NIH recognises back-pain treating mindfulness and epidural stimulation as 2016 research highlights

One quadriplegic patient was able to hold and drink from a cup following epidural stimulation

The US National Institutes of Health (NIH) have recognised two spine-related studies as research highlights for 2016. Research into the effects of meditation and cognitive behavioural therapy on low back pain has been recognised as a “Clinical Breakthrough”, while a study investigating the ability of electrical epidural stimulation to help move the hands of paralysed individuals was recognised as a “Promising Medical Advance”.

The mindfulness study, published online in the Journal of the American Medical Association, successfully demonstrated that meditation and cognitive-behavioural therapy can reduce chronic low back pain in adults. According to an NIH article, Daniel Cherkin (Cherkin Health Research Institute, Seattle, USA) and colleagues “enrolled 342 people, ages 20 to 70 years, who had back pain for more than three months that could not be attributed to a specific cause. Participants were randomly assigned to one of three treatments groups: cognitive behavioural therapy, mindfulness-based stress reduction, or usual care.”

Those individuals in the cognitive behavioural therapy and mindfulness groups received exercise books and compact discs to supplement weekly two-hour sessions, attended for eight weeks. “The usual care group could seek whatever treatment, if any, they wanted,” the article states.

Functional improvement was found to be higher for 61% of the mindfulness group and 58% of the cognitive behavioural therapy group at six months. Only 44% of the usual care group experienced higher functional improvement compared to baseline. The amount of individuals reporting improved back pain was significantly higher for the mindfulness and cognitive behavioural therapy groups compared to the usual care group (44%, 45% and 27%, respectively).

Moderate benefits were sustained to one year.

“The research suggests that training the brain to respond differently to pain signals may be more effective—and last longer—than traditional physical therapy and medication,” says Cherkin in the NIH article.

“The results from this research affirm that non-drug/non-opioid therapies, such as meditation, can help manage chronic low-back pain. Physicians and their patients can use this information to inform treatment decisions,” says NCCIH director Josephine Briggs.

The second piece of research recognised by the NIH was a proof-of concept study, testing the possibility of improving hand function in patients with cervical spinal cord injury. Whilst this approach has been used to treat lower limbs before, this is the first time it has been used on upper limbs of people with severe spinal cord injuries. The study was published in Neurorehabilitation and Neural Repair.

Daniel Lu (University of California, Los Angeles, USA) and colleagues implanted an array of 16 electrodes across the injury sites of two quadriplegic people with severe cervical spinal injury, who had been paralysed for over 18 months. According to an NIH report on the study, “The participants practiced grasping and moving a handgrip while receiving varying levels of electrical pulses from the devices. One person was tested daily over 7 days while the other had weekly sessions for 8 weeks.”

The individuals experienced increases in hand strength over the course of just one session, which they found they were able to increase over further sessions. Control of their hands also improved. Interestingly, the participants were able to sustain these results beyond the duration of stimulation.

“Both individuals made large gains in feeding, dressing, bathing, and grooming. Their mobility in bed and ability to get themselves in and out of bed improved as well. One participant regained the ability to pick up and drink from a cup,” the NIH reports.

“In this study we demonstrate that through cervical epidural stimulation, hand and upper extremity function can be substantially improved, imparting the ability to participate in activities of daily living, self-care and transfer, and to live independently,” Lu says in the NIH article.

“Even relatively minor gains in function of the upper limb can make huge differences in the quality of life for a person who can’t grasp anything,” adds co-author V Reggie Edgerton (University of California, Los Angeles, USA).

According to the report, the team plans to study the approach in more patients, with longer follow-up.