Report of the NIH Task Force on research standards for chronic low back pain.

OBJECTIVE: 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. DESIGN: Expert panel and preliminary evaluation of key recommendations. METHODS: The NIH Pain Consortium 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 minimal data set to describe research subjects (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. CONCLUSION: 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 the RTF recommendations will become a dynamic document, and undergo continual improvement. PERSPECTIVE: A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.

Focus article: report of the NIH Task Force on Research Standards for Chronic Low Back Pain.

UNLABELLED: 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. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary 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. The RTF believes that 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. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement. PERSPECTIVE: A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.

Report of the National Institutes of Health task force on research standards for chronic low back pain.

OBJECTIVES: 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 nonspecific 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. The purpose of this article is to disseminate the report of the National Institutes of Health (NIH) task force on research standards for cLBP. METHODS: The NIH Pain Consortium 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 minimal data set to describe research subjects (drawing heavily on the Patient Reported Outcomes Measurement Information System methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved these recommendations, which investigators should incorporate into NIH grant proposals. CONCLUSIONS: The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of cLBP. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document and undergo continual improvement.

Relationships between joint motion and facet joint capsule strain during cat and human lumbar spinal motions.

OBJECTIVE: The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and is thought to contribute to proprioception and pain. Biomechanical investigations of the FJC have commonly used human cadaveric spines, whereas combined biomechanical and neurophysiological studies have typically used nonhuman animal models. The purpose of this study was to develop mathematical relationships describing vertebral kinematics and FJC strain in cat and human lumbar spine specimens during physiological spinal motions to facilitate future efforts at understanding the mechanosensory role of the FJC. METHODS: Cat lumbar spine specimens were tested during extension, flexion, and lateral bending. Joint kinematics and FJC principal strain were measured optically. Facet joint capsule strain-intervertebral angle (IVA) regression relationships were established for the 3 most caudal lumbar joints using cat (current study) and human (prior study) data. The FJC strain-IVA relationships were used to estimate cat and human spine kinematics that corresponded to published sensory neuron response thresholds (5% and 10% strain) for low-threshold mechanoreceptors. RESULTS: Significant linear relationships between IVA and strain were observed for both human and cat during motions that produced tension in the FJCs (P < .01). During motions that produced tension in the FJCs, the models predicted that FJC strain magnitudes corresponding to published sensory neuron response thresholds would be produced by IVA magnitudes within the physiological range of lumbar motion. CONCLUSIONS: Data from the current study support the proprioceptive role of lumbar spine FJC and low-threshold mechanoreceptive afferents and can be used in interpreting combined neurophysiological and biomechanical studies of cat lumbar spines.

Validation of the cat as a model for the human lumbar spine during simulated high-velocity, low-amplitude spinal manipulation.

High-velocity, low-amplitude spinal manipulation (HVLA-SM) is an efficacious treatment for low back pain, although the physiological mechanisms underlying its effects remain elusive. The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and it has been theorized that the neurophysiological benefits of HVLA-SM are partially induced by stimulation of FJC neurons. Biomechanical aspects of this theory have been investigated in humans while neurophysiological aspects have been investigated using cat models. The purpose of this study was to determine the relationship between human and cat lumbar spines during HVLA-SM. Cat lumbar spine specimens were mechanically tested, using a displacement-controlled apparatus, during simulated HVLA-SM applied at L5, L6, and L7 that produced preload forces of approximately 25% bodyweight for 0.5 s and peak forces that rose to 50-100% bodyweight within approximately 125 ms, similar to that delivered clinically. Joint kinematics and FJC strain were measured optically. Human FJC strain and kinematics data were taken from a prior study. Regression models were established for FJC strain magnitudes as functions of factors species, manipulation site, and interactions thereof. During simulated HVLA-SM, joint kinematics in cat spines were greater in magnitude compared with humans. Similar to human spines, site-specific HVLA-SM produced regional cat FJC strains at distant motion segments. Joint motions and FJC strain magnitudes for cat spines were larger than those for human spine specimens. Regression relationships demonstrated that species, HVLA-SM site, and interactions thereof were significantly and moderately well correlated for HVLA-SM that generated tensile strain in the FJC. The relationships established in the current study can be used in future neurophysiological studies conducted in cats to extrapolate how human FJC afferents might respond to HVLA-SM. The data from the current study warrant further investigation into the clinical relevance of site targeted HVLA-SM.

AAPT Diagnostic Criteria for Chronic Low Back Pain.

Chronic low back pain (CLBP) conditions are highly prevalent and constitute the leading cause of disability worldwide. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the US Food and Drug Administration and the American Pain Society (APS), have combined to create the ACTTION-APS Pain Taxonomy (AAPT). The AAPT initiative convened a working group to develop diagnostic criteria for CLBP. The working group identified 3 distinct low back pain conditions which result in a vast public health burden across the lifespan. This article focuses on: 1) the axial predominant syndrome of chronic musculoskeletal low back pain, 2) the lateralized, distally-radiating syndrome of chronic lumbosacral radicular pain 3) and neurogenic claudication associated with lumbar spinal stenosis. This classification of CLBP is organized according to the AAPT multidimensional framework, specifically 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. PERSPECTIVE: An evidence-based classification of CLBP conditions was constructed for the AAPT initiative. This multidimensional diagnostic framework includes: 1) core diagnostic criteria; 2) common features; 3) medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.

Comparing recruitment strategies in a study of acupuncture for chronic back pain.

BACKGROUND: Meeting recruitment goals is challenging for many clinical trials conducted in primary care populations. Little is known about how the use of different recruitment strategies affects the types of individuals choosing to participate or the conclusions of the study. METHODS: A secondary analysis was performed using data from participants recruited to a clinical trial evaluating acupuncture for chronic back pain among primary care patients in a large integrated health care organization. We used two recruitment methods: mailed letters of invitation and an advertisement in the health plan's magazine. For these two recruitment methods, we compared recruitment success (% randomized, treatment completers, drop outs and losses to follow-up), participant characteristics, and primary clinical outcomes. A linear regression model was used to test for interaction between treatment group and recruitment method. RESULTS: Participants recruited via mailed letters closely resembled those responding to the advertisement in terms of demographic characteristics, most aspects of their back pain history and current episode and beliefs and expectations about acupuncture. No interaction between method of recruitment and treatment group was seen, suggesting that study outcomes were not affected by recruitment strategy. CONCLUSION: In this trial, the two recruitment strategies yielded similar estimates of treatment effectiveness. However, because this finding may not apply to other recruitment strategies or trial circumstances, trials employing multiple recruitment strategies should evaluate the effect of recruitment strategy on outcome. TRIAL REGISTRATION: Clinical Trials.gov NCT00065585.

Dynamic responsiveness of lumbar paraspinal muscle spindles during vertebral movement in the cat.

Muscle spindles provide essential information for appropriate motor control. In appendicular muscles, much is known about their position and movement sensitivities, but little is known about the axial muscles of the low back. We investigated the dynamic responsiveness of lumbar paraspinal muscle spindle afferents from L(6) dorsal root filaments during constant velocity movement of the L(6) vertebra (the feline has seven lumbar vertebrae) in Nembutal-anesthetized cats. Actuations of 1 mm applied at the L(6) spinous process were delivered at 0.5, 1.0 and 2.0 mm/s. The slow velocity component was measured as the slope of the relationship between displacement during the constant velocity ramp and instantaneous discharge frequency. The quick velocity component was the slope's intercept at zero displacement. The peak component was determined as the highest discharge rates occurring near the end of the ramp compared with control. The slow velocity component over the three increasing velocities was 23.9 (9.9), 21.6 (9.6) and 20.5 (9.5) imp/(s mm) [mean (SD)], respectively. The quick velocity component was 28.4 (8.6), 31.4 (9.8) and 35.8 (10.6) imp/s, respectively. These measures of dynamic responsiveness were at least 5-10 times higher compared with values reported for appendicular muscle spindles. The peak component's velocity sensitivity was 2.9 (imp/s)/(mm/s) [0.2, 5.5, lower, upper 95% confidence interval] similar to that for cervical paraspinal muscles as well as appendicular muscles. Increased dynamic responsiveness of lumbar paraspinal muscle spindles may insure central driving to insure control of intervertebral motion during changes in spinal orientation. It may also contribute to large, rapid and potentially injurious increases in paraspinal muscle activity during sudden and unexpected muscle stretch.

Characteristics of patients with chronic back pain who benefit from acupuncture.

BACKGROUND: Although many clinicians believe there are clinically important subgroups of persons with "non-specific" low back pain, such subgroups have not yet been clearly identified. As part of a large trial evaluating acupuncture for chronic low back pain, we sought to identify subgroups of participants that were particularly responsive to acupuncture. METHODS: We performed a secondary analysis of data for the 638 participants in our clinical trial comparing different types of acupuncture to usual care to identify baseline characteristics that predicted responses to individualized, standardized, or simulated acupuncture treatments. After identifying factors that predicted improvements in back-related function or symptoms, we determined if these factors were more likely to predict improvement for those receiving the acupuncture treatments than for those receiving usual care. This was accomplished by testing for an interaction between the prognostic factors and treatment group in four models: functional outcomes (measured by the Roland-Morris Disability Scale) at 8 and 52 weeks post-randomization and symptom outcomes (measured with a numerical rating scale) at 8 and 52 weeks. RESULTS: Overall, the strongest predictors of improvement in back function and symptoms were higher baseline levels of these measures, receipt of an acupuncture treatment, and non-use of narcotic analgesics. Benefit from acupuncture compared to usual care was greater with worse pre-treatment levels of back dysfunction (interaction p < 0.004 for the functional outcome, Roland Morris Disability Scale at 8 weeks). No other consistent interactions were observed. CONCLUSION: This secondary analysis found little evidence for the existence of subgroups of patients with chronic back pain that would be especially likely to benefit from acupuncture. However, persons with chronic low back pain who had more severe baseline dysfunction had the most short-term benefit from acupuncture.

Financial support for research training and career development in complementary and alternative medicine from the National Institutes of Health.

Research careers are a relatively new reality for complementary and alternative medicine (CAM) practitioners (eg, chiropractors, naturopaths, doctors of oriental medicine, etc). Before the establishment in 1998 of the National Center for Complementary and Alternative Medicine (NCCAM) as part of the National Institutes of Health (NIH), there were few funding resources available for those interested in a CAM research career and fewer still feasible paths. Now, however, NCCAM provides a broad array of research training and career development awards for those seeking a long-term career in CAM research. These awards include predoctoral and postdoctoral fellowships, individual career development awards, and institutional training awards. The goal of this article is to provide information about current research training funding opportunities from NCCAM and NIH as a whole that are available to CAM practitioners in the context of the historical challenges of transitioning from a clinical career in CAM practice to a CAM research career.

National Institutes of Health Research Plan on Rehabilitation: NIH Medical Rehabilitation Coordinating Committee.

One in five Americans experiences disability that affects their daily function because of impairments in mobility, cognitive function, sensory impairment, or communication impairment. The need for rehabilitation strategies to optimize function and reduce disability is a clear priority for research to address this public health challenge. The National Institutes of Health (NIH) recently published a Research Plan on Rehabilitation that provides a set of priorities to guide the field over the next 5 years. The plan was developed with input from multiple Institutes and Centers within the NIH, the National Advisory Board for Medical Rehabilitation Research, and the public. This article provides an overview of the need for this research plan, an outline of its development, and a listing of six priority areas for research. The NIH is committed to working with all stakeholder communities engaged in rehabilitation research to track progress made on these priorities and to work to advance the science of medical rehabilitation.This article is being published almost simultaneously in the following six journals: American Journal of Occupational Therapy, American Journal of Physical Medicine and Rehabilitation, Archives of Physical Medicine and Rehabilitation, Neurorehabilitation and Neural Repair, Physical Therapy, and Rehabilitation Psychology. Citation information is as follows: NIH Medical Rehabilitation Coordinating Committee. Am J Phys Med Rehabil. 2017;97(4):404-407.

Biomechanical evaluation of surgical constructs for stabilization of cervical teardrop fractures.

BACKGROUND CONTEXT: Cervical flexion teardrop fractures (CFTF) are highly unstable injuries, and the optimal internal fixation construct is not always clearly indicated. PURPOSE: The purpose of the current study was to determine whether the type of fixation construct (anterior, posterior, or combined) or number of joint levels involved in fixation (one or two) affected the relative stability of a CFTF injury at C5-C6. STUDY DESIGN/SETTING: Human cadaveric cervical spine specimens were mechanically tested under displacement control in the intact state and after creation of CFTF at C5-C6 with stabilization using five different instrumentation constructs. Joint stiffness and intervertebral translation of the constructs were compared with the intact state and normalized (instrumented/intact) to assess relative differences across the five constructs. METHODS: Spine specimens were mechanically tested in the intact state during flexion, extension, lateral bending, and axial rotation. CFTF was created at C5-C6 by creating an osteotomy at C5 and transecting the posterior ligaments and intervertebral disc. Specimens were tested with anterior, posterior, and combined single-level constructs (C5-C6). Then, a corpectomy was performed at C5, and specimens were retested with the two-level constructs (C4-C6; anterior and anterior-posterior). Joint stiffness and intervertebral translations were computed. RESULTS: All five fixation constructs resulted in joint stability that was as good as or better than that of the intact specimens. Relative stiffness of the constructs differed depending upon the motion type considered, though the two-level anterior-posterior construct typically provided the greatest stability. Intervertebral translation along the major axis was reduced the most for both of the combined instrumentation systems, although there were few changes in total intervertebral translation across the five constructs. CONCLUSIONS: All five constructs restored stability comparable to that of the intact specimens. The significance of the relative differences in constructs for the in vivo spine is unclear and warrants further clinical investigation.

The 2005 conference on the biology of manual therapies.

A historic and critically important scientific workshop for all professions involved with manual therapies was held at the National Institutes of Health (NIH) on June 9 and 10, 2005. The conference was jointly sponsored and organized by the NIH and the Canadian Institutes of Health Research and was the first ever national or international research conference to focus on the biologic mechanisms that underlie a broad range of interventions, which can be described as "manual therapies." Leading scientific experts from North America and Europe presented their latest findings and theories related to 5 different areas of science relevant to manual therapies: neuroscience, biomechanics, endocrinology, imaging, and immunology. During the conference, breakout groups composed of scientists, physicians and therapists, and patient advocates were formed in the relevant disciplines. These groups developed consensus statements on key unanswered research questions, which were then submitted back to the conference for comment and approval. The outcomes of this workshop have subsequently been incorporated into a new initiative by the NIH and Canadian Institutes of Health Research for funding research on the biology of manual therapies. This editorial includes presentation summaries and 13 key consensus recommendations relating to mechanisms of action for manual therapies.

Basic science research related to chiropractic spinal adjusting: the state of the art and recommendations revisited.

OBJECTIVE: The objectives of this white paper are to review and summarize the basic science literature relevant to spinal fixation (subluxation) and spinal adjusting procedures and to make specific recommendations for future research. METHODS: PubMed, CINAHL, ICL, OSTMED, and MANTIS databases were searched by a multidisciplinary team for reports of basic science research (since 1995) related to spinal fixation (subluxation) and spinal adjusting (spinal manipulation). In addition, hand searches of the reference sections of studies judged to be important by the authors were also obtained. Each author used key words they determined to be most important to their field in designing their individual search strategy. Both animal and human studies were included in the literature searches, summaries, and recommendations for future research produced in this project. DISCUSSION: The following topic areas were identified: anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system. A relevant summary of each topic area and specific recommendations for future research in each area were the primary objectives of this project. CONCLUSIONS: The summaries of the literature for the 6 topic sections (anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system) indicated that a significant body of basic science research evaluating chiropractic spinal adjusting has been completed and published since the 1997 basic science white paper. Much more basic science research in these fields needs to be accomplished, and the recommendations at the end of each topic section should help researchers, funding agencies, and other decision makers develop specific research priorities.

Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States.

Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches-acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga-as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines.

Neural coding of the location and direction of a moving object by a spatially distributed population of mechanoreceptors.

A neural code for the location and direction of an object moving over the fingerpad was constructed from the responses of a population of rapidly adapting type I (RAs) and slowly adapting type I (SAs) mechanoreceptive nerve fibers. The object was either a sphere with a radius of 5 mm or a toroid with radii of 5 mm on the major axis and either 1 or 3 mm on the minor axis. The object was stroked under constant velocity and contact force along eight different linear trajectories. The spatial locations of the centers of activity of the population responses (PLs) were determined from nonsimultaneously recorded responses of 99 RAs and 97 SAs with receptive fields spatially distributed over the fingerpad of the anesthetized monkey. The PL at each moment during each stroke was used as a neural code of object location. The angle between the direction of the trajectory of the PL and mediolateral axis was used to represent the direction of motion of the object. The location of contact between the object and skin was better represented in SA than in RA PLs, regardless of stroke direction or object curvature. The PL representation of stroke direction was linearly related to the actual direction of the object for both RAs and SAs but was less variable for SAs than for RAs. Both the SA and RA populations coded spatial position and direction of motion at acuities similar to those obtained in psychophysical studies in humans.

Comparison of human lumbar facet joint capsule strains during simulated high-velocity, low-amplitude spinal manipulation versus physiological motions.

BACKGROUND CONTEXT: Spinal manipulation (SM) is an effective treatment for low back pain (LBP), and it has been theorized that SM induces a beneficial neurophysiological effect by stimulating mechanically sensitive neurons in the lumbar facet joint capsule (FJC). PURPOSE: The purpose of this study was to determine whether human lumbar FJC strains during simulated SM were different from those that occur during physiological motions. STUDY DESIGN/SETTING: Lumbar FJC strains were measured in human cadaveric spine specimens during physiological motions and simulated SM in a laboratory setting. METHODS: Specimens were tested during displacement-controlled physiological motions of flexion, extension, lateral bending, and axial rotations. SM was simulated using combinations of manipulation site (L3, L4, and L5), impulse speed (5, 20, and 50 mm/s), and pre-torque magnitude (applied at T12 to simulate patient position; 0, 5, 10 Nm). FJC strains and vertebral motions (using six degrees of freedom) were measured during both loading protocols. RESULTS: During SM, the applied loads were within the range measured during SM in vivo. Vertebral translations occurred primarily in the direction of the applied load, and were similar in magnitude regardless of manipulation site. Vertebral rotations and FJC strain magnitudes during SM were within the range that occurred during physiological motions. At a given FJC, manipulations delivered distally induced capsule strains similar in magnitude to those that occurred when the manipulation was applied proximally. CONCLUSIONS: FJC strain magnitudes during SM were within the physiological range, suggesting that SM is biomechanically safe. Successful treatment of patients with LBP using SM may not require precise segmental specificity, because the strain magnitudes at a given FJC during SM do not depend upon manipulation site.

High loading rate during spinal manipulation produces unique facet joint capsule strain patterns compared with axial rotations.

PURPOSE: Lumbar spinal manipulation (SM) is a popular, effective treatment for low back pain but the physiological mechanisms remain elusive. During SM, mechanoreceptors innervating the facet joint capsule (FJC) may receive a novel stimulus, contributing to the neurophysiological benefits of SM. The biomechanics of SM and physiological axial rotations were compared to determine whether speed or loading site affected FJC strain magnitudes or patterns. METHODS: Human lumbar spine specimens were tested during physiological rotations and simulated SM while measuring applied torque, vertebral motion, and FJC strain. During physiological rotations, specimens were actuated at T12 to 20 degrees left and right axial rotation at 2 degrees to 125 degrees per second. During SM simulations, a 7-mm impulse displacement was applied to L3, L4, or L5 at 5 to 50 mm per second. RESULTS: Physiological rotations. Increasing displacement rate resulted in significantly larger torque magnitudes (P < .001), whereas vertebral kinematics and FJC strain magnitudes were unchanged (P > .05). Physiological rotations vs SM. Applied torque and vertebral rotation magnitudes were similar across speed and vertebral level. Total vertebral translations were slightly larger during physiological rotations vs SM at a given loading rate (P < .05). Patterns of vertebral motions and FJC strain during SM and physiological rotations varied significantly with loading rate (P < .05) but not with actuation site (P > .15). CONCLUSIONS: The similar patterns observed in vertebral motion and FJC strain across actuation sites during SM and physiological rotations suggest that site specificity of SM may have minimal clinical relevance. High loading rates during lumbar SM resulted in unique patterns in FJC strain, which may result in unique patterns of FJC mechanoreceptor response.

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain.

UNLABELLED: 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. The NIH Pain Consortium therefore charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary 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 minimal data set 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. 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. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement. PERSPECTIVE: A Task Force was convened by the NIH Pain Consortium, with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimal dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.

Report of the NIH Task Force on research standards for chronic low back pain.

UNLABELLED: 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. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary 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. The RTF believes that 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. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement. PERSPECTIVE: A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.