This story focuses on a JAMA study investigating whether mindfulness-based stress reduction (MBSR) is as effective as cognitive behavior therapy (CBT) and standard treatment at helping patients reduce lower back pain. The story does a good job of quantifying the benefits and risks seen in the study. However, there were three things we wanted to call special attention to:
Lower back pain is an extremely common problem around the world. For example, a 2012 paper reported that lower back pain was responsible for more than three percent of all emergency room visits in the United States. An earlier paper found that health care expenditures in the U.S. directly attributable to back pain came to around $26 billion. When we consider the number of people affected by back pain, and the related economic impact, it’s clear that any research that offers insight into how to effectively treat lower back pain is worth covering.
The story doesn’t address costs for any of the treatment options discussed. Is MBSR comparable to CBT? Does insurance cover either treatment option?
The story tells readers what percentage of study participants who got MBSR treatment reported improvement in pain, as well as what percentage of MBSR participants “reported improvement in the activities they could do.”
It also offered the same numbers for participants who received CBT and for the control group, which received typical medical care for this condition. These details deserve a Satisfactory rating. But:
The story notes: “The study did caution that 30 of the 103, or about one-third, of the participants in the meditation group reported an ‘adverse event,’ most often an increase in pain due to yoga.” It’s good to see that included. Since the story is effectively comparing MBSR to CBT and conventional treatment, it would also have been worth noting “adverse events” for those groups in the study. According to the study, 10 percent of the CBT group also experienced “adverse events,” and no adverse events were mentioned for the control group.
Defining “adverse events” would also have been good, since it’s not clear whether they mean momentary pain or a debilitating flare-up of long-term pain. According to the study, the pain–for both MBSR and CBT groups–was “mostly temporary” and no “serious” adverse events were reported. Those things are worth mentioning. (It’s also worth finding out what “mostly” and “serious” mean.)
The story describes the study in detail, explicitly stating the study size and the absolute percentages in each arm that had benefit. It also acknowledged the study was randomized. We’ll count this as sufficient for Satisfactory, keeping in mind the following:
As explained in the summary above, the story doesn’t make clear MBSR and CBT were used in addition to conventional medical treatment, rather than instead of medical treatment.
The story didn’t mention that the study excluded participants with what the study authors term “a specific diagnosis (eg, spinal stenosis).” In other words, the study did not address treatments for back pain caused by issues like a herniated disc or rheumatoid arthritis. Many readers have these conditions, and should be informed that these study results may not be applicable to their situation.
Lastly, we would have welcomed a discussion of the high rates of success within the control group. Forty-four percent in that group experienced a gain in functionality, for example. That seems pretty good! What do the researchers have to say about that?
No disease mongering here. However, we did want to point out that the story “fear mongers” in a sense, by stating back pain is “one reason why more and more people are addicted to painkillers.”
The story insinuates that these other treatment methods–especially meditation–could help with that. And maybe they could. But the study itself says “No overall differences in treatment effects were observed for…self-reported use of medications for back pain.” So why the mention of painkiller addiction?
Conflicts of interest don’t appear to be an issue here, and the story includes statements from an accompanying editorial in JAMA, which was written by experts unaffiliated with the research. This squeaks by as Satisfactory, though it should be noted that most of this material was available via news releases (see below).
The story is effectively all about comparing alternatives, though–again–it should have made clear that MBSR and CBT were used in conjunction with conventional medical treatment, and it left out discussion of other well-known non-medication treatment methods, such as exercise.
It’s not clear from the story whether MBSR is widely available, is available in mainly metropolitan areas, or is a relatively new field that is still uncommon. The story does quote from a separate editorial in JAMA that says health care systems “should provide access to affordable mind-body therapies,” implying that it’s not widely available. Is this the case, or can it be easily accessed?
Given the constraints of a brief news story, the piece does a nice job of articulating the differences between MBSR and CBT. It would have been even more helpful for the story to mention previous studies on the impact of MBSR and CBT on low back pain, to help us understand how novel this new study is.