Whole person experience of pain: Novel integration with low back pain phenotypes

About This Grant

Project Abstract As a highly complex and multifactorial condition, chronic low back pain (cLBP) greatly contributes to disability, opioid use disorder, and negatively impacts quality of life. Previously supported by the HEAL Initiative’s BACPAC consortium, the University of Pittsburgh Mechanistic Research Center (LB3P) has gathered unprecedented and comprehensive data on clinical, biological, biomechanical, and behavioral characteristics from over 1,000 cLBP participants with impressive one-year follow-up, as well as from persons without low back pain. This landmark work by a transdisciplinary collaborative team of investigators has led to the creation of large datasets and novel preliminary phenotypes that illuminate the multi-dimensional nature of cLBP and help predict treatment responses. Importantly, BACPAC research has laid the groundwork for achieving comprehensive phenotyping of cLBP by integrating deep phenotyping datasets into a theoretical model of LBP, facilitating a precision medicine approach. However, significant knowledge gaps remain, particularly regarding how the phenotypes of this chronic condition change over time and how they relate to other chronic overlapping pain conditions (COPCs) and common musculoskeletal (MSK) disorders, which can severely impact treatment outcomes and the pain experience. By leveraging the successful infrastructure and existing cohorts achieved through BACPAC, we aim to deepen our understanding of the key features associated with the overall experience of cLBP to promote whole-person health. To this end, we propose the following specific aims: (1) determine the evolution of whole person pain characteristics in cLBP individuals and (2) validate, refine and augment cLBP models to include longitudinal data, COPCs, and other MSK conditions, and perspectives and outcome preferences from people with lived experiences and health disparities to guide patient-centered precision medicine approaches to non-addictive treatments of pain. This will be achieved by leveraging existing collaborations within HEAL-funded programs including experts in other pain conditions to supplement our unprecedented interdisciplinary team for thorough assessment of a large chronic low back pain longitudinal cohort, supporting the INTERACT Initiative. This work will also leverage the commitment from external collaborators to bring the field together to understand the whole person experience of pain with unparalleled levels of breadth and depth of phenotyping features and clinically applicable models, creating a unique opportunity to significantly impact care for persons experiencing chronic pain.