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Focus article report of the NIH task force on research standards for chronic low back pain
Richard A Deyo1, Samuel F Dworkin, Dagmar Amtmann
1*Oregon Health and Sciences University, Portland, Oregon †University of Washington, Seattle, Washington ‡Rush University Medical Center, Chicago, Illinois §George Washington University, Washington, District of Columbia ∥Stanford University, Stanford, California ¶Johns Hopkins University, Baltimore, Maryland #Northwestern University, Evanston, Illinois **VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania ††Palmer College of Chiropractic, Davenport, Iowa ‡‡National Center for Complementary and Alternative Medicine, Bethesda, Maryland §§National Institute for Arthritis, Musculoskeletal and Skin Diseases, Bethesda, Maryland ∥∥New England Baptist Hospital, Roxbury Crossing, Massachusetts ¶¶Dartmouth University, Hanover, New Hampshire ##Group Health Research Institute, Seattle, Washington.
Background:
Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus.
Methods:
The NIH Pain Consortium therefore charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting.
Results:
The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals.
Conclusions:
The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement.
