Low back pain affects over 600 million people and is the single leading cause of disability worldwide . New research from Boston Medical Center (BMC), the largest essential hospital in New England, suggests that the Optimizing Pain Treatment In Medical settings Using Mindfulness (OPTIMUM) trial, where an adapted group mindfulness program is delivered through primary care telehealth for patients with chronic low back pain, produced sustained reductions in pain and improvements in patients' daily lives. The findings, published in JAMA Internal Medicine , highlight a scalable, non-pharmacological approach for treating chronic pain.
Not only can chronic low back pain limit the ability of a person to walk, work, sleep, and socialize, but it can also negatively impact a person's mental health and overall wellbeing. Low back pain is also one of the most common reasons people visit their primary care physician , yet the treatment options routinely available are limited. Medications carry risks, surgery helps only a narrow subset of patients, and effective non-pharmacological therapies can be difficult to access.
"What our program does is give people real, repeatable skills for how to respond to pain differently," said Natalia Morone, MD, MS, the study's lead author and a primary care and internal medicine clinician at BMC. "Once patients have those skills, they also seem to carry them forward and we see improvements lasting beyond the program."
The researchers tested a version of Mindfulness-Based Stress Reduction (MBSR) adapted specifically to treat pain as a stressor. 451 participants across three states attended 120-minute group sessions over a period of eight weeks. The sessions were led by a trained mindfulness instructor and a primary care physician. Rather than referring patients out to a separate program, the OPTIMUM trial brought the clinician into the room and gave every participant direct access to a physician as an integrated part of the experience. Through gentle stretching exercises and mindfulness activities, participants learned to work with their pain rather than against it, adapting their activities and building awareness of how pain shapes their lives.
The team found that participants showed significant improvements to pain and pain interference, or how much pain limited their physical activity and their enjoyment of life measured on a 0-to-10 scale, with those gains sustained at a 12-month follow-up.
The trial was designed to reach as many patients as possible. Entry criteria were intentionally broad to reflect the diversity of real patients, and the telehealth approach removed transportation and scheduling barriers that often keep people from accessing structured programs. The program model is also billable as a group medical visit, meaning it can be reimbursed through existing payment structures in a scalable way.
"We have evidence-based guidelines, but the challenge has been getting those approaches to more people," said Dr. Morone. "If we can bring evidence-based treatment into primary care and build a model the healthcare system can sustain, we have a real opportunity to help far more people. That's what drives this research — getting effective care to the people who need it most."
