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Original Investigation |

A Mind-Body Program for Older Adults With Chronic Low Back Pain A Randomized Clinical Trial

Natalia E. Morone, MD, MS1,2,3; Carol M. Greco, PhD4; Charity G. Moore, PhD5; Bruce L. Rollman, MD, MPH1,2; Bridget Lane, MA1; Lisa A. Morrow, PhD6; Nancy W. Glynn, PhD7; Debra K. Weiner, MD2,3,6,8,9
[+] Author Affiliations
1Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
2Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
3Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
4Department of Psychiatry, Center for Integrative Medicine at University of Pittsburgh Medical Center (UPMC), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
5Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, North Carolina
6Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
7Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
8Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
9Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Intern Med. 2016;176(3):329-337. doi:10.1001/jamainternmed.2015.8033.
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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 adults residing within the Pittsburgh metropolitan area were recruited from February 14, 2011, to June 30, 2014, with 6-month follow-up completed by April 9, 2015. Eligible participants were 65 years or older with functional limitations owing to their chronic LBP (≥11 points on the Roland and Morris Disability Questionnaire) and chronic pain (duration ≥3 months) of moderate intensity. Data were analyzed from March 1 to July 1, 2015.

Interventions  The intervention and control groups received an 8-week group program followed by 6 monthly sessions. The intervention was modeled on the Mindfulness-Based Stress Reduction program; the control program, on the “10 Keys” to Healthy Aging.

Main Outcomes and Measures  Follow-up occurred at program completion and 6 months later. The score on the Roland and Morris Disability Questionnaire was the primary outcome and measured functional limitations owing to LBP. Pain (current, mean, and most severe in the past week) was measured with the Numeric Pain Rating Scale. Secondary outcomes included quality of life, pain self-efficacy, and mindfulness. Intent-to-treat analyses were conducted.

Results  Of 1160 persons who underwent screening, 282 participants enrolled in the trial (95 men [33.7%] and 187 women [66.3%]; mean [SD] age,74.5 [6.6] years). The baseline mean (SD) Roland and Morris Disability Questionnaire scores for the intervention and control groups were 15.6 (3.0) and 15.4 (3.0), respectively. Compared with the control group, intervention participants improved an additional −1.1 (mean, 12.1 vs 13.1) points at 8 weeks and −0.04 (mean, 12.2 vs 12.6) points at 6 months (effect sizes, −0.23 and −0.08, respectively) on the Roland and Morris Disability Questionnaire. By 6 months, the intervention participants improved on the Numeric Pain Rating Scale current and most severe pain measures an additional −1.8 points (95% CI, −3.1 to −0.05 points; effect size, −0.33) and −1.0 points (95% CI, −2.1 to 0.2 points; effect size, −0.19), respectively. The changes in Numeric Pain Rating Scale mean pain measure after the intervention were not significant (−0.1 [95% CI, −1.1 to 1.0] at 8 weeks and −1.1 [95% CI, −2.2 to −0.01] at 6 months; effect size, −0.01 and −0.22, respectively).

Conclusions and Relevance  A mind-body program for chronic LBP improved short-term function and long-term current and most severe pain. The functional improvement was not sustained, suggesting that future development of the intervention could focus on durability.

Trial Registration  clinicaltrials.gov Identifier: NCT01405716

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Figure 1.
CONSORT Diagram of Study Participation

GDS indicates Geriatric Depression Scale; MMSE, Mini-Mental State Examination; PI, principal investigator; and RMDQ, Roland and Morris Disability Questionnaire.

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Figure 2.
Global Impression of Change Findings

Participants in both groups answered the question “How much have your back symptoms changed as a result of the treatment provided in this study?” Assessment was performed at the end of each program (8 weeks). Improvement in back pain symptoms among the intervention participants was significantly greater than among control participants (P < .001).

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