All ETDs from UAB

Advisory Committee Chair

Burel Goodin

Advisory Committee Members

Jarred Younger

Robert Sorge

Edwin Aroke

D Leann Long

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

ABSTRACT Chronic low back pain (cLBP) is one of the most common disabling conditions in the world, and is one of the leading contributors to medical care seeking in adults. The worldwide prevalence of activity-limiting (acute and chronic) low back pain is about 12%, which equates to approximately 933 million people globally suffering with low back pain at any given time. Despite the prevalence and frequency of medical intervention, sustained pain relief and functional restoration are rarely achieved for those with cLBP. The vast majority of cLBP is “non-specific” with no identifiable pathology of the spine or related tissues. Without a clear target for treatment of cLBP, effective pain management can be difficult to achieve. Even when pathoanatomical changes in the spine are detected, there is often poor correspondence between these diagnostic measures of cLBP and clinical symptoms. This suggests that factors above and beyond pathoanatomy, such as altered pain modulation and inflammation, may contribute to cLBP severity. Past research examining predictors of cLBP outcomes, specifically markers of inflammation and endogenous pain modulation, has been mixed. One reason for this may be that many of the studies investigating cLBP severity have relied on measurements of ii pain at rest that incorporated validated self-report questionnaires as the clinically-relevant index of pain severity. However, individuals with musculoskeletal pain conditions including cLBP often experience movement-evoked pain upon completion of physical activity. Emerging evidence has revealed distinct mechanistic differences between pain at rest and movement-evoked pain. Thus, pain at rest may fail to accurately isolate the type of pain that is most predictive of cLBP or explain contradictory outcomes. Thus, the objective of this dissertation was to identify inflammatory and endogenous pain modulatory processes that could possibly differentially predict severity of movementevoked pain versus pain at rest in individuals with non-specific cLBP.

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