Overcoming Challenges to Implementing Mindfulness-Based Pain Interventions

PMID: 39158897 DOI: 10.1001/jamainternmed.2024.3952

In this issue of JAMA Internal Medicine, Burgess and colleagues1 provide encouraging evidence in their randomized clinical trial (RCT) that implementing low-cost online mindfulness-based interventions (MBIs) for chronic pain in a health care system can improve patient outcomes. Their RCT, conducted in Veterans Affairs (VA) health care systems, compared the effects of implementing 2 different types of 8-week telehealth MBI programs with usual care. The first was a group intervention with prerecorded mindfulness education and skill training videos led by an experienced instructor, and the second was a self-paced asynchronous intervention using the same videos supplemented with 3 phone calls with a facilitator. The effects of the 2 MBIs on pain outcomes (pain-related function and pain intensity) and psychosocial outcomes (anxiety, depression, posttraumatic stress disorder, sleep disturbance, and participation in social roles/activities) were measured at 12 weeks, 6 months, and 1 year. Strengths of this trial were a large sample size (N = 811), follow-up rates between 83% and 91% for the 3 study arms at 12 months, and satisfactory adherence to the assigned treatment: 69% of participants in the group MBI attended at least 6 of 9 sessions, and 76% of participants in the self-paced arm attended at least 2 of 3 facilitator calls.