Facet-mediated Low back pain as a SubGroup for Studying Heterogeneity in Pain
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PROJECT SUMMARY/ABSTRACT The overall objective of this proposal is to use a well-defined, large, and clinically-relevant subgroup of people with persistent low back pain (pLBP) —those with real or potential facet-mediated pLBP— as a model to understand inter-individual differences in pain. Efforts to understand mechanisms and inter- individual differences in pain among those with pLBP are critically limited by the many heterogenous diagnoses underlying the symptom of low back pain. Despite this well acknowledged heterogeneity, most patients with pLBP are considered to have “non-specific low back pain” for research purposes, however most clinicians recognize other spine-related phenotypes with distinct treatment pathways within this non-specific group. Ignoring clinical subgroups may limit our ability to understand mechanisms, inter-individual differences in pain, and treatment response. To address these important limitations, we will recruit a new observational cohort of people with facet mediated pLBP and validate findings in a separate, ongoing clinical trial of 300 people with facet mediated persistent low back pain (“ASTRAL”). The Aims are to (1) confirm mechanisms of key domains and factors on pain outcomes, and prioritize them according to causal impact, among people with facet-mediated pLBP, (2) develop and validate models to stratify people with facet-mediated pLBP by pain outcomes, and (3) develop and validate models to test treatment effect modifiers of lumbar radiofrequency ablation on pain outcomes, among those with facet mediated pLBP. We will enroll 750 adults with pLBP who are scheduled for lumbar medial branch blocks at one of four study sites. Baseline characteristics and candidate predictor variables, selected a priori, will be measured at baseline and then monthly for the first 6 months. Our recruitment process and measures will mirror those of the ASTRAL trial, our validation sample. The successful completion of these goals will inform causal mechanisms that explain individual differences in pain outcomes for those with facet mediated low back pain and stratify patients with facet mediated low back pain into subgroups with different responses to lumbar radio frequency ablation. Ultimately, this work will help clinicians and researchers create patient-centered pathways to better address the needs of people with persistent, facet mediated low back pain.
