Examining Interoceptive Awareness as a Mechanism of Change in Yoga for Chronic Low Back Pain

项目摘要 慢性疼痛是一个主要的公共卫生问题，也是成年人寻求医疗护理的最常见原因之一。 美国的慢性疼痛是一个复杂的生物心理社会过程，受心理因素的调节，包括 感知、评价和感觉的情绪处理。慢性腰痛（CLBP）越来越常见， 与身体和精神健康状况不佳有关。长期使用药理学方法相对无效 疼痛治疗，并具有高成瘾性和滥用潜力。考虑到无数的经济、心理和社会成本， 与CLBP相关，身心疗法（MBT），如瑜伽，受到越来越多的关注和经验支持 用于其治疗。尽管如此，关于瑜伽如何改善CLBP的疼痛结果，或者与之相比， 它是否与通常用于治疗CLBP的其他体力活动干预措施不同。一个假设 MBT改善慢性疼痛的机制是通过改善内感受性意识，或 一个人的身体内部感觉。到目前为止，研究还没有检查内感受性意识的机械作用 用于CLBP的MBT。因此，在一项正在进行的NCCIH资助的随机对照试验（RCT）的基础上， 瑜伽和身体活动干预CLBP，拟议的博士前研究旨在1）测试瑜伽是否 与体力活动相比，干预导致内感受性意识发生更大的变化; 2）确定 内感受性意识的变化是否能解释瑜伽对CLBP患者的临床益处， 通过多种疼痛测量进行评估。这项博士前研究利用了正在进行的临床试验，并增加了一个独特的 通过评估参与者在基线、治疗中期（6周） 治疗后（12周）。拟议的项目将测试内感受性意识的机械作用， 自我报告（即，疼痛严重性和干扰）和目的（即，疼痛敏感性）评估 慢性疼痛。这个研究项目将直接解决三个NCCIH的首要研究重点，阐明 内感受在身心疼痛治疗中的机械作用。如果内感受器的机械作用 如果瑜伽中的意识得到支持，非药物身心疼痛疗法可以进一步优化， 有效缓解CLBP。研究金的培训目标与拟议研究的目标密切相关 项目个性化培训计划将为申请人提供内感受、RCT方面的专业培训 方法学，MBTs，生物统计学和行为医学研究生涯的专业发展。的 培训计划将利用申请人的主要机构，大学现有的资源， 康涅狄格州，与全国领先的专家合作和指导。

PROJECT SUMMARY Chronic pain is a major public health concern and among the most common reasons adults seek medical care in the United States. Chronic pain is a complex biopsychosocial process modulated by psychological factors, including the perception, appraisal, and emotional processing of sensations. Chronic low back pain (CLBP) is increasingly common and is associated with poor physical and mental health. Pharmacological approaches are relatively ineffective for long term pain treatment and have high addictive and abuse potential. Given the myriad economic, psychological, and social costs associated with CLBP, mind-body therapies (MBTs) such as yoga have received growing attention and empirical support for its treatment. Still, less is known about how yoga improves pain outcomes for CLBP or how it compares to and whether it operates distinctly from other physical activity interventions commonly used to treat CLBP. One hypothesized mechanism of MBTs for improving chronic pain is through improvements in interoceptive awareness, or the awareness of one’s internal bodily sensations. To date research has not examined the mechanistic role of interoceptive awareness in MBTs for CLBP. Thus, building on an ongoing NCCIH-funded randomized controlled trial (RCT) comparing 12-week yoga and physical activity interventions for CLBP, the proposed predoctoral study aims to 1) test whether a yoga intervention results in greater changes in interoceptive awareness compared to physical activity; and 2) determine whether changes in interoceptive awareness account for the clinical benefit of yoga for individuals with CLBP as assessed by multiple measures of pain. This predoctoral study capitalizes on an ongoing clinical trial and adds a unique and important contribution by assessing participants’ interoceptive awareness at baseline, mid-treatment (6-weeks), and post-treatment (12-weeks). The proposed project will test the mechanistic role of interoceptive awareness on improvements in both self-report (i.e., pain severity and interference) and objective (i.e., pain sensitization) assessments of chronic pain. This research project will directly address three of NCCIH’s top research priorities by elucidating the mechanistic role of interoception in mind and body treatments for pain. If the mechanistic role of interoceptive awareness in yoga is supported, non-pharmacological mind-body pain therapies can be further optimized for enhanced effectiveness in relieving CLBP. The fellowship’s training aims align closely with the goals for the proposed research project. The individualized training plan will provide the applicant with specialized training in interoception, RCT methodology, MBTs, biostatistics, and professional development for a research career in behavioral medicine. The training plan will leverage existing resources available at the applicant’s primary institution, the University of Connecticut, with collaboration and mentorship from leading experts across the nation.