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An Interventional Response Phenotyping Study in Chronic Low Back Pain: Protocol for a Mechanistic Randomized Controlled Trial.

Pain medicine (Malden, Mass.)
January 1, 1970
Afton L Hassett et al. (27 authors)
Clinical Trial ProtocolJournal ArticleResearch Support, N.I.H., ExtramuralHuman StudyClinical
Study Details

Study Goal

The researchers aimed to determine whether mindfulness-based stress reduction could effectively treat chronic low back pain (cLBP) in patients who did not respond to initial self-management.

Results Summary

The study did not report specific results for mindfulness alone, but it was included as one of the interventions for cLBP patients who showed no improvement after initial treatment. The broader study design suggests mindfulness may be effective for a subset of patients.

Population

Adults with chronic low back pain (n=400, with a subset of 160 for deeper phenotyping).

Effective Dosage

Not specified

Duration

8 weeks (after initial 4-week run-in period)

Interactions

None mentioned

Extracted Claims (8)
InterventionDirectionEndpointPopulationDosageImpactClaim #
web-based pain self-management program
no change
pain
cLBP participants
-
no or minimal improvement
#1
mindfulness-based stress reduction
decrease
pain
cLBP patients
-
respond to
#2
physical therapy and exercise
decrease
pain
cLBP patients
-
respond to
#3
acupressure self-management
decrease
pain
cLBP patients
-
respond to
#4
duloxetine
decrease
pain
cLBP patients
-
respond to
#5
different treatment
no change
pain
individuals
-
remain symptomatic
#6
clinically derived measures
neutral
treatment response
cLBP patients
-
can predict differential responsiveness
#7
new experimental measures
neutral
treatment response
subset of participants
-
predict differential responsiveness
#8
Abstract

Evidence-based treatments for chronic low back pain (cLBP) typically work well in only a fraction of patients, and at present there is little guidance regarding what treatment should be used in which patients. Our central hypothesis is that an interventional response phenotyping study can identify individuals with different underlying mechanisms for their pain who thus respond differentially to evidence-based treatments for cLBP. Thus, we will conduct a randomized controlled Sequential, Multiple Assessment, Randomized Trial (SMART) design study in cLBP with the following three aims. Aim 1: Perform an interventional response phenotyping study in a cohort of cLBP patients (n = 400), who will receive a sequence of interventions known to be effective in cLBP. For 4 weeks, all cLBP participants will receive a web-based pain self-management program as part of a run-in period, then individuals who report no or minimal improvement will be randomized to: a) mindfulness-based stress reduction, b) physical therapy and exercise, c) acupressure self-management, and d) duloxetine. After 8 weeks, individuals who remain symptomatic will be re-randomized to a different treatment for an additional 8 weeks. Using those data, we will identify the subsets of participants that respond to each treatment. In Aim 2, we will show that currently available, clinically derived measures, can predict differential responsiveness to the treatments. In Aim 3, a subset of participants will receive deeper phenotyping (n = 160), to identify new experimental measures that predict differential responsiveness to the treatments, as well as to infer mechanisms of action. Deep phenotyping will include functional neuroimaging, quantitative sensory testing, measures of inflammation, and measures of autonomic tone.

Medical Subject Headings (MeSH)
HumansChronic PainLow Back PainPhysical Therapy ModalitiesResearch DesignDuloxetine HydrochlorideTreatment OutcomeRandomized Controlled Trials as Topic
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality85/10
Citation Metrics
Total Citations5
Citations/Year2.5
Relative Citation Ratio1.87
NIH Percentile72.4%
Research Impact Scores
APT Score0.75
Weight Score1.63
Normalized Score0.67
Related Supplements
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