Back pain is one of the most frequent reasons patients seek pain relief from physicians.
Most current treatments for back pain are not very effective, and those that are, such as opioids, carry significant risks.
The Back Pain Consortium, a federally funded program, is looking to improve treatment options for back pain through large-scale clinical studies.
Back pain is often cited as one of the most frequent reasons patients visit HCPs for pain relief options. The NIH created the Back Pain Consortium (BACPAC) to conduct trials to help determine which back pain treatments are most effective for specific individuals. The goal is to help HCPs reduce the need to prescribe opioids for chronic low back pain.
Back pain: The data
The National Center for Health Statistics (NCHS), part of the CDC, published a data brief showing the extent of back pain in the US.
Based on findings from the National Health Interview Survey, they reported that, in 2019, nearly 3 in 5 adults (58.9%) had experienced pain of any kind in the prior 3 months. Back pain affected 39.0% of adults. Other common types of pain were lower limb pain, in 36.5%, and upper limb pain, in 30.7%. The prevalence of pain increased with age, and was highest among adults older than age 65.
The fact that current treatment options for chronic low back pain are not very effective has led to an increase in the use of opioids. Instead of the default use of opioids for back pain, personalized treatments would be preferable.
BACPAC is a translational, patient-centered effort to identify such treatments using interdisciplinary methods. The BACPAC Research Program will accomplish three goals:
Develop a state-of-the-art model for chronic low back pain, incorporating biological, biomechanical, psychosocial, and other factors
Identify and test treatments that target specific pathways
Conduct a large-scale clinical study to develop a management algorithm based on back pain phenotype
BACPAC stakeholders include patients, providers, medical associations, payors, pharmaceutical companies, and government organizations. The BACPAC Research Program is federally funded through the NIH and the Helping to End Addiction Long-term® (HEAL) Initiative.
The Biomarkers for Evaluating Spine Treatments (BEST) clinical trial is underway as part of the BACPAC Research Program. For the BEST trial, chronic low back pain is defined as back pain lasting at least 3 months, and occurring “at least half the days in the past 6 months.” The trial will last 38 weeks.
The goal of this precision medicine study is to find links between individual biomarkers and the effectiveness of four existing back pain treatments:
Acceptance and commitment therapy (an established approach that focuses on the whole person, their pain, health, and quality of life, while helping them learn new skills for dealing with pain)
Duloxetine, a generic serotonin-norepinephrine reuptake inhibitor
Enhanced self-care (an online program that uses personalized messaging to teach evidence-based strategies and lifestyle skills to help patients manage their pain)
Evidence-based exercise and manual therapy (a combination of simple exercises, such as basic stretches and strength training, and hands-on treatment by a physical therapist or chiropractor)
Trial participants will receive one or two of the above treatments.
According to an Informational Briefing for the HEAL Initiative, in 2021, more than 100,000 Americans died from drug overdoses, and more than 80,000 of those deaths were from opioids.
The HEAL Initiative is focusing on the association between undertreatment of conditions like chronic back pain and the problems of opioid misuse and addiction.
The NIH has invested more than $2.5 billion in this program to fund more than 1,000 projects in all 50 states.
Preventing opioid use disorder
The NIH also has another, separate initiative for preventing opioid use disorder. The rationale for this program is based on sobering statistics: Responses to the 2020 National Survey on Drug Use and Health indicated that 9.5 million people aged 12 or older had misused opioids in the previous year, and 2.7 million people had an opioid use disorder.
Many strategies for preventing substance use disorders—especially involving opioids—have been implemented, but their efficacy has not been well-demonstrated.
This program aims to find prevention interventions that can be used in settings that intersect with the populations most affected by the opioid crisis, so that all who need such services might benefit.
An important objective for the research is to build an evidence base for prevention interventions and to identify social determinants. Associations between tobacco, cannabis, and opioid use will also be examined.
What this means for you
HCPs can refer patients with back pain to the BEST trial website to enroll in the study. In their own practice, they can try to identify patients with chronic back pain who might have opioid use disorder. It is important to stay current with the HEAL Initiative as data on comparative treatments for back pain emerge.