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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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“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]
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“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]
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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In the citing paper
“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]
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“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”
The cited source says what the claim attributes to it.
In the citing paper
“Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP)”
The cited source says what the claim attributes to it.
In the citing paper
“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 measuredThe cited source says what the claim attributes to it.
In the citing paper
“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.”
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In the citing paper
“session attendance rates (56.6% and 50.9% of randomized participants attended at least 6 sessions of CBT and MBSR, respectively)”
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In the citing paper
“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]
The cited source says what the claim attributes to it.
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“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]
The cited source says what the claim attributes to it.
In the citing paper
“Relevant trials have suggested that MBSR may be an effective treatment option for patients with chronic low back pain [14–16].”
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In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Self-citationMINDFULNESS-BASED APPROACHES IN NURSING: A COMPREHENSIVE SYSTEMATIC REVIEW
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ResultGerhart, J., Burns, J. W., Thorn, B. E., Jensen, M., Carmody, J., & Keefe, F. (2024) · Pain · doi:10.1097/j.pain.0000000000003374 · Cited by 4
Recent Advances in Pain Management
Bashir, M. K. (2024) · medtigo Journal of Medicine · doi:10.63096/medtigo30622432 · Cited by 3
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CORRELATION BETWEEN CHRONIC LOW BACK PAIN AND FEMALE SEXUAL FUNCTION
Drummond, H. F., Farcic, T. S., Carvas, N., Baldan, C. S., Masson, I. F. B., & Machado, A. F. P. (2020) · Coluna/Columna · doi:10.1590/s1808-185120201904222821 · Cited by 3
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Mindfulness Training's Effect of Pain Outcomes in Musculoskeletal Pain: A Systematic Review
Cruze, E., & Games, K. E. (2021) · Journal of Sports Medicine and Allied Health Sciences Official Journal of the Ohio Athletic Trainers Association · doi:10.25035/jsmahs.07.02.01 · Cited by 4
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Understanding the confluence of injury and obesity in a Grade 2 obesity and above population
Franklin, R. C., Franklin, J. L., Swinbourne, J. M., Manson, E., Loughnan, G., Markovic, T., & HOCKING, S. L. (2023) · Australian and New Zealand Journal of Public Health · doi:10.1016/j.anzjph.2022.100008 · Cited by 4
Mindfulness interventions and pain management in a patient with encephalomyelitis
Allone, C., Corallo, F., Scarlata, F., Formica, C., Cartella, E., Buono, V. L., Todaro, A., Logiudice, A. L., Alagna, A., Bramanti, P., et al. (2019) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2019.06.001 · Cited by 3
Gregg, S. R., Brown, A. E., & Pasvogel, A. E. (2019) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000245 · Cited by 3
A preliminary study of an online pain management programme for patients with ankylosing spondylitis
Yu, K., Lo, L., Lin, M., Cheung, Y., & Wong, S. (2020) · Counselling and Psychotherapy Research · doi:10.1002/capr.12314 · Cited by 3
Innovating to Improve Care for Low Back Pain in the Military
Cherkin, D. C. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.0106 · Cited by 3
Self-citationMaddali‐Bongi, S., Orlandi, M., Pollina, A., & Aoufy, K. E. (2019) · Alternative and Complementary Therapies · doi:10.1089/act.2019.29239.smb · Cited by 3
Complementary and Integrative Health
Kim, H. S. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-72216-2.00008-9 · Cited by 3
Chronic Pain Management in the Homeless Population
Pangarkar, S., & Chang, L. (2021) · Springer eBooks · doi:10.1007/978-3-030-70135-2_4 · Cited by 3
Mindfulness, Mindful Consumption, & Life Satisfaction: An Experiment with Higher Education StudentsPreprint
Gupta, S., & Verma, H. V. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3907449 · Cited by 3
Predictors of vaginal penetration in women with provoked Vestibulodynia
Brown, N. B., Zdaniuk, B., & Brotto, L. A. (2021) · Journal of Sex & Marital Therapy · doi:10.1080/0092623x.2021.1921087 · Cited by 2
“Importantly, these findings indicate that MBSR and CBT were similarly effective in reducing patients’ functional limitations (Cherkin et al., 2016).”
BackgroundRowland, B., Barth, K. S., Bell, K. M., Brooks, A. K., Chadwick, A. L., Cleven, A., Hurley, R. W., Mackey, S., Patel, K. V., Piva, S. R., et al. (2025) · Pain Medicine · doi:10.1093/pm/pnaf073 · Cited by 2
“1,45 From comprehensive patient reported pain outcomes, including the Michigan Body Map, we confirmed that we enrolled a sample of participants with chronic pain, where low back pain is their primary source of pain.”
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“Similarly, Ryum and Stiles reported that increases in self-efficacy significantly mediated the relationship between changes in pain intensity and disability in the treatment of LBP [15].”
De-implementing spinal injections in pursuit of value-based care: Rethinking pain relief
Ballengee, L. A., Lentz, T. A., Goertz, C., McStay, F. W., Morken, I., & George, S. Z. (2026) · Journal of Pain · doi:10.1016/j.jpain.2026.106245 · Cited by 2
Daniels, C. J., Anderson, D. R., & Cupler, Z. A. (2022) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2022.01.002 · Cited by 2
Mindfulness-Based Stress Reduction in the Management of Chronic Pain and Its Comorbid Depression
Marske, C., Shah, S., Chavira, A., Hedberg, C., Fullmer, R., Clark, C. J., Pipitone, O., & Kaiser, P. (2020) · The Journal of the American Osteopathic Association · doi:10.7556/jaoa.2020.xxx · Cited by 2
Predictors of older adults' chronic pain in the context of opioid adverse drug events
McDonald, D. D., & Walsh, S. J. (2022) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000734 · Cited by 2
“Mindfulness reduces chronic low back pain (Cherkin et al., 2016).”
Changing or Acknowledging Cognitions: A Meta-Analysis of Reducing Depression in Adolescence
Uluköylü, Ş., Leijten, P. H. O., & Assink, M. (2023) · Journal of Emotional and Behavioral Disorders · doi:10.1177/10634266231154209 · Cited by 3
“Available comparative research mostly comes from adult samples, where comparing different intervention strategies against each other is more common (e.g., Cherkin et al., 2016; Garland et al., 2016).”
Randomized controlled trial protocol of health coaching for veterans with complex chronic pain
Crosky, S., McFarlin, M. L., Sullivan, N. L., Winograd, D. M., Litke, D. R., Masheb, R. M., Lu, S., Costanzo, M. E., Anastasides, N., Gonzalez, C., et al. (2023) · Trials · doi:10.1186/s13063-023-07113-6 · Cited by 2
Amiot, L., Daneau, C., Couëpel, B., Descarreaux, M., Bernier, M., Fournier, J., Ruffault, A., & Courbalay, A. (2023) · Movement & Sport Sciences - Science & Motricité · doi:10.1051/sm/2023006 · Cited by 2
Liu, X., & Lu, H. (2023) · European Journal of Neurology · doi:10.1111/ene.16004 · Cited by 2
Alqhtani, R. S., Ahmed, H., Alshahrani, A., Alyami, A. M., Khan, A. R., & Khan, A. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13121671 · Cited by 3
“The interplay between psychological distress and chronic back pain underscores the importance of addressing both mental and physical health [10].”
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Ward, L. G., Bourjeily, G. R., Guthrie, K. M., Salmoirago‐Blotcher, E., Sharp, M., Desmarattes, A., & Bublitz, M. H. (2024) · Journal of Integrative and Complementary Medicine · doi:10.1089/jicm.2023.0757 · Cited by 2
“9 In nonpregnant samples, mindfulness interventions effectively reduce distress and reactivity to painful or uncomfortable physical sensations 10,11 and foster disen-gagement from worrying thoughts, 12 thus suggesting that MT may target common sleep barriers experienced by pregnant people.”
How Bud Craig’s Insights Reshape the Research on Pain and Mind–Body Therapies
Mehling, W. E. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_521 · Cited by 3
Hansen, K. A., Blakeney, E. A., & Price, C. J. (2025) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130251319244 · Cited by 2
Self-citationApplication of Algorithm-Based Treatment Approach to Low Back Pain in the Emergency Department
Strickland, K. J., Kim, H. S., & Seitz, A. L. (2025) · Physical Therapy · doi:10.1093/ptj/pzaf016 · Cited by 3
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“Bothersomeness of Pain (BOP) in the past 7 days will be assessed using a single item 11-point NRS [71].”
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Assessing the effectiveness of a pilot test of a brief art-based mindfulness task on appraisal
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“…based stress reduction (mBsr) in the clinical setting have been shown to make positive contributions to the experience of chronic back pain (Cherkin et al., 2016; garland & howard, 2013), cardiovascular related conditions (van den hurk et al., 2015) and daily hassles associated with acting…”
Secular Mindfulness-Based Interventions: Efficacy and Neurobiology
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Mindfulness Intervention for Chronic Low Back Pain: A Systematic Review
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Ambulante Wirbelsäulenrehabilitation der Phase 3: Bedeutung psychologischer Interventionen
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“Die positiven Veränderungen im Roland-MorrisDisability-Fragebogen sind bis zu einem Jahr anhaltend zu beobachten [13].”
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Minding the Mind-Body Literature
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Geriatrics Literature 2016 Year in Review
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“Background: A mindfulness-based stress reduction program yielded greater improvement in back pain and function than cognitive behavioral therapy or usual care in adults younger than 70.(23) This study applied mindfulnessbased tactics to older adults.”
Watson, N., Demetriou, G., Cole, D., Hassenkamp, A.-M., & Thomson, D. (2019) · European Journal of Physiotherapy · doi:10.1080/21679169.2019.1598487 · Cited by 3
“Page 10 of 18 based mindfulness interventions to compare the results to, however, significant reductions with moderate to large effect sizes have been seen as a result of other mindfulness-based interventions [42,43, 44, 45].”
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“A large body of evidence supports the possible benefits of MBIs for patients with chronic pain.(11,23,26,31,35).”
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“…n 5 40 MBSR Chavooshi,14 2016 Medically unexplained pain 3 ISTDP or TAU Weekly sessions for 8 weeks MBSR, n 5 20; ISTDP, n 5 23; TAU, n 5 20 MBSR Cherkin,16 2016 Back pain 3 CBT or TAU Weekly sessions for 8 weeks MBSR, n 5 116; CBT, n 5 113; TAU, n 5 113 MBSR Esmer,27 2010 Back pain, leg pain 2…”
BackgroundInfluentialWhat's New in Orthopaedic Rehabilitation.
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The chiropractor's role in primary, secondary, and tertiary prevention of suicide: a clinical guide.
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Self-citation
Metadata
- 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
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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