Public Release: 

Pitt to lead $14 million national trial comparing approaches to treat back pain, avoid surgery

The 5-year Patient-Centered Outcomes Research Institute award was facilitated by the University of Pittsburgh Comparative Effectiveness Research Center, which seeks to answer health care questions important to patients

University of Pittsburgh Schools of the Health Sciences

PITTSBURGH, Feb. 25, 2015 - The University of Pittsburgh will lead a $14 million clinical trial to determine how well an intervention that helps people better understand their back pain early on works toward promoting recovery and keeping the pain from becoming chronic down the road. UPMC will be the first in the trial to offer the intervention, followed by four other academic medical centers nationwide.

The five-year award from the Patient-Centered Outcomes Research Institute (PCORI) is the 13th and largest to come in to Pitt and UPMC through the Comparative Effectiveness Research Center housed in the university's Health Policy Institute. This Center bridges Pitt's Schools of the Health Sciences and UPMC, providing a multidisciplinary platform and research infrastructure for patient-centered comparative effectiveness research across all of the health sciences.

The Pitt-led study will examine the transition from acute lower back pain to chronic lower back pain, and compare two approaches that can be delivered in a primary care office. The first approach allows physicians to do what they think is best, which is termed "usual care." The second approach teams up physicians with physical therapists to deliver cognitive behavioral therapy, a specialized therapy designed to help patients put their lower back pain in perspective, allowing them to identify and overcome barriers to recovery.

"Certain patients are more inclined to worry that when their back hurts they are further harming it, causing them to become inactive," said lead investigator Anthony Delitto, Ph.D., chair of the Department of Physical Therapy in Pitt's School of Health and Rehabilitation Sciences. "That can seriously impede recovery, cause further damage and lead to chronic back pain. Once the problem becomes chronic, the effects are magnified, even causing some people to lose their jobs and have prolonged difficulty with most daily activities. Chronic lower back pain is clearly something we would like to avoid."

Lower back pain accounts for about $86 billion in health care expenditures every year, according to a study in the Journal of the American Medical Association. A major focus of the Affordable Care Act is mandating studies to examine pain as a public health problem and look for solutions.

"Our Comparative Effectiveness Research Center was created to provide the infrastructure to support these larger, pragmatic studies," said Sally C. Morton, Ph.D., director of Pitt's Comparative Effectiveness Research Center and chair of the Department of Biostatistics at Pitt's Graduate School of Public Health. "We built the necessary methodological expertise and data environment to allow researchers to answer the questions facing our health system that are important to patients. Ultimately, these taxpayer investments through PCORI will improve outcomes and inform national policy and practice. "

Dr. Delitto's study, called TARGET, will recruit 60 primary-care clinics affiliated with UPMC, Intermountain Healthcare, Johns Hopkins Hospital and Health System, Boston Medical Center and The Medical University of South Carolina. At each site, 12 primary-care clinics will be randomly assigned to one of two study arms: the usual care their physician would prescribe for lower back pain or primary care coupled with physical and cognitive behavioral therapy.

Across the five regional sites, the team expects to recruit 2,640 patients with acute lower back pain, which is defined as pain they feel less than half the time and have had for less than 6 months. These patients will be evaluated with a standardized test that characterizes their response to pain and their predisposition to psychosocial characteristics that cause them to avoid pain out of fear.

The study will compare a patient-centered outcome that asks how well the patients perform activities that typically bother people with lower back pain, such as sitting, standing, walking, lifting, traveling and sleeping. Finally, the research team will measure the number of X-rays, MRIs, surgery and other lower back-related medical procedures for all patients enrolled in the study.

"This is the heart of patient-centered comparative effectiveness research," said Everette James, J.D., M.B.A., director of Pitt's Health Policy Institute. "Our mission is to use real-life research to find the right treatment for each patient at the right time."

The PCORI award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

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About the University of Pittsburgh Comparative Effectiveness Research Center

The Comparative Effectiveness Research Center (CERC) is the nexus of patient-centered comparative effectiveness research at the University of Pittsburgh and UPMC. Established in 2011, and newly housed in Pitt's Health Policy Institute, the CERC leads and participates in high-quality clinical and methodological research, collaborates on educational activities, and fosters interactions between researchers and stakeholders interested in patient-centered comparative effectiveness research. The CERC Data Center is a University-wide resource to facilitate research using large public health datasets containing protected health information. It provides secure data storage, high-throughput computing and access to multiple state and federal databases. Through the CERC, Pitt and UPMC have received awards totaling more than $50 million. For more information, go to http://www.hpi.pitt.edu/cerc/.

About UPMC

A world-renowned health care provider and insurer, Pittsburgh-based UPMC is inventing new models of accountable, cost-effective, patient-centered care. It provides more than $887 million a year in benefits to its communities, including more care to the region's most vulnerable citizens than any other health care institution. The largest nongovernmental employer in Pennsylvania, UPMC integrates more than 60,000 employees, more than 20 hospitals, more than 500 doctors' offices and outpatient sites, a more than 2.5-million-member health insurance division, and international and commercial operations. Affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC ranks No. 12 in the prestigious U.S. News & World Report annual Honor Roll of America's Best Hospitals -- and No. 1 in Pennsylvania. For more information, go to UPMC.com.

About the Patient-Centered Outcomes Research Institute

PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI's funding awards, visit the Research and Results page on http://www.pcori.org.

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Contact: Allison Hydzik
Phone: 412-647-9975
E-mail: HydzikAM@upmc.edu

Contact: Chuck Finder
Phone: 412-996-5852
E-mail: FinderCE@upmc.edu

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