Mind-Body Therapies to Prevent Chronic Low Back Pain

描述(申请人提供)：虽然约10%的急性下腰痛(ALBP)患者会发展为慢性下腰痛(CLBP)，但他们消耗了约75%的LBP相关医疗费用，并构成社会的主要经济负担。从急性向慢性下腰痛的转变与多种危险因素有关，其中心理社会危险因素具有最大的预测能力。这表明情绪、应对和认知(心理)与LBP(身体)的身体体验之间存在相互作用。强调身心联系的CAM模式，如基于正念的减压、Feldenkrais和瑜伽，可能会修正这些风险因素，帮助预防慢性LBP。临床医生目前还没有一种简单、有效的工具来识别aLBP的慢性疼痛高危患者，也不清楚是否(如果是的话)哪些CAM疗法可以改变aLBP患者的风险状况和结果。这些信息将有助于规划LBP心身疗法的对照试验，确定这些疗法的可能作用机制，并将卫生保健资源用于慢性LBP预防。 候选人将进行两个项目：(1)在北加州Kaiser Permanente进行的前瞻性队列研究(n=620)，(A)为初级保健诊所开发和验证简短的预测工具，(B)评估风险因素随时间的变化及其与LBP结果变化的关联；(2)在随机和观察性研究中评估特定的心智-身体疗法是否改变了用新预测工具测量的变量。该候选人将追求一个有组织的教育计划，其中包括课程作业，指导和监督这些项目，以发展必要的技能，在行为科学，心理测量评估措施，和临床研究的实施。候选人的总体目标是成为一名独立的研究员，进行预防慢性下腰痛的心身方法的临床研究。

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.