Study: Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. Image Credit: Pixel-Shot / Shutterstock.com
Question: How effective are scalable, relatively low-resource mindfulness-based interventions (MBIs) delivered via telehealth for veterans with chronic pain?
Implementing mindfulness-based interventions (MBIs) at scale has several challenges, such as the need for trained instructors and dedicated space. A recent JAMA Internal Medicine study compares the effectiveness of scalable telehealth MBIs for patients with chronic pain to standard care.
MBIs to alleviate chronic pain
Chronic pain is an expensive and debilitating public health issue that disproportionately affects veterans. Non-pharmacologic treatments for chronic pain are not frequently used due to multiple barriers at the clinician, patient, and organization levels.
Currently, MBIs are recommended as a first-line treatment, as they can improve chronic pain and comorbid conditions such as sleep disorders, post-traumatic stress disorder (PTSD), substance misuse, and depression. However, several MBIs, such as mindfulness-based stress reduction (MBSR), have certain features that make them difficult to implement.
About the study
The present randomized clinical trial (RCT) assessed the efficacy of two scalable telehealth approaches for delivering MBIs to veterans suffering from comorbid biopsychosocial conditions. MBIs were adapted from MBSR that considered implementation barriers at the patient and organization levels.
Veteran study participants were recruited in six waves between November 2020 and May 2022, during which these individuals were stratified into group MBI, self-paced MBI, and control groups. Follow-up visits occurred between March 2021 and August 2023.
To be eligible, study participants had two qualifying pain diagnoses within the same diagnostic category, were willing to engage in intervention-specific procedures, experienced pain for at least six months, and had a pain score of at least four on a scale of zero to 10.
All study participants also had access to a smartphone and the Internet and were not enrolled in another pain study program. Patients with serious behavioral or mental health issues were excluded.
The group MBI involved eight weekly sessions of 90 minutes, each delivered through videoconferencing. The self-paced MBI consisted of eight weekly sessions, with each session lasting between 30 and 60 minutes. The material in the self-paced MBI was identical to that for group MBI, except for the group interaction, and was supplemented by three individual facilitator calls.
The Brief Pain Inventory (BPI) interference scale was used to assess pain-related function at 10 weeks, six months, and one year. Biopsychosocial outcomes, including physical function, anxiety, fatigue, pain intensity, sleep disturbance, depression, participation in social roles and activities, PTSD, and patient ratings of improvement of pain, were also assessed.
Study findings
A total of 694 participants participated in the trial, 10 of whom were American Indian/Alaska Native, six were Asian American, 204 were Black or African American, 51 were Hispanic, one was Native Hawaiian/Pacific Islander, and 536 were White.
The most common diagnosis was extremity pain/arthritis, followed by back pain. Baseline characteristics between the randomized groups were similar; however, the self-paced group exhibited higher pain self-efficacy scores.
No significant effect modification by gender was observed, which led to the inclusion of gender as a covariate factor. Averaged across the three follow-up visits, significantly lower BPI interference scores were reported for the group MBI and self-paced MBI arms compared to standard care.
As compared to the control group, both MBI groups led to improved BPI scores at 10 weeks and six months. At one year, the veterans in the self-paced MBI group exhibited lower BPI interference scores.
The likelihood of 30% improvement from baseline was higher following group MBI at 10 weeks and six months as compared to standard care, with this effect observed for self-paced MBI at all time points. The probability of 50% improvement was also greater at 10 weeks for group MBI and at all time points for self-paced MBI.
Both MBI arms led to better secondary outcome scores as compared to the control group, with no significant differences observed between the group and self-paced MBI. No serious adverse events were reported throughout the study period for any intervention group.
At 10 weeks, 27% and 23% of veterans in the group and self-paced MBI arms, respectively, experienced improvements in their psychological or physical symptoms as compared to 53% in the control group.
Conclusions
The study findings demonstrate that scalable telehealth MBIs improved pain-related function and biopsychosocial outcomes compared to standard care. These observations confirm the effectiveness of non-pharmacological pain treatments like MBIs, which are relatively inexpensive and easily accessible through telehealth platforms.
Journal reference:
- Burgess, D. J., Calvert, C., Campbell, E. M. H., et al. (2024) Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Internal Medicine. doi:10.1001/jamainternmed.2024.3940
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