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Data Coordinating Center for Spinal Manipulation and Patient Self-Management for Preventing Acute to Chronic Back Pain (PACBACK)

预防急性至慢性背痛的脊柱手法和患者自我管理数据协调中心 (PACBACK)

基本信息

批准号：
10895775
负责人：
PATRICK J HEAGERTY
金额：
$ 13.82万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10895775
关键词：
Acute Address Adult Affect Back Behavior Behavioral Caring Chronic low back pain Data Data Coordinating Center Dissemination and Implementation Drug usage Effectiveness Enrollment Guidelines Health Occupations Healthcare Hybrids Intervention Low Back Pain Medical Methods National Center for Complementary and Integrative Health Opioid Overdose Pain management Patients Pharmaceutical Preparations Pharmacotherapy Prevention Psychosocial Factor Randomized Recommendation Recovery Research Risk Factors Role Screening procedure Secondary Prevention Self Management Societies Spinal Manipulation Strategic Planning Structure Subgroup Testing Translating Translations addiction biopsychosocial chronic back pain chronic pain chronic painful condition clinical practice cost design disability effectiveness evaluation empowerment future implementation high risk implementation strategy improved nondrug therapy novel opioid misuse pain chronification pain reduction pain-related disability prevent primary outcome productivity loss public health priorities randomized trial secondary outcome targeted treatment uptake

项目摘要

SUMMARY. The US is in the midst of an unprecedented pain management crisis. Low back pain (LBP) is the most common chronic pain condition in adults and the leading cause of disability worldwide. Guidelines have recommended non-pharmacologic treatments like spinal manipulation and behavioral approaches for LBP for nearly a decade, however uptake in practice has been poor. Little is known about the role of these treatments in secondary prevention of chronic LBP (cLBP), especially for patients with biopsychosocial risk factors. With burgeoning costs of cLBP and mounting evidence of ineffectiveness and harms of commonly used drug treatments, including opioids, there is a critical need for research on non-pharmacological treatments for cLBP prevention that can be readily translated to practice. The long-term objective is to reduce overall LBP burden by testing scalable first-line non-pharmacologic strategies that address the biopsychosocial aspects of acute/sub-acute LBP and prevent transition to cLBP. We propose a novel randomized hybrid trial addressing both effectiveness and implementation. A total of 1000 patients will be enrolled with nonspecific LBP of 2-12 weeks duration, at medium and high risk of developing cLBP using the Subgroups for Targeted Treatment (STarT) Back Screening Tool (SBST). Aim 1 will assess the effectiveness of Spinal Manipulation Therapy (SMT), Structured Self-Management (SSM), and SMT+SSM relative to Usual Medical Care (UMC) in a randomized trial using a 2x2 factorial design. Primary outcomes are cLBP Impact at 12 months; and cumulative reduction of pain and disability over 1 year. Secondary outcomes include recovery from acute/sub-acute LBP at 6 months, PROMIS-29, productivity loss, health care use, and medication use (including opioids). Aim 2: will use mixed methods to gather data about important influences on the interventions that could affect results interpretation and future implementation. Aligned with the National Center for Complementary and Integrative Health’s (NCCIH) Strategic Plan 2016, this project has the potential to significantly transform LBP management by providing definitive and generalizable evidence regarding front-line non-pharmacologic interventions addressing physical and psychosocial factors for the prevention of cLBP. By empowering patients to engage in healthy pain management behaviors, we anticipate LBP related disability, productivity loss, and reliance on continued health care and medication use (including opioids) will be reduced. The comprehensive dissemination and implementation strategy, informed by major stakeholders, will facilitate translation into clinical practice across health professions.

总结。美国正处于一场前所未有的疼痛管理危机之中。腰痛（LBP）是