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

是什么导致腰痛发作：是否错过了了解背痛的重要机会？

• 批准号: 10709521
• 负责人: Paul William Hodges
• 金额: $ 43.73万
• 依托单位: UNIVERSITY OF QUEENSLAND
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709521
• 关键词: Acute; Address; American; Award; Back Pain; Behavioral; Biological; Biomechanics; Caring; Chronic; Chronic low back pain; Clinical; Collaborations; Cross-Over Studies; Crossover Design; Data; Data Collection; Disease remission; Eligibility Determination; Environmental Risk Factor; Equilibrium; Exposure to; Family; Flare; Foundations; Frequencies; Health behavior; Home; Hour; Individual; Interdisciplinary Study; International; Knowledge; Leisures; Link; Low Back Pain; Measures; Mediating; Methods; Modeling; Neuroimmune; Neuroimmunomodulation; Outcome; Pain; Pain Research; Pain management; Participant; Pathway interactions; Patients; Persons; Physical activity; Physical therapy; Physiological; Prize; Psychological Factors; Quality of life; Reporting; Research; Research Personnel; Review Literature; Risk; Risk Factors; Sampling; Selection for Treatments; Self Management; Sleep; Sleep Architecture; Societies; Symptoms; Technology; Testing; Time; Variant; Waxes; Work; career; case-by-case basis; cohort; cost; disability; experience; global health; improved outcome; innovation; insight; novel strategies; personalized approach; personalized care; personalized intervention; poor sleep; prevent; psychologic; psychosocial; skills; sleep quality; social; social factors; wearable sensor technology

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.

项目概要/摘要 腰痛 (LBP) 传统上被视为急性发作的短暂病症或慢性病症。 持续的情况。然而，人们越来越认识到，对于大多数（>80% 的病例），LBP 具有一个变量 以及以症状波动为特征的持续轨迹——症状更严重的时期称为 “耀斑”。目前关于腰痛危险因素的工作仅考虑与新发作或新发作相关的因素。 转变为慢性腰痛。这项工作的结果未能提供有效的策略来防止新的 发作或慢性，也不能减轻腰痛的过度负担。该提案的基本前提是 腰痛的波动或耀斑是由短暂/波动的暴露于多种因素介导的 领域，因人而异，识别这些因素可以为完全 个性化护理的新模式。该项目将通过直接解决这个问题来重新审视 LBP 使用最新技术进步所支持的创新方法。这项工作是基于我们广泛的 与 LBP 患者的合作为如何定义耀斑提供了重要的见解（令人惊讶的是 不仅仅是基于疼痛）以及他们对腰痛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案例交叉研究，该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， 根据消费者选择的腰痛发作的心理、社会和环境风险因素 观点、文献综述和我们广泛的初步研究。措施将“实实在在”地制定 使用先进的可穿戴和在线技术。 AIM 2 将涉及对来自以下国家的个人的嵌入式研究 经常发作的主要参与者群体。为期7天，符合条件的个人将接受更密集的“真实- 世界”生理和生物力学测量使用可穿戴传感器的创新组合 基于家庭的样本/数据收集，以调查两个令人惊讶的初步结果背后的潜在机制 观察结果：（1）睡眠不佳是随后发作的一个潜在危险因素（与传统观点相反） 疼痛会干扰并导致睡眠质量不佳），以及 (2) 较低而不是较高的体力活动是一个危险因素 用于 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是否存在变化，而且是如何变化——两个 最重要但可改变的健康行为之一是导致腰痛发作。 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重大空白。 LBP的经验。这些因素将为开发和测试更有针对性和个性化提供基础 采取干预措施，以减轻这种疾病给患者和社会带来的巨大且日益恶化的负担。