Chronic low back pain (CLBP) is among the most common types of pain in adults. It is also the domain for many types of so-called alternative medicine (SCAM). However, their effectiveness remains questionable, and the optimal approach to CLBP remains elusive. Meditation-based therapies constitute a form of SCAM with high potential for widespread availability.
This systematic review and meta-analysis of randomized clinical trials evaluated the efficacy of meditation-based therapies for CLBP management. The primary outcomes were pain intensity, quality of life, and pain-related disability; the secondary outcomes were the experienced distress or anxiety and pain bothersomeness in the patients. The PubMed, Embase, and Cochrane databases were searched for studies published from their inception until July 2021, without language restrictions.
A total of 12 randomized clinical trials with 1153 patients were included. In 10 trials, meditation-based therapies significantly reduced the CLBP pain intensity compared with nonmeditation therapies (standardized mean difference [SMD] -0.27, 95% CI = -0.43 to – 0.12, P = 0.0006). In 7 trials, meditation-based therapies also significantly reduced CLBP bothersomeness compared with nonmeditation therapies (SMD -0.21, 95% CI = -0.34 to – 0.08, P = 0.002). In 3 trials, meditation-based therapies significantly improved patient quality of life compared with nonmeditation therapies (SMD 0.27, 95% CI = 0.17 to 0.37, P < 0.00001).
The authors concluded that meditation-based therapies constitute a safe and effective alternative approach for CLBP management.
The problem with this conclusion is that the primary studies are mostly of poor quality. For instance, they do not control for placebo effects (which is obviously not easy in this case). Thus, we need to take the conclusion with a pinch of salt.
However, since the same limitations apply to chiropractic and osteopathy, and since meditation has far fewer risks than these approaches, I would gladly recommend meditation over manipulative therapies. Or, to put it plainly: in terms of risk/benefit balance, meditation seems preferable to spinal manipulation.
28 Responses to Meditation for Chronic Low Back Pain Management?
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Unfortunately, in my opinion, there is absolutely no noninvasive, nonpharmacologic therapy for low back pain that is superior to sham therapy (review, e.g., doi:10.1093/rheumatology/ken470). Many therapies are statistically significant but not clinically so. The effects are so small that they make little difference to the lives of people with the condition. Even the often-vaunted multimodal therapy, such as that used in German rehabilitation, is no exception, as I was able to show in my own study (DOI 10.1055/a-l300-6669). Back pain is an almost unavoidable part of life, much like gray hair.
… and that means we ought to use and recommend those that have the least risks, i.e. not spinal manipulation.
Jürgen, part the problem is how LBP has been researched specifically nonspecific LBP.
Just because we rule out pathology doesn’t mean a specific therapy will show clinical significance as a whole.
The key is matching the right therapy/therapies with the right patient. Sure some therapies are worthless yet others are specific to a specific condition. Clinically that can be a challenge as often it isn’t feasible to run all the tests to isolate a cause or causes.
This is why I/we go with a 2 week trial of care (or should) and research seems to support that approach.
“others are specific to a specific condition”
is this your assumption/speculation or do you have evidence?
This claim is made time and again, especially by orthopedic surgeons who may be uncomfortable with the concept of non-specific back pain. Unfortunately, evidence for this hypothesis is still lacking, although scientific studies have been trying for more than 20 years to reliably create subgroups that should be better helped by a therapy tailored to them (DOI:https://doi.org/10.1016/j.jclinepi.2016.06.003). If you succeed, this would be a real breakthrough.
precisely!
There are folks working on it.
https://www.jospt.org/doi/10.2519/jospt.2015.5723
and you seem to know the result of their work already?
From the same journal, 7 years later:
Classification Approaches for Treating Low Back Pain Have Small Effects That Are Not Clinically Meaningful: A Systematic Review With Meta-analysis
Journal of Orthopaedic & Sports Physical Therapy
Published Online: January 31, 2022. Volume 52 Issue 2. Pages 67-84
https://www.jospt.org/doi/10.2519/jospt.2022.10761
“Subgroup analyses explored classification system, comparator type, pain type, and pain duration.”
Supports what I stated…people are working on it.
Post hoc subgroup analysis is a pseudoscientific tactic to manufacture positive results. Often deployed in conjunction with convenience sampling.
CRITERIA in assessing the credibility of subgroup analysis.
https://www.nature.com/articles/s41433-022-01948-0/tables/1
You start with a conclusion, then scratch around in the statistical dirt for anything that could possibly support your conclusion; in the meantime charging clients for faffing around with their spines.
That, is the pseudoscientific method in action!
You’ve been posting comments on this blog for at least six years, failing dismally to defend the indefensible; to justify the unjustifiable. Whatever you do or say, you post your comments here BECAUSE chiropractic is a branch on the SCAM tree. Chiropractors are not medically qualified to even lance a boil and dress the wound.
Your statement, as written:
“Post hoc subgroup analysis is a pseudoscientific tactic to manufacture positive results.”
Is false. Deal with it.
In the context of:
• this website: SCAM
• this article: Meditation for Chronic Low Back Pain Management?
• this subthread:
https://edzardernst.com/2022/03/meditation-for-chronic-low-back-pain-management/#comment-137912
• by this commentator: the anonymous promoter of quackery, ‘DC’;
Post hoc subgroup analysis is a pseudoscientific tactic to manufacture positive results. Often deployed in conjunction with convenience sampling.
‘DC’ posted “CRITERIA in assessing the credibility of subgroup analysis.”, which is presented in its document before this
See also
Pete: Post hoc subgroup analysis is a pseudoscientific tactic to manufacture positive results.
‘Post-hoc subgroup analyses are data driven and are considered exploratory or hypothesis generating. However, it increases the likelihood of spurious and compelling results by chance alone.’
Pseudoscience: Theories, ideas, or explanations that are represented as scientific but that are not derived from science or the scientific method. Pseudoscience often springs from claims or folk wisdom or selective reading without independent data collection or validation. Scientific statements are specific and well defined while pseudoscience is vague and variable. One of the key differences between science and pseudoscience is that a scientific statement or theory is stated in such as a way as to be falsifiable. In contrast, pseudoscientific statements are usually not falsifiable using objective experimental or observational evidence. Pseudoscience provides no room for challenge and tends to dismiss contradictory evidence or to selectively decide what evidence to accept. Thus, pseudoscience is usually nothing more than a claim, belief, or opinion that is falsely presented as a valid scientific theory or fact.
https://www.oxfordreference.com/view/10.1093/acref/9780199594009.001.0001/acref-9780199594009-e-1007
Now with a little rewording your statement would be true. But as it was written, it is not. I am content with you refusing to acknowledge this. Moving on.
@ ‘DC’,
No rewording is necessary for my statement[1], within the context of this exchange.
Obviously, you didn’t understand my statement at the time you linked to “CRITERIA in assessing the credibility of subgroup analysis.”: such a deeply ignorant response to my statement.
Chiropractic is a branch of the SCAM tree. Chiropractic is one of the many branches of SCAM that is considered to be pseudoscience.[2] This is why you have been commenting on this website for at least six years.
“Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
— Björn Geir Leifsson, MD
“Chiropractic: ‘pretending to get sick people well since 1895’.”
— Michael Kenny
https://edzardernst.com/2016/12/if-we-needed-proof-that-much-of-chiropractic-is-bogus-this-would-be-it/#comment-96066
“A DC degree is a means of pretending to be a doctor, to gain a modicum of the ‘prestige’ and societal recognition these frauds think they so richly deserve but with none of the real leg work.”
— Michael Kenny
https://edzardernst.com/2018/07/the-royal-college-of-chiropractics-pathetic-attempt-at-re-inventing-chiropractic/#comment-104686
1. Post hoc subgroup analysis is a pseudoscientific tactic to manufacture positive results. Often deployed in conjunction with convenience sampling. (The indignant stamping of little feet this has caused suggests… 🛎)
2. Wikipedia, List of topics characterized as pseudoscience.
Pete: This is why you have been commenting on this website for at least six years.
Wrong again. I read and occasionally comment on this blog for two main reasons.
1. In my opinion Ernst doesn’t do a balance reporting on the papers his shares regarding spinal manipulation and chiropractic. Thus, I offer additional insight, a more balanced perspective for the readers.
2. There are a couple of skeptics who occasionally post that do a good job of analyzing papers or topics and they do so in a respectful manner. I enjoy reading their comments.
I will add a third.
3. Ernst, from what I can tell, doesn’t censor people just because they have a different view.
Now, trying to have a discussion with you is like trying to herd cats. Take care.
‘DC’ wrote “I offer additional insight, a more balanced perspective for the readers”.
LOL!
“others are specific to a specific condition”
is false. deal with it.
Look up the therapeutic approach for spondylolisthesis.
stop BSing
the subject is nonspecific back pain
I wrote “…specific condition” so I gave an example of a specific condition.
Well said!
I went through the Resolve trial (intervention A) for lower back pain, having had a history of such for over 25years. The last flare up had me hospitalised on morphine.
I’m pleased to say I have had no further issues in the 5 years since the trial.
https://pubmed.ncbi.nlm.nih.gov/27939089/
@Jürgen Höder
Exactly. And from what I see, the age-corrected prevalence of lower back pain essentially has not changed in many decades, suggesting that there is no progress in either prevention or treatment. Evolution gave us bipedal locomotion, freeing up our hands to do more interesting things – but at the cost of all sorts of adaptation problems that haven’t been ironed out (read: selected against) by that same evolution yet.
I have been experiencing recurring bouts of LBP ever since I was 18 or so, and the only real progress in treatment that I personally recall is a switch away from a lot of rest + painkillers to pain-guided moderate activity(*), which for me indeed halved the duration of these episodes. Physiotherapy, special exercises, massage and the likes had no substantial added effect, at least for me (although these may benefit people with a less active lifestyle). I never tried meditation, unless lying awake at night from the pain and forcing my mind in a restful state also counts as such.
*: Which sometimes gives rise to some amusing scenes, e.g. when veerrrryyy slooowwlyyy trying to get on or off my bicycle trying to avoid those flashes of white-hot stabbing back pain that occur with certain movements. The way I deal with it is just to laugh it off, knowing that there isn’t anything seriously wrong, and that it’ll be over in a couple of days.
Would posture during meditation have an effect on CLBP?
Yes, it could – both in a positive and negative way, I think.