Mindfulness eases chronic back pain, but modestly

Clinical takeaway: A mindfulness group visit embedded in primary care is a low-risk, scalable nonopioid option for chronic low back pain, with real but modest pain benefit.

Mindfulness-based stress reduction is an initial, recommended option for chronic low back pain, based on guidelines from the American College of Physicians. Yet it rarely reaches patients, because few primary care practices can deliver it. A pragmatic, randomized trial tested whether a telehealth group medical visit, built to slot into routine primary care, could close that gap.

Over a year, the mindfulness program consistently outperformed usual care on pain, but the margin remained small. On the Pain, Enjoyment of Life and General Activity (PEG) scale, which runs 0 to 10 and started near 6 in both groups, the intervention edge over usual care ran about 0.6 to 0.9 points across 8 weeks, 6 months, and 12 months. All fell short of the 1-point difference considered clinically meaningful, leaving the benefit statistically real but below the bar patients would notice.

Patients told a bit of a different story than the scores themselves. At 6 months, 70% of intervention participants said they were at least minimally improved, compared with 40% of controls. The program also beat usual care on pain intensity at every time point and on sleep, fatigue, and pain catastrophizing at later ones. It did not move measures on depression, anxiety, or opioid use, though the accompanying editorial notes prior evidence that mindfulness can help those conditions.

The intervention ran as an eight-week telehealth group visit folded into primary care, with a physician or nurse practitioner joining each session for a brief individual check-in. The group-visit format can be reimbursed through existing billing codes, which the authors tie to its scalability. In this trial, sessions were free to participants.

The study randomized 451 adults with chronic low back pain at primary care clinics in Massachusetts, Pennsylvania, and North Carolina to the mindfulness program or usual care. Most had carried the pain for years: about three-quarters reported it for at least five years. The pragmatic design uses broad eligibility and real-world clinics, which strengthens generalizability but dampens the measurable effect. Adherence was modest, with 45% of intervention participants attending at least six of eight sessions.

The central puzzle of the trial is that patients felt better even where the standardized scores said the benefit was small. That gap, the authors suggest, may say as much about how pain improvement is measured as about the program itself, and it complicates any clean read on whether mindfulness "works" for chronic back pain. For now, the practical case rests less on effect size than on fit: a safe, guideline-backed option that primary care can actually deliver.

"Mindfulness-based interventions are especially well suited for treating chronic lower back pain, with evidence that they can improve common co-occurring conditions, such as depression, anxiety, and sleep disorders, that can contribute to and exacerbate pain," wrote Diana Burgess, PhD, of the University of Minnesota Medical School, in an accompanying commentary.

Source: Morone NE, et al. (2026 Jun 29) JAMA Intern Med. Mindfulness-based group medical visits for persons with chronic low back pain: a randomized clinical trial