Low back pain affects over 600 million people and is the single leading cause of disability worldwide. New research from Boston Medical Center (BMC), the largest primary care hospital in New England, suggests that the Optimizing Pain Treatment In Medical settings Using Mindfulness (OPTIMUM) trial, where a tailored group mindfulness program was delivered via primary care telehealth to patients with chronic low back pain, produced consistent pain reduction and improvements in patients’ daily lives. The findings, published in JAMA Internal Medicine, highlight a scalable, non-pharmacological approach to the treatment of chronic pain.
Chronic low back pain can not only limit a person’s ability to walk, work, sleep, and socialize, but it can also negatively affect a person’s mental health and overall well-being. Low back pain is also one of the most common reasons people visit their primary care physician, yet the treatment options typically available are limited. Medicines carry risks, surgery only helps a narrow subset of patients, and access to effective non-pharmacological treatments can be difficult.
What our program does is give people real, repeatable skills on how to respond to pain differently. Once patients have these skills, they seem to promote them and we see improvements that last beyond the program.”
Natalia Morone, MD, MS, lead author of the study and a primary care and internal medicine clinician at BMC
The researchers tested a version of Mindfulness-Based Stress Reduction (MBSR) tailored specifically to treat pain as a stressor. 451 participants in three states attended 120-minute group sessions over an eight-week period. Sessions were conducted by a trained mindfulness instructor and primary care physician. Instead of referring patients to a separate program, the OPTIMUM trial brought the clinician into the room and gave each participant direct access to a physician as an integral part of the experience. Through gentle stretching exercises and mindfulness activities, participants learned to work with their pain rather than against it, adjusting their activities and building awareness of how pain shapes their lives.
The team found that participants showed significant improvements in pain and pain interference, or how much pain limited their physical activity and enjoyment of life measured on a scale of 0 to 10, with these gains maintained at 12-month follow-up.
The trial was designed to reach as many patients as possible. Entry criteria were intentionally broad to reflect the diversity of real patients, and the telehealth approach removed the transportation and scheduling barriers that often prevent people from accessing structured programs. The program model is also billable as a group medical visit, meaning it can be reimbursed through existing payment structures in a tiered fashion.
“We have evidence-based guidelines, but the challenge has been to get these approaches to more people,” Dr. Morone said. “If we can bring evidence-based treatment into primary care and create a model that can support the health care system, we have a real opportunity to help many more people. That’s what drives this research—to deliver effective care to the people who need it most.”
