Combined Chiropractic Care and Tai Chi for Chronic Non-Specific Neck Pain

慢性非特异性颈部疼痛(CNNP)不是由器质性病理引起的，它是显著 直接医疗成本、医疗服务提供者就诊次数以及与工作相关的生产力损失。尽管这是世界上最大的 根据患病率和残疾损失年数计算的五种慢性疼痛情况，到目前为止，颈部疼痛 只有一小部分研究资金用于治疗下腰痛。因此，有一个有限的证据 以基地指导管理。药理学和非药理学干预被广泛用于 管理CNNP，但效果大小充其量是低到中等，没有一种疗法脱颖而出。 从生物心理社会框架来理解CNNP是最好的，该框架识别病因、严重性和 结果是一系列复杂和相互关联的生物、心理和社会因素，并指出 承诺采取互补和综合的保健办法，以实现成功的疾病管理和 治疗。因此，该应用程序探索了务实交付和临床应用的可行性 评估两种广泛使用的CNNP管理方法的联合影响--脊椎疗法 和太极(TC)。之所以选择这些特定的医疗模式，是因为它们各自都显示出在管理方面的前景 CNNP，基于它们互补的方法、优势和治疗成分，有 当两者以协调的方式交付时，极有可能产生相加或协同效应。 我们的长期目标是进行一项多点全功率试验，评估脊椎疗法的有效性。 护理与TC训练相结合，可减少CNNP成人患者的疼痛和残疾。作为第一步，我们建议 进行一项三臂、混合方法的试点研究。我们将招募并随机(1：1：1)48名成人CNNP患者到 接受：1)10次脊椎按摩治疗(超过16周)，同时接受TC培训(16周内 人员小组培训)加上增强的日常护理(EUC；普通护理(UC)和CNNP教育材料)；2) 脊椎疗法加EUC；或3)单独使用EUC。个人将在结束后的8周内接受跟踪 在干预期内评估长期结果。目标1将评估我们招募网络的能力 脊椎按摩师和太极教练，改进我们的干预措施，并评估干预方案的保真度。目标 2将评估招募、保留和监测成人CNNP患者进入我们试验的可行性。 AIM 3将完善数据收集程序，并评估未来试验的结果。 鉴于脊椎按摩和TC在全国范围内的广泛应用，如果被证明有效，这种多式联运 治疗CNNP的方法可能是一种对公共卫生有直接影响的实用战略。这 应用与NCCIH的2021-2025年战略计划一致，包括推进全人研究 以及研究可以改善一线慢性疼痛的非药物疼痛管理策略 管理层。

Chronic nonspecific neck pain (CNNP), which is not due to organic pathology, is responsible for significant direct health care costs, health care provider visits, and work-related productivity loss. Though one of the top five chronic pain conditions in terms of prevalence and years lost to disability, to date, neck pain has received only a small fraction of the research funding given to low back pain. Consequently, there is a limited evidence base to guide management. Both pharmacological and non-pharmacological interventions are widely used to manage CNNP, but effect sizes are, at best, low to moderate, and no one therapy stands out as superior. CNNP is best understood from a biopsychosocial framework that recognizes etiology, severity, and outcomes as a complex and interrelated array of biological, psychological and social factors and points to the promise of complementary and integrative health approaches for successful disease management and treatment. Accordingly, this application explores the feasibility of pragmatically delivering and clinically evaluating the combined impact of two widely available approaches for managing CNNP––chiropractic care and Tai Chi (TC). These specific modalities were chosen because both individually show promise in managing CNNP, and based on their complementary approaches, strengths, and therapeutic components, there is a strong likelihood of additive or synergist effects when the two are delivered in a coordinated manner. Our long-term goal is to conduct a multi-site fully powered trial evaluating the effectiveness of chiropractic care combined with TC training to reduce pain and disability in adults with CNNP. As a first step, we propose to conduct a three-arm, mixed-methods pilot study. We will recruit and randomize (1:1:1) 48 adults with CNNP to receive: 1) 10 chiropractic treatments (delivered over 16 weeks) with concurrent TC training (16 weeks of in- person group training) plus enhanced usual care (EUC; usual care (UC) with CNNP educational materials); 2) chiropractic care plus EUC; or 3) EUC alone. Individuals will be followed for 8 weeks after the end of their intervention period to assess longer-term outcomes. Aim 1 will evaluate our ability to recruit a network of chiropractors and Tai Chi instructors, refine our interventions, and assess fidelity of intervention protocols. Aim 2 will assess the feasibility of recruiting, retaining and monitoring the safety of adults with CNNP into our trial. Aim 3 will refine data collection procedures and evaluate outcomes for future trials. Given the widespread availability of chiropractic and TC nationally, if proven effective, this multimodal approach for treating CNNP could represent a practical strategy with immediate public health impact. This application aligns with NCCIH’s 2021-2025 Strategic Plan, including advancing research on the whole person and investigating non-pharmacological pain management strategies that can improve first-line chronic pain management.