Back pain: What do psychological procedures do?

Mindfulness training or behavioural therapy?

In both cognitive behavioural therapy and so-called mindfulness-based therapy (MBT), patients learn to face pain in a new way so that they can live with it better.

Previous studies have shown that these methods are promising. However, there was a lack of knowledge about the long-term effect of cognitive behavioural therapy, and there were only a few studies for MBT.

Together with his team, Garland has now investigated the effectiveness of both methods on 770 patients with chronic lower back pain. All of them suffered from such serious complaints that they had to take opioids. Various previous treatment attempts had not been able to sufficiently alleviate the pain.

Practice for 30 minutes a day

Half of the participants participated in a behavioural therapy group session led by a therapist twice a week over a period of eight weeks. Instead, the other half completes mindfulness training in the group twice a week.

During this time and in the following ten months, the participants were to complete 30 minutes of corresponding behavioural or mindfulness exercises on their own every day. They were not specifically stimulated to reduce their opioid dose.

Less pain, more quality of life

At the end of the study, participants in both groups reported noticeable and long-lasting improvements. Their pain had decreased, and many participants reduced their opioid dose on their own initiative.

In addition, the women and men reported an improved health-related quality of life even after twelve months.

Cognitive behavioural therapy – established approach

Cognitive behavioural therapy is the standard psychological treatment for people with chronic pain and is therefore part of the treatment guidelines. Among other things, those affected learn to change negative thoughts and thus also negative feelings.

Mindfulness-based therapy – Alternative psychological method

Mindfulness-based therapy (MBT), on the other hand, is an alternative psychological method. In the process, those affected learn to perceive body sensations, thoughts and feelings without judging them. Instead of fighting it, they can adopt an accepting attitude towards the pain.

Help not only for back pain

The research team emphasizes that the methods studied could be used not only for back pain, but for all pain conditions and pain intensities. They are another tool in dealing with chronic pain, the authors write.

Learning to live with chronic pain

“These therapies don’t provide a complete cure, but they teach sufferers how to develop the inner resources they need to cope with chronic pain and live a better life,” Garland says.

“People can live with pain, but they need to know what they can do about it. This study gives them a sense of hope. It shows that you can do it,” explains Penney Cowan, founder of the American Chronic Pain Association and co-author of the study.

Lack of control group weakens significance

One weakness of the study is that there was no control group without appropriate psychological training. This means that there is no evidence that the improvements are the result of the therapies and would not have occurred over time anyway.

However, the researchers consider this to be unlikely overall because of the long-lasting pain in advance and the participants’ previous experience with chronic pain.

Residents here in the UAE

This is particularly relevant to residents in the UAE, especially after Dubai’s updated physiotherapy and rehabilitation coverage mandate introduced in early 2024. With better access to holistic treatments—including physiotherapy and psychology services—patients in Dubai can now explore broader approaches to managing chronic pain.