Remote mindfulness training aided veterans with chronic pain
Mindfulness training delivered via telehealth or in a self-paced program had a greater effect on chronic pain than usual care, a Veterans Affairs study concluded.
Scalable telehealth mindfulness programs improved pain-related function and other outcomes among veterans with chronic pain, according to a study.
Researchers conducted a randomized clinical trial among veterans with moderate to severe chronic pain recruited from three Veterans Affairs facilities from November 2020 to May 2022. One group received group mindfulness training via telehealth with prerecorded mindfulness education and skill training videos by an experienced instructor, accompanied by facilitated discussions. Another group participated in a similar self-paced mindfulness program, supplemented by three individual facilitator calls. The other patients received usual care.
The primary outcome was pain-related function using the Brief Pain Inventory interference scale at three time points of 10 weeks, six months, and one year. Secondary outcomes included pain intensity, physical function, anxiety, fatigue, sleep disturbance, participation in social roles and activities, depression, patient ratings of improvement of pain, and post-traumatic stress disorder. Results were published online Aug. 19 by JAMA Internal Medicine.
Among 694 participants who completed the trial, pain interference scores were significantly lower for both mindfulness programs compared to usual care across the three time points (telehealth group vs. control difference, −0.4 [95% CI, −0.7 to −0.2]; self-paced group vs. control difference, −0.7 [95% CI, −1.0 to −0.4]). Both mindfulness arms had significantly better scores on the secondary outcomes. The study authors calculated that the probability of 30% improvement from baseline compared to control was greater for the telehealth group than the usual care group at 10 weeks and six months and for the self-paced group versus the usual care group at all three time points.
Limitations include that roughly half of participants in the usual care arm also used meditation/mindfulness throughout the study, as well as other concomitant treatment for chronic pain. However, the study authors noted that multimodal treatment is the standard of care for chronic pain management, and mindfulness programs are typically used as adjunct interventions.
An accompanying editorial stated that mindfulness interventions target counterproductive ways in which patients think about and react to their problems, providing patients with strategies and tools “to become more fully aware of what is going on in their minds and hearts that is negatively impacting their lives.” Unlike medications and surgery for a specific condition, mindfulness programs teach patients techniques that are helpful for more effectively managing all of their life stresses, and it was “heartening” to see the VA conducting such research, the editorial said.