2019 IARS Mentored Research Award

Lara Wiley Crock, MD, PhD, MSCI
Assistant Professor,
Division of Pain Management,
Department of Anesthesiology,
Washington University School of Medicine
St. Louis, MI

Dr. Wiley Crock’s Research

Role of the Microbiome in the Persistence of Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a debilitating condition of unknown etiology that develops following surgery or trauma. Patients with a history of CRPS are difficult in terms of anesthesiology and pain management because they are more likely to redevelop CRPS or have uncontrolled post-operative pain when they undergo surgical procedures. In our pain management clinic, around 50% of patients recover if treated within one year. Those who do not are permanently disabled, requiring extensive treatments including long-term opioids. Interestingly, some patients with CRPS have recovered following antibiotic treatment. Further, mouse models suggest a crucial role of the gut microbiome in the development of pain. We hypothesize that the gut microbiome influences development and recovery from CRPS and will test this hypothesis in two phases. First, a cross-sectional observational study will examine the gut microbiome taxonomy and fecal metabolites of patients with current or former CRPS diagnoses. Second, we will follow patients with a new diagnosis of CRPS to determine if microbiome biomarkers predict symptom improvement. This early-stage translational study may lead to important insights into the factors regulating the neurobiology of chronic pain. With improved understanding of associated triggers and biomarkers, we could develop innovative non-opioid treatment modalities targeting the microbiome to treat and prevent development of chronic pain.