Approximately 50 million people in the United States suffer from chronic pain. Musculoskeletal, soft tissue pain is the most prevalent type of chronic pain, with low back and neck pain the areas most frequently affected. These conditions may be associated with hard nodules or trigger points in muscle and soft tissues, but no one knows why these knots appear, persist or why some are painful and others are not.
“Chronic pain is a significant public health problem. In particular, a large number of Americans suffer from soft tissue pain syndromes that are poorly understood. It is actually one of the most common findings in patients who come to a pain center with pain complaints,” says Siddhartha Sikdar, assistant professor of electrical and computer engineering in Mason’s new bioengineering program.
Sikdar was awarded a four-year, $1.974 million grant from the National Institutes of Health (NIH) to investigate the relationship between the nodules or “trigger points” and chronic muscle pain. Women and men over the age of 18 who have ongoing neck pain for at least three months may be eligible to participate in the study.
The researchers use ultrasound imaging and elastography to measure the size and biomechanical properties of patients’ trigger points and the speed of the bloodflow around them. By also performing biochemical analyses of the soft tissue neighborhood and clinical examinations to assess the level of pain, the researchers hope to identify why trigger points are associated with pain in some patients but not in others.
“We expect that this research will help develop preventive and therapeutic strategies, establish objective diagnostic criteria and create outcome measures for measuring treatment efficacy for this common and sometimes disabling condition,” says Sikdar.
Currently, trigger points are often treated with dry needling, a process in which a needle is inserted into the knot and the muscle is twitched. What the researchers don’t understand is why dry needling works. This study will try to answer that question.
The clinical implications for this study are broad, according to Lynn Gerber, director of Mason’s Center for Study of Chronic Illness and Disability in the College of Health and Human Services who is a co-investigator of the study. It is designed to devise objective measures for diagnosing the condition, to identify tissue abnormalities that may be associated with pain and to find out if there are biomarkers that will show which factors contribute to the abnormal physiology of the tissue surrounding the trigger point.
“If we identify markers suggestive of an inflammatory state, this might help direct treatment (pharmacological agents, topical treatments, etc.) designed to ameliorate such states. If we identify tissue property changes, it might suggest certain stretch or stimulation techniques aimed at improving the tissue. The important thing to remember is to develop objective measures to properly diagnose and then use them as treatment outcome measures,” says Gerber.
The study is a truly interdisciplinary effort. In addition to Sikdar and Gerber, Nadine Kabbani, assistant professor of molecular neuroscience in Mason’s Krasnow Institute for Advanced Study; and Jay Shah, a physiatrist and staff clinician at NIH, are gathering the data. Mason professors Saleet Jafri, whose area of expertise is bioinformatics and computational biology, and William Rosenberger, chair of the Department of Statistics, will help them to interpret their data by building a multidimensional matrix that will show how patients with and without pain respond to dry needle treatment.
“That is something that is unique at Mason. We have an environment that promotes collaboration between different units across campus. The fact that Mason is such an entrepreneurial institution enables these interdisciplinary teams to work together productively, something that doesn’t always happen in other institutions that are more firmly established,” says Sikdar.
Patients over the age of 18 who would like to participate in the study may contact Sikdar at 703-993-1539, or Gerber at 703-993-1940.