Rage Against the Pain: An Alternative Yoga Program to Address Chronic Low Back Pain Among Veterans

背景：下背痛是美国成年人残疾的主要原因，并可能导致阿片类药物的使用 以及相关的不良后果。VA认为腰痛是一个严重的问题， 激励采取行动，以改善退伍军人参与疼痛护理（包括补充和 综合治疗）。瑜伽被推荐为腰痛的一线治疗方法，然而，瑜伽 退伍军人的比例很低。在退伍军人中采用的一个潜在障碍可能是他们的 对瑜伽的看法，对一些人来说，包括长期持有但往往不准确的信念， 瑜伽需要和他们的参与将如何看待别人。促进吸收和持续使用 瑜伽，我们建议为退伍军人提供一个不同的瑜伽经验，赋予相同的疼痛管理 他们可能会更好地与他们的偏好保持一致，并与他们的利益产生更大的共鸣。我们称之为瑜伽 项目，对疼痛的愤怒（RAP）“高强度拉伸”。 意义/影响：如果本研究发现RAP是可行的，并为经历过的退伍军人所接受， 慢性腰痛，它将提供一种创新的方法来解决VA的首要任务-使用CIH 疼痛管理和减少阿片类药物使用的计划。我们的长期目标是开发一个可扩展的， 可持续的替代瑜伽计划，以帮助退伍军人与慢性疼痛谁可能找不到其他可用 疼痛管理选项是有吸引力的或有效的。 创新：我们提出的RAP计划促进瑜伽作为一种冥想，内省的活动 做安静平静的音乐和更多的表达，积极的做法设置为音乐普遍享有 在许多退伍军人中（例如，岩石、金属）。RAP的发展（以及程序名称）直接反映了 退伍军人的反馈，并受到“愤怒瑜伽”的启发。我们将借鉴和调整愤怒瑜伽的方面 对退伍军人的健康需求最有意义，采用概念的有益方面（例如， 传统的瑜伽姿势，另类音乐，外向的自我表达）。 具体目标：我们的总体目标是制定和评估RAP计划，旨在改善 退伍军人参与瑜伽，并通过扩展，结果退伍军人与慢性腰痛。 具体目标是：（1）制定RAP方案，其中包括最后确定方案课程， 包括音乐播放列表，自我表达的暗示，以及已知可以缓解低血糖的瑜伽动作。 （2）探讨为退伍军人慢性腰痛提供RAP的可行性和可接受性 疼痛;（3）收集初步数据，为未来的试验提供基础，以检查潜在的 RAP对退伍军人结局和药物使用的有效性。 方法：将邀请经历慢性腰痛的退伍军人参加;符合条件的 参与者将被随机分配到RAP或哈他瑜伽项目中。上课时间为75分钟， 每周一次，持续12周，由退伍军人事务部的娱乐治疗师教授，他们是经过认证的瑜伽教练。一 将制定全面的安全计划。将跟踪和比较项目启动和流失情况 在群体之间。基线和随访结局数据（疼痛强度、干扰和行为; 功能;生活质量;睡眠;抑郁;药物使用）将通过调查收集。退伍军人 将通过定性的半结构化的方法来评估对这些方案的经验和看法。 采访预期结果：我们预计RAP将受到退伍军人的欢迎，并期望 参与RAP将比传统的瑜伽课程更大（自然减员更低）。 实施/后续步骤：测试区域行动方案的有效性及其更广泛的问题 在VA中执行。

Background: Low back pain is a leading cause of disability among US adults, and can drive opioid use and associated adverse outcomes. VA considers low back pain a significant problem and is highly motivated to take action to improve Veteran engagement in pain care (including complementary and integrative treatments). Yoga is recommended as a front-line treatment for low back pain, however, yoga adoption among Veterans is low. One potential barrier to adoption among Veterans may be their perceptions of yoga, which for some, encompass long-held but often inaccurate beliefs of what engaging in yoga entails and how their participation will be viewed by others. To facilitate uptake and sustained use of yoga, we propose to offer Veterans a different yoga experience that imparts the same pain management benefits but may better align with their preferences and resonate more with their interests. We call this yoga program, Rage Against the Pain (RAP) `High Intensity Stretching'. Significance/Impact: If this study finds that RAP is feasible and acceptable to Veterans who experience chronic low back pain, it will provide an innovative approach to address a top priority of the VA – using CIH programs for pain management and opioid use reduction. Our long-term goal is to develop a scalable and sustainable alternative yoga program to help Veterans with chronic pain who may not find other available pain management options to be appealing or effective. Innovation: Our proposed RAP program promotes yoga as less of a meditative, introspective activity done to quiet calming music and more of an expressive, active practice set to music commonly enjoyed among many Veterans (e.g., rock, metal). The development of RAP (and the program name) reflects direct Veteran feedback, and was inspired by “rage yoga.” We will draw upon and tailor the aspects of rage yoga that make the most sense for Veteran health needs, adopting the beneficial aspects of the concept (e.g., traditional yoga poses, alternative music, outward self-expression). Specific Aims: Our overall goal is to develop and evaluate the RAP program, intended to improve Veteran participation in yoga and by extension, outcomes among Veterans with chronic low back pain. Specific Aims are to: (1) Develop the RAP program, which will encompass finalizing the program curriculum, including music play-lists, cues for self-expression, and sets of yoga movements known to alleviate low back pain; (2) Examine the feasibility and acceptability of offering RAP for Veterans with chronic low back pain, and; (3) Gather preliminary data to provide the foundation for a future trial to examine the potential effectiveness of RAP on Veterans' outcomes and medication use. Methodology: Veterans who experience chronic low back pain will be invited to participate; eligible participants will be randomized into RAP or a Hatha yoga program. Classes will be 75 minutes long, held once a week for 12 weeks, and taught by VA recreation therapists who are certified yoga instructors. A comprehensive safety plan will be instituted. Program initiation and attrition will be tracked and compared between groups. Baseline and follow-up data on outcomes (pain intensity, interference and behavior; function; quality of life; sleep; depression; medication use) will be collected via survey. Veterans' experiences with and perceptions of the programs will be assessed through qualitative semi-structured interviews. Expected Results: We anticipate RAP will be well-received by Veterans, and expect that participation in RAP will be greater (and attrition lower) than a traditional yoga program. Implementation/Next Steps: Test the effectiveness of RAP and issues around its broader implementation in VA.