Physical Medicine / OMM
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30823
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Browsing Physical Medicine / OMM by Author "Licciardone, John C."
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Item Candidate gene analysis of 535 "pain genes" and associations with reported intensity of chronic low back pain(2022) Hurd, Christine A.; Phillips, Nicole R.; Lin, Emily; Broadbent, Dallen; Doederlein, Alexander R.; Dubakula, Vishnu; Licciardone, John C.Purpose: Numerous genome-wide association studies have been able to elucidate potential underlying genetic associations with clinical diagnoses. Chronic low back pain (CLBP) is a clinical presentation that has not yet been strongly associated with specific genetic markers. Several studies however have found genetic associations with other various pain disorders, such as the 535 genes identified by Ultsch et al. as "pain genes." Our group aims to find associations between previously identified pain-related genes and clinical reports of the intensity of low back pain using genetic and clinical data collected by the PRECISION Pain Research Registry. Methods: The PRECISION Pain Research Registry is a national registry that has collected demographic, clinical, and genetic information of patients with CLBP. Our analysis is querying associations between these identified "pain genes" and the intensity of low back pain reported by registry participants using a numerical rating scale (NRS). Methods: Participants in the PRECISION Pain Research Registry were genotyped via an Illumina iScan Array Scanner and Global Screening Array. The phenotype of CLBP will be measured by the NRS, which is an 11-point quantifier of pain intensity. The collected genotypes and phenotypic expression of pain will be compared via the Multi-marker Analysis of GenoMic Annotation (MAGMA), which enables candidate gene analysis of the 535 "pain genes" via congregation of single nucleotide polymorphisms (SNPs) and subsequent projection onto principal components in a matrix. Pain intensity will be evaluated as a function of genetic effects accounting for selected covariates-comorbid conditions with a documented relationship to CLBP, smoking status, and genetic ancestry plus residuals, with F-tests to determine the p-values of associations. Results: FN1 and STARD13 were found to be significantly associated with pain intensity in AA registry participants and VEGF-A was found to be significantly associated with widespread pain in NHW registry participants Conclusion: For treatment that is refractory to other strategies, targeted drugs for these protein products can be explored as treatments. These mentioned genes also have significant epigenetic regulation that could be explored in further studies.Item Outcomes in Subgroups of Patients with Chronic Low Back Pain Treated With and Without Osteopathic Manipulative Treatment: A Retrospective Cohort Study(2022) Moore, Samuel; Fix, Kassidy; Blair, Lillian; Ta, Khanh; Licciardone, John C.Purpose: Chronic low back pain (CLBP) is a public health issue that often causes disability and yields high societal costs due to lost productivity. Clinical practice guidelines in the United States recommend spinal manipulation as a first-line treatment for CLBP. Recent evidence demonstrates that osteopathic manipulative treatment (OMT) may reduce low back pain intensity and back-related disability in patients with CLBP. However, it is unclear if patient subgroups respond differently to OMT. This study aims to determine if OMT effects in patients with CLBP differ according to patient characteristics. Methods: This study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation between April 2016 and December 2021. A total of 1243 registry participants reported data on sociodemographic characteristics, psychological variables, and clinical status at enrollment, and 788 provided complete data over 12 months of follow-up. Participants were classified as OMT users or non-users at enrollment. The primary outcomes were low back pain intensity measured with a numerical rating scale (NRS) from 0 to 10, back-related functioning measured with the Roland-Morris Disability Questionnaire (RMDQ), and pain impact derived from the Patient-Reported Outcomes Measurement Information System. Repeated measures analysis of variance was used to assess longitudinal outcomes according to OMT use. Subgroup analyses were then performed using 14 pre-specified variables to identify interaction effects relating to OMT use. Results: At enrollment, 177 (14.2%) participants reported ever using OMT for CLBP. Osteopathic manipulative treatment use was less likely to be reported by Blacks (P< .001) and participants currently using NSAIDs for low back pain (P=.003). Overall, over 12 months, OMT users reported lower scores than non-users for low back pain intensity (NRS score mean difference, -0.54; 95% CI, -0.87 to -0.21; P=.001); back-related disability (RMDQ score mean difference, -2.10; 95% CI, -3.24 to -0.96; P< .001); and pain impact (mean difference, -2.67; 95% CI, -4.39 to -0.95; P=.002). Subgroup analyses showed that the only interaction effect involved gender. Male OMT users reported better outcomes (as compared with male non-users) than did female OMT users (as compared with female non-users) for all primary outcomes (NRS score mean difference for males, -1.12, 95% CI, -1.76 to -0.47 vs. -0.34; 95% CI, -0.72 to 0.04 for females; P=.04; RMDQ score mean difference for males, -4.29, 95% CI, 6.51 to -2.07 vs. -1.33, 95% CI, -2.65 to -0.01 for females; P=.02; pain impact score mean difference for males, -5.75, 95% CI, -9.10 to -2.40 vs. -1.58, 95% CI, -3.57 to 0.40 for females; P=.04). Conclusion: Patients who were current or former users of OMT reported better longitudinal outcomes over 12 months relating to low back pain intensity, back-related disability, and pain impact. Subgroup analyses found that OMT use (vs. non-use) consistently yielded better longitudinal outcomes in males than in females. However, none of the other 13 pre-specified variables was associated with a significant interaction for OMT effect.