empower: empowering the management of pain-obesity-weight through enhanced reward

Conditions: Low Back Pain

Summary: the central objective of research is to examine the feasibility and acceptability of an 8-month single-arm behavioral intervention (i.e., empower) among overweight/obese middle-aged and older adults with moderate-to-high impact low back pain. intervention content will focus on standard behavioral weight loss treatment and cognitive-behavioral pain coping therapy with a focus on environmental reward and positive affect.

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. 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.

Eligibility criteria:
inclusion criteria: * 45-80 years of age * have a bmi≥25kg/m2 * endorse pain in the lower back region (i.e., space between the lower posterior margin of the rib cage and the horizontal gluteal fold), knees, or hips * pain must occur on at least 50% of the days in the previous six months * pain must be rated, at minimum, of moderate intensity (rating of 3 on a numeric rating scale ranging from 0-10) * pain impact must be rated as moderate to severe * study physician reviews medical record and declares patient medically appropriate for exercise protocol exclusion criteria: * current participation in another psychological treatment or structured weight loss program * severe psychiatric illness not adequately controlled by medication or other conditions anticipated to impair intervention engagement (e.g., substance abuse/dependence) * presence of chronic, malignant pain (e.g., cancer) * significant cognitive impairment (\<26) on the montreal cognitive assessment (moca) * inability to read and write english * currently undergoing radiation or chemotherapy for cancer * self-reported cardiac event in the past 6 months or self-reported heart failure (chf) * currently pregnant or breastfeeding, or planning to become pregnant during the study time period * back, knee, or hip surgery within the past six months of study entry (or planned surgical interventions for pain during forecasted study participation) * if currently taking prescription analgesic or psychotropic medication, must be stabilized on these treatments for \>4 weeks prior to the baseline assessment * blood pressure higher than 180/100 mm hg at baseline assessment * has had bariatric surgery in the past year or is planning to have it in the next year * if participant reports the presence of systemic inflammatory disease (e.g., rheumatoid arthritis), the study physician will be consulted to determine eligibility

Keywords: back pain obesity aging overweight