What causes low back pain to flare: Has a major opportunity to understand back pain been missed?

项目总结/摘要 下背痛（LBP）传统上被视为急性发作的短暂性疾病或慢性疼痛。 持续状态。然而，越来越多的人认识到，对于大多数（>80%的病例），LBP具有可变性。 和持续的轨迹特征在于波动的症状-与时期的更严重的症状被称为 “耀斑”。目前关于LBP风险因素的研究仅考虑了与新发作或 向慢性LBP过渡。这项工作的结果未能提供有效的战略，以防止新的 发作或慢性，也不能减轻LBP的过度负担。这项建议的基本前提是， LBP的波动或爆发是由短暂/波动暴露于多种因素介导的。 域，个体之间的差异，这些因素的识别可以提供一个基础， 个性化护理的新模式。这个项目将采取一个新的眼光在LBP直接解决这个问题 利用最新技术进步所带来的创新方法。这项工作是基于我们广泛的 与患有LBP的人合作，提供了关于耀斑如何定义的关键见解（令人惊讶的是， 并不仅仅是基于疼痛）以及他们对LBP发作潜在原因的看法。 我们的多学科研究团队提出了一项创新的病例交叉研究，将解决两个目标。目的 1将在3个月内的多个时间点检查一系列候选生物/行为， 根据消费者选择的LBP发作的心理、社会和环境风险因素 观点，文献回顾和我们广泛的初步研究。措施将在“真实的二字”上发力 使用先进的可穿戴和在线技术。AIM 2将对来自美国的个人进行嵌入式研究。 经常发作的主要参与者队列。为期7天，符合条件的个人将接受更密集的“真实的- 世界”的生理和生物力学措施，使用可穿戴传感器的创新组合， 以家庭为基础的样本/数据收集，以调查两个令人惊讶的初步 观察：（1）睡眠不好是随后发作的潜在风险因素（与传统观点相反 疼痛干扰并导致睡眠不佳），以及（2）低而不是高体力活动是一个风险因素 对于LBP耀斑。我们的目标不仅是确定睡眠质量和身体活动的日常变化，而且是如何变化的。 最重要的，但可以改变的健康行为-驱动下腰痛发作。 这些数据将通过提供对驱动波动机制的新理解来填补一个主要空白。 LBP的经验这些因素将为更有针对性和个性化的开发和测试提供基础 采取干预措施，以减轻这种情况对患者和社会造成的巨大和不断恶化的负担。

PROJECT SUMMARY/ABSTRACT Low back pain (LBP) is traditionally viewed as either a transient condition with acute episodes or a chronic persisting condition. However, it is increasingly recognized that for most (>80% of cases), LBP has a variable and ongoing trajectory characterized by fluctuating symptoms – with periods of worse symptoms referred to as “flares”. Current work regarding risk factors for LBP only considers those associated with a new episode or the transition to chronic LBP. Findings from that work has failed to deliver effective strategies to prevent new episodes or chronicity, nor reduce the excessive burden of LBP. The underlying premise of this proposal is that fluctuation or flaring of LBP is mediated by transient/fluctuating exposure to a range of factors across multiple domains, that differ between individuals, and identification of these factors could provide a basis for a completely new model to personalize care. This project will take a fresh look at LBP by directly addressing this question using innovative methods that are enabled by recent advances in technology. The work is based on our extensive collaboration with people with LBP that has provided critical insight into how flares are defined (which surprisingly is not based on pain alone) and their perspective of the potential causes for LBP flares. Our multidisciplinary research team propose an innovative case-crossover study that will address two aims. AIM 1 will examine, at multiple timepoints over a period of 3 months, an array of candidate biological/behavioral, psychological, social, and environmental risk factors for LBP flare that have been selected based on consumer perspective, literature review and our extensive preliminary studies. Measures will be made in the “real word” using advanced wearable and online technologies. AIM 2 will involve an embedded study of individuals from the main participant cohort who flare frequently. For 7 days, eligible individuals will undergo more intensive “real- world” physiological and biomechanical measures using an innovative combination of wearable sensors and home-based sample/data collection to investigate potential mechanisms underlying two surprising preliminary observations: (1) that poor sleep is a potent risk factor for a subsequent flare (as opposed to the traditional view that pain interferes with and causes poor sleep), and (2) that low rather than high physical activity is a risk factor for LBP flare. We aims to identify not only if, but how, daily variations in sleep quality and physical activity – two of the most important, yet modifiable health behaviors – drive flare of LBP. Together these data will fill a major gap by providing new understanding of mechanisms that drive the fluctuating experience of LBP. Such factors will provide the foundation to develop and test more targeted and personalized interventions to reduce the enormous – and worsening – burden of this condition on sufferers and society.