Making Better Lives: Patient-Focused Care for Low Back Pain (LBP)

Completed · Not applicable

Conditions studied: Chronic Low Back Pain, Hip Ostearthritis, Myofascial Pain Syndrome, Fibromyalgia, Depression, Maladaptive Coping, Lumbar Spinal Stenosis, Insomnia, Sacroiliac Joint Pain, Lateral Hip and Thigh Pain, Anxiety, Dementia, Recent Leg Length Discrepancy

In brief

Back pain is a huge problem for millions of Americans, including nearly 11 million Veterans. Our older Veterans suffer the most. Citizens spend billions of dollars, yet consistently get poor results. Primary Care Providers are often tasked with diagnosing and treating Chronic Low Back Pain, even though they are often undereducated in the field. These PCPs often use advanced imaging, usually MRIs to guide care. These images often show degenerative disc disease and other common pathologies in older adults, even those who are pain free, which can lead to misdiagnosis and treatment. The investigators believe that Chronic Low Back Pain is a syndrome, a final common pathway for the expression of multiple contributors that often lie outside the spine itself. For example, hip osteoarthritis, knee pain, and even anxiety could all lessen back pain if addressed and treated probably. Investigators will measure participants' low back pain-associated disability with the well-validated RMDQ. Data will be collected at baseline and monthly via telephone. The investigators hypothesize that veterans who receive PCCET will experience significantly greater reduction in low back pain-associated disability than those who receive IAUC at six months. Investigators will also measure participants' low back pain with the 0-10 Numeric Rating Scale for Pain. Data will be collected at baseline and monthly via telephone. The investigators hypothesize that veterans who receive PCCET will experience significantly greater reduction in low back pain than those who receive IAUC at six months. The goal of this study is to compare patients treated with usual care, which usually starts with imaging, versus patients who are treated by trained geriatricians who know how to recognize and address 11 key conditions that commonly drive pain and disability in older adults. The investigators believe that older patients who receive care tailored to their needs by educated PCPs will ultimately have less back pain and, more importantly, better quality of life.

Key facts

Study ID: NCT02697435
Run by: VA Office of Research and Development
People needed: 55
Starts: 2016-04-01
Expected to finish: 2018-08-31
Last updated by the study team: 2019-08-19

Who can join

Age: 60 and older, up to 89. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

English-speaking (to ensure the validity of data collected)
Age 60 and older
Lumbar MRI within past 30 days and is without evidence of infection, malignancy, or acute fracture OR scheduled for a lumbar MRI within the next 30 days
CLBP, defined as pain in the lower back of at least moderate severity (assessed with a verbal rating scale), every day or almost every day, for at least 3 months
No red flags that would indicate a serious underlying disorder that would necessitate urgent and specialized treatment, i.e.,
weight loss
fever
sudden severe LBP
change in bowels/bladder
back pain that awakens from sleep
recent leg weakness
No pain in other body locations that is more severe than their low back pain
No psychotic symptoms
No previous spine surgery
No dementia (Folstein Mini-Mental State Examination score of > 24)
No acute illness
No prohibitive communication impairment (e.g., severe hearing or visual impairment)
Able to commit to 6 months of study participation

You may not qualify if…

Vulnerable subjects will not be enrolled
Neither pregnant subjects nor women of childbearing potential will be included because the investigators are targeting older Veterans with CLBP
Neither children nor prisoners will be included
Incompetent subjects will be excluded from participating in this research, as determined by performance on the Folstein Mini Mental State Examination

Where it is running

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA — Pittsburgh, Pennsylvania, United States
Hunter Holmes McGuire VA Medical Center, Richmond, VA — Richmond, Virginia, United States

Full record on ClinicalTrials.gov

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