Telehealth Mindfulness-Based Interventions Improve Pain-Related Function and Biopsychosocial Outcomes Among Veterans with Chronic Pain
BACKGROUND:
Chronic pain is a prevalent and debilitating problem that disproportionately affects Veterans. Although mindfulness-based interventions (MBIs) can improve chronic pain and comorbid conditions and are now recommended as a first-line treatment, implementing them at scale poses many challenges, such as the need for dedicated space and trained instructors. This randomized clinical trial, part of the NIH-DoD-VA Pain Management Collaboratory, aimed to test the effectiveness of two scalable, 8-week telehealth MBIs – group and self-paced – compared to usual care. The group MBI was done via videoconference with prerecorded mindfulness education and skill training videos, accompanied by facilitated discussions. The self-paced MBI was similar but completely asynchronous and supplemented with 3 individual facilitator calls. Participants were diagnosed with moderate to severe chronic pain and recruited from 3 VA facilities from November 2020 to May 2022. Follow-up occurred March 2021 to August 2023. The primary outcome was the change in pain-related function over time using the Brief Pain Inventory (BPI) interference scale. Secondary biopsychosocial outcomes included pain intensity and Veteran ratings of pain improvement, anxiety, depression, PTSD, fatigue, sleep disturbance, physical function, and participation in social roles and activities. Primary and secondary outcomes were assessed at baseline, 10 weeks, 6 months, and 1 year. Among 811 Veterans randomized (mean age 55, 48% women, 66% White, 25% Black/African American, 6% Hispanic, 1% American Indian/Alaska Native), 694 (86%) completed the trial.
FINDINGS:
- Both the group and self-paced MBI significantly improved pain-related function and biopsychosocial outcomes compared to usual care. Group and self-paced MBIs performed similarly.
- Averaged across all 3 time points, pain interference scores were significantly lower for both MBIs.
- Both MBIs had significantly better scores on the secondary outcomes of pain intensity, patient global impression of change, physical function, fatigue, sleep disturbance, social roles and activities, depression, and PTSD.
- Compared to usual care, the probability of 30% improvement from baseline was greater for group MBI at 10 weeks and 6 months, and for self-paced MBI at all 3 time points.
IMPLICATIONS:
- Scalable, relatively low-resource telehealth-based MBIs could help accelerate and improve the implementation of nonpharmacological pain treatment in VA healthcare and beyond.
LIMITATIONS:
- This trial was not designed to answer questions of how less resource-intensive MBIs perform compared to more intensive mindfulness-based stress reduction programs, or how remotely delivered programs compare to in-person MBIs.
AUTHOR/FUNDING INFORMATION:
Drs. Burgess and Calvert, and Ms. Hagel Campbell are with HSR’s Center for Care Delivery and Outcomes Research (CCDOR).
Burgess DJ, Calvert C, Hagel Campbell EM, et al. Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Internal Medicine. August 19, 2024; online ahead of print.
