Cited by 258Musculoskeletal pain and rehabilitationMindfulness and Compassion InterventionsPain Mechanisms and Treatments

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

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Morone, Natalia E., Greco, Carol M., Moore, Charity G., Rollman, Bruce L., Lane, Bridget, Morrow, Lisa A., Glynn, Nancy W., Weiner, Debra K.·2016·JAMA Internal Medicine

DOI 10.1001/jamainternmed.2015.8033PMC PMC6361386

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Abstract

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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“33,60 Lack of increases in mindfulness can result from measurement response-shift, in which participants ’ frame of reference for survey items shifts as a result of the MBI, leading to similar or lower post-intervention mindfulness scores.”
Psychosocial Issues in Geriatric Rehabilitation
Rodriguez, R. M. (2017) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2017.06.003 · Cited by 5
The mindful migraine: does mindfulness-based stress reduction relieve episodic migraine?
Napadow, V. (2020) · Pain · doi:10.1097/j.pain.0000000000001859 · Cited by 8
“In fact, the first mindfulness meditation research trial was conducted specifically for chronic pain patients by Jon Kabat-Zinn, the founder of MBSR, in 1982 [12] and recent large N clinical trials have shown promise for clinical pain reduction [2; 3; 16; 17; 23].”
Background
Participants’ experiences from group-based treatment at multidisciplinary pain centres - a qualitative study
Nøst, T. H., Woodhouse, A., Dale, L.-O., Hara, K. W., & Steinsbekk, A. (2021) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2021-0099 · Cited by 5
Adapting Mindfulness-Based Interventions for Residents of Long-Term Care Facilities
Terry, C., Penland, M., Garland, D., Wang, W., Burton, T., & Dark-Freudeman, A. (2021) · Gerontology and Geriatric Medicine · doi:10.1177/23337214211057703 · Cited by 7
“…to older adults, including improved self-reported symptoms of insomnia (Zhang et al., 2015), improved anxious and depressive symptoms (Wetherell et al., 2017), improved chronic lower back pain (Morone et al., 2008, 2016), reduced worry and improved memory and verbal fluency (Lenze et al., 2014).”
Background
Mindfulness meditation use in chronic pain treatment in rural Australia: Pitfalls and potential – A case report
Bishop, M. E. R., Hamiduzzaman, M., & Veltre, A. S. (2023) · Journal of Neurosciences in Rural Practice · doi:10.25259/jnrp-2022-4-7 · Cited by 6
“A number of studies show reduced pain intensity in groups treated with MBSR, [24-26 , 28 ] but these Mindfulness is often associated with cognitive behavioral therapy (CBT), as there are many similarities between the two practices.”
Designing voice interfaces to support mindfulness-based pain management
Mendu, S., Fosco, S. L. D., Lanza, S. T., & Abdullah, S. (2023) · Digital Health · doi:10.1177/20552076231204418 · Cited by 5
“10,12,13 Despite these promising ﬁ ndings, a number of challenges can hinder the use of MBSR practices for chronic pain management.”
Background
Can We Borrow Your Intervention? Randomized Controlled Trial of an Older Adult Telehealth Wellness Promotion Program Adapted for Middle-Aged Adults With Physical Disability
Molton, I. R., Singsank, K. T., Rivera, N., Munroe, L. A., Flaster, A., Humbert, A. T., Daymon, D., Thompson, M. R., Yang, B., & Denison, P. (2025) · The Gerontologist · doi:10.1093/geront/gnaf079 · Cited by 5
An experimental study to inform adoption of mindfulness-based stress reduction in chronic low back pain
Jones, S. M. W., Sherman, K. J., Bermet, Z. A., Palazzo, L. G., & Lewis, C. C. (2022) · Implementation Science Communications · doi:10.1186/s43058-022-00335-w · Cited by 7
Interdisziplinäre multimodale Schmerztherapie im Alter
Mattenklodt, P., Ingenhorst, A., Flatau, B., Becker, K., & Grießinger, N. (2023) · Der Schmerz · doi:10.1007/s00482-023-00721-w · Cited by 5
Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark
Buskbjerg, C., O'Toole, M. S., Zachariae, R., Jensen, A. B., Frederiksen, Y., Johansen, C., von Heymann, A., Speckens, A., & Johannsen, M. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-066505 · Cited by 4
Effects of a mindfulness-based intervention on pain intensity, disability and quality of life of chronic low back pain patients: A randomised study
Pal, A., Mukhopadhyay, P., Bhattacharyya, D., & Ray, S. (2024) · Indian Journal of Anaesthesia · doi:10.4103/ija.ija_361_24 · Cited by 4
“An RCT by Morone et al. [7] showed it to reduce disability in the elderly with CLBP.”
A Pilot Randomized Controlled Trial of Effectiveness of a Psychoeducational Intervention on the Management of Musculoskeletal Chronic Noncancer Pain
Gutiérrez, C. S., López‐Millán, J. M., de Rivera, A. C. N., & Gil‐García, E. (2023) · Pain Management Nursing · doi:10.1016/j.pmn.2023.01.007 · Cited by 4
Ayurvedic protocols of chronic pain management: spatiotemporality as present moment awareness and embodied time
Agarwal, V. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2024.1327393 · Cited by 4
Race-Based Differences in the Response to a Mindfulness Based Integrative Medical Group Visit Intervention for Chronic Pain
Rodriguez, A. C. I., Nephew, B. C., Polcari, J. J., Melican, V., King, J. A., & Gardiner, P. M. (2024) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130241254793 · Cited by 4
“While some studies focus on speci ﬁ c types of pain such as low back pain, 20,22 ﬁ - bromyalgia 23 or chronic migraines, others broadly target chronic pain.”
Background
The Hidden Complexity of Virtual Mindfulness-Based Group Medical Visits: Comfort, Challenge, and the Influence of Social Determinants of Health
Barnhill, J. L., Castro, G., Lathren, C., Harr, E. D., Roth, I., Baez, J. E., Rodríguez, R., Lawrence, S. M., Gardiner, P. M., Greco, C. M., et al. (2025) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130251326938 · Cited by 4
Self-citation
Caring for older veterans with chronic low back pain using a geriatric syndrome approach: Rationale and methods for the aging back clinics (ABC) trial
Weiner, D. K., Gentili, A., Fang, M. A., Garay, E., Annaswamy, T. M., Castle, S. C., Joseph, L. N., Lawson, L. R., Lee, C. C., Makris, U. E., et al. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106077 · Cited by 4
Self-citation
Effects of proactive healthcare on pain, physical and activities of daily living functioning in vulnerable older adults with chronic pain: a pragmatic clinical trial with one- and two-year follow-up
Dong, H., Peolsson, A. L. C., & Johansson, M. M. (2024) · European Geriatric Medicine · doi:10.1007/s41999-024-00952-9 · Cited by 4
“We might not expect a reduction of pain intensity since this outcome was also controversial in other trials with short-term follow-up [31, 32] and functioning improvements were not always associated with reduced pain intensity [33, 34].”
Result
A randomized controlled trial of mindfulness-based intervention on individuals with physical disabilities in China
Liang, L.-Y., & Shek, D. T. L. (2024) · Applied Research in Quality of Life · doi:10.1007/s11482-024-10305-0 · Cited by 6
“This aligns with previous Western and Chinese research indicating consistent positive effects of MBI across different cultural backgrounds (Banth & Ardebil, 2015; Gan et al., 2019; Morone et al., 2016; Wong et al., 2011; Zhao et al., 2015).”
Developing a Web Platform to Optimize the Self-Management of People Living with a Chronic Respiratory Disease
Tanguay, P., Décary, S., Martineau-Roy, J., Gravel, É., Gervais, I., St-Jean, P., Tousignant, M., & Marquis, N. (2020) · Physiotherapy Canada · doi:10.3138/ptc-2019-0110 · Cited by 4
Patient Outcomes Improve in a Pragmatic Implementation Pilot Study of Mindful Awareness in Body-Oriented Therapy (MABT) for Chronic Pain
Price, C. J., Colgan, D. D., Blakeney, E. A., Pennings, J. S., Davidson, C. A., & Hansen, K. A. (2025) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130251331029 · Cited by 3
Interdisziplinäre multimodale Schmerztherapie im Alter
Mattenklodt, P., Ingenhorst, A., Flatau, B., Becker, K., & Griessinger, N. (2023) · Die Anaesthesiologie · doi:10.1007/s00101-024-01392-7 · Cited by 6
Mindfulness vs. Physiotherapy vs. Medical Therapy: Uncovering the Best Postoperative Recovery Method for Low Back Surgery Patients during the COVID-19 Pandemic—A Single Institution’s Experience
Rocca, G. L., Orlando, V., Galieri, G., Mazzucchi, E., Pignotti, F., Cusumano, D., Bazzu, P., Olivi, A., & Sabatino, G. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14090917 · Cited by 3
“Several studies have shown moderate-quality evidence that mindfulness-based stress reduction (MBSR) is an effective treatment for chronic low back pain [15–18].”
Background
Back pain precedes sleep problems in older men
Lee, S., Muhammad, T., Roseen, E. J., McNaughton, D. T., Mu, C., Øverås, C. K., Jenkins, H. J., Nim, C. G., Young, J. J., Fink, H. A., et al. (2025) · Innovation in Aging · doi:10.1093/geroni/igaf113 · Cited by 3
Effectiveness of Mindfulness-Based Interventions on Pain Intensity in Patients with Chronic Low Back Pain: A Systematic Review
Alipour, F., Norouzi, A., Reskati, M. H., & Hosseini, S. H. (2020) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.102509 · Cited by 3
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
Efectividad de la educación basada en neurociencias en pacientes con dolor lumbar crónico: revisión sistemática con metaanálisis
Valdés-Orrego, I., Araya‐Quintanilla, F., Muñoz-Cuevas, M. J., Maturana-Madrid, K., & Navarrete-Cabrera, M. (2018) · Fisioterapia · doi:10.1016/j.ft.2018.08.001 · Cited by 3
Intracluster correlation coefficients in osteoarthritis cluster randomized trials: A systematic review
King, L. K., Bodmer, N. S., Saadat, P., Bobos, P., HAWKER, G. A., & da Costa, B. R. (2023) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2023.09.006 · Cited by 2
Baseline characteristics of participants in the Biomarkers for Evaluating Spine Treatments clinical trial: a sequential multiple assignment randomized trial for chronic low back pain
Rowland, 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
Self-citation
Habits of Mind: Mindful Awareness from a Habits Framework
Lipsett, M., Berkman, E. T., & Creswell, J. D. (2025) · Springer eBooks · doi:10.1007/978-3-031-91451-5_5 · 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
An Individual Mindfulness-Based Intervention for Residents of Long-Term Care Facilities: A Case Study
Terry, C., Dark-Freudeman, A., McIver, M., & MacKain, S. J. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.07.002 · Cited by 3
Implementation Outcomes From a Pilot Study of Mindful Awareness in Body-Oriented Therapy (MABT) as a Chronic Pain Treatment Modality in an Integrative Health Clinic
Hansen, K. A., Blakeney, E. A., & Price, C. J. (2025) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130251319244 · Cited by 2
Participant Experiences in Using a Telehealth Mindful Exercise Program for Knee Osteoarthritis: A Qualitative Study
Shah, N., Morris, M., Cohn, E. S., Morone, N. E., Ellis, T. D., & Kumar, D. (2025) · Journal of Integrative and Complementary Medicine · doi:10.1177/27683605251364715 · Cited by 2
Self-citation
Secular Mindfulness-Based Interventions: Efficacy and Neurobiology
Schmidtman, E. A., Hurley, R. A., & Taber, K. H. (2017) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.17020034 · Cited by 2
Mindfulness Intervention for Chronic Low Back Pain: A Systematic Review
Najafinejad, S. (2022) · International Journal of Musculoskeletal Pain Prevention · doi:10.52547/ijmpp.7.1.8 · Cited by 2
Osteopathic Manipulative Therapy for Preterm Infants, Acupuncture for Menopausal Symptoms, Mindfulness-Based Stress Reduction for Chronic Low Back Pain, Chocolate for Ischemic Heart Disease, Berberine for Irritable Bowel Syndrome
Pettit, J. M., & Glickman-Simon, R. (2016) · EXPLORE · doi:10.1016/j.explore.2016.06.015 · Cited by 2
Geriatrics Literature 2016 Year in Review
Willham, K., Covinsky, K. E., & Widera, E. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15064 · Cited by 2
“JAMA Intern Med 2016;176:329–337.(22) 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.”
Method
Pain and Healthy Aging
Guerriero, F., & Reid, M. C. (2019) · Springer eBooks · doi:10.1007/978-3-030-06200-2_26 · Cited by 2
The effects of mindfulness training on persistent or intermittent sub-acute pain: using the Headspace®application
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].”
Result
Systematic scoping review of interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: current evidence and future directions
Park, R., Mohiuddin, M., Poulin, P. A., Salomons, T. V., Edwards, R. R., Nathan, H., Haley, C., & Gilron, I. (2020) · PAIN Reports · doi:10.1097/pr9.0000000000000868 · Cited by 2
Traitement de la douleur du sujet âgé
Simunek, A., Perrot, S., & Trouvin, A. (2019) · Revue du Rhumatisme Monographies · doi:10.1016/j.monrhu.2019.03.003 · Cited by 2
Geriatric Pain
Sowa, G., Weiner, D. K., & Camacho‐Soto, A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-40196-8.00041-3 · Cited by 2
Self-citation
Community-based interventions to support aging in place and functional independence in older adults: a systematic review of randomized controlled trials
Kisa, A., & Kisa, S. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1828271 · Cited by 3
“Cognitive and psychological interventions primarily contributed through improvements in executive function, mood, self-efficacy, and perceived cognitive change, suggesting a stronger role as enablers of independence rather than direct determinants of functional autonomy (28, 44–47, 49, 97, 98, 106).”
Influential
“What helps your back pain?” A qualitative analysis of pain management strategies in opioid-treated adults with chronic low back pain
Woods, D. K., Nelson, E. O., Oakley, L. D., Kunkul, F., Barrett, B. P., Hua, N., Burzinski, C. A., Edwards, R. R., Garland, E. L., & Zgierska, A. E. (2024) · Journal of Opioid Management · doi:10.5055/jom.0867 · Cited by 1
Using PROMIS Methodology to Create Self-Report Measures of Mindfulness and Related Concepts
Victorson, D. E., Morone, N. E., Pilkonis, P. A., Schalet, B. D., Yu, L., Jackson, K., Dodds, N. E., Horowitz, B., Johnston, K. L., McFarland, C. E., et al. (2024) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130241290771 · Cited by 1
“8 Research evidence for the ef ﬁ cacy of MBSR and other MBIs for improving health is mounting, particularly in the areas of chronic pain reduction, 9,10 improvement in quality of life, 11-13 and reduction of symptoms of depression and anxiety.”
Self-citation
Patient‐Reported Outcomes Among an Observational Cohort of Individuals With Chronic Low Back Pain
Greco, C. M., Dodds, N. E., Acevedo, A. M., Anderst, W. J., Bell, K. M., Darwin, J., Delitto, A., Jakicic, J. M., McKernan, G., Patterson, C. G., et al. (2025) · JOR Spine · doi:10.1002/jsp2.70097 · Cited by 1
Self-citation
Integrating nonpharmacologic strategies for pain with Inclusion, Respect, and Equity (INSPIRE): a digital health study protocol for a pragmatic multisite randomized controlled trial
Ristau, J., Okobi, A., Miller, M. J., Cheng, J., Deviren, S., Schwarz, E. B., Fairchild, T., Tsoh, J. Y., Aguilera, A., Zheng-Huang, C. J., et al. (2026) · Trials · doi:10.1186/s13063-025-09402-8 · Cited by 1
Defining Therapeutic Patient Education in Musculoskeletal Care: A Scoping Review of Key Themes, Delivery Methods and Intervention Parameters
Cormier, A., Roy, J., Dupuis, F., Lafrance, S., Massé‐Alarie, H., & Desmeules, F. (2026) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2026.13784 · Cited by 1
Mindfulness-Based Group Medical Visits for Persons With Chronic Low Back Pain
Morone, N. E., Faurot, K. R., Weinberg, J., McTigue, K. M., Roth, I., Barnhill, J. L., Gardiner, P. M., Thomas, H. N., Lathren, C., Castro, M. G., et al. (2026) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2026.2186 · Cited by 2
Self-citation

Authors: Morone, N. E., Greco, C. M., Moore, C. G., Rollman, B. L., Lane, B., Morrow, L. A., Glynn, N. W., & Weiner, D. K.
Affiliations: University of Pittsburgh (US)
Carolinas Healthcare System (US)
Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Corresponding author: Morone, Natalia E.
ORCID: Morone, Natalia E.
Greco, Carol M.
Rollman, Bruce L.
Glynn, Nancy W.
Weiner, Debra K.
Venue: JAMA Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2016-03-01
Volume: 176
Issue: 3
Pages: 329
ISSN: 2168-6106 (ISSN-L)
DOI: 10.1001/jamainternmed.2015.8033
PMC: PMC6361386
OpenAlex: W2284879964
Cited by: 258
References: 36
Citations by year: 2026: 13 · 2025: 24 · 2024: 27 · 2023: 18 · 2022: 30 · 2021: 26 · 2020: 32 · 2019: 26 · 2018: 24 · 2017: 24 · 2016: 14
FWCI: 23.71
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Aging (R01AG034078)
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 › Physiology (medical) › Pain Mechanisms and Treatments
Keywords: chronic low back pain, older adults, mind-body interventions, mindfulness-based stress reduction, non-pharmacological pain management, functional disability, pain intensity, quality of life, pain self-efficacy, mindfulness, health education, community-dwelling older adults, analgesic side effects, cognitive behavioral therapy, spinal manipulation, acupuncture, Tai Chi
MeSH terms: Aged, Analgesics, Disability Evaluation, Female, Follow-Up Studies, Health Education, Humans, Male, Pain Measurement, Pennsylvania, Psychophysiology, Quality of Life, Surveys and Questionnaires, Single-Blind Method, Treatment Outcome, Low Back Pain, Meditation, Chronic Pain, Mindfulness

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

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