Mind/Body Interventions for Chronic Low Back and Neck Pain in Military Personnel

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 DESCRIPTION (provided by applicant): Chronic low back pain (CLBP) and chronic neck pain (CNP) are prevalent conditions and military personnel and veterans have higher rates of chronic low back pain (CLBP) than the general US population. CLBP and CNP are leading causes of disability among active-duty military personnel and are often accompanied by co- morbid conditions that pose additional challenges and can interfere with treatment. Recommended treatments for CLBP and CNP begins with medication management and self-care instruction, but other non-pharmacologic approaches are needed because of limited effectiveness and the risks associated with opioid pain medication use. Of the non-pharmacologic approaches, none stand out as the treatment of choice for CLBP. Thus, integrative therapies including yoga are an increasingly important and valued option among military personnel. Yoga therapies involve the integration of specific postures or movement sequences, specialized use of the breath, and focused attention (directed to physical alignment, the breath and other bodily sensations). Meditation and other cognitive activities may also be included. Thus, yoga is a multifaceted intervention, with documented physical and psychological benefits for people with CLBP and CNP including a) increased strength, flexibility, and conditioning through the performance of physical postures, and b) stress reduction/relaxation and improved psychological functioning facilitated by breathing exercises, concentration, and positive thoughts. In preparation for a full scale study, our study objective is to examine the feasibility and acceptability of conducting a yoga RCT among active-duty military personnel with CLBP/CNP in military and community settings. The study will be conducted in two phases: Phase 1 will involve obtaining IRB approval to conduct research in military settings, collecting qualitative data from stakeholders on attitude and preferences for yoga interventions, and refining the existing Yoga for CLBP intervention for the needs of active-duty military and persons with CNP. Phase 2 will recruit and randomize 50 military personnel with CLBP or CNP to either active hatha or restorative yoga. Pain interference, pain severity, physical function, opioid medication use, and mental health outcomes are of primary interest. Mechanisms will also be studied. Accomplishing these aims will prepare us for an R01 proposal to study the efficacy of yoga for military personnel with CLBP in a full-scale randomized, controlled trial. To be successful and maximize the scientific knowledge obtained from an R01 study, it is crucial to first establish working relationships with military researchers, ensure that recruitment and randomized assignment are feasible, pilot test measurement strategies, and ensure that both interventions have been optimally chosen.