Total-body PET for assessing myofascial pain

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Project Summary Myofascial pain syndrome (MPS) is a prevalent and debilitating condition representing a significant burden to society. This syndrome may occur as an isolated condition, often localized in the lower back area, or be part of more complex clinical scenarios, such as hemoglobinopathy, inflammation, cancer and trauma, that affect the myofascial unit. There is a paucity of validated biomarkers for qualitative or quantitative assessment of MPS. The objective of this proposal is to establish novel measures derived from Total-body-Positron Emission Tomography/Computed Tomography (TB-PET/CT) as quantitative biomarkers to monitor response and predict outcomes for interventions that have potential to relieve myofascial pain. The TB-PET/CT measures we will assess include those reflective of myofascial tissue metabolism, perfusion, and fatty infiltration. These processes are intimately associated with myofascial tissue dysfunction and monitoring them may provide means to assess sources of pain. Therefore, this proposal is responsive to the RFA-AT-22-003 and addresses the interest area: “Quantitative evaluation of tissue metabolism, perfusion, oxygenation, and fatty infiltration”. The condition assessed in this proposal is chronic low back pain. We hypothesize that TB-PET/CT measures will (1) offer a unique insight into myofascial tissue pathology in this condition; and (2) provide biomarkers that will associate with myofascial tissue dysfunction and response to interventions. The proposed project will have two phases. The first is the R61 phase where we will conduct an observational, cross-sectional study. In this phase we will establish the association of quantitative TB-PET/CT measures with HEAL outcome measures and will determine TB-PET/CT measures that differentiate diseased versus healthy myofascial tissue. The second phase will be the R33 phase where we will carry out a randomized, controlled longitudinal interventional study. Participants will be randomly assigned to the intervention arm or the control arm. In this phase we will determine the capability of TB-PET/CT measures to track with changes in HEAL outcome measures in response to the intervention. We have defined quantitative transition criteria that will be applied to the imaging measures in the R61 phase before introducing them into the R33 phase. Therefore, through this work we hope to establish TB-PET/CT measures as potential biomarkers for providing the much-needed objectivity, sensitivity, and precision for characterizing myofascial tissue, and as surrogate measures for dysfunction, pain and for predicting and monitoring response to interventions.