Ferguson Lab Trainee Spotlight: Valerio Tonelli Enrico, PT, MSCE

Valerio Tonelli Enrico, PT, MSCE, is a Rehabilitation Science PhD candidate and graduate research assistant at the University of Pittsburgh School of Health and Rehabilitation Sciences and research trainee in the Ferguson Laboratory for Spine Research. He began his studies at the University of Pittsburgh in June 2020 and is expecting to complete his doctoral studies in Summer 2024.

Valerio earned a Bachelor of Science in Physiotherapy from the Universitá Degli Studi di Torino in Torino, Italy and then practiced as a physical therapist in multiple settings in Italy until 2014. His thesis during physiotherapy training focused on neural mobilization in treating post-thoracotomy pain.

He then went on to earn a Master’s degree in clinical epidemiology from Memorial University in Newfoundland, Canada. His thesis involved research into the dietary inflammatory index and chronic pain in an adult, noninstitutionalized civilian population in the US.

The majority of Valerio’s research during his academic training, and his clinical practice has been focused on understanding and treating chronic pain and pain syndromes, including low back pain.

“After PT training, and while I was working as a therapist and taking numerous post-graduate training courses, I developed an interest in conducting research,” says Valerio. “This solidified further after a meeting with a PT from Canada during a year-long course on motor control who introduced me to an instructor in Newfoundland who was developing a comprehensive clinical framework for PT that included motor control but also assimilated aspects of psychosocial components, systemic inflammation and other aspects which I found very interesting in relation to the manifestation and control of chronic pain.”

His work in the clinical epidemiology program in Newfoundland delved into how diet-related inflammation may be related to various musculoskeletal pain patterns.

After completing his Master’s degree, Valerio moved to the United States to continue his PT practice while looking for a program that he could continue his research studies into chronic pain and low back pain, but also maintain a patient practice.

“It was very clear in my mind what kind of research I wanted to conduct and what kind of PhD program I wanted to be involved in,” says Valerio. “Through my prior work and my training in Canada, I made it a focus to conduct research on different biomarkers associated with chronic pain, how systemic inflammation can contribute to the manifestation, presentation, and severity of pain, and how overall systemic dysregulation with the body can influence one’s experience of pain.”

That’s not an easy or common type of program to find he explains. It took nearly three years of search and applications to eventually be led to the University of Pittsburgh, the Ferguson Lab, and Dr. Sowa, who was just beginning the LB³P NIH-funded research project designed to better understand the pathophysiology, biomarkers, and phenotypes of chronic low-back pain.

“The Pitt programs and Ferguson Lab aligned with my personal interests, and exciting work they were embarking upon with LB³P, it was a quick decision to pack up and move to Pittsburgh from New Mexico where I was working,” says Valerio.

Research in the Ferguson Laboratory

One of the interesting things about Valerio’s journey to Pittsburgh and the Ferguson Lab is how his prior work and studies in Canada aligned with the work being conducted by Drs. Sowa, Vo, and colleagues in Pittsburgh.

“The very idea that led me to move to Canada was to develop a subclassification system for pain patients in the outpatient setting,” says Valerio. “This idea of a classification was something that I found very fascinating. It’s probably the single concept that impacted me the most as a clinician through the years - this idea that you can have the same clinical presentation of, for example, low back pain, but then have so many different factors playing into that output. And this is exactly what we’re trying to do in Pittsburgh with the LB³P study and was a driving factor for coming to the Ferguson Lab.”

An interesting facet of chronic pain, and in particular low back pain, is how and to what degree a patient’s existing comorbidities may play into its manifestation and influence not only the trajectory of the condition or its severity, but also how these factors may influence an individual’s response to a specific therapy. Psychological factors like depression or anxiety, genetic and epigenetic variables, environmental factors, trauma or injury, diseases like diabetes or obesity – all likely can and do have a profound influence on chronic pain – but in who, why, and to what degree is the clinical challenge to solve.

“This whole concept of the modulatory factors that can contribute to chronic pain - like low back pain – who’s susceptible, what predispositions may influence it, how to screen for these, is largely a mystery,” says Valerio. “But it’s exactly the mystery that LB³P is trying to solve and that I hope to continue to study into the future.”

One aspect or possible factor gaining more attention, and something Valerio has been working on during his time in the Ferguson Lab contributing to LB³P research is the potential role of the gut microbiome in chronic low back pain. As Valerio explains, by looking into the specific taxa, species, and overall diversity of gut bacteria, the aim of this work is to establish an initial baseline for future studies probing correlations and metrics relating the microbiome with pain syndromes.

“The microbiome is a major modulator of health and physiology, affecting everything from the autonomic nervous system to the immune system and even the production of hormones and vitamins,” says Valerio. “No doubt it likely can and does influence things like chronic low back pain but we really only have hypotheses right now.”

His doctoral studies are primarily focused on the microbiome and targeted proteomics – qualitative and quantitative analysis of the microbiome volume and specific cytokines with a goal of beginning to find associations between the baseline microbiome of individuals and proteomic profiles with pain and function in patients, as well as to identify any correlation between these baseline values and patient outcomes following physical therapy.

“What I’ve been interested in my entire career so far is what LB³P is designed to study – how and what constitutes a specific phenotype of chronic pain low back pain,” says Valerio. “Once we know that, we can better screen for the condition, predict what trajectory an individual will follow, and how to optimally treat a person given all of the underlying factors and predispositions contributing to their condition. That’s a big challenge but definitely one worth pursuing.”

* The Back Pain Consortium Research Program is administered by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. This research was supported by the National Institutes of Health through the NIH HEAL Initiative under award number U19AR076725-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or its NIH HEAL Initiative.