Investigation of Hypermobility, Biomarkers, and Pain Generators in Chronic Pain Patients

This is an observational study of patients with neck and back pain followed by a pain
management clinic. Patients with particular pain generators in the neck and back will be
defined by a positive response to one of several targeted interventional pain procedures.
Each patient may undergo a physical exam to determine whether they have hypermobile joints.
The study will thus evaluate the rate of hypermobility for each pain generator. In addition
blood, urine, or saliva samples may be taken for biomarkers for pain or rheumatologic
factors.

Inclusion Criteria:

- Clinical diagnosis of axial back pain (neck, mid-back, lower back) or pain radiating
to the extremity, with suspected diagnosis of a specific pain generator amenable to a
pain procedure, including disorders of the nerves, joints, and muscles as listed
immediately below.

- Clinical decision to schedule patient for a pain procedure, including procedures
targeting the following disorders:

- Facet arthropathy: intra-articular facet joint injection, medial branch block,
medial branch radiofrequency ablation

- Sacroiliac joint dysfunction: sacroiliac joint injection, lateral branch block,
lateral branch radiofrequency ablation

- Myofascial pain syndrome: trigger point injection

- Radiculopathy, spinal stenosis, or herniated nucleus pulposus: epidural steroid
injection, selective nerve root block

- Piriformis syndrome: piriformis injection

- Greater trochanteric bursitis: greater trochanteric bursa injection

- Able to provide HIPAA authorization to share prior medical records/imaging.

Exclusion Criteria:

- Previous diagnosis of cancer.

- Currently pregnant.

- Previously enrolled for the same procedure or the same pain generator site. (For
example, this would exclude a patient who had an intra-articular facet joint injection
at the right L5/S1 if: 1) he had the same injection 3 months ago and was enrolled at
that time, or 2) the patient was already enrolled for a medial branch block at the
right L5 and sacral ala, as this targets the same facet joint.)

- Inability or unwillingness of subject or legal guardian/representative to give
informed consent (e.g., ward of the state)