Do Telehealth Mindfulness Interventions Improve Pain Management for Veterans?

A randomized clinical trial examining scalable, telehealth mindfulness-based interventions (MBIs) to improve pain-related function and other biopsychosocial outcomes in veterans with chronic pain found that both group and self-paced MBIs led to improvements compared to usual care.

Chronic pain, which affects many veterans and often coexists with psychological conditions, is challenging to manage in a clinical setting due to the need for specialized resources and personnel for in-person mindfulness training. With growing interest in nonpharmacologic treatments, scalable MBIs could bridge gaps in care by reducing logistical barriers and providing broad access to evidence-based pain management.

In this trial, researchers recruited 811 veterans with an average of 54.6 years from three Veterans Affairs facilities between November 2020 and May 2022, randomizing them to either group MBI, self-paced MBI, or usual care. The group MBI utilized a videoconferencing format, combining pre-recorded mindfulness education with interactive discussions. The self-paced MBI, designed to be completed asynchronously, included similar content with three one-on-one facilitator calls to support engagement. Primary outcomes were evaluated using the Brief Pain Inventory interference scale to assess pain-related function, while secondary measures addressed pain intensity, physical function, and other biopsychosocial outcomes such as anxiety, fatigue, sleep disturbance, social roles and activities, depression, and posttraumatic stress disorder.

At all follow-up points, both MBIs demonstrated statistically significant improvements in pain interference scores and secondary outcomes compared to usual care. Averaged across three follow-up points (10 weeks, 6 months, and 1 year), pain interference scores were reduced in both MBI arms, with the group MBI showing a mean difference of -0.4 (95% CI, -0.7 to -0.2) and the self-paced MBI showing a mean difference of -0.7 (95% CI, -1.0 to -0.4) compared to control. Both group and self-paced MBI arms were associated with improvements in pain intensity, patient global impression of change, physical function, fatigue, sleep, social participation, depression, and posttraumatic stress disorder. The probability of achieving a 30% improvement from baseline in pain interference was higher in the group MBI arm at 10 weeks and 6 months, and across all time points for the self-paced MBI.

The study's limitations include its exclusive focus on veterans, which may limit generalizability to other populations. Additionally, although follow-up was completed over a year, longer-term effectiveness and adherence to MBI practices post-study remain unknown.

“In this randomized clinical trial, scalable telehealth MBIs improved pain-related function and biopsychosocial outcomes compared to usual care among veterans with chronic pain,” the authors concluded. “Relatively low-resource telehealth-based MBIs could help accelerate and improve the implementation of nonpharmacological pain treatment in health care systems.”

Reference

Burgess DJ, Calvert C, Hagel Campbell EM, et al. Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Intern Med. 2024;184(10):1163–1173. doi:10.1001/jamainternmed.2024.3940