Telehealth Mindfulness-Based Interventions Were Helpful for Veterans With Chronic Pain in a Large Real-World Study

In a study of veterans with moderate-to-severe chronic pain, 8-week virtual group or self-paced mindfulness-based interventions were more helpful than usual care in improving pain-related function. This study, which was part of the Pain Management Collaboratory (PMC), a large-scale effort to assess nondrug treatments for pain in the military and veterans’ health care systems, was supported by the PMC Coordinating Center, which is funded by the National Center for Complementary and Integrative Health and published in the journal JAMA Internal Medicine. 

Previous research has shown that mindfulness-based interventions and other evidence-based nonpharmacologic treatments are helpful for patients with chronic pain, but these approaches are underused because of challenges with putting them into clinical care delivery. Standard in-person, mindfulness-based programs require trained instructors and dedicated spaces for classes. They also take up a lot of patients’ time and may be difficult for some patients to access. Briefer interventions delivered virtually could be a more practical option if they are found to be effective.

In this study, conducted among patients at U.S. Department of Veterans Affairs (VA) health care systems in Minnesota, North Carolina, and California, 811 veterans with moderate-to-severe chronic pain were randomly assigned to one of two 8-week telehealth mindfulness-based interventions (group delivered with a facilitator or self-paced that included three calls with a facilitator) in addition to their usual pain care or to usual care alone. The participants included 424 men (52.3 percent) and 387 women (47.7 percent); 536 (66.1 percent) were White and 204 (25.2 percent) were Black, with smaller numbers from other racial and ethnic groups. Because the study participants were recruited from the settings where they usually receive their care, they had a variety of different pain conditions, and many also had additional health problems. More than half had at least one diagnosed mental health condition.

Pain-related function, as assessed through a questionnaire that asked about the impact of pain on general activity, mood, walking, work, relationships, sleep, and enjoyment of life, was significantly better after 10 weeks and 6 months in patients who participated in either of the mindfulness-based interventions than in those who only received usual care, and continued to be significantly better at 1 year for those in the self-paced program. At 10 weeks, 6 months, and 1 year, significantly more participants in the self-paced intervention reported 30 percent (moderate) or 50 percent (substantial) improvement in pain-related function, compared to those receiving usual care alone. Those in the group-delivered intervention reported 30 percent (moderate) improvement in pain-related function at 10 weeks, 6 months, and 1 year, compared to those receiving usual care alone. Participants in both interventions also showed significant improvements in other outcomes, including pain intensity, physical function, sleep disturbance, depression, fatigue, social roles and activities, and post-traumatic stress disorder.

The study did not directly compare the telehealth interventions with traditional in-person, mindfulness-based programs. However, the size of the effects was similar to that seen in a previous high-quality study of in-person, mindfulness-based stress reduction for pain conditions. 

The researchers who conducted this study concluded that these two scalable, relatively low-resource interventions could help accelerate the implementation of nondrug pain treatment in health care systems.