Algorithm-Informed Treatment for Chronic Lower Back Pain

(ADAPT Trial)

This trial aims to find the best treatment for individuals with chronic lower back pain. Researchers use an algorithm to predict the most effective treatment based on personal factors like symptoms and lifestyle. Participants may receive treatments such as Cognitive-Behavioral Therapy for Pain (PRISM-CBT), Duloxetine (a type of medication), mHealth Acupressure Self-Management, and Physical Therapy (PT) and Exercise. It is ideal for those who have experienced back pain for at least six months and struggle with pain on most days. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could personalize pain management strategies.

Research has shown that the treatments in this trial are generally safe.

Cognitive-Behavioral Therapy for Pain (PRISM-CBT) is considered safe. Studies indicate it helps manage chronic pain without major side effects, reducing pain and improving quality of life.

Duloxetine, a medication already approved by the FDA for other uses, significantly reduces back pain and is usually well-tolerated. Most patients do not experience serious side effects.

mHealth Acupressure Self-Management has shown positive results with few side effects. Some users might experience minor issues like bruising, but these are rare.

Physical Therapy and Exercise are also safe options, providing significant pain relief. Some people might feel sore after exercise, but this is usually temporary and not harmful.

Researchers are excited about this trial because it explores a combination of treatments for chronic lower back pain that might offer more comprehensive relief than existing options. Traditional treatments often include medications like NSAIDs or opioids, physical therapy, or cognitive-behavioral therapy. However, this trial investigates the use of an algorithm-informed approach that combines Cognitive-Behavioral Therapy for Pain (PRISM-CBT), Duloxetine, mHealth Acupressure Self-Management, and Physical Therapy (PT) and Exercise in various sequences. These combinations aim to address pain from multiple angles - physiological, psychological, and behavioral - potentially offering a more personalized and effective treatment strategy. By exploring how these therapies interact and complement each other, researchers hope to discover new insights that could lead to improved pain management strategies.

Research has shown that Cognitive-Behavioral Therapy for Pain (PRISM-CBT), one of the treatments in this trial, can reduce pain and improve function in individuals with chronic lower back pain. Studies have found significant improvements in pain management with this therapy. Duloxetine, another treatment option in this trial, has significantly reduced pain in people with chronic low back pain, with many patients experiencing more relief than those taking a placebo. mHealth Acupressure, also under study in this trial, is a self-care technique that shows promise as a non-drug option for managing chronic pain by pressing specific points on the body to ease discomfort. Lastly, Physical Therapy and Exercise, another treatment arm in this trial, have provided modest improvements in physical function, effectively managing chronic pain through regular activity. Each of these treatments has evidence supporting their ability to help manage chronic lower back pain.¹³⁵⁶⁷