EMPOWER: Empowering the Management of Pain-Obesity-Weight Through Enhanced Reward

Chronic low back pain (cLBP) is the leading cause of disability worldwide and is one of the top reasons for seeking healthcare. High-impact low back pain is particularly problematic, defined as chronic pain accompanied by significant restrictions in work, social, and/or self-care activities for six months or more. High-impact pain is associated with greater pain-related disability, opioid use, and healthcare costs compared to pain of lower impact. Thus, efforts to reduce chronic pain impact have become a public health initiative. Low back pain and overweight/obesity are highly comorbid; overweight and obese individuals are up to 43% more likely to have cLBP compared to normal weight individuals. Together, the additive effects of overweight/obesity and chronic pain may play a larger role in increasing the risk for other adverse health-related comorbidities.

The aim of this exploratory study is to examine the feasibility and acceptability of an integrated pain and weight management intervention (EMPOWER) for middle-aged and older adults with moderate-to-high impact low back pain by addressing mechanisms of environmental reward and positive affect. Forty adults (ages 45-80 years) with comorbid overweight/obesity (BMI≥25 kg/m2) and moderate-to-high impact cLBP will be assigned to an 8-month intervention, whereby they will receive a group- and telephone-based program featuring integrated behavioral weight loss treatment and cognitive-behavioral pain coping therapy. To address the key mechanisms of environmental reward and positive affect, the proposed intervention will incorporate systematic pleasant activity scheduling and values-clarification techniques. Assessments will be conducted at baseline and at the 4- and 8-month time points.

Inclusion criteria

• 45-80 years of age
• Have a BMI≥25kg/m2
• Endorse pain in the lower back region (i.e., space between the lower posterior margin of the rib cage and the horizontal gluteal fold), knees, or hips
• Pain must occur on at least 50% of the days in the previous six months
• Pain must be rated, at minimum, of moderate intensity (rating of 3 on a numeric rating scale ranging from 0-10)
• Pain impact must be rated as moderate to severe
• Study physician reviews medical record and declares patient medically appropriate for exercise protocol

Exclusion criteria

• Current participation in another psychological treatment or structured weight loss program
• Severe psychiatric illness not adequately controlled by medication or other conditions anticipated to impair intervention engagement (e.g., substance abuse/dependence)
• Presence of chronic, malignant pain (e.g., cancer)
• Significant cognitive impairment (<26) on the Montreal Cognitive Assessment (MoCA)
• Inability to read and write English
• Currently undergoing radiation or chemotherapy for cancer
• Self-reported cardiac event in the past 6 months or self-reported Heart Failure (CHF)
• Currently pregnant or breastfeeding, or planning to become pregnant during the study time period
• Back, knee, or hip surgery within the past six months of study entry (or planned surgical interventions for pain during forecasted study participation)
• If currently taking prescription analgesic or psychotropic medication, must be stabilized on these treatments for >4 weeks prior to the baseline assessment
• Blood pressure higher than 180/100 mm Hg at baseline assessment
• Has had bariatric surgery in the past year or is planning to have it in the next year
• If participant reports the presence of systemic inflammatory disease (e.g., rheumatoid arthritis), the study physician will be consulted to determine eligibility