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

项目概要/摘要 慢性下背痛（cLBP）是全球残疾的主要原因，也是导致残疾的主要原因之一。 寻求医疗保健。高冲击性腰痛尤其成问题，定义为慢性疼痛伴随 在工作、社交和/或自我照顾活动方面受到重大限制达六个月或以上。高冲击性疼痛是 与较低的疼痛相关残疾，阿片类药物使用和医疗保健费用相比， 冲击因此，减少慢性疼痛影响的努力已成为一项公共卫生倡议。腰痛和 超重/肥胖是高度共病的;超重和肥胖个体有高达43%的可能性 cLBP与正常体重个体相比。总之，超重/肥胖和慢性 疼痛可能在增加其他不良健康相关合并症的风险方面发挥更大的作用。了解 超重和疼痛影响之间的关系，我们已经开发了一个概念模型， 对于患有共病cLBP和超重/肥胖的成人，将观察到疼痛影响的最大降低， 提供旨在增加非食品环境奖励和积极影响的内容， 以证据为基础的减肥和疼痛应对治疗。因此，本探索性研究的目的是 检查疼痛和体重综合管理干预（EMPOWER）的可行性和可接受性 中老年人的中度至高度影响下腰痛，通过解决机制， 环境奖励和积极影响。40名成人（年龄45-80岁）伴超重/肥胖症 (BMI≥25 kg/m2）和中度至高度影响的cLBP将被分配到8个月的干预， 将接受一个以小组和电话为基础的计划，该计划以综合行为减肥治疗为特色， 认知行为疼痛应对疗法要解决环境奖励和积极的关键机制 影响，拟议的干预将纳入系统的愉快活动安排和价值观澄清 技术.将在基线以及4个月和8个月时间点进行评估。拟议 这项研究将是朝着开发旨在改善疼痛和体重的治疗方式迈出的一步 管理患有共病cLBP和超重/肥胖的成人，并将提供必要的信息， 指导一个更大的，随机对照试验的EMPOWER干预。

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.