Mind-Body Treatments Touted as Superior to Usual Care for Chronic Low Back Pain
Engaging the minds as well as the bodies of injured workers with chronic pain is finally gaining more traction among mainstream medical providers. A new report looks at alternatives to opioids and ‘usual care’ treatments to understand their effectiveness.
Despite vast amounts of research showing the mind-body connection involved in chronic pain, the authors said such treatments are less commonly prescribed than other, noninvasive therapies. They speculated that could be due to a lack of knowledge about the value and effectiveness of the therapies, barriers to access or insurance policies preventing coverage.
The researchers analyzed studies involving ‘cognitive and mind-body treatments’ for chronic low back pain. Their report could pave the way for increased use of these methods for injured workers.
“Given what we now know about the safety, effectiveness, and value of cognitive and mind-body therapies for CLBP and the emerging neuroscience research elucidating connections between spinal impairments and changes in the brain, the time seems ripe for developing, implementing, and evaluating innovative strategies to improve care for chronic spine pain,” the report concluded.
The study, Cognitive and Mind-Body Therapies for Chronic Low Back and Neck Pain: Effectiveness and Value, was published by the Institute for Clinical and Economic Review (ICER) and summarized in the Journal of the American Medical Association Internal Medicine. ICER is described on its website as an independent research organization that objectively evaluates the clinical and economic value of medications, medical tests and other healthcare innovations, then seeks input to help stakeholders interpret and apply the findings to improve patient outcomes and control costs.
The researchers examined data from 28 randomized clinical trials for chronic low back pain. The cognitive and mind-body treatments analyzed included cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), acupuncture, yoga and tai chi.
“The ICER report breaks important new ground by focusing on therapies that engage patients’ minds as well as their bodies and by providing evidence that some of these therapies are not only effective for CLBP but also cost-effective and likely affordable options for insurers to add coverage,” they wrote. “ICER’s findings provide a strong clinical and economic rationale for increasing use of cognitive and mind body treatments for CLBP.
Because chronic pain can be exacerbated by cognitive factors, the researchers said they “thought it timely” to analyze the effectiveness of cognitive and mind-body therapies. With the exception of tai chi, all the interventions demonstrated both improvements in function and decreases in pain when combined with usual care, vs. usual care by itself.
For example, one of the studies looked at CBT and MSBR. It showed that after 6 months, there were clinically meaningful improvements from baseline:
- 60 percent of the patients in the MBSR group
- 58 percent of the CBT patients
That compared with 44 percent who improved with usual care.
The study also looked at cost effectiveness, based on the following treatment regimens:
- CBT and MBSR — 8 weekly 2-hour meetings
- Yoga — 12 weekly 75-minute sessions
- Tai chi — 18 sessions lasting 40-minutes each over 10 weeks
- Acupuncture — 10 sessions of 20-minutes each over 10 weeks
All were group sessions except acupuncture.
“Each of the non-pharmacologic interventions resulted in increased costs compared to usual care, but most remained below or within the commonly accepted threshold for cost-effectiveness of $100,000-$150,000 per quality adjusted life year (QALY) gained,” the authors explained. “Value-based price benchmarks, or the prices at which the costs of the intervention would align with the benefits to patients, suggest that while some therapies would require modest discounts of up to 10 percent to meet the lower threshold, many of the therapies would remain cost-effective even if prices were higher.”
Additionally, ICER noted potential unmeasured benefits, such as reduced opioid use, savings on caregivers, and increased work productivity.
In addition to helping to improve function and reduce pain, the studies showed CBT also was effective in reducing depression and improving quality of life. Often we see injured workers with chronic pain and delayed recoveries who also have feelings of anger, depression and guilt, which negatively impact all aspects of their lives.
As the report explained, family members are also affected, as they “must modify their activities and expend considerable emotional energy to care for a family member in pain. One patient advocate told us the only difference between a family member and the person in pain is that the family member does not feel the pain, but they experience the anger, frustration, and guilt. Pain controls their life as well.”
The ICER report confirms what those of us who work with injured workers in chronic pain see every day—that CBT and other mind-body treatments are highly effective in helping them cope with their pain. This report is encouraging, and we hope it expands acceptance of these treatments.