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Behandling af negativ påvirkning hos patienter med lænderygsmerter (TNA-LBP)

27. august 2026 opdateret af: Ajay Wasan, MD, Msc

Proof of Concept-undersøgelse til behandling af negativ påvirkning ved kroniske lænderygsmerter

Denne undersøgelse vil undersøge, hvordan brugen af ​​antidepressiva, fysioterapi og kombination af begge påvirker smerter, funktion og depression hos patienter med kroniske lænderygsmerter.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Cirka 20 millioner amerikanere er ramt af kroniske lændesmerter og negative affektive tilstande som depression og angst. Disse negative tilstande har alle været forbundet med højere smerteintensitet, lavere smertetolerance, større brug af smertestillende medicin, dårlige smertebehandlingsresponser og højere niveauer af psykiatrisk komorbiditet blandt patienter med lændesmerter. For at forbedre disse resultater for dem, der lider af lændesmerter, er det vigtigt at implementere flere metoder med fokus på behandling af negativ påvirkning til smertebehandling i stedet for at bruge opioider alene.

Antidepressiv (AD) og frygtundgåelsesbaseret fysioterapi (EFAR) har individuelt vist sig at være lovende metoder til smertebehandling. I denne undersøgelse vil AD, EFAR og kombinationsterapien af ​​de to behandlinger blive udforsket og implementeret for at undersøge deres effektivitet til at forbedre smerte, funktion, depression og angst. Nøgleinnovationen er at teste en ny og effektiv multimodal behandling, der kan hjælpe med at håndtere smerte, samt adressere negativ påvirkning.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

308

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

  • Navn: Bhagyasri Jain Dharmaraj, BPharm
  • Telefonnummer: (412)-665-2904
  • E-mail: bhd20@pitt.edu

Studiesteder

    • Massachusetts
      • Chestnut Hill, Massachusetts, Forenede Stater, 02467
        • BWH Pain Management Center
    • Minnesota
      • Rochester, Minnesota, Forenede Stater, 55905
        • Mayo Clinic
    • Pennsylvania
      • Pittsburgh, Pennsylvania, Forenede Stater, 15206
        • UPMC Pain Medicine At Centre Commons

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 75 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Beskrivelse

Inklusionskriterier:

  • Alder 18-75
  • Smertevarighed > 6 måneder
  • Skal opfylde minimumskriterierne for kognitiv funktion ved brug af PROMIS 2-element kognitiv screener (>3)
  • Gennemsnitlig smertescore på > 3/10, hvor lænderygsmerter er det primære smertested
  • CLBP møde Quebec Task Force Classification System kategorier I-III (fra kun aksiale smerter til smerter, der udstråler ud over knæet uden neurologiske tegn). Konstant radikulær smerte forbundet med sansetab er meget behandlingsresistent uden operation
  • Bevis på en tidligere røntgen af ​​lænden for at udelukke røde flag, såsom infektion, tumor eller fraktur
  • Skal opfylde kriterier for høj negativ påvirkning ved 1. studiebesøg: mindst 5 på PHQ-4 (også kaldet PHQ-2 + GAD-2). Score over dette niveau er i høj grad forbundet med at have en komorbid svær depression eller generaliseret angstdiagnose
  • At have tilgængelige elektroniske lægejournaler fra UPMC, Brigham and Women's Hospital eller Mayo Clinic, Rochester.
  • For dem, der tager opioider (opioidundergruppen), skal deltagerne have ordineret opioider i øjeblikket i mindst 3 på hinanden følgende måneder før tilmelding. Patienter skal tage opioider i mindst tre måneder, tage dem på daglig basis eller med mellemrum i løbet af ugen. Efterforskerne vil inkludere dem på stærke opioider, såsom oxycodon og svage opioider, såsom tramadol.
  • Forsøgspersonen skal acceptere, at opioider ikke kan øges under undersøgelsen
  • For dem, der tager opioider, har der ikke været nogen forstyrrelse i brugen af ​​aktive stoffer i det seneste år som bestemt af PI med brugen af ​​værktøjet Tobak, alkohol, receptpligtig medicin og andre stoffer (TAPS) og en urintoksikologisk screening. Undtagelserne er tobak, medicinsk marihuanabrug i Pennsylvania eller Minnesota, rekreativ eller medicinsk marihuana på Boston-stedet eller mild receptpligtig opioidbrugsforstyrrelse såsom opioidmisbrug
  • Ingen akut suicidalitet eller historie med større tankeforstyrrelser (såsom mani eller psykose). Dette vil blive vurderet ved studiestart, som også vil omfatte en gennemgang af historie i EPIC/EMR
  • Skal have en mobilenhed eller tablet, der kan sende og modtage tekstbeskeder og få adgang til internettet

Ekskluderingskriterier:

  • Rygoperation inden for de seneste seks måneder
  • Aktive arbejdstagers kompensation eller retssager
  • Nye smerte- og/eller psykiatriske behandlinger inden for 2 uger efter tilmelding
  • Hensigt om at tilføje nye eller øge smertebehandlinger i løbet af undersøgelsesperioden, såsom rygkirurgi, nerveblokeringsprocedurer eller medicin
  • Hensigt om at tilføje nye psykiatriske behandlinger i løbet af de første 4 måneder af undersøgelsen
  • Enhver klinisk ustabil systemisk sygdom, der vurderes at interferere med forsøget
  • Anamnese med hjerte-, nervesystem- eller åndedrætssygdom, der efter efterforskerens vurdering udelukker deltagelse i undersøgelsen på grund af et øget potentiale for respirationsdepression
  • Ikke-ambulerende status
  • Graviditet eller hensigten om at blive gravid under undersøgelsen. Kvinder i den fødedygtige alder vil alle indsende en urinprøve graviditetstest ved tilmelding.
  • Ikke flydende engelsk og/eller ikke i stand til at udfylde spørgeskemaerne

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Sekventiel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Antidepressant (AD)

Subjects will be randomly assigned to receive the antidepressant medication for 4 months prescribed by a psychiatrist or an advanced practice provider supervised by a psychiatrist. During Phase 1 phone calls every 2 weeks or in person visits will be used to evaluate the treatment and adjust the medication. If the patient was prescribed opioids prior to study entry, they will meet separately with a study physician to discuss possible weaning during the first 4 months (Phase 1)

Non-responders determined at the end of 4 months will be re-randomized to continue receiving AD or EFAR for another 4 months.

Den antidepressive behandling anvender antidepressiv medicin til at forbedre smerte, funktion og depression.

Formularen til antidepressiv behandlingshistorie (ATHF) vil blive brugt til at vurdere tilstrækkeligheden af ​​enhver tidligere antidepressiv medicinbehandling og til at hjælpe med beslutningen om, hvilket antidepressivum der skal startes. Et medicinflowdiagram vil hjælpe med at tjene som rettesnor i hele lægemiddelvalget og doseringsbestemmelsen. Ugentlige vurderinger gennemført af forsøgspersoner vil hjælpe med at bestemme respons, tolerabilitet og nødvendigheden af ​​dosisjustering eller medicinændring.

Andre navne:
  • AD: aripiprazol, bupropion, duloxetin, escitalopram, mirtazapin, sertralin, venlafaxin
Eksperimentel: Enhanced Fear Avoidance Rehabilitation (EFAR)

Subjects will be randomly assigned to receive 8, 1-hour fear avoidance rehabilitation sessions conducted by a physical or occupational therapist, consisting of therapy sessions, pain education, and motivational messaging via a pain education self-help app for 4 months. Trained physical/occupational therapists will determine the activities as part of the treatment. If the patient was prescribed opioids prior to study entry, they will meet separately with a study physician to discuss possible weaning during the first 4 months (Phase 1).

Non-responders determined at the end of 4 months will be re-randomized to continue receiving EFAR or AD for another 4 months.

The EFAR treatment utilizes standardized physical and/or occupational therapy fear avoidance approaches, including pain education, and motivational messaging to improve pain, function, and depression outcomes. Subjects will engage in gradual exposure to exercises and activities they are apprehensive about, such as standing to wash dishes.
Andre navne:
  • EFAR
Eksperimentel: Antidepressant (AD) + Enhanced Fear Avoidance Rehabilitation (EFAR)
Subjects will receive a combination of antidepressant medication and EFAR for the first 4 months (Phase 1). In the 2nd 4 months (Phase 2) the AD treatment will be continued at the same dose(s) and they will be asked to maintain a home exercise program. If the patient was prescribed opioids prior to study entry, they will meet separately with a study physician to discuss possible weaning during the first 4 months (Phase 1). No re-randomization will be done in this treatment group.

Den antidepressive behandling anvender antidepressiv medicin til at forbedre smerte, funktion og depression.

Formularen til antidepressiv behandlingshistorie (ATHF) vil blive brugt til at vurdere tilstrækkeligheden af ​​enhver tidligere antidepressiv medicinbehandling og til at hjælpe med beslutningen om, hvilket antidepressivum der skal startes. Et medicinflowdiagram vil hjælpe med at tjene som rettesnor i hele lægemiddelvalget og doseringsbestemmelsen. Ugentlige vurderinger gennemført af forsøgspersoner vil hjælpe med at bestemme respons, tolerabilitet og nødvendigheden af ​​dosisjustering eller medicinændring.

Andre navne:
  • AD: aripiprazol, bupropion, duloxetin, escitalopram, mirtazapin, sertralin, venlafaxin
The EFAR treatment utilizes standardized physical and/or occupational therapy fear avoidance approaches, including pain education, and motivational messaging to improve pain, function, and depression outcomes. Subjects will engage in gradual exposure to exercises and activities they are apprehensive about, such as standing to wash dishes.
Andre navne:
  • EFAR
Eksperimentel: AD -> EFAR

Subjects will be randomly assigned to receive the antidepressant medication for 4 months prescribed by a psychiatrist or an advanced practice provider supervised by a psychiatrist. During Phase 1 phone calls every 2 weeks or in person visits will be used to evaluate the treatment and adjust the medication. If the patient was prescribed opioids prior to study entry, they will meet separately with a study physician to discuss possible weaning during the first 4 months (Phase 1)

Non-responders determined at the end of 4 months will be re-randomized to continue receiving AD or EFAR for another 4 months. Those re-randomized to EFAR for 4 months will receive 8 treatment visits. The same opioid weaning process will be followed as in Phase 1.

Den antidepressive behandling anvender antidepressiv medicin til at forbedre smerte, funktion og depression.

Formularen til antidepressiv behandlingshistorie (ATHF) vil blive brugt til at vurdere tilstrækkeligheden af ​​enhver tidligere antidepressiv medicinbehandling og til at hjælpe med beslutningen om, hvilket antidepressivum der skal startes. Et medicinflowdiagram vil hjælpe med at tjene som rettesnor i hele lægemiddelvalget og doseringsbestemmelsen. Ugentlige vurderinger gennemført af forsøgspersoner vil hjælpe med at bestemme respons, tolerabilitet og nødvendigheden af ​​dosisjustering eller medicinændring.

Andre navne:
  • AD: aripiprazol, bupropion, duloxetin, escitalopram, mirtazapin, sertralin, venlafaxin
The EFAR treatment utilizes standardized physical and/or occupational therapy fear avoidance approaches, including pain education, and motivational messaging to improve pain, function, and depression outcomes. Subjects will engage in gradual exposure to exercises and activities they are apprehensive about, such as standing to wash dishes.
Andre navne:
  • EFAR
Eksperimentel: EFAR -> AD

Subjects will be randomly assigned to receive 8, 1-hour fear avoidance rehabilitation sessions conducted by a physical or occupational therapist, consisting of therapy sessions, pain education, and motivational messaging via a pain education self-help app for 4 months. Therapists will determine the activities as part of the treatment. If the patient was prescribed opioids prior to study entry, they will meet separately with a study physician to discuss possible weaning during the first 4 months (Phase 1).

Non-responders at the end of 4 months will be re-randomized to continue receiving EFAR or AD for another 4 months (Phase 2). Those re-randomized to receive AD will be prescribed medications by a psychiatrist or an advanced practice provider supervised by a psychiatrist. Phone calls every 2 weeks or in person visits will be used to evaluate the treatment and adjust the medication.

The same opioid weaning process will be followed as in Phase 1.

Den antidepressive behandling anvender antidepressiv medicin til at forbedre smerte, funktion og depression.

Formularen til antidepressiv behandlingshistorie (ATHF) vil blive brugt til at vurdere tilstrækkeligheden af ​​enhver tidligere antidepressiv medicinbehandling og til at hjælpe med beslutningen om, hvilket antidepressivum der skal startes. Et medicinflowdiagram vil hjælpe med at tjene som rettesnor i hele lægemiddelvalget og doseringsbestemmelsen. Ugentlige vurderinger gennemført af forsøgspersoner vil hjælpe med at bestemme respons, tolerabilitet og nødvendigheden af ​​dosisjustering eller medicinændring.

Andre navne:
  • AD: aripiprazol, bupropion, duloxetin, escitalopram, mirtazapin, sertralin, venlafaxin
The EFAR treatment utilizes standardized physical and/or occupational therapy fear avoidance approaches, including pain education, and motivational messaging to improve pain, function, and depression outcomes. Subjects will engage in gradual exposure to exercises and activities they are apprehensive about, such as standing to wash dishes.
Andre navne:
  • EFAR

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
"Composite Responder", Involving the Domains of Pain, Function, and Depression. See "Other Pre-Specified Outcomes" for Description of These Sub-components.
Tidsramme: Baseline vs. 4th month of study

To create the "composite responder" measure, Pain+ function changes will be 1 meaure, and the response rate to depression will be the 2nd component, which simplifies the assessment of multi-domain responses. We will determine the "composite responder" rate of multimodal vs. single-modal treatment primarily, and then between each arm secondarily, along with the subcomponents. The "composite responder" measure will be the number and percentage of participants meeting the measure in each arm in Phase 1.

A participant could be a pain+function responder, a depression responder, both, or neither. We use standard benchmarks for determining responses in each domain. The primary outcome is the rate of response vs. non-response on the "Composite Responder" measure. It will be expressed as percentiles in each category. We will also report the rate of pain+function responders and the rate of depression responders (other pre-specified outcomes).

Baseline vs. 4th month of study

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change From Baseline Pain Interference at 4 Months Using PROMIS
Tidsramme: Baseline vs. 4 months
The PROMIS Short Form v1.1 - Pain Interference 4a will assess self-reported consequences of pain with 4 questions ranked on a 5-point scale, from "not at all" to "very much". The minimum raw summed score is 4 and the maximum score is 20. This is converted to a T score. A lower T-scores suggest better outcomes. The population mean is 50 and 10 points is +/- 1 standard deviation. A T score >60 suggests moderately elevated levels of the measure. Outcomes will be measured and compared between the 3 treatment groups.
Baseline vs. 4 months
Change From Baseline Anxiety at 4 Months Using PROMIS
Tidsramme: Baseline vs. 4 months
The PROMIS Short Form v1.0 - Anxiety 4a will assess self-reported symptoms with 4 questions ranked on a 5-point scale, from "never" to "always". The minimum raw score is a 4 and the maximum is 20.. These are converted to a T score. The population mean is 50 and 10 points is +/- 1 standard deviation. A T score >60 suggests moderately elevated levels of the measure. Lower T-scores suggest better outcomes. Outcomes will be measured and compared between the 3 treatment groups.
Baseline vs. 4 months
Change From Baseline Sleep Disturbance at 4 Months Using PROMIS
Tidsramme: Baseline vs. 4 months
The PROMIS Short Form v1.0 - Sleep Disturbance 6a self-reported perceptions of sleep quality and sleep depth with 6 questions ranked on a 5-point scale. The minimum raw summed score is 6 and the maximum score is 30. This is converted to a T score. Lower T scores suggest better outcomes. Outcomes will be measured and compared between the 3 treatment groups. The population mean is 50 and 10 points is +/- 1 standard deviation. A T score >60 suggests moderately elevated levels of the measure.
Baseline vs. 4 months
Change From Baseline Subject's Perception of Change From Treatment at 4 Months Using Patient Global Impression of Change (PGIC)
Tidsramme: Baseline vs. 4 months
The subject's impression of the impact of the treatment on their pain and function will be measured with a 7-item scale (1 = very much worse, 2 = much worse, 3 = minimally worse, 4 = no change, 5 = minimally improved, 6 = much improved, 7 = very much improved). This is the percentage reporting "very much improved" or "much improved" at the end of Phase 1. We averaged their PGIC ratings in the 4th month.
Baseline vs. 4 months
Neuropathic Pain Symptoms Change, Baseline vs. 4 Months
Tidsramme: Baseline vs. 4 months
Using PainDetect, we will compare changes in neuropathic pain symptoms from baseline to 4 months. PainDetect is scored from 0-38 and based on ratings to symptom items scored from '0' (never) to '5' (very strongly). Lower scores are better.
Baseline vs. 4 months
Fear Avoidance Beliefs, Baseline vs. 4 Months
Tidsramme: Baseline vs. 4 months
Using the Fear Avoidance Beliefs Questionnaire, Physical Activities Items, subjects rate from '0' (completely disagree) to '6' (completely agree) five physical activities which may make their pain worse. The items are summed to produce the total score. The minimum score is a 0 and the maximum is a 30. Lower scores are better.
Baseline vs. 4 months
Widespread Pain Index
Tidsramme: Baseline vs. 4 months
This measure assesses the degree of widespread pain. 20 body regions are rated by patient as having pain or not. The minumum scores is a 0 and the maximum is a 20. The number of regions is summed to give the total score. Lower scores are better.
Baseline vs. 4 months
Change in PROMIS Fatigue Score From Baseline vs. 4 Months
Tidsramme: Baseline vs. 4 months
The PROMIS short form v. 1.0 for Fatigue consists of 2 items rated from 1-5, from "not at all" to "very much." The minimum raw score is a 2 and the maximum is a 10. The raw score is summed and converted to a T score. Lower T scores are better. The population mean is 50 and 10 points is +/- 1 standard deviation. A T score >60 suggests moderately elevated levels of the measure.
Baseline vs. 4 months
WPI Symptom Severity Score
Tidsramme: Baseline to 4 months
Overall symptom severity is rated 0-10. Lower scores are better.
Baseline to 4 months

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change in Physical Function Using PROMIS Short Form 2.0. Function is Part of the Composite Responder Measure, and a Pain+Function Metric More Specifically. A Subject Could be a Pain+Function Responder, a Depression Responder, Both, or Neither.
Tidsramme: Baseline vs. 4 months
The PROMIS Short Form v2.0 - Physical Function 6b questionnaire will assess self-reported capability with 6 qualitatively scaled questions ranked on a 5-point scale, from "without any difficulty" to "unable to do" or "not at all" to "cannot do." The minimum raw summed score is 6 and the maximum score is 30. Lower t-scores suggest better outcomes. A responder analysis was used as a subcomponent of the "composite responder" primary outcome. A "physical function responder" had to have at least a 3-point improvement in T score at 4 months vs. baseline. The "physical function responder" measure will be the number and percentage of participants meeting the measure in each arm in Phase 1.
Baseline vs. 4 months
Change in Pain Intensity Using PROMIS. Pain is Part of the Composite Responder Measure, and a Pain+Function Metric More Specifically. A Subject Could be a Pain+Function Responder, a Depression Responder, Both, or Neither.
Tidsramme: Baseline vs. 4 months
The PROMIS Numeric Rating Scale v1.0 for average pain intensity-- Pain Intensity 1a questionnaire will assess how much a person hurts on average over the past 7 days, with a question ranked on a 11-point scale, from "0 = no pain" to "10 = worst imaginable pain." The minimum raw summed score is 0 and the maximum score is 10. Lower scores suggest lower pain intensity and better outcomes. To be a "pain responder" a subject had to have at least 30% improvement in pain. The "pain responder" measure will be the number and percentage of participants meeting the measure in each arm in Phase 1.
Baseline vs. 4 months
Change in Depression Using PROMIS. Depression is Part of the "Composite Responder" Measure. A Subject Could be a Pain+Function Responder, a Depression Responder, Both, or Neither.
Tidsramme: Baseline vs. 4 months
The PROMIS Short Form v1.0 - Depression 4a will assess self-reported negative mood and views of self with 4 questions ranked on a 5-point scale, from "never" to "always". The minimum raw summed score is 4 and the maximum score is 20. Lower T scores suggest better outcomes. A T score improvement of at least 5 points is considered a responder. The "depression responder" measure will be the number and percentage of participants meeting the measure in each arm in Phase 1.
Baseline vs. 4 months

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Ajay Wasan, MD, MSc, University of Pittsburgh

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

31. marts 2021

Primær færdiggørelse (Faktiske)

4. november 2024

Studieafslutning (Faktiske)

20. december 2024

Datoer for studieregistrering

Først indsendt

6. januar 2021

Først indsendt, der opfyldte QC-kriterier

5. februar 2021

Først opslået (Faktiske)

10. februar 2021

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

28. august 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

27. august 2026

Sidst verificeret

1. august 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • STUDY21010105
  • UG3AR076568 (U.S. NIH-bevilling/kontrakt)

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ja

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

produkt fremstillet i og eksporteret fra U.S.A.

Ingen

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .