Chronic low back pain (CLBP) is common among older adults;treatment is inadequate and will only become a bigger problem with the aging of the American population. We believe that mind-body therapies are poised to meet the demand for enhanced pain treatment. Participants in our pilot study significantly improved in self- reported function after participation in an 8-week mind-body program. Furthermore, they improved in measures of neuropsychological performance (NP) including improved attention and executive function. To further this work, we propose the following specific aims: 1) to determine the effectiveness of a mind- body program in increasing function and reducing pain among older adults with CLBP, and 2) to evaluate the impact of mindfulness meditation on NP in older adults with CLBP. To accomplish these aims we will conduct a randomized, controlled clinical trial of 300 CLBP sufferers aged 65 years or older. The mind-body program is modeled on the Mindfulness-Based Stress Reduction Program, which we have modified to specifically target chronic pain sufferers. We will offer monthly """"""""booster"""""""" classes at the completion of the programs for up to 12 months. The control group will be randomized to an education control program which will be adapted from the 10 KeysTM to Healthy Aging. We will measure self-reported and objectively measured physical function with tests validated in an older population. We view pain as multidimensional;therefore, to adequately capture the impact of the mind-body program on pain we will include a variety of measures to assess not only pain intensity, but psychological function. NP will be assessed with the Computer- Based Assessment of Mild Cognitive Impairment a brief, standardized, computer-based assessment of mental status. Focus groups will be conducted on a subset of participants to collect in-depth personal descriptions of using mindfulness meditation for improving function and reducing pain. Since maintaining functional independence is of foremost importance to older adults, our primary hypothesis is: mindfulness meditation will be associated with a clinically meaningful 2.5-point improvement in the Roland and Morris Disability Questionnaire, which is specific to the low back, immediately following an 8-week mind-body program as compared to an education control group. This new investigator application responds to PA-07-046 Research on Mind-Body Interactions and Health by 1) examining the effects of a mind-body program on physical function and the multidimensional aspects of pain, 2) evaluating the effects of mindfulness meditation on NP, and 3) bringing together an experienced interdisciplinary team of researchers. The proposed study represents the first large, well-controlled, comprehensive examination of the effects of a mind-body program on the independent older adult with chronic pain. If proven effective, this mind-body program could be broadly implemented as an adjunct method to increase function and decrease pain in this population.
The potential relevance to the public health of this study is the increase of function, decrease of pain and increase in neuropsychological performance of older adults with chronic low back pain as a result of participating in an 8-week mind-body program.
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