Meditation and cognitive behavioral therapy pay off for back pain

Dr. Cherkin reflects on new results suggesting CBT is cost-effective, and mindfulness-based stress reduction may be cost-saving

by Daniel Cherkin, PhD, senior investigator emeritus at Kaiser Permanente Washington Health Research Institute

Last year JAMA published results from our randomized controlled trial showing that back pain eased in patients who took a class in either a kind of meditation called mindfulness-based stress reduction (MBSR) or cognitive behavioral therapy (CBT). Chronic low back pain is expensive in terms of health care costs and lost productivity. But little is known about the cost-effectiveness of mind-body interventions like MBSR and CBT.

That’s why we worked on a cost analysis with our colleague Patricia Herman, ND, PhD, a senior behavioral scientist at the RAND Corporation. Now we’ve published in SPINE that CBT is probably cost-effective — and MBSR is likely to be cost saving: Cost-Effectiveness of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care among Adults with Chronic Low-Back Pain.

We found that MBSR — but not CBT — reduced overall and back- related health care costs when compared with usual care. We also took into account loss of productivity at work: both absenteeism and “presenteeism,” when workers are present but health problems interfere with their work.

Lowering costs unrelated to back pain

Intriguingly, compared with usual care, both CBT and MBSR reduced health care costs that were not related to back pain. Evidently these interventions have potentially wide-ranging health impacts, because they may change how people perceive pain.

More than 300 Kaiser Permanente Washington patients aged 20 to 70 took part in the trial. Their low back pain had lasted at least three months and could not be attributed to a specific cause. They were randomly assigned to receive either usual care or 8 weekly 2-hour group sessions of either MBSR or CBT.

The National Center for Complementary and Integrative Health of the National Institutes of Health supported this research (award number R01AT006226).

Dr. Herman’s and my coauthors are Karen Sherman, PhD, Ben Balderson, PhD, and Melissa Anderson, MS, at Kaiser Permanente Washington Health Research Institute; and Judith Turner, PhD, of the University of Washington (UW) School of Medicine’s Departments of Psychiatry and Behavioral Sciences and Rehabilitation Medicine.