Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. OBJECTIVE: To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care. DESIGN, SETTING, AND PARTICIPANTS: Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113). INTERVENTIONS: CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received. MAIN OUTCOMES AND MEASURES: Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks. RESULTS: There were 342 randomized participants, the mean (SD) [range] age was 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 years), 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overall P = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group (overall P = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes. CONCLUSIONS AND RELEVANCE: Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01467843.
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The benefits do not appear to be maintained in the long term.
“However, these effects do not seem to be maintained in the long term [32,42].”
From Prevention of non-specific back pain through exercise and education: A systematic review and meta-analysis (2024) · cites this paper as [32]
The Discussion reports that both MBSR and CBT improved back pain and functional limitations relative to usual care at 26 and 52 weeks, and describes MBSR's effectiveness as increasing over that period. The Results say MBSR's significant differences from usual care persisted at 52 weeks. Although CBT was not superior to usual care on the binary primary outcomes at 52 weeks, the paper does not support the general claim that the benefits were not maintained. (LLM, conf=0.91)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn the meta-analysis, the combined intervention showed a strong effect on disability.
“The disability variable also showed a strong effect in the meta-analysis [28,29,30,31,32,33,36,37,39,40,41,43].”
From Prevention of non-specific back pain through exercise and education: A systematic review and meta-analysis (2024) · cites this paper as [32]
The Results (Co-Primary Outcomes; page unavailable) report significantly greater improvement in disability-related functional limitations with mindfulness-based stress reduction than with usual care. However, this paper reports a randomized trial, not the cited meta-analysis’s pooled effect; its Discussion (page unavailable) describes the treatment effects as moderate, not strong. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOne article had a high drop-out rate (61% adherence).
“One article had a high drop-out rate (61% adherence) (Cherkin et al., 2016)”
From What works in mindfulness interventions for medically unexplained symptoms? A systematic review (2020) · cites this paper as Cherkin et al., 2016
The Results report limited session attendance—51% of MBSR participants and 57% of CBT participants attended at least six sessions—and the Discussion says about 20% were lost to follow-up. Neither is 61% adherence: the Abstract’s 61% refers to clinically meaningful improvement in functional limitations in the MBSR group, not adherence or dropout. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMindfulness-based interventions such as MBSR and MBCT are efficacious for improving patient-reported outcomes such as pain interference, pain intensity, and psychological distress for people living with chronic pain.
“Mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR) 1 and mindfulness-based cognitive therapy (MBCT) 2 are efficacious for improving patient-reported outcomes such as pain interference, pain intensity, and psychological distress for people living with chronic pain.3–5”
From Are Formal and Informal Home Mindfulness Practice Quantities Associated With Outcomes? Results From a Pilot Study of a Four-Week Mindfulness Intervention for Chronic Pain Management. (2024) · cites this paper as [3]
The Results (Co-Primary and Secondary Outcomes; page not provided) report that MBSR improved functional limitations, pain bothersomeness, and pain intensity more than usual care in adults with chronic low back pain. The claim is broader than this trial: it did not test MBCT or chronic pain conditions generally, and MBSR's psychological-distress benefit was limited to depression and mental-health scores at 8 weeks. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAttendance averaged ∼75%, or three out of four sessions, which is within the range of 5.5 to 7.6 sessions attended (out of eight) found in previous studies of MBIs for chronic pain.
“Attendance averaged ∼75%, or three out of four sessions, which is within the range of 5.5 to 7.6 sessions attended (out of eight) found in previous studies of MBIs for chronic pain [19, 47–49].”
From Feasibility and Acceptability of an Abbreviated, Four-Week Mindfulness Program for Chronic Pain Management. (2020) · cites this paper as [19]
The Methods describe an eight-session MBSR program, and the Results report that 51% of participants assigned to MBSR attended at least six sessions (page not provided). The paper does not report a mean of 5.5–7.6 sessions attended, so it supports the comparison with an eight-session chronic-pain study but not the stated numerical range. (LLM, conf=0.82)
Experimental — accuracy not yet measured
In the earlier MAP randomized trial, both CBT and MBSR improved pain and function in adults with chronic low back pain.
“In the Mind-body Approaches to Pain (MAP) randomized controlled trial (RCT), we found both CBT and mindfulness-based stress reduction (MBSR) to have benefits for pain and function among individuals with chronic low back pain (CLBP).13”
MBSR and CBT each reduce chronic low back pain.
“Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP)”
Twenty-six percent of participants randomized to MBSR attended the retreat.
“and retreat attendance rate (26% of participants randomized to MBSR),13”
From Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain (2023) · cites this paper as [13]
Experimental — accuracy not yet measuredThese results suggest that the MAP RCT finding of greater CBT than MBSR benefit for depression may have been largely due to differences among more depressed participants.
“These results suggest that the finding in the MAP RCT of CBT having greater benefit than MBSR for depression post-treatment13 may have been due largely to treatment differences among those who were more depressed.”
Among randomized participants, 56.6% attended at least six CBT sessions and 50.9% attended at least six MBSR sessions.
“session attendance rates (56.6% and 50.9% of randomized participants attended at least 6 sessions of CBT and MBSR, respectively)”
Mindfulness meditation reduces pain intensity, pain interference, and pain-related affect.
“research demonstrating that MM can lead to reductions in pain intensity,[16] pain interference,[15, 29] and pain-related affect,[30, 31]”
From The chronic pain skills study: Protocol for a randomized controlled trial comparing hypnosis, mindfulness meditation and pain education in Veterans (2020) · cites this paper as [15]
Hypnosis and mindfulness meditation are promising for multiple chronic pain conditions and are considered priorities for additional research and dissemination.
“Two self-management approaches, hypnosis (HYP)[12–14] and mindfulness meditation(MM)[15–17], show promise across a range of chronic pain conditions and have been identified as priorities for further study and dissemination.[18]”
From The chronic pain skills study: Protocol for a randomized controlled trial comparing hypnosis, mindfulness meditation and pain education in Veterans (2020) · cites this paper as [15]
Mindfulness-based stress reduction (MBSR) may be an effective treatment option for patients with chronic low back pain.
“Relevant trials have suggested that MBSR may be an effective treatment option for patients with chronic low back pain [14–16].”
In the meta-analysis, the combination of exercise therapy and health education produced a strong effect on pain compared with exercise therapy alone or health education alone.
“The combination of exercise therapy and health education has a strong effect on the pain variable compared to exercise therapy alone or health education alone [31,32,33,34,35,36,37,38,39,40,43].”
From Prevention of non-specific back pain through exercise and education: A systematic review and meta-analysis (2024) · cites this paper as [32]
The Methods (Interventions) describe a randomized trial comparing mindfulness-based stress reduction, cognitive behavioral therapy, and usual care. The Discussion reports pain outcomes for those groups, but neither section addresses exercise therapy combined with health education versus either intervention alone. Searches for that comparison and for a corresponding meta-analysis found no supporting passage in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredBoth MBSR and CBT significantly improved ratings of functional limitations, pain-related distress, and pain intensity in chronic lower back pain patients when compared with standard of care.
“By contrast, in a seminal study, Cherkin et al.19 found that both MBSR and CBT significantly improved ratings of functional limitations, pain-related distress, and pain intensity in chronic lower back pain patients when compared with standard of care.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [19]
Findings for MBSR and CBT persisted at 8-, 26-, and 52-week follow-up, demonstrating durability of mindfulness on certain pain-related outcomes over time.
“In the same study, findings persisted for MBSR and CBT at 8-, 26-, and 52-week follow-up, demonstrating the durability of mindfulness on certain pain-related outcomes over time.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [19]
Long-term mindfulness practice (>1000 hours) can lead to significant increases in pain threshold values and lower pain sensitivity even when participants are not explicitly practicing mindfulness.
“There is reliable and growing evidence demonstrating that long-term mindfulness practice can lead to significant increases in pain threshold values and lower pain sensitivity even when participants are not explicitly practicing mindfulness.13,19,43,46,82,83”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [19]
For chronic low back pain, MBSR and CBT both reduced pain intensity and bothersomeness more than usual care at 8, 26, and 52 weeks.
“The MBSR and CBT programs were found to be significantly more effective at reducing pain intensity and reports of pain being bothersome when compared to usual care after 8, 26, and 52 weeks.71”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [71]
CBT and MBSR did not differ significantly on pain-related outcomes.
“While there were no significant differences between the CBT and MBSR programs in pain-related outcomes”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [71]
MBI has been successfully implemented to improve psychological health and coping skills in a range of clinical populations, including chronic disease, pain disorders and cancer.
“In recent years, MBI has been successfully implemented to improve psychological health and coping skills 8 in a range of clinical populations, including chronic disease 9 , pain disorders 10 and cancer 11 .”
From Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis (2021) · cites this paper as [10]
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Mindfulness Training and Physical Health: Mechanisms and Outcomes
Creswell, J. D., Lindsay, E. K., Villalba, D. K., & Chin, B. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000675 · Cited by 252 · see citing works
Tompkins, D. A., Hobelmann, J. G., & Compton, P. A. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.12.002 · Cited by 251 · see citing works
“Pain relief tends to be short-term but improvements in physical functioning have been maintained up to 26 weeks of follow-up (Cherkin et al., 2016).”
BackgroundIatrogenic Opioid Dependence in the United States
Waljee, J. F., Li, L., Brummett, C. M., & Englesbe, M. J. (2016) · Annals of Surgery · doi:10.1097/sla.0000000000001904 · Cited by 239 · see citing works
“From the patient perspective, interventions that leverage motivational and cognitive behavioral strategies to improve resilience, self-efficacy, and expectations are effective in the setting of chronic pain management, and could be applied to perioperative care.(14) A multidisciplinary approach that leverages the broa…”
BackgroundEffects of Brief Mindfulness-Based Interventions on Health-Related Outcomes: a Systematic Review
Howarth, A., Smith, J. G., Perkins-Porras, L., & Ussher, M. (2019) · Mindfulness · doi:10.1007/s12671-019-01163-1 · Cited by 219 · see citing works
“…therapies (most commonly MBSR and MBCT) have been applied successfully to a range of clinical populations (Gotink et al. 2015) including patients recovering from cancer, patients with low back pain, and patients with general anxiety disorders (Cherkin et al. 2016; Evans 2016; Johns et al. 2015).”
BackgroundMultimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress
Shi, Y., & Wu, W. (2023) · BMC Medicine · doi:10.1186/s12916-023-03076-2 · Cited by 260 · see citing works
Garcia, L. M., Birckhead, B. J., Krishnamurthy, P., Sackman, J., Mackey, I. G., Louis, R. G., Salmasi, V., Maddox, T., & Darnall, B. D. (2021) · Journal of Medical Internet Research · doi:10.2196/26292 · Cited by 225 · see citing works
deVibe, M., Bjørndal, A., Fattah, S., Dyrdal, G. M., Halland, E., & Tanner-Smith, E. E. (2017) · Campbell Systematic Reviews: Better Evidence for a Better World · doi:10.4073/csr.2017.11 · Cited by 198 · see citing works
Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Meta-analysis
Anheyer, D., Haller, H., Barth, J., Lauche, R., Dobos, G., & Cramer, H. (2017) · Annals of Internal Medicine · doi:10.7326/m16-1997 · Cited by 197 · see citing works
“Cherkin et al, 2016 (32); secondary data analysis by Turner et al, 2016 (37) 342 (3) UC: 48.”
BackgroundResultInfluentialDarnall, B. D., Roy, A., Chen, A. L., Ziadni, M. S., Keane, R. T., You, D. S., Slater, K., Poupore-King, H., Mackey, I., Kao, M.-C., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.13401 · Cited by 191 · see citing works
International Olympic Committee consensus statement on pain management in elite athletes
Hainline, B. W., Derman, W. E., Vernec, A. R., Budgett, R., Deie, M., Dvořák, J., Harle, C. A., Herring, S. A., McNamee, M., Meeuwisse, W. H., et al. (2017) · British Journal of Sports Medicine · doi:10.1136/bjsports-2017-097884 · Cited by 198 · see citing works
Self-citationWells, R. E., O’Connell, N., Pierce, C. R., Estave, P., Penzien, D. B., Loder, E., Zeidan, F., & Houle, T. T. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.7090 · Cited by 183 · see citing works
Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis
Garland, E. L., Brintz, C. E., Hanley, A. W., Roseen, E. J., Atchley, R. M., Gaylord, S. A., Faurot, K. R., Yaffe, J., Fiander, M., & Keefe, F. J. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.4917 · Cited by 190 · see citing works
Khoo, E.-L., Small, R., Cheng, W., Hatchard, T., Glynn, B., Rice, D. B., Skidmore, B., Kenny, S., Hutton, B., & Poulin, P. A. (2019) · Evidence Based Mental Health · doi:10.1136/ebmental-2018-300062 · Cited by 175 · see citing works
“Given this uncertainty and the paucity of head-to-head trials comparing them (only one study 34 ), it is not yet possible to determine which intervention might be more beneficial for patients with different pain, medical and psychosocial presentations.”
InfluentialDiscogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment
Fujii, K., Yamazaki, M., Kang, J. D., Risbud, M. V., Cho, S. K.-W., Qureshi, S. A., Hecht, A. C., & Iatridis, J. C. (2019) · JBMR Plus · doi:10.1002/jbm4.10180 · Cited by 189 · see citing works
Mindfulness-based interventions for chronic pain: evidence and applications
Majeed, M. H., Ali, A. A., & Sudak, D. M. (2018) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2017.11.025 · Cited by 173 · see citing works
Psychological Interventions for the Treatment of Chronic Pain in Adults
Driscoll, M. A., Edwards, R. R., Becker, W. C., Kaptchuk, T. J., & Kerns, R. D. (2021) · Psychological Science in the Public Interest · doi:10.1177/15291006211008157 · Cited by 176 · see citing works
Mindfulness Meditation for Primary Headache Pain: A Meta-Analysis
Gu, Q., Hou, J.-C., & Fang, X.-M. (2018) · Chinese Medical Journal · doi:10.4103/0366-6999.228242 · Cited by 162 · see citing works
“[30] Although CBT has become a first‐line psychosocial treatment for individuals with chronic pain,[31] mindfulness meditation has shown the same effect as CBT when treating adult patients with low back pain.[32] Furthermore, mindfulness meditation could reduce the anxiety and stress levels as the biofeedback.”
BackgroundWaldron, E. M., Hong, S., Moskowitz, J. T., & Burnett-Zeigler, I. (2018) · Mindfulness · doi:10.1007/s12671-018-0920-5 · Cited by 137 · see citing works
Darnall, B. D., Krishnamurthy, P., Tsuei, J., & Minor, J. D. (2020) · JMIR Formative Research · doi:10.2196/17293 · Cited by 162 · see citing works
Peters (2017) · doi:10.1097/ajp.0000000000000494 · Cited by 144 · see citing works
Prescription Opioid Taper Support for Outpatients With Chronic Pain: A Randomized Controlled Trial
Sullivan, M. D., Turner, J. A., DiLodovico, C., D'Appollonio, A., Stephens, K. A., & Chan, Y.-F. (2016) · Journal of Pain · doi:10.1016/j.jpain.2016.11.003 · Cited by 146 · see citing works
Self-citationBest Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain
Malfliet, A., Ickmans, K., Huysmans, E., Coppieters, I., Willaert, W., Bogaert, W. V., Rheel, E., Bilterys, T., van Wilgen, P., & Nijs, J. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8071063 · Cited by 129 · see citing works
“Incorporating stress management in CLBP treatment could help patients to cope with everyday stressors, and leads to a clinically meaningful reduction in disability even at long-term (one year) follow-up [93].”
BackgroundZeidan, F., Baumgartner, J. N., & Coghill, R. C. (2019) · PAIN Reports · doi:10.1097/pr9.0000000000000759 · Cited by 115 · see citing works
“demonstrating that long-term mindfulness practice can lead to significant increases in pain threshold values and lower pain sensitivity even when participants are not explicitly practicing mindfulness.(13,19,43,46,82,83) Grant and Rainville(46) were the first to demonstrate that adept Zen practitioners (a mindfulness…”
BackgroundYang, J., Lo, W. L. A., Zheng, F., Cheng, X., Yu, Q., & Wang, C. (2022) · Pain Research and Management · doi:10.1155/2022/4276175 · Cited by 121 · see citing works
“Turner et al. [42] and Cherkin et al. 2016 belong to the same RCT and Harris et al. [30] was part of a larger randomized controlled multicenter trial conducted by Reme et al. [37].”
BackgroundUsing Integrative Medicine in Pain Management: An Evaluation of Current Evidence
Lin, Y., Wan, L., & Jamison, R. N. (2017) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000002579 · Cited by 120 · see citing works
Farb, N., Anderson, A., Ravindran, A., Hawley, L., Irving, J., Mancuso, E., Gulamani, T., Williams, G., Ferguson, A., & Segal, Z. V. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000266 · Cited by 104 · see citing works
Seminowicz, D. A., Burrowes, S. A. B., Kearson, A., Zhang, J., Krimmel, S. R., Samawi, L., Furman, A. J., Keaser, M. L., Gould, N. F., Magyari, T., et al. (2020) · Pain · doi:10.1097/j.pain.0000000000001860 · Cited by 110 · see citing works
“Age: median years (range) 36 (18-65) 36 (21-63) 36 (18-65) NS”
Brief Mindfulness-Based Interventions for Acute and Chronic Pain: A Systematic Review
McClintock, A. S., McCarrick, S. M., Garland, E. L., Zeidan, F., & Zgierska, A. E. (2019) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2018.0351 · Cited by 107 · see citing works
Cox, C. E., Hough, C. L., Jones, D. M., Ungar, A., Reagan, W., Key, M. D., Gremore, T., Olsen, M. K., Sanders, L., Greeson, J. M., et al. (2019) · Thorax · doi:10.1136/thoraxjnl-2017-211264 · Cited by 102 · see citing works
Psychological therapy for centralized pain: an integrative assessment and treatment model
Lumley, M. A., & Schubiner, H. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000654 · Cited by 116 · see citing works
Kechter, A., Amaro, H., & Black, D. S. (2019) · Mindfulness · doi:10.1007/s12671-018-0974-4 · Cited by 102 · see citing works
“Among studies that included an active control group, all ten (40%) articles described equivalent methods of monitoring the delivery of both groups (Cherkin et al. 2016; Eisendrath et al. 2016; Garland et al. 2016; Garland et al. 2014; Gross et al. 2010; Hoge et al. 2013; Hughes et al. 2013; Shallcross et al. 2015; Wil…”
BackgroundHeapy, A. A., Higgins, D. M., Goulet, J. L., LaChappelle, K. M., Driscoll, M. A., Czlapinski, R. A., Buta, E., Piette, J. D., Krein, S. L., & Kerns, R. D. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.0223 · Cited by 101 · see citing works
Ma, K., Zhuang, Z., Wang, L., Liu, X., Lu, L., Yang, X.-Q., Lü, Y., Fu, Z., Song, T., Huang, D., et al. (2019) · Pain Research and Management · doi:10.1155/2019/8957847 · Cited by 99 · see citing works
“Progressive relaxation can relieve the posttreatment pain [121, 122] and promote functional improvement.”
Putting Integrative Oncology Into Practice: Concepts and Approaches
Latte-Naor, S., & Mao, J. J. J. (2019) · Journal of Oncology Practice · doi:10.1200/jop.18.00554 · Cited by 98 · see citing works
Kligler, B., Bair, M. J., Banerjea, R., DeBar, L., Ezeji-Okoye, S., Lisi, A., Murphy, J. L., Sandbrink, F., & Cherkin, D. C. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4323-z · Cited by 95 · see citing works
Self-citationManaging Chronic Pain in Primary Care: It Really Does Take a Village
Seal, K. H., Becker, W. C., Tighe, J., Li, Y., & Rife, T. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4047-5 · Cited by 96 · see citing works
Upchurch, D. M., & Johnson, P. J. (2018) · Journal of Women s Health · doi:10.1089/jwh.2018.7178 · Cited by 93 · see citing works
Day, M. A., Ward, L. C., Ehde, D. M., Thorn, B. E., Burns, J., Barnier, A., Mattingley, J. B., & Jensen, M. P. (2019) · Pain Medicine · doi:10.1093/pm/pny273 · Cited by 91 · see citing works
Wardhan, R., & Chelly, J. E. (2017) · F1000Research · doi:10.12688/f1000research.12286.1 · Cited by 91 · see citing works
Brotto, L. A., Bergeron, S., Zdaniuk, B., Driscoll, M., Grabovac, A., Sadownik, L. A., Smith, K. B., & Basson, R. (2019) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2019.04.002 · Cited by 87 · see citing works
“Mindfulness led to significantly greater reductions in pain catastrophizing and stress-related affect compared with CBT in patients with rheumatoid arthritis,(23) but similar improvements in disability symptoms and pain bothersomeness in patients with chronic low back pain.(24) Given that women with PVD have premorbid…”
ResultYoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial
Groessl, E. J., Liu, L., Chang, D. G., Wetherell, J. L., Bormann, J. E., Atkinson, J. H., Baxi, S. C., & Schmalzl, L. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.05.019 · Cited by 89 · see citing works
“In the current study, both groups showed reductions in RMDQ scores at the 6-week and 12-week time points, which is not unexpected with comparison groups receiving placebo or usual care in cLBP trials.(35,47) However, the initial improvement in RMDQ scores among DT participants was not reflected in the painintensity sc…”
MethodResultHerman, P. M., Anderson, M. L., Sherman, K. J., Balderson, B. H. K., Turner, J. A., & Cherkin, D. C. (2017) · Spine · doi:10.1097/brs.0000000000002344 · Cited by 87 · see citing works
“Details on the design of the trial, including its interventions and outcomes were previously published.(6,10) The trial compared the effectiveness of two mind-body interventions (MBSR and CBT) to UC in individuals with chronic (>3 months) nonspecific low back pain.”
Self-citationPrimary Care of Patients With Chronic Pain
Schneiderhan, J. R., Clauw, D. J., & Schwenk, T. L. (2017) · JAMA · doi:10.1001/jama.2017.5787 · Cited by 85 · see citing works
Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations
Adler-Neal, A. L., & Zeidan, F. Z. (2017) · Current Rheumatology Reports · doi:10.1007/s11926-017-0686-0 · Cited by 85 · see citing works
Gascón, E. M. P., Narambuena, L., Leal‐Costa, C., & Román, C. J. V.-D. H. (2020) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2020.08.001 · Cited by 85 · see citing works
Chronic Pain and Sleep Disorders in Primary Care
Jank, R., Gallee, A., Boeckle, M., Fiegl, S., & Pieh, C. (2017) · Pain Research and Treatment · doi:10.1155/2017/9081802 · Cited by 83 · see citing works
Cherkin, D. C., Anderson, M. L., Sherman, K. J., Balderson, B. H. K., Cook, A. J., Hansen, K. E., & Turner, J. A. (2017) · JAMA · doi:10.1001/jama.2016.17814 · Cited by 77 · see citing works
Self-citationAn update on non-pharmacological interventions for pain relief
Wang, Y., Aaron, R. V., Attal, N., & Colloca, L. (2025) · Cell Reports Medicine · doi:10.1016/j.xcrm.2025.101940 · Cited by 78 · see citing works
Complementary and Integrated Health Approaches: What Do Veterans Use and Want
Taylor, S. L., Hoggatt, K. J., & Kligler, B. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-04862-6 · Cited by 77 · see citing works
Ali, A., Weiss, T. R., Dutton, A., McKee, D., Jones, K. D., Kashikar-Zuck, S., Silverman, W. K., & Shapiro, E. D. (2017) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2016.12.053 · Cited by 75 · see citing works
Jensen, M. P., Mendoza, M. E., Ehde, D. M., Patterson, D. R., Molton, I. R., Dillworth, T. M., Gertz, K. J., Chan, J., Hakimian, S., Battalio, S. L., et al. (2020) · Pain · doi:10.1097/j.pain.0000000000001943 · Cited by 75 · see citing works
“However, researchers tend to most often evaluate the efficacy of 6 to 10 psychological pain treatments sessions, with 8 sessions being the most common.(5,16,36,42,80,82,87,92) Here, we chose to evaluate the efficacy of 4 sessions of treatment.”
BackgroundResultLeading the Way to Solutions to the Opioid Epidemic: AOA Critical Issues
Seymour, R. B., Ring, D., Higgins, T., & Hsu, J. R. (2017) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.17.00066 · Cited by 74 · see citing works
Garland, E. L., Bryan, C. J., Finan, P. H., Thomas, E. A., Priddy, S. E., Riquino, M. R., & Howard, M. O. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.07.033 · Cited by 71 · see citing works
“To date, mindfulness approaches for chronic pain have been shown to be efficacious but not superior to traditional CBT in well-controlled trials (Cherkin et al., 2016) and meta-analyses (Veehof et al., 2011).”
BackgroundA Pilot Mobile-Based Mindfulness Intervention for Cancer Patients and Their Informal Caregivers
Kubo, A., Altschuler, A., Kurtovich, E., Hendlish, S., Laurent, C. A., Kolevska, T., Li, Y., & Avins, A. (2018) · Mindfulness · doi:10.1007/s12671-018-0931-2 · Cited by 73 · see citing works
Henriksson, J., Wasara, E., & Rönnlund, M. (2016) · Psychological Reports · doi:10.1177/0033294116675086 · Cited by 73 · see citing works
“Support of the effectiveness of a MBI for pain was provided in a subsequent study by Cherkin et al. (2016).”
BackgroundNeurophysiological Mechanisms Supporting Mindfulness Meditation–Based Pain Relief: an Updated Review
Jinich-Diamant, A., Garland, E., Baumgartner, J., Gonzalez, N., Riegner, G., Birenbaum, J., Case, L., & Zeidan, F. (2020) · Current Pain and Headache Reports · doi:10.1007/s11916-020-00890-8 · Cited by 69 · see citing works
Petrucci, G., Papalia, G. F., Russo, F., Vadalà, G., Piredda, M., Marinis, M. G. D., Papalia, R., & Denaro, V. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010060 · Cited by 70 · see citing works
“Study Intervention (s) Control Follow-Up Outcomes (Tool) Conclusion Cherkin et al., 2016 Mindfulness: body scan, yoga, meditation, for 8 weeks.”
BackgroundMethodInfluentialPain Catastrophizing: How Far Have We Come
Simić, K., Savic, B., & Knežević, N. N. (2024) · Neurology International · doi:10.3390/neurolint16030036 · Cited by 74 · see citing works
Baer, R., Gu, J., Cavanagh, K., & Strauss, C. (2019) · Psychological Assessment · doi:10.1037/pas0000744 · Cited by 66 · see citing works
The Role of Heart Rate Variability in Mindfulness-Based Pain Relief
Adler-Neal, A. L., Waugh, C. E., Garland, E. L., Shaltout, H. A., Diz, D. I., & Zeidan, F. Z. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.07.003 · Cited by 70 · see citing works
“Mindfulness and CBT produce similar pain relieving effects and both techniques likely employ executive control processes to reduce pain, although CBT is premised on changing thoughts about pain, whereas mindfulness is based on accepting thoughts about pain.(19,43,53,57) Importantly, there were no significant differenc…”
BackgroundYoshida, K., Takeda, K., Kasai, T., Makinae, S., Murakami, Y., Hasegawa, A., & Sakai, S. (2020) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsaa020 · Cited by 68 · see citing works
“, 2014), low-back pain (Cherkin et al., 2016) and residual symptoms in depression (Rubia, 2009; Chiesa and Serretti, 2011).”
BackgroundHarrison, R., Zeidan, F., Kitsaras, G., Ozcelik, D., & Salomons, T. V. (2019) · The Journal of Pain · doi:10.1016/j.jpain.2018.10.011 · Cited by 67 · see citing works
Goldberg, S. B., Riordan, K. M., Sun, S., Kearney, D. J., & Simpson, T. L. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110232 · Cited by 65 · see citing works
The Global Spine Care Initiative: model of care and implementation
Johnson, C. D., Haldeman, S., Chou, R., Nordin, M. C., Green, B. N., Côté, P., Hurwitz, E. L., Kopansky-Giles, D. R., Acaroglu, E. R., Cedraschi, C., et al. (2018) · European Spine Journal · doi:10.1007/s00586-018-5720-z · Cited by 70 · see citing works
Intervenciones psicológicas basadas en mindfulness y sus beneficios: estado actual de la cuestión
Hervás, G., Cebolla, A., & Soler, J. (2016) · Clínica y Salud · doi:10.1016/j.clysa.2016.09.002 · Cited by 67 · see citing works
Mindfulness, mindful consumption, and life satisfaction
Gupta, S., & Verma, H. V. (2019) · Journal of Applied Research in Higher Education · doi:10.1108/jarhe-11-2018-0235 · Cited by 65 · see citing works
Sverre, K. T., Nissen, E. R., Farver-Vestergaard, I., Johannsen, M., & Zachariae, R. H. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102234 · Cited by 72 · see citing works
Becker, W. C., DeBar, L. L., Heapy, A. A., Higgins, D., Krein, S. L., Lisi, A., Makris, U. E., & Allen, K. D. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4345-6 · Cited by 59 · see citing works
Myofascial pain – A major player in musculoskeletal pain
Lam, C. M., Francio, V. T., Gustafson, K., Carroll, M. K., York, A., & Chadwick, A. L. (2024) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2024.101944 · Cited by 75 · see citing works
Darnall, B. D., & Colloca, L. (2018) · International review of neurobiology · doi:10.1016/bs.irn.2018.07.022 · Cited by 65 · see citing works
Evaluation Challenges for the Application of Extended Reality Devices in Medicine
Beams, R., Brown, E., Cheng, W., Joyner, J. S., Kim, A. S., Kontson, K. L., Amiras, D., Baeuerle, T., Greenleaf, W., Grossmann, R. J., et al. (2022) · Journal of Imaging Informatics in Medicine · doi:10.1007/s10278-022-00622-x · Cited by 62 · see citing works
“In addition, novel clinical applications provide engaging environments and training for pain management [5, 6] and psychotherapy [7], and the gamification of physical therapy can be employed to increase patient compliance [8].”
BackgroundNathan, H. J., Poulin, P., Wozny, D., Taljaard, M., Smyth, C., Gilron, I., Sorisky, A., Lochnan, H., & Shergill, Y. (2017) · Clinical Diabetes · doi:10.2337/cd17-0077 · Cited by 61 · see citing works
“(33), however, showed no such differences between CBT and MBSR for chronic back pain.”
BackgroundBiobehavioral Mechanisms of Mindfulness as a Treatment for Chronic Stress: An RDoC Perspective
Garland, E. L., Hanley, A. W., Baker, A. K., & Howard, M. O. (2017) · Chronic Stress · doi:10.1177/2470547017711912 · Cited by 62 · see citing works
“Indeed, laboratory-based studies have shown that MBIs can reduce pain sensitivity(107,108) and pain intensity(109,110) during standardized, experimental acute pain inductions, whereas clinical trials indicate that MBIs can reduce chronic pain severity.(67,111) With regard to nonpainful aversive stimuli, participation…”
BackgroundBurns, J. W., Jensen, M. P., Thorn, B., Lillis, T. A., Carmody, J., Newman, A. K., & Keefe, F. (2022) · Pain · doi:10.1097/j.pain.0000000000002357 · Cited by 58 · see citing works
Behavioral therapy approaches for the management of low back pain: an up-to-date systematic review
Vitoula, K., Venneri, A., Varrassi, G., Paladini, A., Sykioti, P., Adewusi, J., & Zis, P. (2018) · Pain and Therapy · doi:10.1007/s40122-018-0099-4 · Cited by 60 · see citing works
“Supplementary therapy with MBSR rather than usual care alone can result in greater improvement in back pain and functional limitations [15, 23].”
BackgroundMusic as an Adjunct to Opioid-Based Analgesia
Chai, P. R., Carreiro, S., Ranney, M. L., Karanam, K., Ahtisaari, M., Edwards, R. R., Schreiber, K. L., Ben-Ghaly, L., Erickson, T. B., & Boyer, E. W. (2017) · Journal of Medical Toxicology · doi:10.1007/s13181-017-0621-9 · Cited by 60 · see citing works
“, catastrophizing, depression) while increasing pain acceptance through cognitive behavioral therapy (CBT) or mindfulness (MT) [5, 6].”
BackgroundNi, Y., Ma, L., & Li, J. (2021) · Journal of Diabetes Investigation · doi:10.1111/jdi.13439 · Cited by 59 · see citing works
Ziadni, M. S., Gonzalez-Castro, L., Anderson, S., Krishnamurthy, P., & Darnall, B. D. (2021) · Journal of Medical Internet Research · doi:10.2196/29672 · Cited by 59 · see citing works
“In contrast, behavioral medicine approaches are low risk and have been shown to have low-to-moderate efficacy for a range of chronic pain conditions [5,7,10-12], with cognitive behavioral therapy (CBT)–pain as the established evidence-based treatment for chronic pain [8,9].”
Burrowes, S. A. B., Goloubeva, O. G., Stafford, K. A., McArdle, P. F., Goyal, M., Peterlin, B. L., Haythornthwaite, J. A., & Seminowicz, D. A. (2021) · Pain · doi:10.1097/j.pain.0000000000002372 · Cited by 59 · see citing works
Necessary components of psychological treatment in pain management programs: A Delphi study
Sharpe, L., Jones, E. B., Ashton-James, C. E., Nicholas, M. K., & Refshauge, K. M. (2020) · European Journal of Pain · doi:10.1002/ejp.1561 · Cited by 59 · see citing works
“Differences on secondary outcomes vary with some favouring CBT (Cherkin et al., 2016, 2017; Zautra et al., 2008) and others favouring ACT (Wetherell et al., 2011) or mindfulness (Dowd et al., 2015).”
ResultInfluentialA Retrospective Systematic Review of Diversity Variables in Mindfulness Research, 2000–2016
Eichel, K., Gawande, R., Acabchuk, R. L., Palitsky, R., Chau, S., Pham, A., Cheaito, A., Yam, D., Lipsky, J., Dumais, T., et al. (2021) · Mindfulness · doi:10.1007/s12671-021-01715-4 · Cited by 57 · see citing works
Castellano‐Tejedor, C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19148536 · Cited by 58 · see citing works
Positive affect and chronic pain: a preregistered systematic review and meta-analysis
Ong, A. D., Thoemmes, F. J., Ratner, K., Ghezzi‐Kopel, K., & Reid, M. C. (2020) · Pain · doi:10.1097/j.pain.0000000000001828 · Cited by 56 · see citing works
Recent advances in understanding neuropathic pain: glia, sex differences, and epigenetics
Machelska, H., & Celik, M. Ö. (2016) · F1000Research · doi:10.12688/f1000research.9621.1 · Cited by 54 · see citing works
Newman, A. K., Dyke, B. P. V., Torres, C. A., Baxter, J. W., Eyer, J. C., Kapoor, S., & Thorn, B. E. (2017) · Pain · doi:10.1097/j.pain.0000000000000964 · Cited by 55 · see citing works
“…moderate to moderately severe levels of depression for the average participant.43 In comparison to a lessdisadvantaged population, Cherkin et al. (2016) report average PHQ-8 scores that represent mild depressive symptoms (mean5 5.6, SD 5 4.1),8,44 Grattan et al.27 report a…”
BackgroundInfluentialWestenberg, R. F., Zale, E. L., Heinhuis, T. J., Özkan, S., Nazzal, A., Lee, S.-G., Chen, N. C., & Vranceanu, A.-M. (2018) · Clinical Orthopaedics & Related Research · doi:10.1007/s11999.0000000000000086 · Cited by 52 · see citing works
“6% rate that has been observed in multisession interventions [14, 25] of classic length.”
BackgroundResultInfluentialCurrent Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside
Siqueira-Campos, V. M., de Deus, M. S. C., Poli-Neto, O. B., Silva, J. C. R. E., de Deus, J. M., & Conde, D. M. (2022) · International Journal of Women s Health · doi:10.2147/ijwh.s224891 · Cited by 53 · see citing works
- Authors
- Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A.
- Affiliations
- Kaiser Permanente Washington Health Research Institute (US)
- University of Washington (US)
- Corresponding author
- Cherkin, Daniel C.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2016-03-22
- Volume
- 315
- Issue
- 12
- Pages
- 1240
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4914381
- OpenAlex
- W2304035054
- Cited by
- 729
- References
- 42
- Citations by year
- 2026: 53 · 2025: 71 · 2024: 82 · 2023: 66 · 2022: 72 · 2021: 80 · 2020: 81 · 2019: 65 · 2018: 54 · 2017: 72 · 2016: 31 · 2014: 1 · 2012: 1
- FWCI
- 59.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- National Center for Complementary and Integrative Health (R01AT006226)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- mindfulness-based stress reduction, cognitive behavioral therapy, chronic low back pain, functional limitations, pain-related disability, mindfulness meditation, yoga, usual care, young and middle-aged adults, treatment effectiveness comparison, integrated health system, pain catastrophizing, pain acceptance, pain-related hopelessness, pain-related helplessness
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Stress, Physiological, Stress, Psychological, Washington, Yoga, Cognitive Behavioral Therapy, Treatment Outcome, Low Back Pain, Sample Size, Young Adult, Intention to Treat Analysis, Mindfulness
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