Could a Robotic “Backpack” Replace Opioids to Relieve Lower Back Pain?

Sixteen million Americans-8 percent of the adult population-suffer persistent back pain. Many more visit their doctor for the occasional twinge. According to a 2018 study in JAMA, low back pain is one of the most common reasons given for prescribing opioids. That’s fueling the opioid crisis-and there’s little evidence the powerful painkillers even help.

“Chronic low back pain is often debilitating,” says Lou Awad, a Boston University Sargent College of Health & Rehabilitation Sciences assistant professor of physical therapy. “Many turn to opioids to help manage the pain, but mistake short-term relief for a long-term cure. Unfortunately, long-term opioid therapies can cause serious problems. Perhaps more importantly, the underlying cause of the pain is never addressed.”

The solution, he says, might not be a pill you swallow-it might be something you wear.

Awad researches and develops robotic apparel, battery-powered exosuits that make mobility and movement easier for patients who have had a stroke. He’s now coleading a clinical team developing similar technology for people with back pain. The work is funded by a five-year, $2.8 million grant from the National Institutes of Health as part of its Helping to End Addiction Long-term Initiative (HEAL), an all-out effort to find better treatments for pain and the opioid abuse it can spawn.

A major clinical trial has shown that the exosuit can be a safe and effective tool for the lower limb rehabilitation of survivors of stroke. Read “A Step Forward” to learn more.

“The robotic apparel consists of cables that apply mechanical forces in parallel with the underlying muscles,” Awad says. “The system is designed to be worn like a backpack, with attachments over the shoulder, around the waist, and also around the thighs. It is very unobtrusive.”

When the power’s off, the wearer can move, bend, and reach without any restriction. Hit the “on” button, and the device “responds to the speed and motion of the user to adaptively help lift and hold objects,” Awad says. Meanwhile, its sensors monitor the wearers’ movements, recording diagnostic data for their physical therapist and offering biofeedback for them, showing “how to move in a way that may reduce their pain and increase their function.”

Getting help from a physical therapist has been shown to help with pain while reducing reliance on opioids, says Awad. “The robotic technology that we are advancing has a lot of potential to enhance a physical therapist’s ability to assess and treat low back pain.”

The exosuit will be tested at the BU Physical Therapy Center in the Ryan Center after the study team’s physical therapists and engineers complete modifications, says Diane Dalton, coleader of the clinical team and a Sargent clinical associate professor of physical therapy and athletic training. The BU team is collaborating with Harvard University’s Conor Walsh, an adjunct associate professor at Sargent, who leads the engineering side of the research. “Eventually, we will begin testing its use by people with low back pain as part of a clinical trial,” Dalton says. That testing has been held up due to the COVID-19 pandemic, but Dalton can’t wait to begin. “This is exciting technology.”

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