Nearly 1 in 4 adults experience chronic low back pain (CLBP): long-lasting lower back pain that lasts several weeks or more (1). CLBP can start after an injury heals or without any clear cause. It makes daily tasks like working, sleeping, or spending time with others difficult. This is often due to "pain interference," which refers to how much pain interrupts a person’s ability to carry out daily activities (2).
Finding effective treatments for CLBP is especially important. Many doctors prescribe pain pills called opioids which are common but carry significant risks like addiction and dependency. That's why finding other ways to help with pain is so important. A 2024 research article titled “The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial” assessed three non-drug treatments for CLBP: cognitive therapy (CT), mindfulness meditation (MM), and behavioral activation (BA)(3). CT focuses on changing negative thought patterns about pain, MM helps patients stay present and accept their pain without judgment, and BA encourages staying active and finding joy in meaningful activities.
While previously validated and effective for in-person treatment, this research study assessed telehealth – using technology, like video calls or apps, to get medical care or therapy without having to visit a doctor’s office in-person.
The study used a randomization process with no control group, meaning that participants were randomly assigned to one of the three treatment groups (CT, MM, or BA) and all participants received one of the three treatments, allowing for a direct comparison. This helps make sure the groups are fair and similar, which strengthens the study's results. The researchers looked at all three groups at the same time, or in parallel, meaning they tested each treatment on different groups of people and compared the results. Also, they intentionally excluded participants whose conditions could influence treatment results, such as those with severe mental health diagnoses.
Most participants of the study were women who were mostly around 50 years old, white, married, and had some type of higher education. The main results showed that all three online therapy treatment methods can be used for pain management and reduced long term back pain, improved sleep, and boosted mood and daily functioning. These positive results lasted throughout the three and six month follow up time points after treatments ended, proving that these methods worked as a stable and reliable form of treatment for participants. Additionally, the study had moderate to large effect sizes in each treatment method. In simpler terms, these effect sizes help show how big the change in things like pain or sleep improvement is due to the given treatments. For example, the large effect size means the treatments had a strong or very noticeable impact on reducing participants' pain and a moderate effect size means participants felt a meaningful improvement in their daily lives like in their mood.
Another important result was that participants reported fewer doctor visits during their follow ups which means that the CT, BA, and MM treatment methods also helped reduce healthcare needs. Furthermore, the results demonstrated that each treatment method would work on its own and could potentially be interchangeable with each other depending on accessibility and availability of treatment resources per location. A major problem associated with using online treatment is the lack of psychologists available to provide these therapies, but the study suggests training other professionals like nurses to also deliver the treatments to help solve this issue. Overall, there was only one notable difference in results between treatment methods, which was that the behavioral activation group showed the most improvement in sleep disturbances compared to the other two treatment groups, though researchers aren't sure why.
The most important takeaway was that these results from the online treatments proved to be just as effective and consistent with the in-person therapy treatments previously studied. This ultimately means that internet treatment can be a safe approach for dealing with health issues like CLBP and can be used to expand access to healthcare in remote places. Moreover, this makes it easier to help more people with long term back pain. A disclaimer related to the results of this study was that researchers still don’t know if certain people respond better to specific treatments, so more studies are needed.
One issue during the study was adverse events—when a treatment causes harm or worsens symptoms. Out of 278 adverse events reported, 23 were related to the study, 10 were probably related, three might have been related, 240 were unrelated, and two were explicitly linked to the treatments. This shows the importance of ensuring patient safety, even with virtual care options.
These findings have important real-world implications. Imagine a 55-year-old woman named Maria who lives in a rural area with limited access to healthcare. Maria struggles with CLBP but cannot travel regularly to a doctor due to the long distance and high costs. Telehealth could allow her to join weekly video group sessions for CT, MM, or BA, providing her with tools to manage her pain without leaving her home.
Telehealth has the potential to be a game changer for individuals like Maria, offering safe, effective treatments and reducing reliance on medications like opioids. However, it's crucial to conduct more research to understand how to make these programs safer and ensure they work for people of all backgrounds. This ongoing commitment to research and patient care could transform pain management, especially for underserved communities, by bringing care directly to those who most need it.
References:
Cleveland Clinic. (2021). Low back pain: Causes, diagnosis & treatments [Internet]. https://my.clevelandclinic.org/health/diseases/7936-lower-back-pain
Amtmann, D., Cook, K. F., Jensen, M. P., Chen, W. H., Choi, S., Revicki, D., Cella, D., Rothrock, N., Keefe, F., Callahan, L., & Lai, J. S. (2010). Development of a PROMIS item bank to measure pain interference. Pain, 150(1), 173–182. https://doi.org/10.1016/j.pain.2010.04.025
Day, M. A., Ciol, M. A., Mendoza, M. E., Borckardt, J., Ehde, D. M., Newman, A. K., Chan, J. F., Drever, S. A., Friedly, J. L., Burns, J., Thorn, B. E., & Jensen, M. P. (2024). The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial. BMC medicine, 22(1), 156. https://doi.org/10.1186/s12916-024-03383-2
Information About The Authors
Charlotte Butler: bcharlot@umich.edu University of Michigan
Jim Chen chenjiling21@gmail.com 6265518125 UCLA
Malik Evans: malikevans11@hotmail.com/ 559-942-0274 Fresno State
Tara Joolhar: taranikzadjoolhar@gmail.com Virginia Commonwealth University