health. “Many doubted anything could help, which made the improvements we saw even more meaningful.”

Chronic low back pain is incredibly common—data suggests as many as 28% of Americans experience it. But treatment options are often lacking. A study published in March found that just 10% of non-surgical treatments for lower back pain are actually effective.

So researchers wanted to investigate whether cognitive behavioral therapy (CBT) and mindfulness-based therapy (MBT) could be helpful.

In cognitive behavioral therapy, patients:

• Identify thoughts and behaviors that are negatively affecting their life
• Use problem-solving skills, reflection, and self-monitoring to reframe negative thought patterns

With mindfulness-based therapy, on the other hand, people:

• Learn to adopt awareness of bodily experiences, feelings, or thoughts without reacting
• Meditate to focus on the present moment

The methods are different, but the idea is that both MBT and CBT can help people learn to cope with their pain by accepting it as a part of life.

Zgierska and her colleagues evaluated 770 adults taking opioids to manage their chronic low back pain. The participants were about 58 years old on average and had moderate-to-severe pain, functional limitations, and impaired quality of life.

Half of the participants received CBT, and half received MBT. For eight weeks, participants attended weekly two-hour group sessions. Then, they were told to practice what they learned on their own for 30 minutes each day, six days per week, throughout the 12-month study.

Only about 70% of the participants continued with the study by the six-month mark. But results showed that those participants, regardless of whether they did CBT or MBT, had:

• Less reported pain
• Reductions in daily opioid use
• Better function
• Improved quality of life

These benefits continued through the year, though just over 65% of participants were reporting on their progress at that time.

“The kind of chronic back pain [these participants] had usually doesn’t improve on its own—and often gets worse over time,” Zgierska said. “That’s why it was so striking to see lasting improvements after just eight weeks of therapy.”

And because there was no “clear winner” between the two therapies, “people can confidently choose either option,” she added. “Some may prefer the structure of CBT, while others may relate more to the mindfulness approach. Both in-person and online formats were effective.”

This new JAMA Network Open study did have some limitations—importantly, there was no control group to compare these therapies to, and there was a lack of racial and ethnic diversity among the participants.

This means that “we can’t say for certain that the MBT AND CBT therapies caused the improvements,” said Zgierska.

However, these findings are in line with other research out there, which has similarly found that adults using opioids for chronic pain can benefit from behavioral therapies.

In general, though, this is an area of study that needs more research. Just 17 studies have assessed MBT for chronic low back pain, and only three have directly compared it to CBT, Zgierska and her colleagues wrote in their report.

Previous studies have demonstrated that MBT and CBT are effective for pain relief in general, though they usually don’t include participants who take opioids to manage chronic back pain, Zgierska added. The fact that this new research showed CBT and MBT can help in these more severe cases further backs up the findings, she explained.

Any reductions in opioid use—even small ones—are a positive sign, added Amanda Williams, PhD, professor of clinical health psychology at University College London. In the long run, daily use of opioids can actually make chronic pain worse, so other pain management methods are preferable.

“It certainly makes much more sense to reduce opioids while offering other methods to manage pain, rather than just—as happens a lot—cutting the opioid prescription with little or no support and no other help with pain,” she told Health.

When it comes to dealing with chronic pain, MBT and CBT aren’t used as readily as other medical treatments, partly due to limited access and insurance issues, the team noted.

But either therapy can be added to your chronic lower back pain toolbox, Zgierska said, and both are good strategies to deal with chronic pain, with or without opioids.

Just check with your doctor and insurer to see what might be covered. Consider in-person or online therapy options, as well as CBT or MBT books or apps, she said.

“[CBT and MBT] aren’t a total cure, but they teach people how to develop the inner resources they need to cope with chronic pain and to live a better life,” study author Eric Garland, PhD, LCSW, professor of psychiatry and professor with the Sanford Institute for Empathy and Compassion at the University of California, San Diego, said in a statement.

Remember, though, that CBT and MBT shouldn’t be used as a “one-time fix,” Zgierska added. “Like any skill, regular practice matters” if you want results, she explained.

“Over time, the skills can become second nature—automatic—and can lead to overall downregulation of pain,” Beth Darnall, PhD, professor of anesthesiology, perioperative and pain medicine at the Stanford University School of Medicine, told Health.