. Chronic low back pain (cLBP) is a major public health problem with a lifetime prevalence rate of ~85% in U.S. adults. cLBP is a leading cause of disability and opioid abuse in the U.S. and costs the nation between $100-200 billion annually. Current treatments for cLBP are limited in scope and often result in low treatment engagement. There is a critical need for novel multidimensional treatments for cLBP. One promising mind-body therapy is Mindfulness-based Dance/Movement Therapy (M-DMT). M-DMT integrates mindfulness-based skills with the psychotherapeutic use of movement to promote physical and emotional health and social well-being. M-DMT addresses management of cLBP through the use of (1) in- vivo graded exposure therapy (i.e., dance/body movement) to promote physical activity and functioning, and enhance self- efficacy and perceived control; (2) creative/expressive movement to increase mindfulness skills, relaxation, and self- expression; and, (3) group therapy structure to normalize pain experiences and build social support. Research, albeit lim- ited, have shown positive associations between DMT and mood, stress, mobility, and pain reduction in patients with chronic pain. However, there is a dearth of research to support the efficacy of DMT, in part due to the absence of manual- ized protocols and methodologically sound randomized controlled trials (RCT). In addition, although mindfulness princi- ples are imbedded in DMT, studies have not formally included mindfulness skills with DMT for cLBP. An uncontrolled pilot study by our group in patients with chronic musculoskeletal pain (n=19) including patients with cLBP, suggests that a 10-week group DMT protocol was well-tolerated and feasible. Patients reported improvements in pain intensity, activity avoidance, attention regulation, acceptance, positive reinterpretation and growth, and a reduction in pain medication use. Based on data, we refined and extended the DMT protocol to 12 sessions and integrated mindfulness skills. The overall objectives of the current proposal are to evaluate the feasibility, acceptability and credibility of our refined M-DMT proto- col; to assess and improve methodological procedures for conducting a RCT test of M-DMT; and, to demonstrate proof of principle by gathering information about the process of change between M-DMT and a control condition.
Our specific aims i nclude 1) to evaluate the feasibility, acceptability and credibility of a refined 12 session M-DMT protocol for pa- tients with cLBP and to further refine the treatment protocol as needed; 2) to evaluate the feasibility, acceptability and methodological procedures of conducting a RCT comparing the 12-session M-DMT protocol to a social support group in adults with cLBP; and 3) to investigate the process of change in clinical outcomes by treatment conditions in order to demonstrate proof of principle. This study is innovative and significant because it 1) is the first study to addresses the po- tential of M-DMT as a creative, non-opioid intervention for cLBP; 2) utilizes a mixed methods design to evaluate the fea- sibility, acceptability and credibility of the M-DMT protocol; and, 3) will provide important methodological and protocol data and substantive pilot data necessary for the next phase of this line of research, namely a fully powered RCT to evalu- ate efficacy and treatment mechanisms of action.
. The proposed research is relevant to public health because it will provide critical information necessary to design rigorous efficacy studies to evaluate and develop an evidence-base for mindfulness-based dance/movement therapy, an innovative mind-body approach, for chronic low back pain management. The proposed research is particularly relevant to the NCCIH's mission, as it will develop knowledge and evidence to guide decisions about the inclusion of mind-body interventions into the delivery of chronic pain care.