Article in latest issue of JAMA (Journal of the American Medical Association)
JAMA. 2016;315(12):1240-1240

"Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain – A Randomized Clinical Trial"

Note: One can down-load the complete study after "registering", which anyone can do (i.e. not limited to MDs). At: http://jama.jamanetwork.com/issue.aspx, click on "Create an Account" at the upper right.

They compare their patients with those getting "usual care", which they define as "whatever the patients want".
lol.

Outcome of study is no surprise.
Of course MBSR is helpful.
No one has backpain when they are sedated with raisins.




Not sure though if this study is really political. (Or maybe are they trying to de-finance CBT against back pain?)
A bit (or lots of) stupid maybe.
What are they gonna try next?
"Effects of MBSR on kids (non-)doing their homework"?

Also, wtf why CBT against back pain?
This seems to be common, but your favourite bread remains puzzled.

edit:
this looks like political science
http://therussells.crossfit.com/2015/07/06/have-coca-cola-and-pepsico-corrupted-the-health-sciences-part-1/
bread is not so amused o_O

Aside from the various curiosities of this study – not defining "back pain", not defining "usual care", and the overkill of mostly empty verbiage describing the details of enrollment, the "interventions", statistical tables, the fact that the "superior" interventions had rather large drop-out rates, etc. – I found it odd JAMA publishing a piece "suggesting" that psychology trumps physical medicine for treating a medical condition. Or are they suggesting that back pain is all in the mind?

Surveying the background of the numerous authors of this study, two are psychologists, the rest apparently statisticians and medical delivery policy wonks. Little trace of hard-core science.

Then there's a suspicion arising from the fact that my MD colleague showed me the issue of JAMA and the article on April 1st, the day he got it in the mail.

No, they are talking about chronic back pain, which is different from back pain in 2 respects:
1) People have basically given up on any chance of healing.
2) iirc Medicine people claim that the mind may indeed play a big role in making pain chronic, but the mechanism is unclear.

Apart from that, MBSR is partly yoga, so I'm not convinced that this is reasonable thing to examine.

re: bernd the broter (4/5/16 9:21 AM as a reply to Chris J Macie)

"No, they are talking about chronic back pain, which is different from back pain in 2 respects:
1) People have basically given up on any chance of healing."

a) So they are ready to turn to religion? Seriously, the whole MBSR, CBT etc. psychological approach is arguably religious – involving belief systems – much the sameas most of the popular notions of science (and seen in the attitudes of many professional scientists) are framed as the rationalre placement for theologically based religious systems. Witness how the radical apologists regularly lock horns with traditional religious factions, e.g. evolution vs creationism.

(For instance, Michael Shermer the "Skeptic", whom I've found usually interesting to read – his column in Scientific American magazine; but his persona is decidely reactionary. A telling comment he once made in passing – that in his younger days he was a sucker for various "far out"ideas. Prior to some kind of "conversion" experience?) 

b) Disclaimer / I have "skin inthe game": Back pain, both acute and chronic, is a staple ("bread and butter", so to speak) of acupuncture practice.Minor "acute" (a lifting strain/sprain, or minor auto accident, etc) is easy to clear, but often comes up in the presence of longer-term vulnerability, i.e. some history of back issues albeit not chronic in the sense of constant. Chronic (constant for at least months) still brings people in searching for relief, usually after unsuccessfully trying "usual" medical, chiro, etc. (Not to say that some don't find relief there.) Success with these is s/w50-50; often relieves, but future flare-ups are likely, which also often clear when they will come back in after coping a couple of days or weeks. One fruitfull tactic is promote awareness of the bio-dynamics of posture and movement. An excellent practical method is Esther Gokale's "Eight Ways to a Pain-Free Back". Her techniques do involve increased "mindfulness" of behavior, and "practice" in reshaping habits. In some cases I will also suggest more formal "meditation", given clues as to receptivity. Even s/t mention MBSR, as it's widely available, become acceptible ("establishment").

"2) iirc Medicine people claim that the mind may indeed play a big role in making pain chronic, but the mechanism is unclear."

Less unclear perhaps to those more deeply into some sort of samadhi/vipassana practice, to thepoint where the nature of materiality-mentality (namarupa) is realized.

btw: curious to see a bernd the broter post that's more or less serious?