Management of Chronic Low Back Pain in Older Adults Using Auricular Point Acupressure

慢性腰痛（cLBP）是65岁或以上患者中最常见的疼痛状况， 美国的虽然正在开发新的干预措施，但它们往往成本更高，需要额外的诊断， 测试，并增加访问卫生保健提供者（HCP）。老年人往往有额外的医疗保健问题 并且需要更多的帮助来访问HCP，这延迟了治疗并进一步增加了成本。镇痛药 经常规定，但他们可以是昂贵的，并有特别麻烦的副作用，在这个已经脆弱的 人口耳穴指压法（阿帕）对耳穴施加类似针刺的刺激， 使用针（即，种子贴在穴位上）来治疗疾病/症状。阿帕特别适合 当前未满足的cLBP管理的挑战。我们提出了一个随机对照试验，以（1）确定 阿帕缓解cLBP的疗效;（2）探讨阿帕对cLBP作用的生理机制。 我们将确定为期4周的阿帕治疗对65岁或以上cLBP成人的疗效。为指导 NIH Pain Consortium Research Task Force，cLBP的标准化研究方法将用于 测量研究结果（即，疼痛强度、疼痛干扰和身体功能）。我们还将测量 心理，行为，个人和社会因素，可能缓和或调解阿帕的影响。我们也 我相信炎性细胞因子可以部分解释阿帕缓解疼痛的作用机制， 背部特定的身体功能和计划来衡量这些。这项研究将确定一种新的方法来管理 老年人的cLBP，这是一种创新的，非侵入性的，低成本的，自我管理的，非药物 作为cLBP的连续治疗方法，副作用最小。如果成功的话， 管理将从传统的医疗模式转向更大的中西医结合和自我管理 这一模式旨在避免不必要的演变，导致长期残疾。

Chronic low back pain (cLBP) is the most common pain condition diagnosed in patients 65 years or older in the United States. While new interventions are being developed, they often cost more, require additional diagnostic tests, and increase visits to health care providers (HCP). Older adults often have additional health care issues and need more assistance to access HCP, which delays treatment and further increases cost. Analgesics are often prescribed, yet they can be costly and have particularly troublesome side effects in this already vulnerable population. Auricular point acupressure (APA) applies an acupuncture-like stimulation to ear acupoints without using a needle (i.e., seeds are taped to the acupoints) to treat illness/symptoms. APA is particularly well-suited for current challenges of unmet cLBP management. We propose a randomized controlled trial to (1) determine the efficacy of APA in relieving cLBP and (2) examine the physiologic mechanisms of the APA effect on cLBP. We will determine the efficacy of a 4-week APA therapy for adults 65 years or older with cLBP. Guided by the NIH Pain Consortium Research Task Force, the standardized research approach on cLBP will be used to measure the study outcomes (i.e., pain intensity, pain interference and physical function). We will also measure psychological, behavioral, personal and social factors that may moderate or mediate the effects of APA. We also believe inflammatory cytokines may partially explain the mechanism of action of APA for pain relief and improved back-specific physical function and plan to measure these. This study will identify a novel approach to manage cLBP in older adults, which is an innovative, non-invasive, low-cost, self-manageable, non-pharmacological approach as an adjunctive therapy for cLBP, with minimal side effects. If successful, the paradigm of pain management will shift from a traditional medical model to a larger integrative medicine and self-management paradigm to avoid unnecessary evolution towards prolonged disability.