Effectiveness of a Mind-Body Program for Older Adults with Chronic Low Back Pain

描述（由申请人提供）：慢性腰痛（CLBP）在老年人中很常见；治疗是不充分的，随着美国人口的老龄化，这只会成为一个更大的问题。我们相信，身心疗法有望满足增强疼痛治疗的需求。在我们的初步研究中，参与者在参加了为期8周的身心计划后，自我报告的功能显著改善。此外，他们在神经心理表现（NP）的测量中也有所改善，包括注意力和执行功能的改善。为了进一步开展这项工作，我们提出了以下具体目标：1)确定身心计划在老年CLBP患者中提高功能和减轻疼痛的有效性；2)评估正念冥想对老年CLBP患者NP的影响。为了实现这些目标，我们将对300名65岁或以上的CLBP患者进行随机对照临床试验。身心计划是以正念减压计划为模型的，我们专门针对慢性疼痛患者进行了修改。我们将在课程完成后每月提供长达12个月的“助推器”课程。对照组将被随机分配到一个教育控制计划，该计划将改编自10个关键到健康老龄化。我们将测量自我报告和客观测量的身体功能，并在老年人群中进行验证。我们认为痛苦是多维的；因此，为了充分捕捉身心程序对疼痛的影响，我们将包括各种测量方法，不仅评估疼痛强度，还评估心理功能。NP将通过轻度认知障碍的计算机评估来评估，这是一种简短的、标准化的、基于计算机的精神状态评估。将对一部分参与者进行焦点小组讨论，以深入收集使用正念冥想来改善功能和减轻疼痛的个人描述。由于保持功能独立性对老年人来说是最重要的，我们的主要假设是：与教育对照组相比，在8周的身心计划之后，正念冥想将与罗兰和莫里斯残疾问卷（专门针对腰背部）中具有临床意义的2.5分改善有关。这一新的研究者申请响应了PA-07-046“身心相互作用与健康研究”的要求：1)检查身心程序对身体功能和疼痛的多维方面的影响，2)评估正念冥想对NP的影响，3)汇集了一个经验丰富的跨学科研究团队。这项提议的研究代表了第一个大型的、控制良好的、全面的关于身心计划对患有慢性疼痛的独立老年人的影响的研究。如果被证明是有效的，这种身心计划可以作为一种辅助方法广泛实施，以增加这一人群的功能和减少疼痛。

DESCRIPTION (provided by applicant): Chronic low back pain (CLBP) is common among older adults; treatment is inadequate and will only become a bigger problem with the aging of the American population. We believe that mind-body therapies are poised to meet the demand for enhanced pain treatment. Participants in our pilot study significantly improved in self- reported function after participation in an 8-week mind-body program. Furthermore, they improved in measures of neuropsychological performance (NP) including improved attention and executive function. To further this work, we propose the following specific aims: 1) to determine the effectiveness of a mind- body program in increasing function and reducing pain among older adults with CLBP, and 2) to evaluate the impact of mindfulness meditation on NP in older adults with CLBP. To accomplish these aims we will conduct a randomized, controlled clinical trial of 300 CLBP sufferers aged 65 years or older. The mind-body program is modeled on the Mindfulness-Based Stress Reduction Program, which we have modified to specifically target chronic pain sufferers. We will offer monthly "booster" classes at the completion of the programs for up to 12 months. The control group will be randomized to an education control program which will be adapted from the 10 KeysTM to Healthy Aging. We will measure self-reported and objectively measured physical function with tests validated in an older population. We view pain as multidimensional; therefore, to adequately capture the impact of the mind-body program on pain we will include a variety of measures to assess not only pain intensity, but psychological function. NP will be assessed with the Computer- Based Assessment of Mild Cognitive Impairment a brief, standardized, computer-based assessment of mental status. Focus groups will be conducted on a subset of participants to collect in-depth personal descriptions of using mindfulness meditation for improving function and reducing pain. Since maintaining functional independence is of foremost importance to older adults, our primary hypothesis is: mindfulness meditation will be associated with a clinically meaningful 2.5-point improvement in the Roland and Morris Disability Questionnaire, which is specific to the low back, immediately following an 8-week mind-body program as compared to an education control group. This new investigator application responds to PA-07-046 Research on Mind-Body Interactions and Health by 1) examining the effects of a mind-body program on physical function and the multidimensional aspects of pain, 2) evaluating the effects of mindfulness meditation on NP, and 3) bringing together an experienced interdisciplinary team of researchers. The proposed study represents the first large, well-controlled, comprehensive examination of the effects of a mind-body program on the independent older adult with chronic pain. If proven effective, this mind-body program could be broadly implemented as an adjunct method to increase function and decrease pain in this population.