title: A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Treatment of chronic low back pain (LBP) in older adults is limited by the adverse effects of analgesics. Effective nonpharmacologic treatment options are needed.
  
  
  OBJECTIVE
  To determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic LBP.
  
  
  METHODS
  This single-blind, randomized clinical trial compared a mind-body program (n = 140) with a health education program (n = 142). Community-dwelling older adults residing within the Pittsburgh metropolitan area were recruited from February 14, 2011, to June 30, 2014, with 6-month follow-up completed by April 9, 2015. Eligible participants were 65 years or older with functional limitations owing to their chronic LBP (≥11 points on the Roland and Morris Disability Questionnaire) and chronic pain (duration ≥3 months) of moderate intensity. Data were analyzed from March 1 to July 1, 2015.
  
  
  METHODS
  The intervention and control groups received an 8-week group program followed by 6 monthly sessions. The intervention was modeled on the Mindfulness-Based Stress Reduction program; the control program, on the "10 Keys" to Healthy Aging.
  
  
  METHODS
  Follow-up occurred at program completion and 6 months later. The score on the Roland and Morris Disability Questionnaire was the primary outcome and measured functional limitations owing to LBP. Pain (current, mean, and most severe in the past week) was measured with the Numeric Pain Rating Scale. Secondary outcomes included quality of life, pain self-efficacy, and mindfulness. Intent-to-treat analyses were conducted.
  
  
  RESULTS
  Of 1160 persons who underwent screening, 282 participants enrolled in the trial (95 men [33.7%] and 187 women [66.3%]; mean [SD] age,74.5 [6.6] years). The baseline mean (SD) Roland and Morris Disability Questionnaire scores for the intervention and control groups were 15.6 (3.0) and 15.4 (3.0), respectively. Compared with the control group, intervention participants improved an additional -1.1 (mean, 12.1 vs 13.1) points at 8 weeks and -0.04 (mean, 12.2 vs 12.6) points at 6 months (effect sizes, -0.23 and -0.08, respectively) on the Roland and Morris Disability Questionnaire. By 6 months, the intervention participants improved on the Numeric Pain Rating Scale current and most severe pain measures an additional -1.8 points (95% CI, -3.1 to -0.05 points; effect size, -0.33) and -1.0 points (95% CI, -2.1 to 0.2 points; effect size, -0.19), respectively. The changes in Numeric Pain Rating Scale mean pain measure after the intervention were not significant (-0.1 [95% CI, -1.1 to 1.0] at 8 weeks and -1.1 [95% CI, -2.2 to -0.01] at 6 months; effect size, -0.01 and -0.22, respectively).
  
  
  CONCLUSIONS
  A mind-body program for chronic LBP improved short-term function and long-term current and most severe pain. The functional improvement was not sustained, suggesting that future development of the intervention could focus on durability.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01405716.
authors.affiliation: Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsy.
authors.forename: Natalia E
authors.initials: NE
authors.lastname: Morone
authors.affiliation: Department of Psychiatry, Center for Integrative Medicine at University of Pittsburgh Medical Center (UPMC), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Greco
authors.affiliation: Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Charity G
authors.initials: CG
authors.lastname: Moore
authors.affiliation: Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsy.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman
authors.affiliation: Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Bridget
authors.initials: B
authors.lastname: Lane
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Morrow
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Nancy W
authors.initials: NW
authors.lastname: Glynn
authors.affiliation: Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania3Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania6Department of Ps.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D059350:Chronic Pain / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D019122:Meditation; D064866:Mindfulness; D010147:Pain Measurement; D010414:Pennsylvania; D011603:Psychophysiology; D011788:Quality of Life; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000700:Analgesics