Cost of opioid-treated chronic low back pain: Findings from a pilot randomized controlled trial of mindfulness meditation-based intervention

J Opioid Manag. 2017 May/Jun;13(3):169-181. doi: 10.5055/jom.2017.0384.

Abstract

Objective: Opioid-treated chronic low back pain (CLBP) is debilitating, costly, and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP.

Design: Twenty-six-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone.

Setting: Outpatient.

Participants: Thirty-five adults with opioid-treated CLBP (≥30 morphine-equivalent mg/day) for 3 + months enrolled; none withdrew.

Intervention: Eight weekly therapist-led MM sessions and at-home practice.

Outcome measures: Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct + indirect costs) were calculated for 6-month pre-enrollment and postenrollment periods and compared within and between the groups.

Results: Participants (21 MM; 14 control) were 20 percent men, age 51.8 ± 9.7 years, with severe disability, opioid dose of 148.3 ± 129.2 morphine-equivalent mg/d, and individual annual income of $18,291 ± $19,345. At baseline, total costs were estimated at $15,497 ± 13,677 (direct: $10,635 ± 9,897; indirect: $4,862 ± 7,298) per participant. Although MM group participants, compared to controls, reduced their pain severity ratings and pain sensitivity to heat stimuli (p < 0.05), no statistically significant within-group changes or between-group differences in direct and indirect costs were noted.

Conclusions: Adults with opioid-treated CLBP experience a high burden of disability despite the high costs of treatment. Although this pilot study did not show a statistically significant impact of MM on costs related to opioid-treated CLBP, MM can improve clinical outcomes and should be assessed in a larger trial with long-term follow-up.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / economics*
  • Analgesics, Opioid / therapeutic use*
  • Chronic Pain / diagnosis
  • Chronic Pain / economics*
  • Chronic Pain / psychology
  • Chronic Pain / therapy*
  • Cost-Benefit Analysis
  • Disability Evaluation
  • Drug Costs*
  • Efficiency
  • Female
  • Humans
  • Low Back Pain / diagnosis
  • Low Back Pain / economics*
  • Low Back Pain / psychology
  • Low Back Pain / therapy*
  • Male
  • Meditation*
  • Middle Aged
  • Mindfulness / economics*
  • Pain Measurement
  • Pilot Projects
  • Sick Leave / economics
  • Time Factors
  • Treatment Outcome
  • Wisconsin

Substances

  • Analgesics, Opioid