The objectives of this pilot study were to assess the feasibility of recruitment and adherence to an eight-session mindfulness meditation program for community-dwelling older adults with chronic low back pain (CLBP) and to develop initial estimates of treatment effects. It was designed as a randomized, controlled clinical trial. Participants were 37 community-dwelling older adults aged 65 years and older with CLBP of moderate intensity occurring daily or almost every day. Participants were randomized to an 8-week mindfulness-based meditation program or to a wait-list control group. Baseline, 8-week and 3-month follow-up measures of pain, physical function, and quality of life were assessed. Eighty-nine older adults were screened and 37 found to be eligible and randomized within a 6-month period. The mean age of the sample was 74.9 years, 21/37 (57%) of participants were female and 33/37 (89%) were white. At the end of the intervention 30/37 (81%) participants completed 8-week assessments. Average class attendance of the intervention arm was 6.7 out of 8. They meditated an average of 4.3 days a week and the average minutes per day was 31.6. Compared to the control group, the intervention group displayed significant improvement in the Chronic Pain Acceptance Questionnaire Total Score and Activities Engagement subscale (P = .008, P = .004) and SF-36 Physical Function (P = .03). An 8-week mindfulness-based meditation program is feasible for older adults with CLBP. The program may lead to improvement in pain acceptance and physical function.
Among older adults, chronic pain is a common condition that can have devastating consequences. Chronic pain is associated with depression (Fishbain et al., 1997 and Bair et al., 2003), decreased appetite (Bosley et al., 2004), impaired sleep (Benca et al., 2004) and overall decreased quality of life (Cooper and Kohlmann, 2001). Not surprisingly, approximately 1/4–1/3 of older adults suffer from low back pain (Urwin et al., 1998 and Thomas et al., 2004). Many older adults’ chronic pain is inadequately treated (Roy and Thomas, 1987 and Woo et al., 1994). This may be due to older adults’ increased susceptibility to medication side effects and increased number of co-morbidities that prohibit surgical interventions (Gagliese and Melzack, 1997).
Approximately 1/3 of older adults have used complementary and alternative medicine (CAM) in the previous year (Foster et al., 2000). Chronic pain is one of the top medical conditions for which they seek CAM modalities (Foster et al., 2000 and Astin, 2004). The growing use of CAM presents researchers with the responsibility of studying it scientifically. We were interested in studying a mind–body technique called mindfulness meditation for the treatment of chronic pain in older adults.
Mindfulness meditation was introduced as a clinical intervention for conditions such as chronic pain and anxiety in 1979 (Kabat-Zinn, 1982 and Kabat-Zinn et al., 1992). It is currently taught and studied in many clinical trials as the Mindfulness-Based Stress Reduction Program (MBSR) (Kabat-Zinn, 1990 and Kabat-Zinn, 2003). Previous research of Kabat-Zinn showed a significant reduction of chronic pain among 90 patients with a variety of chronic pain conditions (Kabat-Zinn et al., 1985). He then published 4-year follow-up data showing maintenance of pain improvement among 60–72% of 225 chronic pain patients (Kabat-Zinn et al., 1986). The studies did not include a comparison group. Sustained pain reduction up to 4 months after the MBSR intervention was noted in 28 fibromyalgia patients (Creamer et al., 2000). In a different study, fibromyalgia patients were randomized to an MBSR or an education program, both groups showed improvement in pain self-report, but the differences between the two groups did not reach statistical significance (Astin et al., 2003). None of these studies targeted older adults or chronic low back pain (CLBP). It is not known if older adults would differ from a younger population in terms of program adherence and effects. Recent reviews support the use of meditation training in the older adult (Lindberg, 2005 and Morone and Greco, 2007).
Kabat-Zinn states mindfulness is: “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003).
The primary aim of this pilot study was to assess the feasibility of recruitment and adherence to an eight-session mindfulness meditation program for community-dwelling older adults ⩾ age 65 with CLBP. The secondary aim was to develop initial estimates of treatment effects on measures of pain, physical function and quality of life.
