The current opioid crisis has spurred the need for nonpharmacological therapies for chronic low back pain. In a study published in JAMA Internal Medicine, we reported that in 282 older adults with chronic low back pain, an 8-week mind-body group program modeled on Mindfulness-Based Stress Reduction (MBSR) decreased long-term pain and increased short-term function. Barriers to uptake remain such as patient resistance to accepting the benefits of nonpharmacological treatments for chronic low back pain. They may fear the clinician does not believe their pain complaint because they are not being offered a pain pill. By not appreciating the value of the therapy in helping their chronic low back pain, the patient may not be compliant with recommendations. Resistance likely derives from lack of understanding how a mind-body approach like MBSR can help relieve the sensation of pain as well as help increase function. Clinicians can help break through this barrier by educating their patients about the different way...
Objective: Mindfulness is a nonpharmacologic mind-body therapy that has been shown to be effective in older adults with chronic low back pain (cLBP). There are few first-person accounts in the literature that describe the older adult experience and perspective while learning mindfulness and meditation to treat pain. The objective of this study was to investigate dominant themes present in the experiences of older adults applying mindfulness and meditation to cope with cLBP. Design: Qualitative a...
Last. Mary Ann Forciea(UPenn: University of Pennsylvania)H-Index: 16
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Abstract The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain. Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinic...
Importance Treatment of chronic low back pain (LBP) in older adults is limited by the adverse effects of analgesics. Effective nonpharmacologic treatment options are needed. Objective To determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic LBP. Design, setting, and participants This single-blind, randomized clinical trial compared a mind-body program (n = 140) with a health education program (n = 142). Community-dwelling older a...
#2David R. Vago(Brigham and Women's Hospital)H-Index: 21
Pain is a multidimensional experience that involves interacting sensory, cognitive, and affective factors, rendering the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast-acting nonpharmacological approaches ...
Importance Treatment of chronic low back pain (LBP) in older adults is limited by the adverse effects of analgesics. Effective nonpharmacologic treatment options are needed. Objective To determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic LBP. Design, Setting, and Participants This single-blind, randomized clinical trial compared a mind-body program (n = 140) with a health education program (n = 142). Community-dwelling older a...
Last. Bart W. Koes(EUR: Erasmus University Rotterdam)H-Index: 143
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Background Chronic back pain is an important health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat people with low back pain, especially people with acute back pain. Short term NSAID use is also recommended for pain relief in people with chronic back pain. Two types of NSAIDs are available and used to treat back pain: non-selective NSAIDs and selective COX-2 NSAIDs. In 2008, a Cochrane review identified a small but significant effect from NSAIDs compared to plac...
Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other ...
Last. Dennis C. Turk(UW: University of Washington)H-Index: 137
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Abstract Systematic review and meta-analysis. To assess the efficacy of opioids in adults with chronic low back pain (CLBP). Opioids for CLBP has increased dramatically. However, the benefits and risks remain unclear. We updated a 2007 Cochrane Review through October 2012 of randomized controlled trials from multiple databases. Use of noninjectable opioids in CLBP for at least 4 weeks was compared with placebo or other treatments; comparisons with different opioids were excluded. Outcomes includ...
STUDY DESIGN. Literature review, expert panel, and a workshop during the "VIII International Forum on Primary Care Research on Low Back Pain" (Amsterdam, June 2006). OBJECTIVE. To develop practical guidance regarding the minimal important change (MIC) on frequently used measures of pain and functional status for low back pain. SUMMARY OF BACKGROUND DATA. Empirical studies have tried to determine meaningful changes for back pain, using different methodologies. This has led to confusion about what...
BACKGROUND Chronic pain and heavy drinking are conditions that commonly co-occur among primary care patients. Despite the availability of behavioral interventions that target these conditions individually, engagement and adherence to treatment remain a challenge, and there have been no interventions designed to address both of these conditions together for patients presenting to primary care. This study seeks to incorporate the perspectives of patients regarding symptoms, treatment experiences, ...
Mindfulness is a focused approach toward accepting one’s thoughts without judgment or perseveration, with ancient Indo-Sino-Tibetan philosophical origins. Many variations exist; however, they typically include focused attention where one concentrates on a specific sensation such as breathing and open monitoring where one concentrates on consciousness itself. Mindfulness-based interventions (MBIs) are specific, organized, targeted methods to teach mindfulness with specific goals. MBIs have shown ...
In this month’s publication of ‘Mindfulness in Migraine: A Narrative Review’ we described the evidence to date of mindfulness-based interventions (MBIs) for the treatment of migraine [1]. Of the ei...
AbstractIntroduction: Migraine is the second leading cause of disability worldwide, yet many patients are unable to tolerate, benefit from, or afford pharmacological treatment options. Non-pharmaco...