# Biomarkers to Advance Clinical Phenotypes of Low Back Pain (BACk)

> **NIH NIH R01** · DUKE UNIVERSITY · 2020 · $614,675

## Abstract

Project Summary/Abstract
Intervertebral disc degeneration (IDD) and facet joint osteoarthritis (FOA) result in a combined collective cost of
over $40 billion per year in interventions because of their strong association with chronic low back pain (cLBP).
A large proportion of these costs are for interventions without significant improvement in patient quality of life.
A major reason for this clinical problem is due to the limited understanding of the etiological process for both
IDD and FOA that is needed to develop a clinically valid method for phenotyping patients into groups, such as
mechanical, inflammatory or heightened pain sensitivity. The overall goal of this research is to define
phenotypes of IDD or FOA that lead to cLBP. The objective of this project is to conduct the first and largest
longitudinal analyses of biomarkers ever performed in the lumbar spine by capitalizing on extant data from two
large existing cohorts: the Johnston County Osteoarthritis Project (development cohort) and Genetics of
Generalized Osteoarthritis Study (external validation cohort). The rationale for this proposed research is that:
1) cLBP is a heterogeneous diagnosis that can result from mechanical, inflammatory or pain sensitivity sources
and these sources can be identified by biomarkers 2) there is a subgroup of individuals that can be identified
with biochemical and quantitative sensory biomarkers with heightened pain sensitivity and 3) there are risk
factors that can be identified to predict incidence and progression of lumbar spine disease with and without
symptoms. The findings from this study would lead to the development and testing of pharmaceutical,
behavioral, physical or surgical interventions by biomarker identified lumbar spine phenotypes. In Aim I, we will
demonstrate the degree to which biochemical biomarkers predict the incidence or progression of radiographic
IDD and FOA. In Aim II, we will determine longitudinal relationships between pain and quantitative sensory
biomarkers and symptomatic radiographic IDD or FOA."In Aim III, because imaging and cLBP can be
discordant we will identify combinations of risk factors (i.e., demographic, clinical, self-reported and
biomarkers) that differentiate symptomatic from asymptomatic IDD and/or FOA. To achieve these aims, we will
conduct the largest (n=4,167) longitudinal study to date of biomarkers from two large community based studies
with and without lumbar spine IDD or FOA. Specimen collection, lumbar spine radiographs, and LBP were
consistently measured in both studies. The multidisciplinary team includes collaborative and productive
researchers with expertise in OA, cLBP, epidemiology, rheumatology, biomarkers, IDD biology and
biostatistics. The Principal Investigator is a New and Early Stage Investigator with advanced training as a
musculoskeletal epidemiologist and a physical therapist with a productive history of scholarly activity and
funding in low back pain and lumbar spine research.
"

## Key facts

- **NIH application ID:** 9970412
- **Project number:** 5R01AR071440-04
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Adam Goode
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $614,675
- **Award type:** 5
- **Project period:** 2017-09-07 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9970412

## Citation

> US National Institutes of Health, RePORTER application 9970412, Biomarkers to Advance Clinical Phenotypes of Low Back Pain (BACk) (5R01AR071440-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9970412. Licensed CC0.

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