Mind-Body Therapies to Prevent Chronic Low Back Pain

描述（由申请人提供）：急性腰痛（aLBP）患者中约10%会发展为慢性腰痛（cLBP），他们消耗了约75%的腰痛相关医疗费用，构成了社会的主要经济负担。从急性到cLBP的转变与多种危险因素有关，其中心理社会危险因素具有最大的预测能力。这表明情绪、应对和认知（心理）与LBP（身体）的身体体验之间存在相互作用。强调身心联系的CAM模式，如基于正念的减压、Feldenkrais和瑜伽，可能会改变这些风险因素，并有助于预防cLBP。临床医生目前还没有一种简单、有效的工具来识别慢性疼痛高风险的aLBP患者，并且尚不清楚CAM治疗是否（如果是的话，是哪种）可以改变aLBP患者的风险概况和结果。这些信息将有助于规划身心疗法治疗腰痛的对照试验，确定这些疗法的可能作用机制，并确定预防腰痛的卫生保健资源。

DESCRIPTION (provided by applicant): While about 10% of patients presenting with acute low back pain (aLBP) will develop chronic low back pain (cLBP), they consume about 75% of LBP related health care expenses and constitute a major economic burden for society. The transition from acute to cLBP is associated with multiple risk factors, of which psychosocial risk factors have the greatest predictive power. This suggests an interaction between emotion, coping, and cognition (mind) and the physical experience of LBP (body). CAM modalities emphasizing the mind-body link, such as Mindfulness Based Stress Reduction, Feldenkrais, and Yoga, may modify these risk factors and help prevent cLBP. Clinicians currently do not have a simple, validated tool for identifying patients with aLBP at high risk for chronic pain and it is unclear whether (and, if so, which) CAM therapies can modify the risk profile and outcome in patients presenting with aLBP. Such information would aid in planning controlled trials of mind-body therapies for LBP, in identifying possible mechanisms of action of these therapies, and in targeting health care resources for cLBP prevention. The candidate will conduct 2 projects: (1) a prospective cohort study (n = 620) at Kaiser Permanente, Northern California (a) to develop and validate a brief prediction tool for primary care clinics and (b) to assess changes in risk factors over time and their association with changes in LBP outcomes; (2) an assessment of whether specific mind-body therapies alter the variables measured with the new prediction tool in randomized and observational studies. The candidate will pursue a structured educational program that includes coursework, mentoring, and supervision of these projects to develop the necessary skills in behavioral science, psychometric evaluation of measures, and clinical research implementation. The candidate's overall goal is to become an independent investigator conducting clinical research of mind-body approaches for the prevention of cLBP.