A groundbreaking clinical trial has demonstrated that mindfulness meditation and cognitive-behavioral therapy (CBT) can significantly reduce chronic low back pain and decrease reliance on opioid medications, offering new hope for millions suffering from this debilitating condition.
The study, published in JAMA Network Open, represents the largest trial to date comparing mindfulness and CBT as potential therapies for severe chronic pain currently managed with opioids. Researchers recruited 770 adults being treated for low back pain across three medical centers in Madison, Wisconsin; Boston; and Salt Lake City.
"The people in this study had quite severe back pain that interfered with their life and was bad enough to need opioid medication. Usually, in that condition, people don't really get better over time on their own," explained co-lead researcher Dr. Bruce Barrett, professor of family medicine and community health at the University of Wisconsin-Madison.
Therapeutic Approaches and Study Design
Participants were randomly assigned to receive either mindfulness therapy or CBT, delivered through therapist-led two-hour group sessions over eight weeks. The mindfulness group learned techniques to notice bodily sensations, giving them greater control over how they relate and respond to pain. Meanwhile, the CBT group focused on developing skills and strategies to change negative thought patterns and behaviors contributing to back pain.
"Mindfulness is a self-regulated tool that comes from within, unlike surgery or medication where something is being done to you from the outside," noted senior researcher Eric Garland, professor of health sciences and psychology at the University of California-San Diego. "By learning these techniques, patients continue to experience lasting benefit."
Participants were instructed to practice these techniques for 30 minutes daily, six days a week throughout the 12-month study period. Importantly, they were not explicitly told to reduce their opioid dosage but to continue their regular medication routine alongside either mindfulness or CBT.
Significant Clinical Outcomes
By the end of the study, both groups reported substantial and long-lasting benefits. Participants experienced less pain, improved physical function, and better health-related quality of life. Perhaps most notably, many patients spontaneously reduced their reliance on opioid painkillers.
"Both mindfulness and cognitive behavioral therapy were shown to be safe, effective treatments, providing lasting benefits for people with opioid-treated chronic back pain," said lead researcher Dr. Aleksandra Zgierska, vice chair for research of family and community medicine at the Penn State College of Medicine.
These improvements resulted from people implementing the skills they learned. For example, participants were taught to take a mindful breath before taking medication, rather than automatically reaching for a pill in response to pain. This mindful approach helped many decrease their opioid use independently after learning better coping mechanisms.
Neurobiological Mechanisms
Recent neuroimaging research provides insight into why mindfulness meditation may be particularly effective for pain management. A separate study involving brain scans revealed that mindfulness meditation engages distinct brain mechanisms to reduce pain that are separate from placebo effects.
This research demonstrated that mindfulness meditation reduced synchronization between brain areas involved in introspection, self-awareness, and emotional regulation—components of what researchers call the Neural Pain Signal. By contrast, placebo treatments engaged entirely different brain mechanisms.
"The mind is extremely powerful, and we're still working to understand how it can be harnessed for pain management by studying the brain," explained Fadel Zeidan, a professor of anesthesiology with the University of California, San Diego. "By separating pain from the self and relinquishing evaluative judgment, mindfulness meditation is able to directly modify how we experience pain in a way that uses no drugs, costs nothing, and can be practiced anywhere."
Broader Implications for Pain Management
These findings have significant implications for chronic pain management beyond low back pain. Experts believe both mindfulness and CBT could help people manage various types of chronic pain conditions.
"Mindfulness and CBT are other tools that you can add to your toolbox to increase your capacity to cope and live a meaningful life," noted Christin Veasley, founder of the Chronic Pain Research Alliance. "What's important about the types of therapies, like the ones evaluated in this study, is that they can be used broadly across all pain conditions and all pain severities."
Penney Cowan, founder of the American Chronic Pain Association, emphasized the hope these findings offer: "The study's interventions likely helped reduce the participants' sense of suffering, which probably allowed them to function a whole lot better. People can live with pain, but they need to know how to do it. This study provides a sense of hope. It says you can do this and help yourself to a better quality of life."
Future Directions
While these results are promising, researchers acknowledge that these therapies aren't a complete cure. "These therapies 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," Garland explained.
The success of this large-scale trial opens the door for further research into how these mind-body approaches can be integrated into standard pain management protocols, potentially reducing the need for pharmacological interventions with significant side effects and addiction risks.
As healthcare systems continue to grapple with the dual crises of chronic pain and opioid dependence, these evidence-based non-pharmacological approaches offer valuable tools that empower patients to take an active role in managing their pain and improving their quality of life.
