Although numerous treatments exist for low back pain, few provide real relief for the one in four Americans living with this chronic and disabling condition, which is also a significant cause of disability worldwide. More than 80% of individuals with chronic low back pain report a strong desire for better treatment options. In the absence of sufficient relief, many turn to opioid medications, which, while offering temporary alleviation, carry serious risks of addiction.
A multi-institutional research team led by Penn State College of Medicine and the University of Wisconsin-Madison has delivered promising results. In a randomised clinical trial, they found that eight weeks of either mindfulness-based therapy or cognitive behavioural therapy (CBT) led to significant improvements in physical function, pain levels, quality of life, and even reductions in opioid use. Importantly, these benefits lasted up to 12 months after treatment.
Published on 7 April in JAMA Network Open, this study is the largest trial yet to directly compare mindfulness and CBT for opioid-treated chronic low back pain, and it involved a longer follow-up than previous research. “Both mindfulness and cognitive behavioural therapy were shown to be safe, effective treatments, providing lasting benefits for people with opioid-treated chronic back pain,” said Professor Aleksandra Zgierska, lead author of the study. She called for these therapies to be standard options within routine clinical care.
Chronic low back pain is complex, often involving physical, emotional, and psychological components. Although behavioural therapies have been previously suggested as helpful, earlier studies tended to be small and short-term. Professor Eric Garland of the University of California, San Diego, noted that pain is still primarily viewed as a purely physical issue despite growing evidence that psychological interventions can be equally crucial.
The trial enrolled 770 adults across three sites: Madison, Wisconsin; Boston, Massachusetts; and Salt Lake City, Utah. All participants had moderate-to-severe low back pain and functional impairments and had been using opioids daily for at least three months. They were randomly assigned to receive either mindfulness or CBT through therapist-led group sessions lasting two hours each week for eight weeks. Participants also practised daily at home and continued their regular care.
Both groups reported lasting improvements at follow-up intervals of three, six, nine, and twelve months. Participants experienced reduced pain, improved ability to carry out daily activities, enhanced quality of life, and lower opioid dosages, even though they were not directly instructed to decrease their medication use. These findings suggest that learning new coping strategies naturally led participants to manage their symptoms more independently.
Penney Cowan, founder of the American Chronic Pain Association and co-author of the study, described the findings as a vital hope. “People can live with pain, but they need to know how to manage it. This study shows they can,” she said. The researchers stressed that mindfulness and CBT are not cures but powerful tools. As Professor Garland explained, these therapies teach patients to draw on their internal resources, offering lasting relief and improved quality of life, even amidst ongoing chronic pain.
More information: Aleksandra Zgierska et al, Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.3204
Journal information: JAMA Network Open Provided by Penn State
