Mind Your Pain: Validating a Mindful Interoceptive Exposure Task for Patients With Chronic Low Back Pain
Condition: Chronic Low-back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Observational

Summary: 
      The usual coping mechanism with chronic pain is distraction, It is unclear whether the
      opposite, sensory monitoring, can benefit patients with chronic low back pain (cLBP). The
      study assesses the feasibility and acceptability of a 2-minute phone-based attention
      exercise, used several times a day over 8 weeks plus a 1-hour introduction, in patients with
      cLBP. The attention exercise is based on mindfulness-based interoceptive exposure, a task
      that has been tested before in a mixed pain population in Australia.
    

Detailed description: 
      Mind your Pain (MyP), also known as Mindfulness-based Interoceptive Exposure Therapy (MIET)
      is an innovative brief mindfulness-based task, developed within the frame of
      mindfulness-based cognitive therapy, and has been pilot tested in a small cohort of 15
      patients with chronic musculoskeletal pain, the majority with cLBP, in Australia. It consists
      of an individual guided 1-hour introduction session and a 1 to 2-minute attention task
      subsequently performed several times per day over 12 weeks. The task will be provided by a
      smart phone app and be sent to participants as phone message reminders at up to 5 times per
      day: according to participant preference once in the morning and once at bedtime, as well as
      up to 3 additional times when participants are asked to use the app whenever they perceive
      the pain at its worst. The task is to focus on the most intense pain sensation in a detached
      and equanimous way and carefully observe potential changes in five aspects of that sensation:
      space (region/ borders/ immobile/ moving); sense of mass (heavy/ neutral/ light), temperature
      (cold/ warm/ hot/ neutral); density (dense/ solid/ loose/ constricted), and borders (diffuse/
      sharp). This neutral sensory-descriptive interoceptive attention focus is aiming at
      preventing the learned aversive response to pain that entails ruminating thoughts, and
      negative affect rather than immediate sensory awareness. The pilot study in 15 chronic pain
      patients showed significant beneficial pre-post effects (Cohen's d, ES) of 0.96 for pain
      anxiety, 0.86 for pain duration and 1.37 for pain intensity, maintained at 2-month follow-up.
      The investigators offer the MyP-MIET to patients in the US with clearly defined chronic low
      back pain over 8 weeks, validate it with 30 participants for feasibility and acceptability
      and exploratory self-report key pain outcomes and objectively (using QST and fMRI), who fit a
      low interoceptive awareness phenotype. The investigators also use qualitative exit
      interviews.
    

Intervention name(s): MyP
Intervention type(s): Behavioral
Intervention description(s): see above: attention exercise based on phone app
Other intervention name(s): Mind your Pain
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        patients with chronic low back pain living in the Bay Area
      
Keywords: chronic low back pain; interoceptive exposure; attention