Mindfulness physical therapy, pain management, rehabilitation

MBSR Cost Savings for Chronic Low Back Pain

Patients with Chronic Low Back Pain (CLBP) present a higher economic burden to society and insurance payers than those without CLBP.1 This is largely due to increased prescribing of pain-related medications, greater healthcare resource utilization and lost productivity.1 In an examination of the societal and payer cost effectiveness of Mindfulness-Based Stress Reduction (MBSR), Herman and colleagues undertook an economic evaluation of 301 health plan members with CLBP, enrolled >=180 days in a large health plan in Washington State, pre-and post- randomization to Usual Care (UC), MBSR or Cognitive Behavioral Therapy (CBT).2 Societal costs included participant co-payments for healthcare, employer productivity losses and overall healthcare costs to health plan.

Compare to UC, MBSR reduced total societal costs by $724 per participant over 1 year. Most of these cost savings were due reduced healthcare costs to the insurance payer of $982 per participant over 1 year. CBT was not found to be cost saving.

In my experience, MBSR provides patients with CLBP skills to observe and self-manage physical, cognitive and emotional reactions to pain and stress. While maladaptive, automatic reactions such as catastrophic thinking, fear and muscle guarding can contribute to amplifying symptoms, more conscious, deliberate choices, such as calming self-talk, self-compassion and relaxation, can contribute to improved symptom management and/or symptom reduction. It follows that patients who are better skilled at self-managing and reducing pain and stress symptoms would experience improved well-being and have less need to access healthcare resources.

1Gore M, Sadosky A, Stacey BR, et al. The burden of chronic low back pain: clinical comorbidities, treatment patterns and healthcare costs in usual care settings. Spine. 2012;37(11):E668-77.

2Herman PM. Anderson ML, Sherman KJ, et al. Cost-effectiveness of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care among adults with chronic low back pain. Spine. 2017. Jul 24. [Epub ahead of print]