VCU news

By Angela Flagg
VCU School of Nursing

The Virginia Commonwealth University School of Nursing has received a three-year National Institutes of Health (NIH) grant totaling more than $1.2 million to study the influence of genetic factors on pain perception and how this may contribute to an increased risk of chronic low back pain.

Persistent back pain affects nearly 36 million Americans every year. It is one of the most costly conditions in the United States when considering direct medical expenses and lost productivity. Although most cases of acute low back pain will resolve in less time than six weeks, an estimated 40 percent of patients will continue to suffer from debilitating pain even after receiving standard health care treatment, according to Angela Starkweather, Ph.D., principal investigator of the grant.

“This sets up a really frustrating course for the patient,” Starkweather said. “Pain is usually a protective mechanism that alerts the body of injury, but for patients with chronic low back pain, it’s no longer protective and it can be very difficult to find an effective treatment.”

Starkweather, associate professor and chair of the Department of Adult Health and Nursing Systems, said that the brain normally releases endorphins and other pain-inhibiting molecules in response to acute injury. Yet, studies have shown this system is not working properly in some people and may be a reason they are more prone to chronic pain.

“Currently, we don’t have a way to accurately identify the specific alterations in the pain pathways of patients who are more prone to have chronic low back pain,” she said. “Since the pain pathways of the body are regulated by genes, we will be able to examine whether this vulnerability is associated with changes in neurotransmitter or receptor levels as well as other molecules that are involved in pain perception. By identifying the mechanisms of the patient’s pain, we can then use this information to tailor the patient’s treatment plan – it’s a step closer to personalized health care.”

The grant will enable Starkweather and her research colleagues to conduct sensory testing and to measure genetic factors that influence it.

“Our ultimate goal is to identify specific tests that we can use clinically to recognize patients who are vulnerable to experiencing chronic pain and develop interventions that can be initiated early on to reduce the risk of transitioning from acute to chronic pain,” Starkweather said.

The study will follow 220 participants with acute low back pain until their pain resolves or until six months have elapsed.

“This will allow us to compare sensory function and gene expression patterns between patients who either spontaneously get better or go on to have chronic low back pain,” Starkweather said.

Starkweather will work with an interprofessional research team that includes members from the University of Maryland’s Center for Pain Studies. The VCU School of Nursing team members include Debra Lyon, Ph.D. , associate dean for research, co-investigator; Nancy McCain, the Nursing Alumni Distinguished Professor, co-investigator; R.K. Elswick, Ph.D., director of biostatistics and data services, co-investigator; Amy Heineman, project director; Kim Austin, Ph.D., student research assistant; Gil Rubia, undergraduate research assistant; Tenesha Bottoms, undergraduate research assistant; and Laura Hughes, undergraduate research assistant. Team members from UMD’s Center for Pain Studies include Susan Dorsey, Ph.D., director of the center, co-investigator, and Joel Greenspan, Ph.D., director of the center’s biobehavioral core, co-investigator.

The study is titled “Pain Sensitivity in Low Back Pain” and it is supported through grant #1R01NR013932-01, National Institute of Nursing Research, NIH.