Mindfulness in Managing Chronic Pain Save

JAMA reports that outpatient resource mindfulness-based interventions (MBIs) delivered via telehealth are effective in managing chronic pain amongst veterans.

The challenge of mindfulness interventions is often the access, availability and dedicated space for trained instructors.

MBI delivered by telehealth was compared to usual care in veterans with chronic pain, in a randomized clinical trial. Patients with moderate to severe chronic pain were recruited from 3 Veterans Affairs facilities. The were randomized to receive either two 8-week telehealth MBIs (group and self-paced) or usual care (control). MBI was done via videoconference with prerecorded mindfulness education and skill training videos by an experienced instructor, accompanied by facilitated discussions. The self-paced MBI was similar but completed asynchronously and supplemented by 3 individual facilitator calls. The primary outcome was pain-related function scoring at 10 weeks, 6 months, and 1 year.

A total of 811 veterans (mean age 55 yrs; 48% women) were randomized and 86% completed the trial. 

At all 3 time points, pain reduction was better with MBI:

• Group MBI vs control difference: −0.4 [95% CI, −0.7 to −0.2]; 
• Self-paced MBI vs control difference: −0.7 [95% CI, −1.0 to −0.4])

MBI was also superior at secondary outcomes: pain intensity, patient global change, physical function, fatigue, sleep disturbance, depression, and posttraumatic stress disorder. Having at least 30% improvement from baseline was better for group MBI at 10 weeks and 6 months, and for self-paced MBI, at all 3 time points.

Using low-resource telehealth-based MBIs showed nonpharmacological pain improvement, regardless if done in groups or as self-paced MBIs.