Moderators of the Effects of Telehealth Mindfulness-based Interventions for Chronic Pain: A Secondary Responder Analysis of the LAMP Randomized Controlled Trial.
C. Calvert, Emily M. Hagel Campbell, et al. • The Clinical Journal of Pain • 2026
Both self-paced and group telehealth Mindfulness-Based Interventions had higher rates of improvement across all outcomes compared to usual care, with limited evidence for differential effects by gender or mental health diagnoses among veterans with chronic pain.
Key Findings
Results
Both MBI arms showed higher rates of improvement across all outcomes compared to usual care.
The sample consisted of 811 veterans with moderate to severe chronic pain recruited from three Veterans Affairs sites from 2020 to 2022.
Outcomes measured included pain interference, pain intensity, anxiety, depression, PTSD, fatigue, sleep disturbance, physical function, and social functioning.
Survey data were collected at baseline and three follow-up timepoints: 10 weeks, 6 months, and 12 months.
Both the group MBI and self-paced MBI arms outperformed usual care across all measured outcomes.
Results
In the group MBI arm, women had greater improvement in pain severity and depression than men.
Gender was tested as a moderator of MBI treatment effects.
This differential effect by gender was observed specifically in the group MBI arm, not the self-paced MBI arm.
The finding suggests a potential gender-based differential response to the group format of MBI.
Overall evidence for differential effects by gender across all outcomes was described as limited.
Results
In the group MBI arm, participants with anxiety diagnoses had less improvement in PTSD than those without anxiety diagnoses.
Anxiety diagnosis was one of three mental health conditions tested as moderators, along with depression and PTSD.
This differential effect was specific to PTSD outcomes within the group MBI arm.
The finding indicates that a comorbid anxiety diagnosis may attenuate PTSD-related benefits of group-format MBI.
Overall evidence for differential effects by mental health diagnoses across all outcomes was described as limited.
Results
Both MBIs benefitted participants broadly across subgroups defined by gender and mental health diagnoses.
Moderators tested included gender and diagnoses of depression, anxiety, and post-traumatic stress disorder.
The study used a responder analysis approach to measure clinically important changes rather than mean differences.
Despite some statistically detected moderation effects, the overall pattern showed broad benefit across subgroups.
The authors concluded there was 'limited evidence for differential effects by gender or mental health diagnoses.'
Methods
The study design was a three-arm randomized controlled trial comparing self-paced MBI, group MBI, and usual care among veterans with chronic pain.
ClinicalTrials.gov ID: NCT04526158.
Participants were recruited from three Veterans Affairs sites from 2020 to 2022.
Eligibility required moderate to severe chronic pain.
The trial included 811 veterans with survey data collected at baseline, 10 weeks, 6 months, and 12 months.
The study was conducted via telehealth modality.
Discussion
Further research is needed to more systematically determine whether MBIs can be optimized for key subgroups.
The authors note that little is currently known about who benefits most from MBIs.
It is also unclear whether certain groups differentially benefit from group-based versus non-group-based MBI formats.
The secondary responder analysis approach used here represents one method to examine clinically meaningful differential effects.
The authors call for more systematic investigation into subgroup optimization of MBI delivery.
What This Means
This research examines who benefits most from mindfulness-based programs delivered via telehealth for veterans living with chronic pain. The study compared two types of mindfulness programs — one delivered in a group format and one that participants could complete at their own pace — against usual medical care among 811 veterans. Both mindfulness programs outperformed usual care on every outcome measured, including pain, anxiety, depression, PTSD, fatigue, sleep, physical function, and social functioning, across a full year of follow-up.
The study also looked at whether certain groups of people responded differently to the programs. Women in the group mindfulness program showed greater improvements in pain severity and depression compared to men. Veterans with an anxiety diagnosis who participated in the group program showed smaller improvements in PTSD symptoms than those without an anxiety diagnosis. However, these were isolated findings, and overall the evidence for meaningful differences between subgroups was limited — meaning most veterans benefited from both formats regardless of gender or whether they had depression, anxiety, or PTSD.
This research suggests that telehealth mindfulness programs are broadly beneficial for veterans with chronic pain across a range of demographic and mental health characteristics. The findings also hint that the group format may work somewhat differently for women and for people with comorbid anxiety, which could eventually help clinicians match patients to the most appropriate program type. The authors emphasize that more research is needed to fully understand how mindfulness interventions can be tailored to work best for specific groups of people.
Check Your Own Numbers
Upload your bloodwork. We'll cross-reference your results against this study and 4,700 others.
C. Calvert, Emily M. Hagel Campbell, Lee J. S. Cross, A. Bangerter, G. Bronfort, Roni Evans, et al.. (2026). Moderators of the Effects of Telehealth Mindfulness-based Interventions for Chronic Pain: A Secondary Responder Analysis of the LAMP Randomized Controlled Trial.. The Clinical Journal of Pain. https://doi.org/10.1097/AJP.0000000000001416