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

描述（由申请人提供）：慢性腰痛（CLBP）在老年人中很常见;治疗不足，只会随着美国人口的老龄化而成为一个更大的问题。我们相信，身心疗法有望满足增强疼痛治疗的需求。在我们的初步研究中，参与者在参加了为期8周的身心项目后，自我报告的功能有了显着改善。此外，他们在神经心理学表现（NP）的措施，包括改善注意力和执行功能。为了进一步开展这项工作，我们提出了以下具体目标：1）确定身心计划在增加CLBP老年人功能和减少疼痛方面的有效性，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。身心计划是以正念减压计划为蓝本的，我们已经修改了该计划，专门针对慢性疼痛患者。我们将在课程完成后提供每月的“助推器”课程，为期长达12个月。对照组将被随机分配到一个教育对照计划，该计划将根据健康老龄化的10个关键TM进行调整。我们将测量自我报告和客观测量的身体功能与测试验证在老年人群。我们认为疼痛是多维的，因此，为了充分捕捉身心程序对疼痛的影响，我们将包括各种措施，不仅评估疼痛强度，但心理功能。NP将采用基于计算机的轻度认知障碍评估进行评估，这是一种简短的、标准化的、基于计算机的精神状态评估。将对一部分参与者进行焦点小组讨论，以收集关于使用正念冥想改善功能和减轻疼痛的深入个人描述。由于保持功能独立性对老年人来说至关重要，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分改善相关，该问卷是专门针对下背部的，与8周身心计划相比。这个新的研究者应用程序响应PA-07-046研究身心互动和健康1）检查身心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，和3）汇集一个经验丰富的跨学科研究团队。这项拟议的研究代表了第一个大的，良好的控制，全面检查身心计划对独立的老年慢性疼痛患者的影响。如果证明有效，这种身心计划可以广泛实施，作为一种辅助方法，以增加功能，减少疼痛，在这一人群。 公共卫生相关性：这项研究与公共卫生的潜在相关性是，由于参加了为期8周的身心计划，患有慢性腰痛的老年人的功能增加，疼痛减轻，神经心理学表现增加。

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. PUBLIC HEALTH RELEVANCE: The potential relevance to the public health of this study is the increase of function, decrease of pain and increase in neuropsychological performance of older adults with chronic low back pain as a result of participating in an 8-week mind-body program.