Toward visualized pathophenotyping: a multimodal imaging-guided conceptual framework for chronic low back pain

Chronic low back pain (CLBP) remains a leading cause of disability, yet many current interventions are limited by operator dependence and an inability to target deep pathophysiological drivers. This Perspective proposes Visualized Pathophenotyping, a conceptual precision paradigm that integrates multimodal imaging to characterize patient-specific deep structural and perfusion abnormalities and guide targeted interventions. The framework comprises three pillars: (1) precise assessment using shear wave elastography and infrared thermography or laser Doppler flowmetry to define mechanical and ischemic phenotypes; (2) ultrasound-guided deep mechanical stimulation for accurate targeting of fascial adhesions and myofascial trigger points; and (3) phenotype-specific intelligent monitoring with virtual/augmented reality and wearable AI to sustain tissue remodeling and prevent recurrence. Emerging evidence from randomized trials and meta-analyses suggests that visualization-guided approaches yield superior short-term pain relief and functional improvement compared with blind techniques. Digital therapeutics may enhance adherence and some functional outcomes, although broader biopsychosocial effects remain to be confirmed. By shifting CLBP management from operator-dependent procedures toward objective, data-driven care, this hypothesis-generating framework may reduce recurrence, minimize opioid reliance, and improve scalability, pending validation through prospective multicenter trials of diagnostic accuracy, clinical utility, and cost-effectiveness.