CATEGORY: STRESS & MIND-BODY
The trial team expected mindfulness to beat cognitive behavioral therapy. It did not. Among 770 adults whose chronic low back pain had persisted while they took daily opioid medication, eight weeks of mindfulness training and eight weeks of CBT, the long-established standard, finished level with each other. At six and twelve months the two groups’ pain ratings sat within about a quarter of a point on a ten-point scale, a gap about the width of a pencil line on a ten-inch ruler. Physical function improved and opioid doses fell in both groups, with no serious side effects reported.1
Eight Weeks of Classes Aimed at Years of Pain
The two programs had the same shape and taught opposite-looking skills. Each ran eight weekly two-hour group sessions led by a trained therapist, plus 30 minutes of home practice six days a week. Mindfulness meditation trains a person to notice body sensations, pain included, with steady attention and without judgment. Over time that can loosen the grip those sensations hold on mood and movement. Cognitive behavioral therapy, or CBT, is a structured talk therapy that teaches people to catch and redirect the thought patterns that amplify chronic pain, catastrophizing and fear of movement among them. Participants kept seeing their regular doctors throughout and were given no instructions about their medications.
Three Cities and a Full Year of Follow-Up
Researchers in Madison, Boston and Salt Lake City enrolled 770 adults, average age 58, about 56% of them women. All had back pain that persisted despite treatment, and all had been taking opioids at a meaningful dose, at least 15 morphine-milligram equivalents a day, for three months or longer. A coin toss, in effect, decided which program a person entered. Pain intensity averaged 6.1 at the outset on a 0-to-10 scale. Pain-related disability, on a standard 0-to-100 questionnaire, started at 47.2, which is solidly moderate to severe. Both measures were taken again at six and twelve months, alongside quality of life and daily opioid dose.
The Gap Never Reached Half a Point
Both groups got meaningfully better. The distance between them was too small to matter or to reach statistical significance: 0.21 points of pain at six months, 0.13 at twelve, with functional-limitation scores essentially identical. Mindfulness cleared the trial’s formal bar for being no worse than CBT. Improvements in pain, function and quality of life held across the whole year, in a group whose pain had already outlasted many treatments. Opioid doses drifted down on both sides even though neither program asked anyone to cut back. One thing this design cannot show is how either group would have fared with no therapy at all, since everyone received an active treatment. An earlier randomized trial covered that ground. Among 342 adults with chronic low back pain, 61% assigned to mindfulness-based stress reduction and 58% assigned to CBT reached meaningful functional improvement at six months, against 44% who got usual care alone.2 The two trials converge: mindfulness and CBT work about equally well, and both beat doing nothing extra.
Key Takeaways
- Eight weeks of group mindfulness training matched cognitive behavioral therapy for chronic low back pain treated with opioids. Final pain scores differed by roughly a quarter point or less on a ten-point scale, gains in pain, function and quality of life lasted a full year, and daily opioid doses declined in both groups without any instruction to reduce them.
- The researchers had expected mindfulness to win outright. The tie leaves two interchangeable options rather than two useless ones, a reading backed by an earlier trial in which both therapies beat usual care.
References
- Zgierska AE, Edwards RR, Barrett B, et al. Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical Trial. JAMA Network Open. 2025;8(4):e253204. link
- Cherkin DC, Sherman KJ, Balderson BH, et al. 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. JAMA. 2016;315(12):1240–1249. link