For Back Pain Treated With Opioids, Mindfulness Rivaled the Established Therapy

CATEGORY: STRESS & MIND-BODY

Adults who had lived with chronic low back pain while taking daily opioid medication improved about as much with eight weeks of mindfulness training as with cognitive behavioral therapy, the long-established standard, in a 770-person randomized trial published in JAMA Network Open.¹ At both six and twelve months, the two groups’ pain ratings sat within about a quarter of a point of each other on a ten-point scale—a gap about the width of a pencil line on a ten-inch ruler—while physical function improved and opioid doses fell in both groups, with no serious side effects reported.

Eight Weeks of Classes Aimed at Years of Pain

The two programs took the same shape—eight weekly two-hour group sessions led by a trained therapist, plus 30 minutes of home practice six days a week—but taught very different skills. Mindfulness meditation trains a person to notice body sensations, including pain itself, with steady attention and without judgment, which over time 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 recognize and redirect the unhelpful thought patterns—catastrophizing, fear of movement—that amplify chronic pain. Participants kept seeing their regular doctors throughout and were given no instructions about their medications.

Three Cities, One Coin Flip, One Full Year

Researchers at sites in Madison, Boston and Salt Lake City enrolled 770 adults—average age 58, about 56% women—whose low back pain had persisted despite treatment and who had been taking opioids at a meaningful dose (at least 15 morphine-milligram equivalents a day) for three months or longer. Each participant was assigned by chance to one program or the other, the design that makes the two groups alike in everything but the treatment being tested. Pain intensity on a 0-to-10 scale started at an average of 6.1, and pain-related disability on a standard 0-to-100 questionnaire at 47.2—solidly moderate to severe. Both were measured 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, and the differences between them were too small to matter or to reach statistical significance: 0.21 points of pain at six months and 0.13 at twelve, with functional-limitation scores essentially identical. Mindfulness met the trial’s formal bar for being no worse than CBT, and improvements in pain, function and quality of life lasted through the full year—notable in a group whose pain had already outlasted many treatments. Opioid doses declined in both groups over the year even though neither program asked participants to cut back.

The Researchers Bet on a Winner and Got a Tie

The trial team went in hypothesizing that mindfulness would prove superior. It did not; the result was a draw. That reframes the practical meaning of the study: rather than crowning a better therapy, it doubles the menu of proven non-drug options for one of the hardest problems in pain medicine—chronic back pain that persists even on long-term opioids.

A Decade-Old Trial Fills In the Missing Comparison

Because everyone in the new trial received an active treatment, it cannot say how either group would have fared with no therapy at all. An earlier randomized trial answered that: among 342 adults with chronic low back pain, 61% of those assigned to mindfulness-based stress reduction and 58% assigned to CBT achieved meaningful functional improvement at six months, versus 44% who got usual care alone.² Together the two trials point the same way—mindfulness and CBT work about equally well, and both beat doing nothing extra.

Key Takeaways

• In a 770-person randomized trial, eight weeks of group mindfulness training matched cognitive behavioral therapy for opioid-treated chronic low back pain, with benefits in pain, function and quality of life lasting a full year.
• Final pain scores differed by roughly a quarter point or less on a ten-point scale, and daily opioid doses declined in both groups without any instruction to reduce them.
• The researchers had expected mindfulness to come out ahead; instead the trial showed the two therapies are interchangeable options, which matters where one or the other is easier to find.
• An earlier trial found both therapies beat usual care, so the tie reflects two effective treatments rather than two ineffective ones.

References

1. 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
2. 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