Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial.
Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial.
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DOI：
10.1001/jama.2016.2323
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发表时间：
2016-03-22
期刊：
影响因子：
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通讯作者：
Turner JA
中科院分区：
文献类型：
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作者：
Cherkin DC;Sherman KJ;Balderson BH;Cook AJ;Anderson ML;Hawkes RJ;Hansen KE;Turner JA
基于正念的减压（MBSR）尚未对患有慢性腰痛的年轻人和中年人进行严格的评估。评价正念减压疗法与常规治疗（UC）和认知行为疗法（CBT）治疗慢性下腰痛的疗效。一项在华盛顿州综合医疗保健系统中进行的随机、访视盲、对照试验，纳入了342名20-70岁的CLBP成人，这些成人于2012年9月至2014年4月期间入组，并随机分配至MBSR组（n = 116）、CBT组（n = 113）或UC组（n = 113）。CBT（改变疼痛相关想法和行为的训练）和MBSR（正念冥想和瑜伽的训练）被分为8个每周2小时的小组。UC包括参与者接受的任何护理。共同主要结局是第26周时功能限制（改良罗兰残疾问卷[RDQ];范围0 - 23）和自报背痛困扰（0 - 10量表）较基线有临床意义（≥30%）改善的受试者百分比。还在第4、8和52周时评估了结局。在342名随机参与者中（平均年龄49岁（范围20-70岁）; 225名（66%）女性;平均背痛持续时间7.3年（范围3个月至50年），<60%参加了8个疗程中的6个或更多个疗程，294名（86.0%）在26周时完成了研究，290名（84.8%）完成了52周的研究。在意向治疗分析中，在26周时，MBSR（61%）和CBT（58%）的RDQ有临床意义改善的参与者百分比高于UC（44%）（总体P = 0.04; MBSR与UC：RR [95% CI] = 1.37 [1.06至1.77]; MBSR与CBT：0.95 [0.77至1.18]; CBT vs UC：1.31 [1.01至1.69]。在疼痛困扰方面有临床意义改善的受试者百分比在MBSR组为44%，在CBT组为45%，在UC组为27%（总体P = 0.01; MBSR与UC：1.64 [1.15至2.34]; MBSR与CBT：1.03 [0.78至1.36]; CBT与UC：1.69 [1.18至2.41]）。在52周时，正念减压疗法的两个主要结局的结果保持不变。在患有慢性腰痛的成年人中，与UC相比，MBSR和CBT治疗在26周时导致背痛和功能限制的更大改善，MBSR和CBT之间的结局无显著差异。这些发现表明，正念减压疗法可能是慢性腰痛患者的一种有效治疗选择。
Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. To evaluate the effectiveness for chronic low back pain of MBSR versus usual care (UC) and cognitive-behavioral therapy (CBT). Randomized, interviewer-blind, controlled trial in integrated healthcare system in Washington State of 342 adults aged 20–70 years with CLBP enrolled between September 2012 and April 2014 and randomly assigned to MBSR (n = 116), CBT (n = 113), or UC (n = 113). CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. UC included whatever care participants received. Co-primary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range 0 to 23) and in self-reported back pain bothersomeness (0 to 10 scale) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks. Among 342 randomized participants (mean age, 49 (range, 20–70); 225 (66%) women; mean duration of back pain, 7.3 years (range 3 months to 50 years), <60% attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks and 290 (84.8%) completed the study 52weeks. In intent-to-treat analyses, at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for MBSR (61%) and CBT (58%) than for UC (44%) (overall P = 0.04; MBSR versus UC: RR [95% CI] = 1.37 [1.06 to 1.77]; MBSR versus CBT: 0.95 [0.77 to 1.18]; CBT versus UC: 1.31 [1.01 to 1.69]. The percentage of participants with clinically meaningful improvement in pain bothersomeness was 44% in MBSR and 45% in CBT, versus 27% in UC (overall P = 0.01; MBSR versus UC: 1.64 [1.15 to 2.34]; MBSR versus CBT: 1.03 [0.78 to 1.36]; CBT versus UC: 1.69 [1.18 to 2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes. Among adults with chronic low back pain, treatment with MBSR and CBT, compared with UC, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.