An Interventional Response Phenotyping Study in Chronic Low Back Pain: Protocol for a Mechanistic Randomized Controlled Trial.
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
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
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 |
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.