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Untangling the Complexities of Back Pain

William Marras, director of Ohio State's Spine Research Institute, has spent his career discovering innovative ways to understand, prevent and treat back pain in a more precise manner than people often receive. “If you don’t know what the problem is, it’s really hard to treat,” he said. “The spine is tremendously complex.”

If you’ve never experienced back pain, you’re lucky. You’re in rare company.  But chances are you’re not out of the woods.

Eighty percent of us experience back pain at some point in our lives. And it’s not pretty. Back pain sufferers describe it as, “stabbing” and “shooting,” “aching” and “tingling.”

Back pain is debilitating and widespread. It burdens people, the workforce and economies.  

“It’s a humongous problem, and the incident rates are just mind boggling,” said Ohio State’s William Marras, director of the Spine Research Institute (SRI) and the Honda Chair in the Department of Integrated Systems Engineering.  Marras has spent his career discovering innovative ways to understand, prevent and treat back pain in a more precise manner than people often receive.

A ‘tremendously complex’ problem

Back pain affects more than 1.3 billion people worldwide, causing more than 100,000 workdays lost and $100 billion to treat in the United States each year.  Why? We barely understand what causes it.

Consider the spine as a mechanism: 24 discs, 26 vertebrae, 220 muscles and 364 joints, all stacked on each other, each performing a different job. When one component isn’t working, you might have pain.  But which component is it?  It’s often hard to say because current X-rays and MRIs are taken from static, inactive positions, sitting or lying down. According to Marras, these methods find a person’s back pain source about 15% of the time.  The other 85%? Scary as it sounds, it’s just guessing based on where a clinician believes the pain may be. That often leads to trial-and-error treatments that could include physical therapy, surgery (around 50% of back surgeries actually work), or pain-killers (the No. 1 opioid prescriptions written in the United States are for back pain).

“The vast majority of the time, people don’t know what the problem is and if you don’t know what the problem is, it’s really hard to treat,” Marras said. “The spine is tremendously complex.”  Along with the biomechanical complexities of the spine, psychological and sociological factors can also play a part in a person’s back pain. However, those factors are not always taken into account during a doctor’s visit. As a researcher, Marras and his team take a different approach because many of them see the problem from different angles.

Diversity of thought

To solve such a complex problem, Marras wants as many eyes on the spine as possible.  His research includes a close collaboration between Ohio State’s College of Engineering and College of Medicine. And his Spine Research Institute team brings together problem-solvers, such as mechanical engineers, ergonomic engineers, orthopedic surgeons, physical medicine and rehabilitation specialists, mathematic modelers, neurosurgeons and anesthesiologists.

Over the years, he’s collaborated with other universities along with hundreds of industry and military personnel for insight.  “The underlying philosophy is: We need diversity in everything we do and everybody we engage when we tackle a problem,” Marras said.  It’s a convergent, collaborative mindset to find new solutions to help people lead better lives.

It’s a mindset that is preventing back pain already and is primed for major breakthroughs in treatment. In fact, Marras’ work has received FDA Breakthrough designation, meaning the FDA (the U.S. Food and Drug Administration) will work to fast-track the development to market.

Cutting through the complexity

Two of the three most prominent health conditions worldwide — heart disease and diabetes — use quantitative tools to find personalized treatments. For the third, back pain, there’s no similar tool.  That’s where Marras comes in.

To find what causes the problem, he uses a Biopsychosocial Model — biological, psychological and sociological factors that cause the pain — to holistically research what causes back pain.

His team’s track record is strong. He’s already helped hundreds of companies find workplace interventions and improve ergonomics to prevent employee back problems. For example, he has worked extensively with Honda, reducing injury rates on work lines by over 90% and, in all of North America, has helped the company reduce musculoskeletal injuries by 70%. You can read more success stories here.

When it comes to treatment, Marras and his team are developing technology to help physicians pinpoint and treat back pain properly through the Spine Phenome Project. The project is part of BACPAC (Back Pain Consortium Research Program), which is under a National Institutes of Health initiative called HEAL (Helping to End Long-Term Addiction), to prevent and treat opioid misuse.

“The No. 1 reason people take opioids is for back pain, and we’re determined to find a better way to relieve people’s suffering without having to rely on opioids,” Marras said.  To do that, Marras and his team have developed, or are developing, tools to understand all the elements that may cause back pain.  One includes wearable sensors that analyze a person’s spine as he or she move around. It identifies potential pain sources and mobility problems by creating a computer model, accurately showing physicians and surgeons why someone might be experiencing pain.  “We’re marrying imaging data with motion data and bringing the MRI to life,” Marras said.

The bigger piece of the project is building a digital health computer platform that provides data-driven information to help physicians evaluate and treat patients accurately. The platform will work as a statistical database that pulls in information from back pain sufferers — through the motion sensors as well as family history, perceptions, health and environmental factors — and uses machine learning to phenotype patients, allowing clinicians to decipher more exactly what is happening in a patient.

“We’re trying to cut through the complexity,” Marras said. “It’s a huge puzzle we’re trying to figure out. But the reason you do research is because you want to do some good for society. I want to help the world.”

This article was first published in Ohio State Insights.