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Invited Commentary
December 14, 2020

Are Methods for Evaluating Medications Appropriate for Evaluating Nonpharmacological Treatments for Pain?—Challenges for an Emerging Field of Research

Author Affiliations
  • 1Kaiser Permanente Washington Health Research Institute, Seattle
JAMA Intern Med. 2021;181(3):328-329. doi:10.1001/jamainternmed.2020.7081

Interest in identifying safe and effective nonpharmacological treatments for chronic or recurrent pain conditions has rapidly grown in recent years, largely because of growing concerns about the adverse effects and questionable effectiveness of opioids and other pharmacological treatments. In this issue of JAMA Internal Medicine, Wells and colleagues1 present the results of their randomized clinical trial comparing the effectiveness of mindfulness meditation (specifically mindfulness-based stress reduction [MBSR]) and headache education (HAE) for persons experiencing 4 to 20 migraines per month for at least 1 year. Ninety-six participants were enrolled, 49 (51%) to MBSR and 47 (49%) to HAE. The primary outcome, improvement in diary-reported migraine day frequency from baseline to 12 weeks, did not differ significantly in the 2 groups. However, the MBSR group had significantly greater improvements in disability, quality of life, self-efficacy, pain catastrophizing, and depression. The effect sizes for these measures were moderate to large and persisted at least 36 weeks. Finally, MBSR participants reported significantly greater decreases from baseline in pain unpleasantness and intensity following experimentally induced pain.

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