Preventing Chronicity of Sub-acute Low Back Pain by Altering the Neural Emotional Response to Pain

Study Overview
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Brief Summary
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Aim of the study It could be stated that chronification of low back pain in some respects depends on the emotional reactions to the acute pain state. This approach enables advancing novel therapeutics for preventing pain chronification by altering the pain-related affective states. At present, no publication evaluating the efficacy of IET in altering brain responses related to sub-acute low back pain seems available. Neither have we found any studies specifically addressing the efficacy of mindfulness training on the functional connection between PFC and NAc. The aim of this study project is three-fold: A systematic literature review of behavioural methods in the prevention of low back pain chronicity Orenius T, Silén E, Nuortimo A, Ristolainen L. Psychological interventions in preventing chronicity of sub-acute back pain: a systematic review. Scand J Pain. 2022 Jan 24;22(2):211-217. doi: 10.1515/sjpain-2021-0063. PROSPERO: CRD42019053580 A pilot study (n=7+7) to address the efficacy and feasibility of IET in preventing chronicity of sub-acute pain A full scale study (n=20+20) addressing the efficacy and feasibility of IET in the prevention of chronicity of sub-acute low back pain

Detailed Description
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To assess the efficacy of IET on the chronification of LBP, participants who are found to have a higher risk of pain chronification due to the presence of a biomarker (positive mPFC-Nac connectivity) will be randomized to the intervention group (IET) or control group A (treatment as usual). To assess how well this biomarker predicts the chronification of LBP, participants who are not found to have the biomarker will be assigned to control group B (treatment as usual).

Official Title
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Preventing Chronicity of Sub-acute Low Back Pain by Altering the Neural Emotional Response to Pain - a Pilot Study Addressing the Efficacy and Feasibility of an Interoceptive Exposure Technique.

Conditions
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Preventive Medicine

Intervention / Treatment
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* Behavioral: Interoceptive exposure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The selection of subjects will meet same criteria as in the study by Baliki et al. (2010). Low back pain diagnosed by a clinician Low back pain intensity > 40/100 on NRS Low back pain duration 4-12 weeks Exclusion Criteria: Other chronic painful condition Systemic disease History of head injury Diagnosed psychiatric disorders Depression exceeding mild depression (score > 19), as defined by Beck's Depression Inventory (BDI)
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Sub-acute low back pain active intervention<br>To assess the efficacy of IET on the chronification of LBP, participants who are found to have a higher risk of pain chronification due to the presence of a biomarker (positive mPFC-Nac connectivity) will be randomized to the intervention group (IET) | Behavioral: Interoceptive exposure<br>* A pilot study addressing the efficacy and feasibility of an interoceptive exposure technique.<br>|
| Sham Comparator: Sub-acute low back pain passive intervention<br>Control group, treatment as usual. | Behavioral: Interoceptive exposure<br>* A pilot study addressing the efficacy and feasibility of an interoceptive exposure technique.<br>|
| No Intervention: No intervention<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain intensity change | Measured by numeric rating scale (NRS) with a pain intensity ranging from no pain to worst pain (1 to 10) according to the conventional use of NRS | Pain intensity at the beginning of the intervention and pain intensity change at 3 months and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anxiety change | Anxiety symptoms are measured by State-Trait Anxiety Inventory (STAI) | Anxiety at the beginning of the intervention and anxiety change at 3 months and 12 months. | 
| Depression change | Depression is measured by Beck Depression Inventory (BDI), version II | Depression at the beginning of the intervention and depression change at 3 months and 12 months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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prevention, sub-acute, low back pain, interoceptive