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

慢性下腰痛(CLBP)是65岁或以上患者最常见的疼痛状况。 美国。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，并增加对卫生保健提供者(HCP)的访问。老年人通常有额外的医疗保健问题 并需要更多援助才能获得HCP，这延误了治疗并进一步增加了成本。止痛药是 通常是处方药，但它们可能很昂贵，而且在已经很脆弱的情况下会产生特别麻烦的副作用 人口。耳穴穴位按压(APA)对耳穴进行类似针灸的刺激，而不是 使用针(即，种子被绑在穴位上)来治疗疾病/症状。APA特别适合 对于未满足的cLBP管理的当前挑战。我们提出了一个随机对照试验来(1)确定 APA对cLBP的降压作用；(2)研究APA对cLBP作用的生理机制。 我们将确定为期4周的APA疗法对65岁或65岁以上患有cLBP的成年人的疗效。在指导下 NIH疼痛联盟研究工作组，关于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)。我们还将衡量 心理、行为、个人和社会因素，这些因素可能调节或调节APA的影响。我们也 我认为炎性细胞因子可能部分解释了APA的止痛和改善作用机制 背部特定的身体功能，并计划测量这些。这项研究将确定一种新的管理方法 CLBP在老年人中的应用，这是一种创新的、非侵入性的、低成本的、自我管理的、非药理学的 作为慢性下腰痛的辅助治疗方法，副作用最小。如果成功，疼痛的范例 管理将从传统的医学模式向更大的综合医学和自我管理模式转变 避免不必要地演变为长期残疾的范例。

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.