OVERALL OASIS CENTER ABSTRACT More than half of all Americans suffer from a chronic condition and 70% of deaths annually can be attributed to chronic conditions. One of the most frequent and debilitating is pain, which can occur as a symptom of chronic illness or as a primary problem. According to the Institute of Medicine (IOM) report on Relieving Pain in America, chronic pain is a public health epidemic affecting more than 116 million Americans and costing more than $600 billion per year in healthcare expenses and lost work productivity. Despite advances in conventional pharmacological treatments that are informed by our current understanding of basic biological mechanisms of chronic pain, most people do not obtain adequate pain relief. An important focus has been to determine whether self-management interventions improve pain. Various types of self-management interventions have been tested, including cognitive behavioral therapy (CBT), non-pharmacologic treatments (e.g., heat, cold, acupuncture, etc.), exercise/physical activity, others. However, much like pharmacogenomic influences on individual response to drug treatment, self-management intervention trials have demonstrated mixed results in that some, but not all, study participants respond or participate. This is could be due to many factors, including resilience, motivation and/or capability to engage in the activity. In some cases it is unclear what dose and intensity of the self-management intervention provide a benefit. Moreover, the molecular mechanisms underlying the relative success or failure of self-management interventions on an individual level have been understudied. The purpose of the University of Maryland, Baltimore (UMB) Omics Associated with Self- management Interventions for Symptoms (OASIS) Center, guided by an adapted version of the National Institutes of Health Symptom Science Model (NIHSSM), is to combine rigorous phenotyping of pre-clinical models and patients in chronic pain with cutting edge omics methods to advance our understanding of how individual differences influence one's resilience, motivation and capability to engage in physical activity and exercise to manage chronic pain. We hypothesize that an individual's genomic, transcriptomic, epigenomic and proteomic (hereafter referred to as ?omics?) profile predicts their resilience, motivation and capability to engage in self-management behaviors and their response to treatment. Potential mediators and moderators (e.g., psychosocial factors, sex differences, the environment) may also influence either the response to self-management interventions or the level of chronic pain. Our goal is not to test the efficacy of physical activity on chronic pain reduction in experimental versus control conditions; we know these strategies can work; but rather, to understand the omics correlates that will begin to inform us about mechanisms that underlie the resilience, motivation and capability to engage, and the response of the individuals to physical activity. We acknowledge that other factors, such as psychosocial status, the environment, and sex differences can moderate or mediate omics effects. We assert that our interdisciplinary team-based OASIS Center and translational, mechanism-based approach will accelerate the science of self-management to produce high impact results that will move the field forward.
OVERALL OASIS CENTER NARRATIVE More than half of all Americans have chronic condition like diabetes, heart disease, or cancer. One of the most difficult for patients to deal with is pain, which can occur as a symptom of chronic illness or as a primary problem. This pain, which affects more than 116 million Americans and costs more than $600 billion per year in healthcare expenses and lost work days, is difficult to treat. Very few medications can completely relieve pain, and they often have burdensome side effects and the potential for addiction. Some have suggested that self- management behaviors such as exercise reduces pain, however it works for some, but not all people. This is could be due to many factors. The purpose of the University of Maryland, Baltimore (UMB) Omics Associated with Self-management Interventions for Symptoms (OASIS) Center is to examine why exercise and physical activity works to reduce chronic pain and in which individuals would it work best. We will also test which dose, time or intensity of activity is needed to provide the maximum pain reduction benefit.
