Chronic low back pain is one of the most common and disabling health problems in the world.
In the United States, about one in four adults suffers from this condition, and many rely on opioids for relief when other treatments fail.
Unfortunately, opioids can be addictive and often do not solve the problem in the long term. Many people with back pain say they wish there were better options.
Now, a new study brings hope.
Researchers from Penn State College of Medicine and the University of Wisconsin-Madison, along with partners in Boston and Salt Lake City, tested two behavioral therapies—mindfulness and cognitive behavioral therapy (CBT)—in people with chronic back pain who were already taking opioids.
The study included 770 adults, making it the largest trial of its kind so far. The results, published in JAMA Network Open, show that both approaches helped participants experience less pain, improved daily functioning, better quality of life, and even reduced opioid use.
The participants had been struggling with moderate to severe back pain for years, and their condition was serious enough to require daily opioid treatment for at least three months. Most had tried many other therapies without success.
They were divided into two groups.
One group received mindfulness training, learning to pay attention to their body’s sensations and how to respond calmly to pain. The other group received CBT, which focused on recognizing and changing negative thought patterns about pain.
Both groups attended two-hour sessions led by therapists once a week for eight weeks. They were also asked to practice at home for about 30 minutes a day, six days a week, throughout the year-long study.
Importantly, participants were not asked to cut down their opioid use. Yet, many did so voluntarily after learning new coping tools. The researchers explained that by using mindfulness or CBT strategies, people gained more control over how they reacted to pain and stress.
For example, some participants learned to take a mindful breath before reaching for pain medication, which helped them reduce how often they needed it.
At the three, six, nine, and twelve-month check-ins, participants reported lasting improvements. Both mindfulness and CBT helped reduce pain and improve mental and physical well-being.
Participants also reported better ability to perform daily activities and improved overall quality of life. In both groups, opioid use decreased over time, showing that these therapies may help people depend less on medication.
Experts emphasize that chronic pain is not only a physical problem but also affects emotions, thoughts, and overall life satisfaction. Behavioral therapies like mindfulness and CBT don’t remove pain completely, but they give people tools to manage it.
According to Penney Cowan, founder of the American Chronic Pain Association and a co-author of the study, the goal of treatment is to reduce suffering and improve life quality. These therapies seem to achieve exactly that.
Another strength of this research was the involvement of patients and advocacy groups in planning the study.
This ensured that the trial reflected real-world needs and experiences of people living with chronic pain. Participants’ feedback confirmed that these methods were practical and meaningful in everyday life.
The researchers stress that mindfulness and CBT are not cures, but valuable additions to a “toolbox” of coping strategies. Unlike surgery or medication, these approaches come from within and can be used across different pain conditions.
They are safe, non-addictive, and empower people to manage their pain on their own.
In conclusion, this large clinical trial shows that both mindfulness and CBT can provide lasting benefits for people with chronic back pain, even those who rely on opioids. These therapies not only improve physical function and quality of life but also help reduce dependence on addictive medications.
For the millions struggling with chronic back pain, this study offers a message of hope: with the right tools, it is possible to live a better and healthier life.
The study is published in JAMA Network Open.
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