Lay summary
Chronic musculoskeletal pain (CMP) affects one-third of the global population and is a leading cause of disability in Aotearoa New Zealand. Māori, Pacific peoples, and disabled communities experience disproportionately high rates of CMP and limited access to effective pain services. Current treatments offer modest benefits and are often costly and inaccessible. Mindfulness meditation (MM) addresses complex biopsychosocial mechanisms and provides a low-cost, non-pharmacological pain management option. Building on an HRC-funded feasibility RCT, this pragmatic multi-centre RCT will evaluate the clinical and cost-effectiveness of a brief, biculturally responsive MM intervention incorporating tikanga Māori, delivered in community settings and via telehealth. The trial will compare usual care with and without MM among Māori and non-Māori adults with CMP. Primary outcome is pain interference with activities. Nested qualitative and economic investigations will assess acceptability and cultural safety of the MM intervention, and cost-effectiveness, informing scalable, equitable pain management strategies for underserved populations.