What causes low back pain to flare: Has a major opportunity to understand back pain been missed?

项目摘要/摘要 腰背痛(LBP)传统上被认为是一种短暂的急性发作的情况或慢性 持久化状态。然而，人们越来越认识到，对于大多数(80%的情况)，LBP有一个变量 以及以波动症状为特征的持续轨迹--更严重的症状被称为 “照明弹”。目前关于LBP风险因素的工作只考虑了与新的发作或 过渡到慢性LBP。这项工作的发现未能提供有效的战略来防止新的 发作或慢性化，也不能减轻LBP的过重负担。这项提议的基本前提是 LBP的波动或耀斑是由瞬时/波动暴露于一系列因素所调节的， 不同个体之间的不同领域，以及对这些因素的识别可以为完全 个性化护理的新模式。这个项目将通过直接解决这个问题来重新审视LBP 使用由最新技术进步带来的创新方法。这项工作是基于我们广泛的 与LBP患者的合作为如何定义耀斑提供了关键的洞察力(这令人惊讶 并不是仅仅基于疼痛)，以及他们对LBP爆发的潜在原因的看法。 我们的多学科研究团队提出了一项创新的病例交叉研究，将解决两个目标。目标 1将在3个月内的多个时间点检查一系列候选生物/行为， 根据消费者选择的LBP火炬的心理、社会和环境风险因素 视角、文献综述和我们广泛的前期研究。措施将以“实实在在”的方式制定。 使用先进的可穿戴和在线技术。目标2将涉及一项对来自 经常发火的主要参与者。在7天的时间里，符合条件的个人将接受更密集的“真正- 使用可穿戴传感器和可穿戴传感器的创新组合 以家庭为基础的样本/数据收集，以调查两个令人惊讶的初步结果背后的潜在机制 观察结果：(1)睡眠不佳是引发后续突发事件的一个潜在风险因素(与传统观点相反 疼痛会干扰并导致睡眠不佳)，以及(2)体力活动少而不是高是一个危险因素 为了LBP火炬。我们的目标不仅是确定睡眠质量和身体活动的日常变化是否，而且是如何变化的--两个 最重要但可改变的健康行为中的一种--推动LBP的爆发。 总而言之，这些数据将通过提供对驱动波动的机制的新理解来填补一个重大空白 LBP的经验。这些因素将为开发和测试更有针对性和个性化的产品提供基础 采取干预措施，减轻这一状况给患者和社会带来的巨大和日益恶化的负担。

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.