Effectiveness of a Mind-Body Program for Older Adults with Chronic Low Back Pain

描述(申请人提供)：慢性下腰痛(CLBP)在老年人中很常见；治疗不足，随着美国人口老龄化，只会成为更大的问题。我们相信，心身疗法有望满足加强疼痛治疗的需求。在我们的初步研究中，参与者在参加了为期8周的身心计划后，自我报告功能有了显著的改善。此外，他们在神经心理表现(NP)方面的指标也有所改善，包括注意力和执行功能的改善。为了进一步推进这项工作，我们提出了以下具体目标：1)确定心身计划在提高CLBP老年人功能和减少疼痛方面的有效性，以及2)评估正念冥想对CLBP老年人NP的影响。为了实现这些目标，我们将对300名65岁或以上的CLBP患者进行随机对照临床试验。心身计划是以正念为基础的压力减轻计划为蓝本，我们对其进行了修改，专门针对慢性疼痛患者。我们将在项目结束时提供每月一次的“助推器”课程，最长可达12个月。对照组将被随机分配到一个教育控制计划中，该计划将从10个KeysTM调整为健康老龄化。我们将通过在老年人群中验证的测试来测量自我报告和客观测量的身体功能。我们认为疼痛是多维的；因此，为了充分捕捉身心计划对疼痛的影响，我们将包括各种衡量标准，不仅评估疼痛强度，还评估心理功能。NP将通过基于计算机的轻度认知障碍评估进行评估，这是一种基于计算机的简短、标准化的精神状态评估。焦点小组将对一部分参与者进行，以收集关于使用正念冥想来改善功能和减轻疼痛的深入个人描述。由于保持功能独立对老年人来说是最重要的，我们的主要假设是：与教育对照组相比，正念冥想将与罗兰和莫里斯残疾问卷中具有临床意义的2.5分的改善有关，该问卷针对腰部，紧接着进行了8周的心身计划。这一新的调查者应用程序通过以下方式响应PA-07-046 Research on Mind-Body Interaction and Health：1)检查心身计划对身体功能和疼痛的多维方面的影响；2)评估正念冥想对NP的影响；以及3)汇集经验丰富的跨学科研究团队。这项拟议的研究是第一次大规模的、控制良好的、全面的精神-身体计划对患有慢性疼痛的独立老年人的影响的检查。如果被证明是有效的，这种心身计划可以作为一种辅助方法在这一人群中广泛实施，以增加功能和减少疼痛。

DESCRIPTION (provided by applicant): Chronic low back pain (CLBP) is common among older adults; treatment is inadequate and will only become a bigger problem with the aging of the American population. We believe that mind-body therapies are poised to meet the demand for enhanced pain treatment. Participants in our pilot study significantly improved in self- reported function after participation in an 8-week mind-body program. Furthermore, they improved in measures of neuropsychological performance (NP) including improved attention and executive function. To further this work, we propose the following specific aims: 1) to determine the effectiveness of a mind- body program in increasing function and reducing pain among older adults with CLBP, and 2) to evaluate the impact of mindfulness meditation on NP in older adults with CLBP. To accomplish these aims we will conduct a randomized, controlled clinical trial of 300 CLBP sufferers aged 65 years or older. The mind-body program is modeled on the Mindfulness-Based Stress Reduction Program, which we have modified to specifically target chronic pain sufferers. We will offer monthly "booster" classes at the completion of the programs for up to 12 months. The control group will be randomized to an education control program which will be adapted from the 10 KeysTM to Healthy Aging. We will measure self-reported and objectively measured physical function with tests validated in an older population. We view pain as multidimensional; therefore, to adequately capture the impact of the mind-body program on pain we will include a variety of measures to assess not only pain intensity, but psychological function. NP will be assessed with the Computer- Based Assessment of Mild Cognitive Impairment a brief, standardized, computer-based assessment of mental status. Focus groups will be conducted on a subset of participants to collect in-depth personal descriptions of using mindfulness meditation for improving function and reducing pain. Since maintaining functional independence is of foremost importance to older adults, our primary hypothesis is: mindfulness meditation will be associated with a clinically meaningful 2.5-point improvement in the Roland and Morris Disability Questionnaire, which is specific to the low back, immediately following an 8-week mind-body program as compared to an education control group. This new investigator application responds to PA-07-046 Research on Mind-Body Interactions and Health by 1) examining the effects of a mind-body program on physical function and the multidimensional aspects of pain, 2) evaluating the effects of mindfulness meditation on NP, and 3) bringing together an experienced interdisciplinary team of researchers. The proposed study represents the first large, well-controlled, comprehensive examination of the effects of a mind-body program on the independent older adult with chronic pain. If proven effective, this mind-body program could be broadly implemented as an adjunct method to increase function and decrease pain in this population.