CompletedNot Applicable

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

United States55 participantsStarted 2016-04-01

Plain-language summary

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.

Who can participate

Age range60 Years – 89 Years

SexALL

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AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.

Inclusion Criteria: * 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 Exclusion Criteria: * 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

What they're measuring

Participants' Level of Low Back Pain-associated Disability as Assessed by Roland Morris Disability Questionnaire (RMDQ)

Timeframe: Baseline and 6 months

Participants' Average 7-day Self-reported Level of Low Back Pain as Assessed by 0-10 Numeric Rating Scale

Timeframe: Baseline and 6 months

Trial details

NCT IDNCT02697435

SponsorVA Office of Research and Development

Sponsor typeFED

Study typeINTERVENTIONAL

Primary completion2018-05-31

Results submitted2019-04-30