Mind-Body Therapies to Prevent Chronic Low Back Pain

描述（由申请人提供）：虽然约10%的急性腰痛（aLBP）患者会发展为慢性腰痛（cLBP），但他们消耗了约75%的LBP相关医疗费用，并构成了社会的主要经济负担。从急性到cLBP的转变与多种风险因素相关，其中心理社会风险因素具有最大的预测能力。这表明情绪，应对和认知（心灵）与LBP的身体体验（身体）之间存在相互作用。强调身心联系的CAM模式，如基于正念的减压，Feldenkrais和瑜伽，可能会改变这些风险因素，并有助于预防cLBP。临床医生目前没有一个简单的，有效的工具来识别慢性疼痛高风险的aLBP患者，目前还不清楚CAM治疗是否（如果是这样，哪些）可以改变aLBP患者的风险特征和结局。这些信息将有助于规划LBP身心疗法的对照试验，确定这些疗法的可能作用机制，并将医疗资源用于CLBP预防。 候选人将进行2个项目：（1）在北方加州的Kaiser Permanente进行的前瞻性队列研究（n = 620）（a）开发和验证初级保健诊所的简要预测工具和（B）评估风险因素随时间的变化及其与LBP结局变化的关联;（2）评估特定的身心疗法是否会改变随机和观察性研究中使用新预测工具测量的变量。候选人将追求一个结构化的教育计划，包括课程，指导和这些项目的监督，以发展行为科学，措施的心理测量评估和临床研究实施的必要技能。 候选人的总体目标是成为一名独立的研究者，进行身心方法的临床研究，以预防cLBP。

DESCRIPTION (provided by applicant): While about 10% of patients presenting with acute low back pain (aLBP) will develop chronic low back pain (cLBP), they consume about 75% of LBP related health care expenses and constitute a major economic burden for society. The transition from acute to cLBP is associated with multiple risk factors, of which psychosocial risk factors have the greatest predictive power. This suggests an interaction between emotion, coping, and cognition (mind) and the physical experience of LBP (body). CAM modalities emphasizing the mind-body link, such as Mindfulness Based Stress Reduction, Feldenkrais, and Yoga, may modify these risk factors and help prevent cLBP. Clinicians currently do not have a simple, validated tool for identifying patients with aLBP at high risk for chronic pain and it is unclear whether (and, if so, which) CAM therapies can modify the risk profile and outcome in patients presenting with aLBP. Such information would aid in planning controlled trials of mind-body therapies for LBP, in identifying possible mechanisms of action of these therapies, and in targeting health care resources for cLBP prevention. The candidate will conduct 2 projects: (1) a prospective cohort study (n = 620) at Kaiser Permanente, Northern California (a) to develop and validate a brief prediction tool for primary care clinics and (b) to assess changes in risk factors over time and their association with changes in LBP outcomes; (2) an assessment of whether specific mind-body therapies alter the variables measured with the new prediction tool in randomized and observational studies. The candidate will pursue a structured educational program that includes coursework, mentoring, and supervision of these projects to develop the necessary skills in behavioral science, psychometric evaluation of measures, and clinical research implementation. The candidate's overall goal is to become an independent investigator conducting clinical research of mind-body approaches for the prevention of cLBP.