PM.20.010 – New individual bio-psychosocial phenotyping to personalize treatment for patients with low back pain

Route: Personalised medicine: the individual at the centre

Cluster question: 080 Can we gain a better understanding of the factors that play a role in the occurrence and persistence of long-term, medically unexplained physical symptoms, leading to better treatments for them?

This project will lead to better understanding of low back pain and better, personalized treatment.
Low back pain is a complex heterogeneous condition, ranked as the leading cause of disability worldwide. Most low back pain patients are treated in primary care. Many patients develop persistent or recurrent symptoms. These patients are often referred to secondary and tertiary care and incur enormous cost. Some interventions have shown to be effective, but effect sizes are small. Current diagnostic options are limited and do not lead to substantial consequences for treatment. Despite all efforts to characterize patients with low back pain, clinicians still struggle to match the right treatment to the right patient. Recent insights show that central pain-modulating mechanisms, changes in pro- and anti-inflammatory biomarkers, pain cognitions and knowledge, psychophysiological and biomechanical factors play an important role in the development of persistent disabling low back pain. How these factors can be used to personalize health care and improved recovery of an individual is still unclear. In phase 1 of this project, we will test the prognostic value of novel and innovative technologies (e.g., epigenetics, immune biomarkers, pain modulation tests, motor control measurements, physical capacity test, instrumented monitoring of activities of daily living, and psychophysiological factors) that have never been used together in large epidemiological studies on low back pain nor in clinical practice. In phase 2, we will evaluate whether the factors that are measured using these technologies can be modified, and whether they mediate clinical outcomes. In phase 3, we will identify treatments that target these modifiable factors and evaluate whether a multidisciplinary treatment approach targeting the personalized phenotypes is more effective and cost-effective compared with usual care.

Keywords

biomechanical, deep phenotyping, low back pain, neuro-immune, pain assessment, Personalized medicine, psychosocial factors

Other organisations

Amsterdam UMC, VU Medisch Centrum Amsterdam (VUMC)

Submitter

Organisation Vrije Universiteit Amsterdam, faculteit Gedrags- en Bewegingswetenschappen (VU)
Name Prof. dr. M.W. (Maurits) van Tulder
E-mail maurits.van.tulder@vu.nl
Website https://research.vu.nl/en/persons/mw-van-tulder