Exploring the intersections between trauma, pain, and biopsychosocial well-being after musculoskeletal injuries: the SYMBIOME project
Chronic pain leads to considerable suffering and disability in those with the condition and represents disproportionately high cost for care. Much of chronic pain can be traced back to a trauma, yet neither trauma nor pain occur in a vacuum. This program of research is intended to better understand the complex biological, psychological, and social interactions that can make a person more resistant or more vulnerable to chronic pain after recent injury.
Project status: Data collection complete, analyses on-going
For many years researchers have been trying to identify the root cause of chronic pain, but too often promising early findings are subsequently discarded when they fail to be replicated in other studies. One possible explanation is that there is no single root cause of chronic pain, but like so many chronic conditions it is best understood as a complex interaction between things like genetics and hormones, meaning of the injury, mood and fear states, and broader social context in which the injury and pain occurs that creates a unique ‘risk profile’ for any injured person. The purposes of this research program are to use advanced analytic techniques across a wide range of possible predictors of chronic pain to better understand these interactions and how they can be useful as either risk or protective factors in the process of recovery or development of chronic pain. Logical next steps will be to create and test personally-tailored, risk-targeted early intervention strategies to prevent the onset of chronic problems in the first place.
CANSpine Researchers
David Walton
Joshua Lee
Collaborators
James Elliott
Paul Tremblay
Curtis May
Joy MacDermid
Mohamed Fakhereddin
Maryam Ghodrati
Shirin Modarresi
Joshua Jesin
Purpose
The SYMBIOME project is a prospective cohort study of people with acute, non-catastrophic injuries of the musculoskeletal system. Through a large set of data collected from each person, the project is a systematic merging of biology, mental health, and environment to create more person-centred and holistic profiles of injured people. The aim is to lead to better-targeted acute stage interventions and create more accurate and useful long-term prognostic models for risk of (non)-recovery
Findings
To date, the SYMBIOME (clinicaltrials.gov ID NCT02711085) data have been used to identify a three-trajectory model of recovery (rapid, slow, and non-recovery) after MSK injury, have been used to establish meaningful scores and properties of four self-report questionnaires, have been used to identify potentially important blood-based biomarkers of pain and distress that may be useful as risk/protection factors in recovery research, and have permitted more advanced multivariate and non-linear analyses of biological, psychological, and social variables in better understanding the acute experience and longer-term outcome of MSK injury.
Impact
A patent has been filed by Western’s WorlDiscoveries arm for the panel of blood markers (W02020198867A1). The data have supported 3 PhD-level students through their degree studies, and so far has resulted in 11 peer-reviewed scientific publications (https://www.ncbi.nlm.nih.gov/sites/myncbi/david.walton.1/collections/62576812/public/) with more to come. The phrase ‘trauma does not occur in a vacuum’, referring to the importance of the complex bio, psycho, and social interactions affecting any injured person’s reactions to injury and pain, has become increasingly recognized as a call-to-action for the research community to consider more than simple linear or bivariate associations between injury vectors and subsequent pain and recovery when creating their prognostic models.
Key Publications
https://www.ncbi.nlm.nih.gov/sites/myncbi/david.walton.1/collections/62576812/public/
Funding
The project has been previously supported through public or not-for-profit arm’s-length entities: The Canadian Pain Society, the Canadian Chronic Pain Network, and the Ontario Ministry of Research and Innovation, in addition to some smaller internal funds through Western University’s Seed and Bridge grant programs. All funds have been awarded to Dr. Walton as the PI, managed through Western’s Dept. of Research Finance.
