Chronic low back pain (cLBP) is the most common pain condition diagnosed in patients 65 years or older in the United States. While new interventions are being developed, they often cost more, require additional diagnostic tests, and increase visits to health care providers (HCP). Older adults often have additional health care issues and need more assistance to access HCP, which delays treatment and further increases cost. Analgesics are often prescribed, yet they can be costly and have particularly troublesome side effects in this already vulnerable population. Auricular point acupressure (APA) applies an acupuncture-like stimulation to ear acupoints without using a needle (i.e., seeds are taped to the acupoints) to treat illness/symptoms. APA is particularly well-suited for current challenges of unmet cLBP management. We propose a randomized controlled trial to (1) determine the efficacy of APA in relieving cLBP and (2) examine the physiologic mechanisms of the APA effect on cLBP. We will determine the efficacy of a 4-week APA therapy for adults 65 years or older with cLBP. Guided by the NIH Pain Consortium Research Task Force, the standardized research approach on cLBP will be used to measure the study outcomes (i.e., pain intensity, pain interference and physical function). We will also measure psychological, behavioral, personal and social factors that may moderate or mediate the effects of APA. We also believe inflammatory cytokines may partially explain the mechanism of action of APA for pain relief and improved back-specific physical function and plan to measure these. This study will identify a novel approach to manage cLBP in older adults, which is an innovative, non-invasive, low-cost, self-manageable, non-pharmacological approach as an adjunctive therapy for cLBP, with minimal side effects. If successful, the paradigm of pain management will shift from a traditional medical model to a larger integrative medicine and self-management paradigm to avoid unnecessary evolution towards prolonged disability.
Chronic low back pain (cLBP) affects almost one-third (30.3%) of persons 65 years and older in the U.S. causing significant a negative impact on individuals and society. The Institute of Medicine and Centers for Disease Control and Prevention provide guidelines for non-pharmacologic and self-management strategies to treat chronic pain. However, patient, provider, and system factors, including patient buy-in and motivation, time intensiveness of office visits, insurance coverage and accessibility to care, may limit adherence to these evidence-based guidelines. Importantly, older adults are less likely to receive adjunctive care (e.g., spinal manipulation, massage therapy, or electrical stimulation) for cLBP. We propose use of auricular point acupressure (APA)?a non-invasive, non-pharmacologic and self-management strategy originating from auricular acupuncture in Chinese medicine?as an innovative solution for cLBP in older adults.