Using Mindfulness to Decrease Chronic Pain

April 28, 2026

Takeaway: This randomized clinical trial showed that Learning to Apply Mindfulness to Pain (LAMP)-a scalable, telehealth mindfulness-based intervention (MBI)-improved pain-related function and biopsychosocial outcomes among Veterans with chronic pain, as well as high levels of psychiatric comorbidity, when compared to usual care. Study results helped investigators get buy-in from VA leadership to implement the LAMP self-paced mindfulness program as part of usual clinical practice.

Background

According to a report from CDC's National Center for Health Statistics, in 2023, 24% of adults suffered from chronic pain, which increased with age: from 12% among adults ages 18 to 29 to 39% among adults ages 65 and older. Further, Veterans experience higher pain prevalence and severity than non-Veterans. Although guidelines currently recommend evidence-based, non-pharmacologic treatment approaches for chronic pain (i.e., exercise, physical therapy, cognitive behavioral therapy, and mindfulness), they are underused due to various barriers at the patient, clinician, and organization levels.

Mindfulness-based Interventions for Chronic Pain

Mindfulness-based interventions (MBIs) can improve chronic pain and comorbid conditions, such as post-traumatic stress disorder (PTSD), sleep disorders, depression, and substance misuse, and are now recommended as a first-line treatment. However, many MBIs, including mindfulness-based stress reduction (MBSR)-one of the most widely adopted MBIs-have features that pose barriers to implementation.

Diana Burgess, PhD, a core investigator with HSR's Center for Care Delivery and Outcomes Research (CCDOR), and colleagues conducted a multi-site, randomized clinical trial to examine the effectiveness of both group and self-paced telehealth mindfulness-based interventions for Veterans with chronic pain compared to usual care. Specifically, they sought to determine the efficacy of Learning to Apply Mindfulness to Pain (LAMP)-a scalable, relatively low-resource MBI delivered via telehealth for Veterans with chronic pain. The study included Veterans (n=811) with moderate to severe chronic pain, recruited from three VA medical centers from November 2020 to May 2022.

Two 8-week telehealth MBIs (group and self-paced) were compared to usual care (control). The group MBI was done via videoconference with pre-recorded mindfulness education and skill training videos by an experienced instructor, accompanied by facilitated discussions. The self-paced MBI was similar but completed asynchronously, and was supplemented by three individual facilitator calls. Study results showed both MBIs improved pain-related function and biopsychosocial outcomes compared to usual care among Veterans with chronic pain. Both group and self-paced MBIs did not significantly differ from one another. The probability of 30% improvement from baseline compared to control was greater for group MBI at 10 weeks and 6 months, and for self-paced MBI at all three time points. Findings further suggested that MBIs are relatively safe, including for patients with mental health diagnoses.

Implications

This study suggests MBIs conducted virtually could help accelerate the implementation of non-pharmacological pain treatment across the VA healthcare system and beyond. The LAMP program is in the process of being implemented using two approaches: 1) Health and wellness coaches in pain management teams, and 2) Virtual academic detailing in rural-serving community-based outpatient clinics (CBOCs).

Partners

The pilot project using virtual academic detailing is funded by VA's Office of Rural Health (ORH); the pilot will start within five VA CBOCs and is expected to expand. The pilot project using health and wellness coaches in pain management teams is funded by the Complementary and Integrative Health Evaluation Center (CIHEC), in partnership with the Office of Patient Centered Care and Cultural Transformation.

Investigator

Diana Burgess, PhD, is Director of VA's Advanced Fellowship Program in Health Services Research at HSR's Center for Care Delivery and Outcomes Research (CCDOR), Director of VA QUERI's Complementary and Integrative Health Evaluation Center, and a Professor of Medicine at the University of Minnesota.

Citations

1. Burgess D, Calvert C, Hagel Campbell E, et al. Telehealth mindfulness-based interventions for chronic pain: The LAMP randomized clinical trial. JAMA Internal Medicine. October 1, 2024;184(10):1163-1173. [This paper received the 2025 Lederle Clinical Research Paper of the Year]
2. Burgess D, Evans R, Allen K, et al. Learning to Apply Mindfulness to Pain (LAMP): Design for pragmatic clinical trial of two mindfulness-based interventions for chronic pain. Pain Medicine. December 12, 2022;21(Suppl 2):S29-S36.