Mindfulness-based interventions (MBIs) are often recommended as first-line or ancillary treatments for chronic pain. However, several barriers prevent widespread access to these programs. including cost, the availability of nearby programs, and the challenge of coordinating patients’ schedules with group session times. 

Newer programs using smartphone and telehealth technologies allow chronic pain patients to learn mindfulness at home, often on their own schedule and at a lower cost. Burgess et al. [JAMA Internal Medicine] conducted a randomized controlled trial to compare the effect of a group-based and a self-paced telehealth MBIs in treating veterans with chronic pain, compared to a treatment-as-usual (TAU) control group.

The researchers randomly assigned 811 American veterans with moderate-to-severe chronic pain (average age = 55; 52% male; 66% White), recruited from three Veterans Affairs (VA) facilities, into one of three groups: a group-based telehealth MBI with treatment as usual, a self-paced telehealth MBI with treatment as usual, or a treatment-as-usual only group. Both MBIs were 8-week programs modeled the after Mindfulness-Based Stress Reduction program.  

The group-based MBI included an orientation session and eight 90-minute synchronous group telehealth sessions, featuring pre-recorded mindfulness education and exercises, followed by facilitated discussions. Participants were encouraged to practice at home using a workbook, smartphone app, and website with guided meditations. 

The self-paced MBI group consisted of eight 30- to 60-minute asynchronous sessions using the same pre-recorded materials as the group-based MBI but without facilitated discussion. Instead, participants received three phone calls from facilitators to address problems, monitor progress, and discuss strategies. TAU included the availability of acupuncture, massage, exercise, yoga, tai chi, meditation, medication, spinal injections, and counseling and psychotherapy. All groups  used the non-meditation TAU modalities to a similar extent, and 42% of the TAU group also accessed some form of meditation or mindfulness training on their own. 

Patients were assessed at 10 weeks, 6 months, and 12 months on primary and secondary outcomes. The primary outcome was improvement in pain-related impairment of daily activities. Secondary outcomes included anxiety, depression, fatigue, sleep disturbance, PTSD, and social role functioning. Sixty-nine percent of the group-based MBI participants completed 6 or more of the group sessions, while 76% of the self-paced group participated in at least two facilitator calls. 

Averaged over the three assessment periods, the group-based MBI (effect size = -0.20) and the self-paced MBI (effect size= -0.40) had significantly lower pain interference scores with their daily lives compared to the TAU controls. There was no significant difference in effect between the two MBI groups. The group-based MBI had significantly lower pain-related interference scores at 10 weeks and 6 months, while the self-paced MBI outperformed the TAU group at all time points. 

A greater percentage of patients in both MBI groups attained 30% and 50% pain improvement over baseline compared to controls. MBI groups showed significantly better improvement on almost all the secondary measures compared to the TAU group. There were no differences between the MBI groups on these secondary measures. No adverse events were reported in any of the study groups

The study reveals that telehealth-delivered MBIs can reduce veteran pain interference with daily life scores compared to TAU. Although the effect sizes were small, they persisted throughout the follow-up period. Notably, the group-based MBI conferred no additional benefit over a self-paced MBI. The study is limited by the lack of comparison between telehealth and in-person treatment, as well as MBIs and other evidenced-based treatments like cognitive-behavioral therapy.

Reference:

Burgess, D. J., Calvert, C., Hagel Campbell, E. M.,… Taylor, B. C. (2024). Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Internal Medicine.

Link to study