Empowering the Management of Pain-Obesity-Weight through Enhanced Reward

通过增强奖励来加强疼痛、肥胖和体重的管理

• 批准号: 10350684
• 负责人: Emily J. Bartley
• 金额: $ 19.06万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-15 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10350684
• 关键词: Address; Adult; Affect; Age; American; Attenuated; Behavior Therapy; Behavioral; Body Weight; Body Weight decreased; Body mass index; Chronic low back pain; Cognition; Cognitive; Data; Eating; Elderly; Feedback; Foundations; Future; Health; Health Care Costs; Health Status; Healthcare; Individual; Intervention; Knee Osteoarthritis; Low Back Pain; Mediator of activation protein; Mental Depression; Modality; Modeling; Obesity; Overweight; Pain; Pain management; Participant; Patients; Physical activity; Pilot Projects; Play; Populations at Risk; Procedures; Public Health; Randomized Controlled Trials; Reporting; Research; Research Design; Research Support; Rewards; Risk; Role; Schedule; Self Care; Severities; Specific qualifier value; Target Populations; Techniques; Testing; Time; Treatment Efficacy; United States; United States Dept. of Health and Human Services; Weight; Weight Gain; Weight maintenance regimen; Work; acceptability and feasibility; adult obesity; arm; base; chronic pain; comorbidity; coping; disability; empowered; evidence base; experience; feasibility trial; improved; innovation; joint loading; middle age; novel strategies; obese person; opioid use; pain reduction; pain-related disability; pilot trial; pleasure; population health; primary outcome; programs; psychosocial; recruit; satisfaction; secondary outcome; social; telephone-based; theories; therapeutic development; treatment effect; weight loss intervention

PROJECT SUMMARY/ABSTRACT Chronic low back pain (cLBP) is the leading cause of disability worldwide and is one of the top reasons for seeking healthcare. High-impact low back pain is particularly problematic, defined as chronic pain accompanied by significant restrictions in work, social, and/or self-care activities for six months or more. High-impact pain is associated with greater pain-related disability, opioid use, and healthcare costs compared to pain of lower impact. Thus, efforts to reduce chronic pain impact have become a public health initiative. Low back pain and overweight/obesity are highly comorbid; overweight and obese individuals are up to 43% more likely to have cLBP compared to normal weight individuals. Together, the additive effects of overweight/obesity and chronic pain may play a larger role in increasing the risk for other adverse health-related comorbidities. To understand the relationship between excess weight and pain impact, we have developed a conceptual model that suggests the greatest reductions in pain impact for adults with comorbid cLBP and overweight/obesity will be observed by delivering content aimed at increasing non-food environmental reward and positive affect, in addition to delivering evidence-based weight loss and pain coping treatments. Therefore, the aim of this exploratory study is to examine the feasibility and acceptability of an integrated pain and weight management intervention (EMPOWER) for middle-aged and older adults with moderate-to-high impact low back pain by addressing mechanisms of environmental reward and positive affect. Forty adults (ages 45-80 years) with comorbid overweight/obesity (BMI≥25 kg/m2) and moderate-to-high impact cLBP will be assigned to an 8-month intervention, whereby they will receive a group- and telephone-based program featuring integrated behavioral weight loss treatment and cognitive-behavioral pain coping therapy. To address the key mechanisms of environmental reward and positive affect, the proposed intervention will incorporate systematic pleasant activity scheduling and values-clarification techniques. Assessments will be conducted at baseline and at the 4- and 8-month time points. The proposed research will be a step toward the development of therapeutic modalities aimed at improving pain and weight management in adults with comorbid cLBP and overweight/obesity, and will provide essential information to guide a larger, randomized-controlled trial of the EMPOWER intervention.

项目概要/摘要 慢性腰痛 (cLBP) 是全球范围内导致残疾的主要原因，也是导致残疾的主要原因之一。 寻求医疗保健的高影响力腰痛尤其成问题，定义为伴有慢性疼痛。 严重影响工作、社交和/或自我护理活动的限制，持续六个月或更长时间。 与较低的疼痛相比，与更大的疼痛相关的残疾、阿片类药物的使用和医疗费用相关 因此，减少慢性疼痛影响已成为一项公共卫生举措。 超重/肥胖是高度共病的；超重且肥胖的人患此病的可能性高出 43%； cLBP 与正常体重个体相比，超重/肥胖和慢性病的累加效应。 疼痛可能在增加其他与健康相关的不良合并症的风险方面发挥更大的作用。 为了研究超重和疼痛影响之间的关系，我们开发了一个概念模型，表明 对于患有慢性腰痛和超重/肥胖的成年人来说，疼痛影响的最大程度减少将通过以下方法观察到： 除了传递内容之外，还传递旨在增加非食品环境奖励和积极影响的内容 因此，这项探索性研究的目的是基于证据的减肥和疼痛应对治疗。 检查综合疼痛和体重管理干预措施 (EMPOWER) 的可行性和可接受性 通过解决以下机制，针对患有中度至重度腰痛的中老年人 环境奖励和积极影响 40 名患有共病超重/肥胖的成年人（年龄 45-80 岁） (BMI≥25 kg/m2) 和中度至高影响的 cLBP 将被分配到为期 8 个月的干预中，其中他们 将接受以团体和电话为基础的计划，以综合行为减肥治疗为特色， 认知行为疼痛应对疗法解决奖励环境和积极的关键机制。 影响，拟议的干预措施将包括系统的愉快活动安排和价值观澄清 评估将在基线以及 4 个月和 8 个月的时间点进行。 研究将朝着开发旨在改善疼痛和体重的治疗方式迈出一步 对患有慢性腰痛和超重/肥胖的成人进行管理，并将提供重要信息 指导一项更大规模的 EMPOWER 干预随机对照试验。