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Mindfulness, cognitive therapy top conventional care for low back pain

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Shift to mind-body approach for chronic low back pain?

The potential relevance of mind-body interventions for chronic low back pain derives from the tremendous individual and societal burden caused by this disabling, costly, and increasingly prevalent condition.

[Increasingly], chronic pain management demands shifting away from the biomedical disease model focused on cure to a biopsychosocial model in which physicians and other clinicians guide patient-centered care that emphasizes patient engagement in daily self-management using a range of tools.

A critical component of self-management includes home practice and the daily implementation of skills learned. Although it does not appear that this component was assessed in this trial, future studies should examine the relationship of home practice and skill development with clinical outcomes to enhance understanding of how these interventions work and help identify the most appropriate candidates for these treatments.

Dr. Madhav Goyal and Dr. Jennifer A. Haythornthwaite are both at Johns Hopkins University in Baltimore. These remarks come from their editorial accompanying the study (JAMA. 2016 Mar;315[12]:1236-7).


 

FROM JAMA

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“Just because something isn’t covered by insurance doesn’t mean it isn’t helpful and cost effective,” he explained. “And on the opposite side, many things that are covered by insurance are not very helpful.”

Dr. Cherkin cautioned that, while the findings of this study are promising – especially as they relate to the growing desire by both providers and patients to turn away from opioids for chronic pain management – these findings are ultimately just one step along a longer journey.

“Opioids are often resorted to out of desperation by both physicians and patients who both feel there isn’t any alternative, and physicians don’t like to see their patients continuing to suffer,” said Dr. Cherkin. “Things have gotten way out of whack over the years, because there has not been an evidence-based approach to ensuring that what is most helpful for patients is available and offered by insurance.

“If we can look at the most effective treatment options available to patients that have low risks of addiction, death, or other harm and make those available so physicians can include those in their repertoire of what they feel they can offer patients, we’re going to be in much better shape,” Dr. Cherkin noted.

The National Center for Complementary and Integrative Health funded the study. The authors did not report any relevant financial disclosures.

dchitnis@frontlinemedcom.com

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