Scalable mindfulness programs delivered via telehealth show promise for veterans with chronic pain

Mindfulness-based interventions delivered via telehealth in a scalable format can improve pain and overall well-being among veterans with chronic pain, according to new research published today in JAMA Internal Medicine. 

In a randomized clinical trial, researchers aimed to test the effectiveness of two eight-week telehealth mindfulness-based interventions (MBIs) designed to be scalable and widely implemented in healthcare systems. MBIs help people pay attention non-judgmentally in the present moment and often involve practices like meditation, breathing exercises or gentle movement.

Although mindfulness interventions are evidence-based treatment for chronic pain and conditions that often accompany pain, like anxiety and depression, many MBIs are difficult to implement at scale in healthcare systems. They require trained mindfulness instructors, dedicated space and pose barriers to patients due to the time commitment involved. We wanted to develop MBIs that were relatively low resource, scalable and more accessible for patients "

Diana Burgess, PhD, professor at the University of Minnesota Medical School and investigator at the Minneapolis Veteran Affairs (VA) Healthcare System

Between November 2020 and May 2022, 811 veterans with moderate to severe chronic pain participated in the Learning to Apply Mindfulness to Pain (LAMP) study at three VA facilities. Outcomes were assessed at outset, 10 weeks, six months and one year. The group MBI was conducted via video conference with pre-recorded mindfulness education and skill training videos, accompanied by discussions led by a trained facilitator who was not an expert in mindfulness. The self-paced MBI was asynchronous -; allowing participants to engage with the MBI at their own pace -; and supplemented with three individual facilitator calls.

Key findings from the study include: 

• Pain-related function improved significantly for patients in the group and self-paced MBIs. 
• There were significant improvements in pain intensity, physical functioning, fatigue, sleep disturbance, social functioning, depression and PTSD among patients in the group and self-paced MBIs over 12 months, compared to usual care.
• The group and self-paced MBIs did not significantly differ from each other.

The results of this study suggest low-resource, telehealth-based MBIs could help accelerate and improve the implementation of non-medication pain treatment in VA healthcare and beyond.

Dr. Burgess and the research team are leading a new project -; called Rural Veterans Applying Mind Body Skills for Pain (RAMP) -; which will test the effectiveness of a scalable, mind-body telehealth intervention for chronic pain, designed for veterans living in rural areas. RAMP builds on LAMP through its use of mindfulness practices while also incorporating pain education, physical and rehabilitative exercise, and cognitive and behavioral strategies.

Funding was provided by the Department of Defense through the Pain Management Collaboratory - Pragmatic Clinical Trials Demonstration Projects [W81XWH-18-2-0003]. The research was also supported by the National Center for Complementary and Integrative Health [U24AT009769] and the Office of Behavioral and Social Sciences Research.