Evaluating Specific and Non-Specific Mechanisms in Two Distinct Complementary/Integrative Interventions for Chronic Pain
Overview
- Phase
- Early Phase 1
- Intervention
- Spinal Manipulation Therapy (SMT)
- Conditions
- Chronic Low-back Pain
- Sponsor
- Rush University Medical Center
- Enrollment
- 140
- Locations
- 2
- Primary Endpoint
- Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference
- Status
- Active, not recruiting
- Last Updated
- 9 months ago
Overview
Brief Summary
Chronic Pain Management (CPM) has increasingly utilized long-term opioid analgesic therapy, a change associated with increased opioid abuse (a greater exposure in vulnerable individuals), non-pain health consequences (hormone changes, falls), and a dramatic rise in opioid-related overdoses and deaths. Treatment strategies that minimize the need for chronic high-dose opioids are sorely needed. This project will aim to test what degree mindfulness therapy (MT) and spinal manipulation therapy (SMT) produce pre- to mid- to post-treatment changes in endogenous opioid (EO) function.
Detailed Description
This project will determine whether enhancing endogenous opioids (via SMT or MT) permits achieving desired levels of analgesia with lower dosages of opioid analgesics, and fewer side effects and abuse-relevant drug effects. This X year project will test study hypotheses in a sample of 240 chronic low back pain patients. The study will have 2 key elements: 1) a randomized, controlled SMT or MT in chronic pain (CP) patients completing daily take home exercises and 2) laboratory evoked thermal pain protocols pre- and post- therapy, permitting the quantification of EO function and the examining of treatment-induced changes in EO function (placebo vs. naloxone). The study will employ a mixed between/within-subjects design using double-blinded and placebo-controlled administration of the opioid antagonist (naloxone). The study will use a 8 week supervised MT or SMT manipulation with subjects randomly assigned to one of the groups. All participants will undergo 4 laboratory pain-induction sessions in total. 2 during the pre-treatment phase, and 2 post-treatment. The laboratory sessions are identical. Each laboratory session will be roughly 2-3 days apart and the first 2 laboratory sessions will occur prior to the randomization to the treatment condition.
Investigators
Eligibility Criteria
Inclusion Criteria
- •significant daily chronic pain intensity (≥4 on a 10-point scale) and interference in performing daily activities due to pain (≥3 on a 10-point scale) for at least 3 months
- •age 18-75 years (inclusive)
- •not using opioid analgesics on a daily basis or within 3 days of each laboratory session (confirmed via urine drug screen)
- •Intact cognitive status and ability to provide informed consent
- •ability to read and write in English sufficiently to understand and complete study questionnaires
Exclusion Criteria
- •meet criteria for alcohol or substance abuse problems
- •meet criteria for past or present psychotic or bipolar disorders
- •inability to understand English well enough to complete questionnaires or participate in therapy
- •pain due to malignant conditions, rheumatoid arthritis, migraine or tension headache, complex regional pain syndrome, or fibromyalgia syndrome
- •lumbar surgery within past 6 months
- •signs of nerve root compression (ie, positive straight-leg raise \<45○).
- •liver diseases (e.g hepatitis or cirrhosis)
- •suicide ideation with intent
- •osteoporosis or bone demineralization
- •opioid-dependency
Arms & Interventions
SMT plus placebo/naloxone
Participants are randomly assigned to an 8 week SMT treatment group conducted by certified physical therapists. Immediately before and after the treatment sessions along with midway through the treatment (after 4 sessions), participants will undergo the placebo/naloxone administration intervention to assess mechanisms of SMT or MT-related changes.
Intervention: Spinal Manipulation Therapy (SMT)
SMT plus placebo/naloxone
Participants are randomly assigned to an 8 week SMT treatment group conducted by certified physical therapists. Immediately before and after the treatment sessions along with midway through the treatment (after 4 sessions), participants will undergo the placebo/naloxone administration intervention to assess mechanisms of SMT or MT-related changes.
Intervention: Naloxone
SMT plus placebo/naloxone
Participants are randomly assigned to an 8 week SMT treatment group conducted by certified physical therapists. Immediately before and after the treatment sessions along with midway through the treatment (after 4 sessions), participants will undergo the placebo/naloxone administration intervention to assess mechanisms of SMT or MT-related changes.
Intervention: Placebo
MT plus placebo/naloxone
Participants are randomly assigned to an 8 week MT treatment group conducted by certified clinical therapists. Immediately before and after the treatment sessions along with midway through the treatment (after 4 sessions), participants will undergo the placebo/naloxone administration intervention to assess mechanisms of SMT or MT-related changes.
Intervention: Naloxone
MT plus placebo/naloxone
Participants are randomly assigned to an 8 week MT treatment group conducted by certified clinical therapists. Immediately before and after the treatment sessions along with midway through the treatment (after 4 sessions), participants will undergo the placebo/naloxone administration intervention to assess mechanisms of SMT or MT-related changes.
Intervention: Placebo
MT plus placebo/naloxone
Participants are randomly assigned to an 8 week MT treatment group conducted by certified clinical therapists. Immediately before and after the treatment sessions along with midway through the treatment (after 4 sessions), participants will undergo the placebo/naloxone administration intervention to assess mechanisms of SMT or MT-related changes.
Intervention: Mindfulness Based Stress Reduction Therapy (MT)
Outcomes
Primary Outcomes
Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference
Time Frame: Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks)
Interference in daily activities attributed to chronic pain as reported by subjects. The PROMIS Pain Interference scale consists of 8 questions with a 5-point response scale ranging from Not at all - Very much. Participants are asked how much in the past 7 days everyday activities were affected by their pain. Higher scores indicate more pain interference in daily activities.
Secondary Outcomes
- Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity (Short Form)(Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks))
- Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (Short Form)(Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks))
- Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Depression(Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks))
- Change in Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance(Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks))