The Back Pain Consortium Research Program Study

Exclusion Criteria

• •History of discitis osteomyelitis (spine infection) or spine tumor
• •History of ankylosing spondylitis, rheumatoid arthritis, polymyalgia rheumatica, or psoriatic arthritis, lupus
• •History of cauda equina syndrome or spinal radiculopathy with functional motor deficit (strength \<4/5 on manual motor testing)
• •Diagnosis of any vertebral fracture in the last 6 months
• •Osteoporosis requiring treatment other than vitamin D and calcium supplements
• •Cancer (History of any bone-related cancer or cancer that metastasized to the bone, Currently in treatment for any cancer or plan to start cancer treatment in the next 12 months, History of any cancer treatment in the last 24 months)
• •Life expectancy less than 2 years
• •Unable to speak and write English
• •Visual or hearing difficulties that would preclude participation
• •Presence of any history that would preclude scanning in magnetic resonance imaging (MRI)
• •Uncontrolled drug/alcohol addiction
• •Individuals receiving disability or compensation within the past year, or involved in litigation
• •Pregnancy or breastfeeding
• •History of allergy to duloxetine
• •Individuals on high doses of opioids (over 100 oral morphine equivalents (OME) per day)
• •Scheduled back surgery, back surgery within the last year, or more than one back surgery in the past.
• •Expecting to receive an injection of surgical procedure within the next year for their cLBP
• •Current/planned (in the next 2 years) enrollment in another study of a device or investigational drug that would interfere with this study, this may include participation in a blinded trial.
• •Any other diseases or conditions that would make a patient unsuitable for study participation as determined by the site principal investigators. This would include but not be limited to severe psychiatric disorders, active suicidal ideations or history of suicide attempts, and an uncontrolled drug and/or alcohol addiction
• •Contraindications to Study Intervention: duloxetine
• •certain medications (per protocol)
• •renal dysfunction (creatinine clearance \<30 milliliters per minute (mL/min) or End- Stage Renal Failure)
• •Hepatic dysfunction: Liver function tests (LFTs) elevated times 1.5
• •Contraindications to Study Intervention: Acupressure
• •Currently receiving acupressure or acupuncture through formal therapy
• •Contraindications to Study Intervention: MBSR
• •Current participation in a structured MBSR program
• •Contraindications to Study Intervention: PT \& Exercise
• •Currently receiving any type of structured manual therapy or exercise treatment for low-back pain.
• •Contraindication for manual therapy and/or participation in an exercise program
• •Severe claustrophobia precluding MRI and evoked pain testing during scanning
• •Diagnosed peripheral neuropathy
• •Current, recent (within the last 6 months), or habitual use of artificial nails or nail enhancements. (Artificial nails can influence pressure pain sensitivity at the thumbnail)
• •Body Mass Index greater than 45 or unable to comfortably fit in the bore of the MRI magnet