Mechanisms underlying functional disabilities in chronic musculoskeletal pain: the role of protective factors

Chronic musculoskeletal pain is a major health issue, which translates into a severe economic burden. Studies on chronic pain conditions have focused primarily on characterizing pain mechanisms with a focus on alleviating clinical pain intensity. The success of these studies in terms of effective treatment remains extremely limited. Rather than focusing on pain intensity, PROTECT will focus on functional disabilities associated with chronic musculoskeletal pain, which are the main complain of patients. They can be extremely debilitating and often result in social isolation of persons with chronic musculoskeletal pain. To date, their mechanisms remain poorly understood. A better understanding of these mechanisms is essential to improve treatment efficiency. In work package (WP) 1 of PROTECT, the impact of athletic identity and mental and physical fatigue on the relationship between resilience and functional disabilities will be studied in adults and minors with chronic musculoskeletal pain (RO1). Resilience is associated with functional disabilities, athletic identity and fatigue, a frequent comorbidity of chronic musculoskeletal pain. Characterizing the complex relationship between these factors using computational modeling will define new treatment targets that can be addressed by adapting already available therapeutical interventions. All factors will be assessed using questionnaires, as well as physical and behavioral tasks. In WP2, resting-state fMRI will be used to assess brain networks of functional disabilities in adults with chronic musculoskeletal pain. In particular, the role of the Default Mode Network (DMN) in functional disabilities will be investigated (RO2). Changes in DMN connectivity have been associated with acute and chronic pain, as well as with resilience and athletic identity. Finally, PROTECT will focus on the potentially mediating role of resilience and athletic identity on the relationship between the DMN and functional disabilities (RO3).