Physical Activity on Neurophysiologic Gene Expression Profiles of Chronic Low Back Pain

Chronic low back pain (cLBP) is the second most frequent chronic pain condition in the United
States and results in billions of dollars each year in health care expenses, disability and
lost productivity. A major factor that contributes to the refractory nature of cLBP is
enhanced pain sensitivity, which is an altered state of pain processing that amplifies pain
sensation and impairs descending pain inhibition. Enhanced pain sensitivity in patients who
develop cLBP is associated with altered expression of pro-nociceptive and inflammatory genes.
On the other hand, regular physical activity of at least moderate intensity for 150 or more
minutes per week is recommended to reduce pain severity and improve function in individuals
with cLBP. Therefore, a deeper mechanistic understanding of the effect of physical activity
on the neurophysiologic and gene transcription alterations that characterize cLBP may inform
more specific treatment options to optimize pain reduction and reduce the risk of pain
chronicity.

The purpose of this longitudinal cohort pilot study is to examine the feasibility,
acceptability, and preliminary efficacy of the Problem-solving Pain to Enhance Living Well
(PROPEL) self-management (SM) intervention on cLBP. This pre-post intervention study will
recruit 40 community dwelling adults (age 18 - 60 years old) with cLBP. They will receive
electronic video modules focused on cLBP SM knowledge and weekly phone consultations to
facilitate monitoring and problem-solving. All participants will be assessed for primary
outcomes including cLBP SM behaviors, physical activity, pain severity and interferance, and
pain sensitivity at baseline and every 2 weeks for 12 weeks. The study will examine
differential neurophysiologic and gene expression profiles between participants with cLBP at
12-weeks post-intervention and correlate these outcome measures to total duration of physical
activity.

Inclusion Criteria:

- be 18-60 years of age;

- have nonspecific cLBP (≥4 on the numeric rating scale; NRS) present for at least 3 out
of the last 6 months and ≥ half the days in the past 6 months;

- comprehend English (due to lack of reliability and validity of study instruments and
the intervention in non-English populations).

- Have daily access to a computer, tablet or smartphone with access to internet

- Have less than 150 minutes of moderate physical activity a week

- Be willing to wear activity tracker for 12 weeks

Exclusion Criteria:

- Chronic pain at another site or associated with a painful condition (eg.,
fibromyalgia, neuropathy, rheumatoid arthritis)

- history of comorbidities that affect sensorimotor function (eg., multiple sclerosis,
cancer, spinal cord injury, diabetes)

- previous spinal surgery within last 1 year

- presence of neurological deficits such as weakness in the lower extremities (motor
strength 4/5 of quads, glutes, hamstrings, EHL)

- bowel or bladder dysfunction such as difficulty voiding or incontinence

- sciatica or (+) leg raise

- positive Romberg test

- being pregnant or within 3 months postpartum

- history of psychological disorders (major depression, bipolar disorder, schizophrenia)

- identification of any "red flag" condition in the volunteer's past medical history
that suggests specific LBP as determined by Dr. Kim such as conditions or medications
that can affect pain sensitivity

- injury to non-dominant hand or presence of open skin lesions, disturbed sensation,
carpal tunnel or rash