Low back pain treated with opioids: accounts from patients who improved after psychological therapy

Interviews after a twelve-month trial

The researchers interviewed 50 adults who had completed a twelve-month randomized trial comparing mindfulness-based therapy with cognitive behavioral therapy, or CBT. Of these, 26 had received the first approach and 24 the second.

To be invited to the interviews, participants had to have attended sessions and reported improvements in the main outcomes assessed and in their experience of the intervention. This recruitment therefore selects for favorable experiences: it does not represent everyone enrolled in the trial.

At baseline, these participants were, on average, moderately to severely affected by their low back pain and were receiving daily opioid doses described as moderate to high.

Reported benefits beyond pain relief

At twelve months, these participants’ questionnaires indicated improvements in pain, functioning and quality of life, along with a reduction in daily opioid dose. The interviews echoed these findings, and most participants attributed these changes to the therapy they had received.

Participants also reported help in coping with emotional difficulties, stressful events and opioid-related adverse effects. The thematic analysis identified techniques they had been taught and were using to manage their symptoms, but the supplied abstract does not describe them in detail.

These accounts document what patients who improved consider useful. On their own, they cannot establish which mechanisms explain their progress.

What this study cannot establish

Although the interviews came from a randomized trial, this qualitative analysis is not a new comparative demonstration of efficacy. The abstract provides neither the full trial results nor an estimate that would allow a judgment on which therapy performed better.

Participants expressed no concerns about the safety of the interventions. However, this absence of a signal in their accounts does not constitute a comprehensive assessment of adverse effects.

The value of this work therefore lies in better understanding a favorable experience, without turning it into a promise for all patients or a reason to change opioid treatment on your own.

What we can take away

This study describes how some patients who improved perceive the help provided by mindfulness and CBT. It measures neither an individual’s chances of benefiting nor the superiority of either approach.