Understanding Acute to Chronic Back Pain Pathways and Testing New Solutions
Abstract
Low back pain (LBP) is the leading cause of disability globally and the sixth most costly condition in the U.S. In the military, it is the leading cause of medical discharge, a top reason for evacuation from deployment, and incurs enormous costs on the Military Health System (MHS). Most of this burden is attributed to the condition when it becomes chronic. The need to understand why some people continue to experience persistent pain after hurting their back and improve ways to reduce this occurrence has become a priority for healthcare systems, including the MHS. Like many types of chronic pain, it is generally thought that the progression from acute to chronic LBP is due, in part, to central sensitization (CS). CS is a process where sensory signals from the periphery (i.e., after injury) affect and alter pain pathways in the central nervous system (CNS) such that sensory experiences including pain become amplified. Over time, repetitive signaling to the CNS can cause maladaptive, long-lasting, and sometimes permanent CS changes that can persist after resolution of the original injury. An important, yet untested, consideration in LBP research is that the rate and nature of development of different aspects of CS is likely influenced by the injury type and affected tissues. Our recent finding that signs of CS present as early as the acute phase (<2 weeks since onset) of LBP and that specific features predict recovery emphasizes the need to close this gap in our knowledge. More importantly, understanding of the trajectory of CS for specific types of LBP could prove critical for deciding when and how best to treat the condition. This project will address these gaps, as well as all three knowledge gaps under the Fiscal Year 2019 Chronic Pain Management Research Program Investigator-Initiated Research Award Focus Area, “Chronification of Pain,” by aiming to determine if and when features of CS overlap in the transition to chronicity in two common yet different types of LBP (discogenic vs. radicular LBP), and whether intervention combinations of improved sleep and/or exercise introduced early (1 week post-injury) or late (6 weeks post-injury) differently effect outcomes. We will also test the overlooked question of whether poor sleep contributes to the development of chronic pain, and the novel idea that exercise might protect against these potentially negative effects. To do this, we will deeply explore biomarkers of CS and pain long-term (16 weeks) in animal models of LBP in which injury type and timing can be controlled and from which CNS tissues can be studied in detail, while manipulating aspects of sleep and exercise. The findings will provide critical data to understand how and why some people continue to experience LBP after an acute episode. They will provide evidence for new risk factors for the development of chronic LBP, which will serve as foundation for targeted approaches to address them. An important aspect of these results is that they will distinguish risk factors that are common or different between the two LBP types, and identify at what stage of development they present. The results will also inform the efficacy of improved sleep and/or exercise in preventing and reducing chronic LBP. While this will have immediate impact on how we think about sleep and exercise in the context of pain, they are intended to guide the likely optimal manner in which they can be applied to prevent and reduce chronic LBP for testing in a clinical trial, potentially as soon as the third year of the grant. The clinical applicability of these results would be immediate, both in terms of new and refined non-pharmacological treatments for LBP as well as influencing advice given by practitioners and strategies advised for self-management. Another important part of the overall impact of this research proposal is that it will assess and inform how the delivery of exercise protects against the potentially negative effects
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010909
Entities
People
- David M Klyne
Organizations
- United States Army
- University of Queensland