Congratulations to C3EN Joyce Chapman Community Grantee John Martin, Assistant Professor of Orthopedic Surgery at Rush University, on receiving an JOR Spine Early Career Research Award and a Spine Section Early-Stage Investigator Award at the Orthopedic Research Society 7th International Spine Research Symposium! Martin studies degeneration, regeneration, and physical function of the musculoskeletal system, primarily the spine. His research group combines medical imaging and data science tools to understand the relationships of back pain and spine disease to socioeconomic factors and physical fitness.

In his JOR Spine award-winning paper, “Socioeconomic status, mental health, and nutrition are the principal traits for low back pain phenotyping: Data from the osteoarthritis initiative,” Martin and collaborators used data from the Osteoarthritis Initiative, a public dataset collected from nearly 5,000 patients with osteoarthritis over an 8-year period, to study the relationship of lower back pain to 1,000 factors, including demographics, anthropometry, diet, physical activity, mental and physical health, medical history, socioeconomics, and medication use. Their analysis demonstrated that the two factors with the greatest impact on back pain are income and education. “I have been interested in biomechanics and how that impacts back pain, but the more I study and do my own experiments, it doesn’t seem like there’s a strong relationship between biomechanics, spine anatomy, and pain. It seems that psychosocial factors are more dominant,” says Martin. “That’s when I started looking into socioeconomic status and musculoskeletal disease.”

C3EN’s Joyce Chapman Community Grant enabled Martin to begin exploring how socioeconomic status directly affects pain and pain management. Developed in partnership with Pastor Michael L. Neal and the Timothy Community Corporation in the Bronzeville neighborhood, the project, “A community-based research team on musculoskeletal pain in African Americans,” convened six meetings of a primarily Black and Hispanic community group to share their lived experience with pain and musculoskeletal disease. “It was totally eye-opening,” says Martin. “The research priorities we had”–such as age-related degeneration and obesity–”were not even on their radar.” Instead, community members consistently expressed an acceptance of bodily pain and said that they were not likely to seek treatment until pain progressed to the point of dysfunction or even disability. “It’s like, ‘I have pain, I’m just going to deal with this pain. It’s not worth going to the public clinic to sit there for six hours to see somebody.’ If they have a broken leg, then they have to go get that fixed, but pain falls on a much lower level of urgency.”

Now a board member of Timothy Community Corporation, Martin is continuing to work with Neal, and they recently submitted an NIH grant together for a project that combines Martin’s expertise in medical imaging with priorities identified by the Bronzeville community and other Chicago neighborhoods through C3EN town halls, such as mental health screening, to learn more about how community members with back pain cope with their pain and how their attitudes towards seeking care for their pain affect their health.

Martin and his group are also broadening their analysis to other neighborhoods in Chicago to map the incidence of back pain by zip code. “It actually matches the same patterns as you expect for other chronic diseases,” he says–that is, areas with lower levels of income and education experience more pain. However, the cause may not be anatomical. “Many people have severe back pain. An MRI will show one disc that looks degenerated, so people think that that disc is the pain generator. There’s lots of people who are trying to regenerate the discs. But I don’t know if that’s the best strategy to improve back pain, because there’s so many people with degenerated discs that are asymptomatic. It seems psychosocial factors are much more important. We’re trying to dive deeper into how socioeconomic factors trigger pain.”