IMPORTANCE: Although mindfulness-based interventions (MBIs) are evidence-based treatments for chronic pain and comorbid conditions, implementing them at scale poses many challenges, such as the need for dedicated space and trained instructors.
OBJECTIVE: To examine group and self-paced, scalable, telehealth MBIs, for veterans with chronic pain, compared to usual care.
DESIGN, SETTING, AND PARTICIPANTS: This was a randomized clinical trial of veterans with moderate to severe chronic pain, recruited from 3 Veterans Affairs facilities from November 2020 to May 2022. Follow-up was completed in August 2023.
INTERVENTIONS: Two 8-week telehealth MBIs (group and self-paced) were compared to usual care (control). The group MBI was done via videoconference with prerecorded mindfulness education and skill training videos by an experienced instructor, accompanied by facilitated discussions. The self-paced MBI was similar but completed asynchronously and supplemented by 3 individual facilitator calls.
MAIN OUTCOMES AND MEASURES: The primary outcome was pain-related function using the Brief Pain Inventory interference scale at 3 time points: 10 weeks, 6 months, and 1 year. Secondary outcomes included biopsychosocial outcomes: pain intensity, physical function, anxiety, fatigue, sleep disturbance, participation in social roles and activities, depression, patient ratings of improvement of pain, and posttraumatic stress disorder.
RESULTS: Among 811 veterans randomized (mean [SD] age, 54.6 [12.9] years; 387 [47.7%] women), 694 participants (85.6%) completed the trial. Averaged across all 3 time points, pain interference scores were significantly lower for both MBIs compared to usual care (group MBI vs control difference: -0.4 [95% CI, -0.7 to -0.2]; self-paced vs control difference: -0.7 [95% CI, -1.0 to -0.4]). Additionally, both MBI arms had significantly better scores on the following secondary outcomes: pain intensity, patient global impression of change, physical function, fatigue, sleep disturbance, social roles and activities, depression, and posttraumatic stress disorder. Both group and self-paced MBIs did not significantly differ from one another. The probability of 30% improvement from baseline compared to control was greater for group MBI at 10 weeks and 6 months, and for self-paced MBI, at all 3 time points.
CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, scalable telehealth MBIs improved pain-related function and biopsychosocial outcomes compared to usual care among veterans with chronic pain. Relatively low-resource telehealth-based MBIs could help accelerate and improve the implementation of nonpharmacological pain treatment in health care systems.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04526158.
| Discipline Area | Score |
|---|---|
| Psychologist |  |
| Physician |  |
| Nurse | |
Nurse rater
This article reports significant and clinically meaningful subjective and objective outcomes in a multisite RCT of two eight-week mindfulness-based interventions (a group intervention, a self-paced intervention, cf usual care comparator), delivered through telehealth for N=811 United States veterans with moderate to severe chronic pain. Both interventions seems to have favorable benefit:risk, and relative to other treatment options might be feasible as an option that is not as prohibitively resource-intensive and potentially more cost-effective than clinic-based management.
Physician rater
The suggestion that low-resource telehealth-based MBIs could help accelerate, expedite, and improve the integration and implementation of non-pharmacological pain treatment into healthcare systems seems like a viable and interesting option. I am, however, concerned that it may not be translatable to other cultures or countries, especially the less developed nations where there are still significant stigma, prejudices, and ignorance about the basics of pain management.
Physician rater
Nice trial design, however, I consider the research question behind it not really thrilling.
Physician rater
This RCT had a great degree of selection bias that makes it hard to transfer this evidence into pragmatic everyday life in general practice. Moreover, measuring latent traits like pain and psychosocial outcomes validly is difficult. Therefore, psychometric issues like unidimensionality of the scales and differential item functioning would be expected to be investigated to know whether the primary and secondary outcomes are invariantly and validly measured.
Physician rater
It could help implementing non-pharmacological pain treatments.
Physician rater
A great and very useful article.
Physician rater
These telehealth interventions are way under utilized compared with the amount of evidence supporting their effectiveness. Health systems need to do more of this.
Physician rater
Needs very clear description of the intervention. For complex interventions such as this, it is very difficult to know what components were necessary to be effective.
Ms. Heather Taylor (8/27/2024 11:06 AM)
This trial showed that mindfulness-based interventions were effective in reducing pain and disability in veterans with chronic pain and high levels of psychiatric conditions. These interventions are relatively low cost with minimal to no side effects, making them good alternatives for pain management in this population.
, McMaster University