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.

项目摘要/摘要 传统上，腰痛（LBP）被视为具有急性发作的瞬态状况或慢性病 持续状态。但是，越来越多地认识到，对于大多数（> 80％的情况），LBP具有变量 以及以症状波动的特征的持续轨迹 - 症状较差的时期称为 “耀斑”。有关LBP风险因素的当前工作仅考虑与新事件或新事件相关的工作 过渡到慢性LBP。这项工作的发现未能提供有效的策略来防止新的 发作或慢性，也不减少LBP的过量燃烧。该提议的基本信念是 LBP的波动或爆炸是通过瞬时/波动暴露于多个因素的一系列因素来介导的 域，个人之间的不同以及对这些因素的识别可以为一个完全的基础提供基础 个性化护理的新模型。这个项目将通过直接解决这个问题来重新查看LBP 使用最新技术进步启用的创新方法。这项工作是基于我们广泛的 与LBP患者的合作，为耀斑的定义提供了重要的见解（令人惊讶的是 不是仅基于疼痛）及其对LBP耀斑的潜在原因的看法。 我们的多学科研究团队提案一项创新的案例分解研究将解决两个目标。目的 1将在3个月内的多个时间点上检查一系列候选生物学/行为， LBP耀斑的心理，社会和环境风险因素已根据消费者选择 观点，文献综述和我们广泛的初步研究。措施将以“真实的词”做出 使用先进的可穿戴技术和在线技术。 AIM 2将涉及对来自 经常爆发的主要参与者。在7天内，符合条件的人将经历更密集的“现实” 世界”的物理和生物力学测量，使用可穿戴传感器和 基于家庭的样本/数据收集，以研究两个惊喜初步的潜在机制 观察：（1）睡眠不良是随后发作的潜在危险因素（与传统观点相反 疼痛会干扰并导致睡眠不佳），（2）低体育锻炼是一个危险因素 对于LBP耀斑。我们的目的不仅是在识别睡眠质量和体育锻炼的每日变化的情况下，还要确定如何 - 两个 最重要但可修改的健康行为 - 驱动LBP的耀斑。 通过提供对推动波动的机制的新理解，这些数据将填补一个重大空白 LBP的经验。这些因素将为开发和测试更具针对性和个性化的基础提供基础 减少对患者和社会状况的巨大且令人担忧的伯恩的干预措施。