Study Finds Comparable Benefits of Mindfulness and CBT for Chronic Low Back Pain Treated With Opioids
A newly published clinical trial has found that both mindfulness-based therapy (MBT) and cognitive behavioral therapy (CBT) are associated with improvements in pain, physical function, and quality of life among adults with chronic low back pain (CLBP) who are being treated with opioids. Neither therapy demonstrated superiority over the other.
Published on April 7, 2025, in JAMA Network Open, the randomized clinical trial compared MBT and CBT in a population of adults with opioid-treated CLBP—a condition known for its treatment complexity and high symptom burden. The study enrolled 770 participants and followed them for 12 months across three sites in the United States.
Participants were randomized to receive either MBT or CBT, in addition to their standard medical care. Both interventions involved eight weekly group sessions led by trained therapists, with participants also encouraged to complete daily at-home practice.
Although MBT and CBT differ in approach—CBT focuses on restructuring maladaptive thoughts and behaviors, while MBT emphasizes present-moment awareness and acceptance—both therapies produced similar outcomes. Participants in each group reported modest reductions in average pain and disability scores, along with improvements in mental and physical health–related quality of life.
At the 6- and 12-month follow-ups, both groups also showed reductions in opioid dosage. No serious adverse events were reported. Statistical analyses indicated that while both interventions led to improvements over time, there were no significant differences between them for any of the primary or secondary outcomes.
Lead author Dr. Aleksandra Zgierska, of Penn State College of Medicine, noted that the findings support broader use of both MBT and CBT in managing opioid-treated CLBP. “These therapies may offer effective, nonpharmacological options for patients who have not responded well to conventional treatments,” she stated in the report.
The researchers concluded that expanding access to these psychological interventions—whether in person or remotely—could help reduce the burden of opioid-related harms and improve patient outcomes. However, they also acknowledged limitations, including a lack of a usual care control group and limited demographic diversity among participants.
While further research is needed to assess long-term benefits and cost-effectiveness, this study adds to growing evidence that structured, therapist-led behavioral interventions can play a key role in comprehensive pain management, particularly for those reliant on long-term opioid therapy.
Source
Zgierska AE, Edwards RR, Barrett B, et al. Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e253204. doi:10.1001/jamanetworkopen.2025.3204