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Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for the treatment of chronic pain: randomized controlled trial.

Pain
January 1, 1970
John W Burns et al. (7 authors)
Journal ArticleRandomized Controlled TrialResearch Support, N.I.H., ExtramuralHuman StudyClinical
Study Details

Study Goal

The researchers aimed to compare the relative efficacies of cognitive therapy (CT), mindfulness-based stress reduction (MBSR), behavior therapy (BT), and treatment as usual (TAU) in improving pain, physical function, mood, and sleep disturbance in people with chronic low back pain.

Results Summary

The study found that CT, MBSR, and BT produced similar pretreatment to posttreatment improvements in all outcomes, with comparable maintenance of gains at 6-month follow-up. All three active treatments outperformed TAU, with significant differences emerging by session 6.

Population

Adults with chronic low back pain (N = 521).

Effective Dosage

Eight individual sessions (frequency not specified).

Duration

8 weeks (assuming weekly sessions).

Interactions

None mentioned.

Extracted Claims (24)
InterventionDirectionEndpointPopulationDosageImpactClaim #
cognitive therapy (CT)
decrease
pain
people with chronic pain conditions
-
produce reductions
#1
cognitive therapy (CT)
increase
physical function
people with chronic pain conditions
-
improvements
#2
cognitive therapy (CT)
increase
mood
people with chronic pain conditions
-
improvements
#3
cognitive therapy (CT)
increase
sleep disturbance
people with chronic pain conditions
-
improvements
#4
mindfulness-based stress reduction (MBSR)
decrease
pain
people with chronic pain conditions
-
produce reductions
#5
mindfulness-based stress reduction (MBSR)
increase
physical function
people with chronic pain conditions
-
improvements
#6
mindfulness-based stress reduction (MBSR)
increase
mood
people with chronic pain conditions
-
improvements
#7
mindfulness-based stress reduction (MBSR)
increase
sleep disturbance
people with chronic pain conditions
-
improvements
#8
behavior therapy (BT)
decrease
pain
people with chronic pain conditions
-
produce reductions
#9
behavior therapy (BT)
increase
physical function
people with chronic pain conditions
-
improvements
#10
behavior therapy (BT)
increase
mood
people with chronic pain conditions
-
improvements
#11
behavior therapy (BT)
increase
sleep disturbance
people with chronic pain conditions
-
improvements
#12
cognitive therapy (CT)
no change
all outcomes
people with chronic low back pain
-
produced similar pretreatment to posttreatment effects
#13
mindfulness-based stress reduction (MBSR)
no change
all outcomes
people with chronic low back pain
-
produced similar pretreatment to posttreatment effects
#14
behavior therapy (BT)
no change
all outcomes
people with chronic low back pain
-
produced similar pretreatment to posttreatment effects
#15
cognitive therapy (CT)
no change
treatment gains
people with chronic low back pain
-
revealed similar levels of maintenance of treatment gains
#16
mindfulness-based stress reduction (MBSR)
no change
treatment gains
people with chronic low back pain
-
revealed similar levels of maintenance of treatment gains
#17
behavior therapy (BT)
no change
treatment gains
people with chronic low back pain
-
revealed similar levels of maintenance of treatment gains
#18
cognitive therapy (CT)
increase
outcomes
people with chronic low back pain
-
produced greater improvements
#19
mindfulness-based stress reduction (MBSR)
increase
outcomes
people with chronic low back pain
-
produced greater improvements
#20
behavior therapy (BT)
increase
outcomes
people with chronic low back pain
-
produced greater improvements
#21
cognitive therapy (CT)
increase
outcomes
people with chronic low back pain
by session 6
differed significantly
#22
mindfulness-based stress reduction (MBSR)
increase
outcomes
people with chronic low back pain
by session 6
differed significantly
#23
behavior therapy (BT)
increase
outcomes
people with chronic low back pain
by session 6
differed significantly
#24
Abstract

Trials of cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) suggest that all 3 treatments produce reductions in pain and improvements in physical function, mood, and sleep disturbance in people with chronic pain conditions. Fewer studies have compared the relative efficacies of these treatments. In this randomized controlled study, we compared CT, MBSR, BT, and treatment as usual (TAU) in a sample of people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of outcomes. Consistent with the prior work, we found that CT, MBSR, and BT produced similar pretreatment to posttreatment effects on all outcomes and revealed similar levels of maintenance of treatment gains at 6-month follow-up. All 3 active treatments produced greater improvements than TAU. Weekly assessments allowed us to assess rates of change; ie, how quickly a given treatment produced significant differences, compared with TAU, on a given outcome. The 3 treatments differed significantly from TAU on average by session 6, and this rate of treatment effect was consistent across all treatments. Results suggest the possibility that the specific techniques included in CT, MBSR, and BT may be less important for producing benefits than people participating in any techniques rooted in these evidence-based psychosocial treatments for chronic pain.

Medical Subject Headings (MeSH)
Behavior TherapyChronic PainCognitive Behavioral TherapyHumansMindfulnessStress, PsychologicalTreatment Outcome
Study Links
Quality Scores
SafetyNot Assessed
Efficacy85/10
Quality90/10
Citation Metrics
Total Citations32
Citations/Year10.7
Relative Citation Ratio5.71
NIH Percentile94.4%
Research Impact Scores
APT Score0.95
Weight Score1.94
Normalized Score0.72
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