A mechanism-based approach to the prevention of chronic pain and its comorbid mental disorders

Introduction

Chronic pain is a major health problem typically associated with mental disorders such as depression or anxiety and is still difficult to treat despite enormous efforts in the biomedical community. This project proposes a radical shift from the symptomatic focus on chronic pain and predefined diagnostic categories to a mechanistic analysis and treatment of psychobiological factors that shape the transition to chronic pain and its associated mental disorders in a transdiagnostic approach.

Project Goals

The proposal aims to identify transdiagnostic mechanisms of the development of chronic pain across three major diagnostic subtypes of pain:

1. Primary musculoskeletal pain
2. Neuropathic pain
3. Primary headache

These subtypes are usually analyzed and treated in isolation. The project will also conduct a proof of principle study of mechanism-based modular digital and virtual reality-based interventions.

Work Packages

WP 1: Meta-Analyses

WP 1 will use meta-analyses to determine common and specific transdiagnostic mechanisms of chronicity across these three diverse pain disorders.

WP 2: Longitudinal Data Analysis

WP 2 will analyze longitudinal data from existing databases on pain development, using machine learning and knowledge graph approaches.

WP 3: Assessment Battery Development

WP 3 will develop an assessment battery for core psychobiological mechanisms and identify predictors of chronicity as well as comorbidity with mental disorders across diagnostic groups using advanced unsupervised learning algorithms.

WP 4: Intervention Development

WP 4 will devise easy-to-apply real-life digital and virtual reality interventions that target core psychobiological processes.

WP 5: Proof of Principle Study

WP 5 will contain a proof of principle study that contrasts standard cognitive-behavioral pain management with the mechanism-based intervention modules. They will be applied in a digital format and contain virtual reality-based interventions.

Statistical Analyses

Statistical analyses will include:

• Linear mixed models
• An n=1 design
• A microrandomized trial

Conclusion

We believe that this transdiagnostic mechanistic approach will make a major contribution to the prevention of chronic pain.