Project Summary / Abstract Chronic low back pain (cLBP) is highly prevalent, expensive and is associated with long term functional impairment, disability and poor quality of life. Several pharmacologic (e.g. duloxetine and gabapentin) and non-pharmacologic treatments such as physical therapy, acupressure and mindfulness-based interventions (MBIs) have shown efficacy in cLBP. Mindfulness-Based Stress-Reduction (MBSR) is an example of an increasingly widely used non-pharmacological intervention for pain reduction, and is now recommended in many treatment guidelines for cLBP. However, despite studies displaying effectiveness in cLBP, only a subset of individuals responds to each treatment modality. There is an urgent need for a greater understanding of pain mechanisms and predictors of response to different therapies with a goal of matching patients based on phenotypes to therapies to which they are most likely to respond. The parent award, a HEAL Initiative award (U19 AR076734), which uses a precision medicine approach to identify what treatments are likely to work in different patient endotypes. The proposed supplement will allow the me, a clinical rheumatologist, to learn these skills through assessment of MBSR on patient-reported pain interference in cLBP. I will also be able to use both clinically available data (such as patient-reported outcomes) as well as state-of-art phenotyping methods such as functional MRI (fMRI) and Quantitative Sensory Testing (QST), to mechanistically explore the proposed neurobiological effects of MBSR. I will subsequently be able to translate this knowledge in how to administer MBSR as well as evaluating pain mechanisms in individuals with autoimmune rheumatologic diseases, and evaluate the patient phenotypes most responsive to different therapies.

Project Narrative / Public Relevance Statement Despite evidence of several therapies with evidence of effectiveness in chronic low back pain (cLBP), a highly prevalent and often debilitating pain condition, only a subset of individuals responds to each modality. There is an urgent need for a greater understanding of pain mechanisms and predictors of response to different therapies. The proposed supplement will allow the trainee, a clinical rheumatologist, to learn these skills through assessment of Mindfulness Based Stress Reduction (MBSR), a standardized mind-body intervention on patient-reported pain interference in cLBP, and subsequently apply these to patients with autoimmune disease. .