“Low back pain is increasingly seen as a chronic condition that requires multimodal approach. Combining exercise, massage, topical modalities like heat or an electrical stimulator, anti-inflammatories, acetaminophen helps most people. There is a condition of hypersensitivity to pain that is now being documented by testing. This makes the pain worse. Exercises make the pain better if properly done and daily. This is another tool to add, mindfulness training, which helped lower low back pain levels. The first two paragraphs are from Medscape. The second article below is from the Journal of American Medical Association Internal Medicine for the details and more comment” Bill Chesnut, MD
Mindfulness training focused on stress reduction may benefit people with chronic low back pain
Reuters (2/23, Doyle) reports that in a 282-patient study, an eight-week program of mindfulness training focused on reducing stress may benefit people with chronic low back pain. The findings were published online Feb. 22 in JAMA Internal Medicine.
According to Medscape (2/23, Garcia), an accompanying editorial observed, “Attention to underlying mechanisms of behavioral change (i.e., how or why the treatment leads to change) will be key, as will efforts directed at identifying what treatment components and/or specific combinations might be particularly influential in treatment outcomes.”
The Editorial referenced above by Medscape: Why We Need Nonpharmacologic Approaches to Manage Chronic Low Back Pain in Older Adults
M. Carrington Reid, MD, PhD1; Anthony D. Ong, PhD2; Charles R. Henderson Jr, MS2 JAMA Intern Med. Published online February 22, 2016. doi:10.1001/jamainternmed.2015.8348
Chronic pain is one of the most common conditions encountered by health care professionals, particularly among patients 65 years and older, and is associated with substantial disability and costs.1,2 Management of chronic pain in older adults is complicated by age-related physiologic changes, competing comorbidities that limit treatment choices, and numerous patient (eg, fear of deleterious effects of medications) and physician (eg, lack of training) barriers. One of the most significant barriers to effective management, however, is a limited evidence base to guide treatment decisions. Recent reviews have documented the paucity of high-quality randomized clinical trials in the field.1,2 Shortcomings include study durations of 12 weeks or less, a lack of study population diversity, and enrollment of young-old study populations without major comorbidities. Studies focused on nonpharmacologic interventions are particularly needed, given that many barriers exist regarding the use of pharmacologic treatments in this target population. Studies further document that older adults with chronic pain are receptive to nonpharmacologic therapies3,4; many already use nondrug treatments and cite concerns about adverse drug effects and the use of too many medications as reasons.4 In this issue of JAMA Internal Medicine, Morone and colleagues5 begin to address this important knowledge gap by presenting data from a well-conducted randomized clinical trial that evaluated the effects of a mindfulness meditation intervention among older adults with chronic low back pain.