# Combined Treatments to Optimize Functional Recovery in Veterans with Chronic Low Back Pain

> **NIH VA I21** · VA PUGET SOUND HEALTHCARE SYSTEM · 2020 · —

## Abstract

Back pain is the #1 contributor to disability in the United States (US), and second only to hearing problems as
a reason for new Veteran disability compensation. The societal burden of back pain is driven mainly by chronic
low back pain (CLBP), defined as low back pain persisting for ≥3 months. Since most individual treatments for
CLBP have only small effects on functional recovery, combining CLBP treatments has recently been
recommended as a priority area for research. However, few prior studies of CLBP have been properly
designed to evaluate the effects of treatment combinations. Large effects on functional recovery from CLBP
may require combining interventions that each target different points on a theoretical pathway to functional
recovery. Procedural treatments for CLBP aim primarily to address early stages in the pathway to functional
recovery, such as problems with the lumbar spinal structures or low back pain itself. In contrast, behavioral
interventions for CLBP generally have effects not only on pain itself, but also work by mitigating the degree to
which the sensation of low back pain impacts function, well-being, and quality of life. These represent later
stages in the pathway to functional recovery from CLBP. Combining procedural and behavioral treatments
may have great potential for achieving large magnitude treatment effects for CLBP in Veterans.
The proposed research uses an innovative application of the 2 x 2 factorial randomized controlled trial (RCT)
design to examine the individual and combined effects of 1) lumbar medial branch nerve radiofrequency
ablation (LRFA), a commonly used procedural intervention to target low back pain severity, and 2) a novel
video telehealth tablet- and personal computer (PC)-based Activity Tracker-Informed Video-Enabled
Cognitive Behavioral Therapy program (“AcTIVE-CBT”), a behavioral intervention designed primarily to
target functional limitations both secondary to, and independent of, improvements in pain. The LRFA treatment
to be used in the proposed study addresses the major patient selection, procedural/technical, methodologic
and reporting limitations of prior studies. AcTIVE-CBT addresses problems with Veteran access and
compliance associated with conventional cognitive behavioral therapy (CBT) delivered in clinic, and uses
currently available activity tracking technology to better promote activity and behavior change as compared to
conventional CBT. This pilot RCT involves 20 Veterans with CLBP who will be followed to evaluate functional
recovery for up to 3 months. The primary outcome is participant-reported back-related functional limitations
(mobility and ADLs) at 3 months, as measured by the validated Roland-Morris Disability Questionnaire.
Secondary outcomes include activity tracker-assessed step counts, back pain intensity, reduction in opioid use,
and quality of life. The study hypotheses are that 1) each individual treatment will result in improvements in
back-related functional li...

## Key facts

- **NIH application ID:** 10174853
- **Project number:** 5I21RX002891-03
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Pradeep Suri
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-07-01 → 2020-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10174853

## Citation

> US National Institutes of Health, RePORTER application 10174853, Combined Treatments to Optimize Functional Recovery in Veterans with Chronic Low Back Pain (5I21RX002891-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10174853. Licensed CC0.

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