Study Highlights Role of Cognitive Behavioral Therapy in Lowering Chronic Back Pain

A new study has found that eight weeks of either mindfulness or cognitive behavioral therapy (CBT) training led to meaningful improvements among adults with chronic low back pain that’s currently treated with opioids and had not responded to prior treatments. These behavioral therapies helped improve physical function and quality of life and reduce pain and opioid dose in a randomized clinical trial. The benefits persisted for up to 12 months. The findings were published today in JAMA Network Open.

The team enrolled 770 adults to participate in a randomized clinical trial conducted in three sites — Madison, Wisconsin; Boston, Massachusetts; and Salt Lake City, Utah. Participants, on average, experienced moderate-to-severe pain, functional limitations, compromised quality of life and numerous prior treatments for their chronic low-back pain and were treated with daily opioid medications for at least three months.

Participants were then assigned to either receive mindfulness-based therapy or CBT, which were conducted in therapist-led, two-hour group sessions for eight weeks. The mindfulness group learned to notice the sensations they experienced, giving them more control over how they related and respond to the pain and other symptoms. The CBT group learned coping skills and strategies to change their negative thought patterns. Participants were instructed to practice on their own for 30 minutes a day, six days a week during the 12-month study and to continue with their routine care. They were not instructed to reduce their opioid dosage. They reported on their pain level, ability to do daily activities, mental and physical health-related quality of life and daily opioid medication use at the start of the study and after three, six, nine and 12 months.

At the end of the study, participants in both groups reported significant and long-lasting benefits including reductions in pain and daily opioid dose. They also reported increased function and health-related quality of life through 12 months. Both mindfulness and CBT tools were shown that they could be effective and used safely over the long-term, the researchers said.

Reference: 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 Netw Open. 2025;8(4):e253204. doi:10.1001/jamanetworkopen.2025.3204