Empowering the Management of Pain-Obesity-Weight through Enhanced Reward

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PROJECT SUMMARY/ABSTRACT Chronic low back pain (cLBP) is the leading cause of disability worldwide and is one of the top reasons for seeking healthcare. High-impact low back pain is particularly problematic, defined as chronic pain accompanied by significant restrictions in work, social, and/or self-care activities for six months or more. High-impact pain is associated with greater pain-related disability, opioid use, and healthcare costs compared to pain of lower impact. Thus, efforts to reduce chronic pain impact have become a public health initiative. Low back pain and overweight/obesity are highly comorbid; overweight and obese individuals are up to 43% more likely to have cLBP compared to normal weight individuals. Together, the additive effects of overweight/obesity and chronic pain may play a larger role in increasing the risk for other adverse health-related comorbidities. To understand the relationship between excess weight and pain impact, we have developed a conceptual model that suggests the greatest reductions in pain impact for adults with comorbid cLBP and overweight/obesity will be observed by delivering content aimed at increasing non-food environmental reward and positive affect, in addition to delivering evidence-based weight loss and pain coping treatments. Therefore, the aim of this exploratory study is to examine the feasibility and acceptability of an integrated pain and weight management intervention (EMPOWER) for middle-aged and older adults with moderate-to-high impact low back pain by addressing mechanisms of environmental reward and positive affect. Forty adults (ages 45-80 years) with comorbid overweight/obesity (BMI≥25 kg/m2) and moderate-to-high impact cLBP will be assigned to an 8-month intervention, whereby they will receive a group- and telephone-based program featuring integrated behavioral weight loss treatment and cognitive-behavioral pain coping therapy. To address the key mechanisms of environmental reward and positive affect, the proposed intervention will incorporate systematic pleasant activity scheduling and values-clarification techniques. Assessments will be conducted at baseline and at the 4- and 8-month time points. The proposed research will be a step toward the development of therapeutic modalities aimed at improving pain and weight management in adults with comorbid cLBP and overweight/obesity, and will provide essential information to guide a larger, randomized-controlled trial of the EMPOWER intervention.