Mindfulness-based stress reduction for low back pain. A systematic review

Holger Cramer,Heidemarie Haller,Gustav Dobos,Romy Lauche

doi:10.1186/1472-6882-12-162

Holger Cramer, Heidemarie Haller + Show 2 more

Open Access

https://doi.org/10.1186/1472-6882-12-162

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Abstract

BackgroundMindfulness-based stress reduction (MBSR) is frequently used for pain conditions. While systematic reviews on MBSR for chronic pain have been conducted, there are no reviews for specific pain conditions. Therefore a systematic review of the effectiveness of MBSR in low back pain was performed.MethodsMEDLINE, the Cochrane Library, EMBASE, CAMBASE, and PsycInfo were screened through November 2011. The search strategy combined keywords for MBSR with keywords for low back pain. Randomized controlled trials (RCTs) comparing MBSR to control conditions in patients with low back pain were included. Two authors independently assessed risk of bias using the Cochrane risk of bias tool. Clinical importance of group differences was assessed for the main outcome measures pain intensity and back-specific disability.ResultsThree RCTs with a total of 117 chronic low back pain patients were included. One RCT on failed back surgery syndrome reported significant and clinically important short-term improvements in pain intensity and disability for MBSR compared to no treatment. Two RCTs on older adults (age ≥ 65 years) with chronic specific or non-specific low back pain reported no short-term or long-term improvements in pain or disability for MBSR compared to no treatment or health education. Two RCTs reported larger short-term improvements of pain acceptance for MBSR compared to no treatment.ConclusionThis review found inconclusive evidence of effectiveness of MBSR in improving pain intensity or disability in chronic low back pain patients. However, there is limited evidence that MBSR can improve pain acceptance. Further RCTs with larger sample sizes, adequate control interventions, and longer follow-ups are needed before firm conclusions can be drawn.

Highlights

Mindfulness-based stress reduction (MBSR) is frequently used for pain conditions
The aim of this review was to systematically assess and - if possible - meta-analyze the effectiveness of MBSR and Mindfulness-based cognitive therapy (MBCT) in patients with low back pain
In one of the two Randomized controlled trials (RCTs), minimal pain intensity was not defined [25] while in the other RCT pain had to be of at least moderate intensity on the “pain thermometer” [26]

Summary

Introduction

Mindfulness-based stress reduction (MBSR) is frequently used for pain conditions. Low back pain is a major public health problem, with 76 % of the population experiencing low back pain in a given year [1]. It has become the largest category of medical claims, placing a major burden on individuals and health care systems [2]. Low back pain is the most common condition for which complementary therapies are used [3]. In the US, more than half of patients suffering from low back pain use complementary therapies [4]. Mindfulness is the common ground of several complementary therapies. Derived from Buddhist spiritual tradition, mindfulness has been secularized and integrated

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