A low-intensity, cognitive-behavioral self-management intervention for chronic musculoskeletal pain in older adults
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DESCRIPTION (provided by applicant): A low-intensity, cognitive-behavioral self-management intervention for chronic musculoskeletal pain in older adults In an influential 2011 report entitled Relieving Pain in America, the Institute of Medicine called attention to the epidemic of chronic pain in the United States, and to the urgent need to improve access to effective pain treatments. Responding to the priorities set in this report, I am seeking to lay the foundation for an independent research program with the goal of increasing the accessibility of evidence-based, cognitive-behavioral interventions for chronic pain management among older adults. This application for a Mentored Career Development Award (K01) proposes training and research activities over a 5-year period that will enable me to launch this research program. To this end, I have formed an interdisciplinary team of mentors and consultants that includes researchers representing Geriatrics, Anesthesiology, Psychology, Physical Medicine and Rehabilitation, Public Health and Psychiatry at the University of Michigan, as well as a prominent pain ethicist from the independent Center for Practical Bioethics. This additional support will build on my strong foundation in conducting behavioral and chronic illness self-management support research among older adults. The training and research aims in this proposal are closely linked. The training goals include acquiring skills and expertise in the areas that are essential for my planned research program: 1) The pathophysiology and management of chronic pain in older adults and cognitive-behavioral approaches to treating chronic pain in this group; 2) Symptom and activity monitoring in older adults, which enables the use of accurate and timely information about patients' progress as part of behavioral interventions, while identifying potential mediators of intervention effects; and 3) Emerging study designs for testing behavioral interventions, with an emphasis on pragmatic, adaptive and patient-centered designs that increase the relevance of research findings. These topics will be mastered through coursework, clinical observations, and self-study under the guidance of the mentorship team. I will also attend relevant seminars, workshops, and scientific conferences throughout the award period. Following the training program, I will develop and pilot-test a low-intensity pain CBT intervention for older adults. The intervention will use a high tech/high touch approach. Using an evidence-based internet CBT intervention for chronic pain management as a starting point, I will develop two additional components that will enhance the appeal and potential efficacy of this program for older adults: a) a series of telephone CBT sessions by non-specialist practitioners to support use of the electronic modules, and b) symptom and activity monitoring using mobile health tools to better tailor the intervention to individual patients' needs. The development and pilot-testing of this program will be accomplished via three sequential research aims. To aid in the development of program content, in Aim 1, I will conduct secondary analysis of data from two recent RCTs of pain CBT interventions to test the hypothesis that there are significant age group differences in pain coping strategies and choice of CBT goals, and to identify the CBT skills that are most appealing and most challenging to older adults. I will also conduct focus groups to obtain feedback from target intervention users on the acceptability and design of the proposed facilitator and monitoring components. In Aim 2, I will conduct usability testing with older pain patients to test our assumption that using a FitBit-type device to automatically- upload accelerometer data results in markedly greater adherence to data collection than manual upload via IVR calls. We will also evaluate the reliability, validity and acceptability of both automated and manual upload to inform the final choice of monitoring strategy used in the pilot study. In Aim 3, I will recruit 50 older adults with chronic musculoskeletal pain and conduct a randomized pilot trial of the intervention with waitlist controls to assess its feasibility and effects on Pai Impact. If successful, results from the pilot study will serve as preliminary work for a larger pragmatic trial to be proposed in the final year of the K01. The University of Michigan, the School of Public Health, and the Center for Managing Chronic Disease provide the ideal environment for carrying out the proposed activities. These units offer opportunities for training, collaboration, and cross-disciplinary pollination. A wide array of resources will facilitate my wor during the award period; e.g., the Geriatrics Center and Institute of Gerontology, the Chronic Pain and Fatigue Research Center, the Michigan Center for Clinical and Health Research, as well as world-class computing, library, and statistical support services. This resource-rich environment, along with a committed team of mentors, will facilitate my transition to an independent research career.
