A better way to treat back pain

By Jan Jarvis

Almost everyone suffers low back pain at some point in their lives. The question is how to relieve it.

Researchers at UNT Health Science Center are working to find the answer.

By analyzing the DNA of low back pain sufferers, the goal is to uncover which patients are most likely to respond to specific drugs, said John Licciardone, DO, MS, MBA, Professor of Family Medicine, Executive Director of the Osteopathic Research Center and the Richards-Cohen Distinguished Chair in Clinical Research.

“We’re measuring outcomes,” Dr. Licciardone said. “We want to find out whether one treatment is better than another for a given patient.”

The project — funded by $400,000 in grants from the Osteopathic Heritage Foundation, Institute for Patient Safety, and the American Osteopathic Association — was created to evaluate the safety and effectiveness of opioids and other drugs. It involves a three-part approach to addressing back pain.

The data is being stored in the Pain Registry for Epidemiological, Clinical and Interventional Studies in North Texas, or PRECISION TEXAS. Eventually this registry will contain data from more than 1,000 patients.

“These are people with non-specific low back pain that has no real explanation,” Dr. Licciardone said. “It’s what 80-90 percent of people have.”

Over-exercising, muscle strains and being out-of-shape contribute to this type of pain. The other 10 percent to 20 percent have herniated discs, sciatica or other medical problems.

Many of these pain sufferers are treated with prescription medications, often opioids.

“By far the two most commonly used drugs for back pain are opioids and non-steroidal anti-inflammatory drugs, and they both may be associated with problems,” Dr. Licciardone said. “Based on the data we collect, we can look at the genes that control how these drugs are metabolized and predict who is at the greatest risk for side effects.”

On one end of the spectrum are people who metabolize opioids, such as codeine, very quickly, which puts them at high risk for serious side effects such as respiratory depression. At the other extreme are people who are poor codeine metabolizers and are unlikely to experience pain relief.

To find out how individuals respond to these common drugs, researchers are collecting saliva to study their DNA.

But it’s not just treatment with drugs that researchers are comparing. Another part of the project examines whether physician empathy provides better outcomes.

How physicians treat and interact with patients may explain whether they get better or not, Dr. Licciardone said.

“It may be that being empathetic and having better communication skills translates to good outcomes,” he said. “We think that if a doctor has good communication skills, then the patient is more likely to listen and follow instructions.”

A third study will explore how pain interferes with the individual’s daily activities, such as household chores, sleeping and walking up stairs. The pain is scored 0-10, with the average registry patient giving it a 6 when they enroll.

The goal is to look at the factors that can predict whether back pain will come and go or become chronic.

Back pain is a common concern that affects an estimated 10 percent of the world population.

“We know it is a serious problem,” Dr. Licciardone said. “We want to look at the factors that can predict who is going to face chronic pain and who is going to recover and be just fine.”

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