Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48106, United States.
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, United States.
Pain Med. 2023 Aug 4;24(Suppl 1):S126-S138. doi: 10.1093/pm/pnad005.
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.
针对慢性下背痛 (cLBP) 的循证治疗方法通常仅对一小部分患者有效,而目前对于应针对哪些患者使用哪种治疗方法几乎没有指导。我们的中心假设是,干预反应表型研究可以识别出疼痛的潜在机制不同的个体,因此他们对 cLBP 的循证治疗有不同的反应。因此,我们将在 cLBP 患者中进行一项随机对照序贯、多次评估、随机试验 (SMART) 设计研究,该研究有以下三个目的。 目的 1:在一组 cLBP 患者(n=400)中进行干预反应表型研究,这些患者将接受一系列已知对 cLBP 有效的干预措施。在 4 周内,所有 cLBP 参与者都将接受基于网络的疼痛自我管理计划作为入门期的一部分,然后报告无改善或改善极小的个体将被随机分配到:a)正念减压,b)物理治疗和锻炼,c)穴位按压自我管理,和 d)度洛西汀。8 周后,仍有症状的个体将重新随机分配到另一种治疗方法,再进行 8 周的治疗。使用这些数据,我们将确定对每种治疗方法有反应的参与者子集。 目的 2:我们将表明,目前可用的临床衍生指标可以预测对治疗的不同反应性。 目的 3:一部分参与者将接受更深入的表型研究(n=160),以确定预测对治疗有不同反应的新实验指标,并推断作用机制。深度表型研究将包括功能神经影像学、定量感觉测试、炎症指标和自主神经张力指标。
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