UCSF Core Center for Patient-centric Mechanistic Phenotyping in Chronic Low Back Pain

1项目概要 下背痛预计会影响80%的普通人群在他们一生中的某个时候。慢性下 3背痛（cLBP）是阿片类药物使用的最常见的非癌症原因，特别难以诊断， 4有效治疗，部分原因是相互关联的生物物理和心理社会因素， 5与cLBP相关的损伤、残疾和疼痛之间的关系。生物心理社会模型认为， 6来自有害刺激的信号受到精神、情感和感觉机制的调节，反过来， 7受心理和社会因素的影响。适应不良的疼痛认知（害怕运动和疼痛） 8灾难化）可以导致补偿性运动模式，直接影响运动生物力学， 9椎旁肌（PSM）的结构和功能，驱动进一步损害，破坏之间的平衡 10被动和主动脊柱稳定器，并加强患者的感知残疾状态。该循环 生物物理和心理因素之间的关系可能在疼痛的表现中起着关键作用 12和cLBP的残疾。更好地理解这种关系将有助于确定 cLBP的13种干预表型，为临床医生提供更好的工具， 14种有效的、针对患者的诊断和治疗方案。这对实现 15识别cLBP亚组，这些亚组可以更好地接受物理和/或认知治疗， 16替代药物干预。阐明生物物理和心理之间的关系 cLBP中的17个因素，我们将研究1）心理因素，脊柱病理学和患者对疼痛的感知 18严重程度和残疾状况影响代偿性运动策略2）运动生物力学， 19个心理因素和疼痛机制与PSM质量有关，3）运动生物力学和 20 PSM质量随时间的变化与心理因素、疼痛机制、疼痛严重程度和处方 21治疗方案我们假设：1）适应不良的疼痛认知对运动的影响更大 22个生物力学和疼痛相关结局随时间的变化，而不是生物物理因素和2）基线测量 23个心理和生物物理因素将预测疼痛相关结局 24对于本研究的培训方面，我将与疼痛管理临床医生密切合作， 25名研究人员，物理治疗师，患者倡导者和工程师，他们将指导我的培训，并提供 26个必要的资源和经验，推动我作为一个临床疼痛走向独立的发展 27研究员我将通过生物统计学和疼痛的课程来发展临床疼痛研究的基本技能 28个关于写作补助金和出版物的评估和方案。通过这种结构化的研究经验， 29培训计划，我将学会有效沟通和促进合作，弥合之间的差距 cLBP和其他慢性疼痛患者的30项疼痛相关指标和生物物理结局。

1 Project Summary 2 Low back pain is predicted to affect 80% of the general population at some point in their lifetime. Chronic low 3 back pain (cLBP), the most common non-cancer reason for opioid use, is particularly difficult to diagnose and 4 treat effectively, in part, due to the interconnected biophysical and psychosocial factors which complicate the 5 relationship between impairment, disability, and pain related to cLBP. The biopsychosocial model posits that 6 signals from noxious stimuli are modulated by mental, emotional, and sensory mechanisms that are, in turn, 7 influenced by psychological and social factors. Maladaptive pain cognitions (fear of movement and pain 8 catastrophizing) can lead to compensatory movement patterns that directly affect movement biomechanics and 9 paraspinal muscle (PSM) structure and function, driving further impairment, disrupting the balance between 10 passive and active spine stabilizers, and reinforcing the patient’s perceived disability status. This cyclic 11 relationship between biophysical and psychological factors likely plays a critical role in the manifestation of pain 12 and disability in cLBP. A better understanding of this relationship will inform the identification of 13 interventional phenotypes in cLBP and provide clinicians with better tools for the development of 14 effective and patient-specific diagnosis and treatment plans. This has important implications towards 15 identifying cLBP subgroups that would be better served with physical and/or cognitive therapies, providing an 16 alternative to pharmaceutical interventions. To clarify the relationship between biophysical and psychological 17 factors in cLBP, we will investigate 1) how psychological factors, spinal pathology, and patient perception of pain 18 severity and disability status influence compensatory movement strategies 2) how movement biomechanics, 19 psychological factors, and pain mechanisms relate to PSM quality and 3) how movement biomechanics and 20 PSM quality change over time in relation to psychological factors, pain mechanism, pain severity, and prescribed 21 treatment plan. We hypothesize that 1) maladaptive pain cognitions will have more influence on movement 22 biomechanics and pain-related outcomes over time than biophysical factors and 2) baseline measures of 23 psychological and biophysical factors will be predictive of pain-related outcomes 24 For the training aspect of this study, I will work closely with pain management clinicians, clinical pain 25 researchers, physical therapists, patient advocates, and engineers who will guide my training and provide 26 necessary resources and experiences driving my development toward independence as a clinical pain 27 researcher. I will develop fundamental skills in clinical pain research through coursework in biostatistics and pain 28 assessment and programs on writing grants and publications. Through this structured research experience and 29 training plan, I will learn to communicate effectively and facilitate collaborations that bridge the gap between 30 pain-related measures and biophysical outcomes in patients with cLBP and other chronic pain.