In September 2019 the UCSF Dept. of Orthopaedic Surgery received NIH funding for nearly $30 million to establish the Core Center for Patient-centric, Mechanistic Phenotyping in Chronic Low Back Pain, or REACH.
REACH is a BACPAC Mechanistic Research Center that conducts translational and clinical research to clarify biopsychosocial mechanisms of chronic low back pain – the interconnection between biology, biomechanics, psychology, and socio-environmental factors – which will be foundational for new diagnostic and therapeutic strategies.
REACH is led by Jeffrey Lotz, PhD, the David S. Bradford M.D. Endowed Chair in Orthopaedic Surgery, and Vice Chair of Research within the Department, and Conor O’Neill, MD, Director of the Department’s Non-Operative Spine Program in the UCSF Spine Center.
Need for REACH
According to the Global Burden of Disease Study 2010, low back pain is one of the most common forms of chronic pain among adults worldwide. As recently as 2015, the National Health Interview Survey indicated that 20 percent of adults in the U.S. reported frequent back pain and 28 percent experienced low back pain that lasted one or more days during the previous three months.
“There is no accepted clinical standard for diagnosing chronic low back pain, and consequently, clinicians are often unable to identify the root cause,” Lotz said. “Back pain is the leading cause of disability and healthcare expenditures worldwide, as well as the leading non-cancer reason for opioid prescription in the U.S.”
In an effort to reverse the nation’s opioid crisis, the National Institutes of Health recently awarded $945 million to institutions across 41 states for grants, contracts and cooperative agreements to support its Helping to End Addiction Long-term Initiative, known as HEAL. As part of HEAL, the NIH formed the Back Pain Consortium (BACPAC) Research Program, a translational, patient-centered effort to address the need for effective, non-addictive, and personalized therapies for chronic low back pain. The national collaboration is composed of mechanistic research centers and technology development sites that will combine translational research and Phase 2 clinical trials to deliver an integrated model of chronic lower back pain. UCSF was awarded three of the program’s 13 grants.
“Our goal over the next five years is to develop an integrated model of low back pain supported by a suite of validated diagnostic tests,” Lotz added. “In doing so, clinicians will be more precise in treating the problem, which should naturally lead to lowering patients’ dependency on opioids to manage their pain.”
The REACH program combines an interdisciplinary research team with expertise in basic and clinical sciences:
behavior and brain function
pathophysiology and advanced imaging
physical function and biomechanics
machine learning and artificial intelligence
Developing technology to provide best treatment options
In addition to REACH, there are two UCSF Technology sites that work with the research team to develop tools to help clinicians identify specific low back pain and help physicians determine who are best for certain therapies.
“By leveraging state-of-the-art imaging and computing tools, we will develop new algorithms that will enable clinicians to precisely diagnose and treat their patients with the best options suited for them,” said Aaron Fields, PhD, who was awarded $1.1 million to lead one of UCSF’s Technology sites in a joint collaboration with Roland Krug, PhD (UCSF Dept. of Radiology and Biomedical Imaging).