Psychosocial moderators of response to a mindfulness-based stress reduction trial for chronic low back pain: considerations for intervention science and development

Dear Editor, Chronic low back pain (cLBP) is increasingly prevalent across populations and ages.1 Low back pain is currently the leading cause of disability worldwide.2 Beyond widespread effects on individual functioning and well-being, the financial,3 psychological,4 and social5 implications of cLBP are vast. Mindfulness-based stress reduction (MBSR) is effective in decreasing various pain outcomes (intensity and interference) and increasing physical and social functioning.6–8 MBSR could hold great promise for chronic pain management and increasing function, but there are still diversity-based limitations and downstream equity gaps in mindfulness-based interventions. This leaves the field ill equipped to understand how MBSR might or might not benefit different swaths of the population. Our previous research has indicated that psychosocial factors (depression, sleep, stress, and racialized identity) predict trajectories of pain outcomes.9,10 The present study investigated various psychosocial factors (ie, race, sex, income, education, and social support) as moderators of the effect of MBSR on trajectories of pain outcomes holistically over the intervention and follow-up periods. This secondary data analysis was conducted on a prior 8-week MBSR clinical trial for cLBP, the Aging Successfully with Pain Study (2011–2014).8