Skip to main content
OpenTrials
Active, Not Recruiting

NCT Number: NCT04744883

Efficacy of Spinal Manipulation Therapy or Mindfulness-based Reduction Therapy on Patients With Chronic Low Back Pain

Chronic Pain Management (CPM) has increasingly utilized long-term opioid analgesic therapy, a change associated with increased opioid abuse (a greater exposure in vulnerable individuals), non-pain health consequences (hormone changes, falls), and a dramatic rise in opioid-related overdoses and deaths. Treatment strategies that minimize the need for chronic high-dose opioids are sorely needed. This project will aim to test what degree mindfulness therapy (MT) and spinal manipulation therapy (SMT) produce pre- to mid- to post-treatment changes in endogenous opioid (EO) function.

Active, Not Recruiting

This study is active but is not currently recruiting participants.

Notify Me

Key information

Conditions

Chronic Low-back Pain

Age range

18 year–75 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Early Phase 1

Primary location

Rush University Medical Center, Chicago, Illinois, United States

Loading trial locations.

About this study

This project will determine whether enhancing endogenous opioids (via SMT or MT) permits achieving desired levels of analgesia with lower dosages of opioid analgesics, and fewer side effects and abuse-relevant drug effects. This X year project will test study hypotheses in a sample of 240 chronic low back pain patients. The study will have 2 key elements: 1) a randomized, controlled SMT or MT in chronic pain (CP) patients completing daily take home exercises and 2) laboratory evoked thermal pain protocols pre- and post- therapy, permitting the quantification of EO function and the examining of treatment-induced changes in EO function (placebo vs. naloxone).

The study will employ a mixed between/within-subjects design using double-blinded and placebo-controlled administration of the opioid antagonist (naloxone). The study will use a 8 week supervised MT or SMT manipulation with subjects randomly assigned to one of the groups. All participants will undergo 4 laboratory pain-induction sessions in total. 2 during the pre-treatment phase, and 2 post-treatment. The laboratory sessions are identical. Each laboratory session will be roughly 2-3 days apart and the first 2 laboratory sessions will occur prior to the randomization to the treatment condition.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • significant daily chronic pain intensity (≥4 on a 10-point scale) and interference in performing daily activities due to pain (≥3 on a 10-point scale) for at least 3 months
  • age 18-75 years (inclusive)
  • not using opioid analgesics on a daily basis or within 3 days of each laboratory session (confirmed via urine drug screen)
  • Intact cognitive status and ability to provide informed consent
  • ability to read and write in English sufficiently to understand and complete study questionnaires

Exclusion criteria

  • meet criteria for alcohol or substance abuse problems
  • meet criteria for past or present psychotic or bipolar disorders
  • inability to understand English well enough to complete questionnaires or participate in therapy
  • pain due to malignant conditions, rheumatoid arthritis, migraine or tension headache, complex regional pain syndrome, or fibromyalgia syndrome
  • lumbar surgery within past 6 months
  • pregnant
  • signs of nerve root compression (ie, positive straight-leg raise <45○).
  • liver diseases (e.g hepatitis or cirrhosis)
  • suicide ideation with intent
  • osteoporosis or bone demineralization
  • opioid-dependency
  • inability to hold breathe for 15 seconds
  • acute trauma to spine
  • long term use of corticosteroids
  • spinal cord stimulator or IT pump inserted in back
  • they have a BMI equal to or above 40

Treatment and study plan

Spinal Manipulation Therapy (SMT)

Other

2 SMT techniques are administered each session, both of which are scripted interactions between the physical therapist (PT) providing the SMT and the subjects: 1) Participants will lie on the SMT table for 20 mins, while the PT sits approximately 6 ft away. As part of the script, the PT will review with subjects the inclusion/exclusion criteria ostensibly to ensure that nothing has changed. 2) The PT will perform the 2 SMT techniques during the next 20 mins. 3) Subjects will sit upright in a chair for the remaining 20 mins, while the PT sits approximately 6 feet away. The PT will review home exercises with participant.

naloxone

Drug

In randomized order (crossover) across 2 laboratory sessions each approximately 3 days apart, participants will receive either 1) 2 doses of saline placebo (20ml each) or 2) weight-adjusted doses of Naloxone beginning with a dose of 0.11mg/kg followed by a weight-adjusted dose of 0.055 mg/kg

Other names: narcan

Placebo

Drug

In randomized order (crossover) across 2 laboratory sessions each approximately 3 days apart, participants will receive either 1) 2 doses of saline placebo (20ml each) or 2) weight-adjusted doses of Naloxone beginning with a dose of 0.11mg/kg followed by a weight-adjusted dose of 0.055 mg/kg

Other names: normal saline placebo

Mindfulness Based Stress Reduction Therapy (MT)

Behavioral

Each MT session consists of (a) body scan meditation accompanied by awareness of breathing and other bodily sensations while in a lying position, (b) sitting meditation, focusing on awareness of breathing, bodily sensations, thoughts, and emotions (c) gentle movement exercises intended to develop awareness (mindfulness) during movement. In-session activities include suggestions for application of mindfulness as a method for responding positively to stress; dealing with the challenges of pain; and exercises focusing on the challenges and achievements patients experience in integrating mindfulness into their lives and the stressful situations they encounter. Additional discussion will focus on stress reactivity and they will be taught problem-solving skills to develop solutions to meet MT goals. Finally, patients will develop a written maintenance plan that includes a list of short- and long-term goals for applying mindfulness methods and a plan for dealing with possible setbacks.

Primary outcomes

  1. Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference

    Time frame: Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks)

    Interference in daily activities attributed to chronic pain as reported by subjects. The PROMIS Pain Interference scale consists of 8 questions with a 5-point response scale ranging from Not at all - Very much. Participants are asked how much in the past 7 days everyday activities were affected by their pain. Higher scores indicate more pain interference in daily activities.

Secondary outcomes

  1. Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity (Short Form)

    Time frame: Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks)

    Intensity of chronic pain reported by subject. The PROMIS Pain Intensity scale consists of 3 questions with a 5-point response scale ranging from Had no pain - Very severe. Participants are asked how intense their pain has been in the past 7 days. Higher scores indicate more intense pain.

  2. Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Depression

    Time frame: Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks)

    Degree of depressive symptoms reported by subject. The PROMIS Depression scale consists of 8 questions with a 5-point response scale ranging from Never - Always. Participants are asked how often they felt depressive emotions in the past 7 days. Higher scores indicate more depressive emotions.

  3. Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (Short Form)

    Time frame: Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks)

    Amount of physical activity reported by subject. The PROMIS Physical Function scale consists of 27 questions with a 5-point response scale ranging from Without any difficulty - Unable to do. Participants are asked how much their pain affects their physical functioning. Higher scores indicate more inability to perform specific physical activities due to pain.

  4. Change in Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance

    Time frame: Baseline, after each weekly treatment session, 3- and 6-month follow-up (roughly 16 weeks)

    Degree of sleep disturbance reported by subject. The PROMIS Sleep Disturbance scale consists of 8 questions with a 5-point response scale ranging from Not at all - Very much. Participants are asked how much in the past 7 days their pain interfered with their sleep. Higher scores indicate more sleep disruptions.

Sponsors and collaborators

Lead sponsor

Rush University Medical Center

Other

Collaborators

  • Vanderbilt University Medical Center

Registry information

Official study title

Evaluating Specific and Non-Specific Mechanisms in Two Distinct Complementary/Integrative Interventions for Chronic Pain

Important dates

Study start
2020
Primary completion
2024
Study completion
2026
First posted
Feb 9, 2021
Registry last updated
Jul 10, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.