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Takeaway: Data from the Learning to Apply Mindfulness to Pain (LAMP) randomized clinical trial show that two versions of a telehealth mindfulness-based intervention (MBI) are each more effective than usual care in relieving chronic pain, and the mental health symptoms that often accompany it, among Veterans. The research team concluded: "These low-resource telehealth-based MBIs could significantly expedite and improve the integration of nonpharmacological pain treatments into healthcare systems." There are plans to roll out the LAMP (Learning to Apply Mindfulness to Pain) intervention among some of VA's interdisciplinary pain management teams.].
A 2016 analysis of National Health Interview Survey (NHIS) data revealed that chronic pain was both more prevalent and more intense among Veterans than non-Veterans, and according to VA data, joint and back pain and other musculoskeletal ailments are the most common diagnoses among post-9/11 Veterans. The VA/DoD Clinical Practice Guidelines for Pain Management have long encouraged the use of evidence-based non-pharmacological treatments for musculoskeletal pain among service members and Veterans.
Among these treatments, mindfulness skills—the ability to experience and attend to the present moment, in a non-judgmental way—have been shown to reduce the intensity and discomfort of pain through multiple pathways, including changes in how the brain processes and perceives pain. Veterans often experience chronic pain along with other comorbidities, such as PTSD, depression, sleep disturbances, or substance abuse, and structured mindfulness-based interventions (MBIs) have proven effective in treating these comorbidities together. MBIs are recommended by VHA, the Army Pain Management Task Force, and the Agency for Healthcare Research and Quality as a treatment for chronic pain, and by the American College of Physicians as a first-line treatment for chronic low back pain.
VA’s standard evidence-based MBI approach, mindfulness-based stress reduction (MBSR), is a group-oriented model that poses significant barriers to widespread implementation. It’s resource intensive, requiring dedicated space and certified instructors within the VA system. It requires considerable commitment from Veteran patients, who travel to VA facilities to meet and devote 45 minutes daily to practice. For some Veterans, another barrier is discomfort with mixed-gender groups. Low adherence and high attrition rates are a persistent challenge for VA’s predominant MBIs.
With these barriers in mind, a team led by Diana Burgess, PhD, Director of the VA Advanced Fellowship Program in Health Services Research at the Center for Care Delivery and Outcomes Research at the Minneapolis VA Healthcare System, conducted a study testing two variants of a new MBI – Learning to Apply Mindfulness to Pain (LAMP) – modified to address them. Co-Investigator Roni Evans, DC, PhD, Director of the Integrative Health & Wellbeing Research Program at the Earl E. Bakken Center for Spirituality & Healing at the University of Minnesota, led the design of the MBIs, which involved pre-recorded content by a trained mindfulness instructor. Working with a Minnesota-based company, the team created a mobile application, using the company’s proprietary platform, to deliver telehealth-based LAMP interventions to Veterans with chronic pain. Videos were also available on the study website.
From November 2020 to May 2022, the investigators conducted a randomized clinical trial across three VA facilities, among 811 Veterans (mean age 55; 48 percent women, 52 percent men) suffering moderate to severe chronic pain. The Veterans were divided into three cohorts receiving different interventions: a self-paced Mobile LAMP intervention (pre-recorded content delivered via the mobile app, supplemented by three calls with a facilitator); a group-based (Mobile+Group) LAMP, pairing the content with video conferences facilitated by an experienced instructor; and a control group receiving “usual care” – the pain treatment each Veteran had been receiving before the trial.
Regardless of whether they received the LAMP intervention, all groups continued to receive pain treatment as usual; they were not asked to make any changes to their usual pain care.
The primary outcome measured was pain-related function, assessed using the Brief Pain inventory interference scale at 10 weeks, six months, and one year after completing the study. Follow-up was completed in November 2023. Secondary outcomes included measures of pain intensity, anxiety, fatigue, sleep disturbance, depression, social activity, and PTSD.
When the pain wakes me I use the meditation and breathing to focus on relieving the pain. This does help and lessens the time I am awake before the pain is reduced and I can again sleep. - a Veteran participant in the LAMP Trial
A separate report on the study data emphasized that LAMP participants, overall, experienced mental health symptoms (fatigue, loneliness, sadness, and anxiousness) at a significantly lower rate than those who received usual care.
The team’s long-term objective – to reduce chronic pain and comorbid conditions among Veterans throughout the VA system with scalable, non-pharmacological, evidence-based, and Veteran-centric MBIs – has begun unfolding within VA. If funded, VA will achieve each of the following steps toward implementation of LAMP:
VA Office of Patient-Centered Care and Cultural Transformation (OCC&CT)
VA Office of Pain Management, Opioid Safety, and Prescription Drug Monitoring (PMOP)
VA Academic Detailing Services
Diana Burgess, PhD, is Director of the VA Advanced Fellowship Program in Health Services Research at the Center for Care Delivery and Outcomes Research at the Minneapolis Veterans Affairs Healthcare System and Professor of Medicine at the University of Minnesota. Her research focuses on non-pharmacological treatment for chronic pain.
Burgess DJ, Evans R, Allen KD, et al. Learning to Apply Mindfulness to Pain (LAMP): Design for a Pragmatic Clinical Trial of Two Mindfulness-Based Interventions for Chronic Pain. Pain Medicine. December 2020;21(S2):S29-S36.
Burgess DJ, Calvert C, Hagel Campbell EM, et al. Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Internal Medicine. October 2024;184(10):1163-1173.
Burgess DJ, Calvert C, Bangerter A, et al. Do mindfulness interventions cause harm? Findings from the Learning to Apply Mindfulness to Pain (LAMP) Pragmatic Clinical Trial. Pain Medicine. November 2024;25(S1):S68-S76.
