A primary care telehealth mindfulness program improved chronic low back pain and pain interference through 12 months in OPTIMUM.
Boston Medical Center investigators reported that a telehealth-delivered, group mindfulness intervention embedded in primary care was associated with sustained improvements in chronic low back pain and pain interference through 12 months in the OPTIMUM trial.1
The findings, published in JAMA Internal Medicine, add to evidence supporting nonpharmacologic care models for a condition frequently managed in primary care and often treated with medications despite guideline support for behavioral and rehabilitative approaches.¹
“What our program does is give people real, repeatable skills for how to respond to pain differently,” Natalia Morone, MD, MS, lead author and a primary care and internal medicine clinician at Boston Medical Center, said in a press release. “Once patients have those skills, they also seem to carry them forward and we see improvements lasting beyond the program.”2
Key Facts
OPTIMUM evaluated an adapted form of mindfulness-based stress reduction (MBSR) for patients with chronic low back pain. According to the report, 451 participants across 3 states attended 120-minute group sessions over 8 weeks. Sessions were delivered through telehealth and led by a trained mindfulness instructor and a primary care physician. The intervention incorporated gentle stretching and mindfulness activities intended to help patients recognize pain-related stress, adapt daily activities, and change behavioral responses to pain.¹
The investigators reported statistically significant improvements in pain and pain interference, measured on 0-to-10 scales, with benefits sustained at 12-month follow-up.¹
Chronic low back pain remains a major source of disability and health care use. The World Health Organization estimates low back pain affects more than 600 million people globally and is the leading cause of disability worldwide.3 In primary care, treatment decisions are often complicated by heterogeneous causes, limited predictive value of imaging for many patients, and the modest benefits and potential harms of long-term pharmacologic therapy.
Current US guideline recommendations generally prioritize nonpharmacologic options for chronic low back pain. The American College of Physicians recommends initial treatment with interventions such as exercise, multidisciplinary rehabilitation, acupuncture, MBSR, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, cognitive behavioral therapy, or spinal manipulation. If response is inadequate, nonsteroidal anti-inflammatory drugs are recommended as first-line pharmacologic therapy, with tramadol or duloxetine as second-line options; opioids are reserved for selected patients after careful risk-benefit assessment.4
MBSR is not a drug or device intervention; it is a structured behavioral program that typically combines mindfulness meditation, body awareness, and movement practices. Prior randomized evidence supports its potential role in chronic low back pain. In a 2016 randomized clinical trial, MBSR and cognitive behavioral therapy were each associated with greater improvement in functional limitations and pain bothersomeness compared with usual care among adults with chronic low back pain, with effects observed at 26 weeks and persisting for some outcomes at 52 weeks.5
The OPTIMUM model differs clinically from many referral-based behavioral programs because it was designed as a group medical visit within primary care and delivered by telehealth. That structure may address access barriers related to transportation, scheduling, geography, and limited availability of specialty pain or behavioral health services. The investigators also noted that the model may be billable within existing group visit reimbursement frameworks, a practical consideration for implementation in health systems.¹
Interpretation should remain cautious until clinicians review the full peer-reviewed trial report. The broad entry criteria may improve generalizability, but the clinical significance of the observed improvements depends on absolute changes, comparator performance, retention, and whether benefits were consistent across subgroups such as older adults, patients with high baseline disability, or those using analgesics. Further study may also clarify training requirements, fidelity monitoring, payer coverage, and scalability outside academic or integrated primary care settings.
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