The Specific Aims of this Midcareer Investigator Award renewal application are to 1) successfully implement an ongoing prospective longitudinal study to determine long term outcomes of pediatric patients with juvenile- onset fibromyalgia (JFM), 2) to refine and test a novel intervention, i.e., combined cognitive-behavioral therapy (CBT) and physical exercise to reduce pain and impairment, and increase coping and physical activity in adolescents with JFM, and 3) continue to use the candidate's ongoing and planned clinical studies in pediatric pain to train postdoctoral fellows and junior faculty. The Candidate s a nationally recognized pediatric pain researcher with a history of >10 years of independently funded patient-oriented research focused on clinical trials of behavioral treatment for JFM and other pain conditions, longitudinal studies, and mentorship of early career researchers. In the first 3.5 years of her current K24 funding, she completed the first rigorously controlled trial demonstrating that CBT is a safe and effective intervention for reduction of disability and depression in JFM and she published 22 papers (along with her mentees) based on her JFM and pediatric pain research. The proposed Research Plan for this renewal application includes two projects: 1) an ongoing NIAMS (R01) funded longitudinal study of long-term outcomes of adolescents with JFM, and 2) an ongoing pilot trial of a novel combined CBT and exercise - FIT Teens (Fibromyalgia Integrative Training for Teens) intervention. The innovation of this new program is that it builds on the candidate's established CBT program and seamlessly integrates an exercise component modified from sports-medicine/injury prevention to improve body mechanics and increase physical activity without fear of pain-flares and activity avoidance which is central to inactivity in JFM patients. Results will inform the next multi-site RCT in JFM. The Mentoring Plan is to train future clinical investigators in the field of clinical trials and outcoms research in pediatric chronic pain. The candidate's plan consists of 1) individualized mentoring of postdoctoral fellows/junior faculty supported by currently funded studies (longitudinal study in JFM (R01), PROMIS in pediatric pain and rheumatology (U01), a 40-site clinical trial of prevention medication for pediatric migraine (U01), and other ongoing studies, 2) mentoring of fellows/faculty to develop their own independent research and 3) participation of fellows in established didactic programs on manuscript/grant writing, research methodology and responsible conduct of human research. Cincinnati Children's provides an ideal setting for this award because of the strong institutional support for patient-oriented research and team-science, presence of an award winning chronic pain program, strong interdisciplinary research collaborations with pediatric rheumatology, pain medicine, sports medicine and neurology researchers interested in pediatric pain, a divisional data core and a commitment of the institution to "change the outcomes" for pediatric patients.

Public Health Relevance

The candidate leads a nationally recognized research program in pediatric chronic pain, including poorly understood musculoskeletal conditions like juvenile fibromyalgia, in which she is doing pioneering work. Her contributions include rigorous clinical trials of behavioral interventions for pain management, innovative assessment methods using objective and patient-reported tools and longitudinal studies of long-term trajectories of pediatric pain into young adulthood. She is dedicated to the training and mentorship of the next generation of clinician-scientists in patient-oriented research in pediatric chronic pain, an under recognized but widely prevalent public health problem.

National Institute of Health (NIH)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
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Serrate-Sztein, Susana
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Cunningham, Natoshia R; Lynch-Jordan, Anne; Barnett, Kimberly et al. (2014) Child pain catastrophizing mediates the relation between parent responses to pain and disability in youth with functional abdominal pain. J Pediatr Gastroenterol Nutr 59:732-8
Kashikar-Zuck, Susmita; Cunningham, Natoshia; Sil, Soumitri et al. (2014) Long-term outcomes of adolescents with juvenile-onset fibromyalgia in early adulthood. Pediatrics 133:e592-600
Lynch-Jordan, Anne M; Sil, Soumitri; Peugh, James et al. (2014) Differential changes in functional disability and pain intensity over the course of psychological treatment for children with chronic pain. Pain 155:1955-61
Lynch-Jordan, Anne M; Kashikar-Zuck, Susmita; Szabova, Alexandra et al. (2013) The interplay of parent and adolescent catastrophizing and its impact on adolescents' pain, functioning, and pain behavior. Clin J Pain 29:681-8
Kashikar-Zuck, Susmita; Sil, Soumitri; Lynch-Jordan, Anne M et al. (2013) Changes in pain coping, catastrophizing, and coping efficacy after cognitive-behavioral therapy in children and adolescents with juvenile fibromyalgia. J Pain 14:492-501
Joffe, Naomi E; Lynch-Jordan, Anne; Ting, Tracy V et al. (2013) Utility of the PedsQL rheumatology module as an outcome measure in juvenile fibromyalgia. Arthritis Care Res (Hoboken) 65:1820-7
Logan, Deirdre E; Claar, Robyn Lewis; Guite, Jessica W et al. (2013) Factor structure of the children's depression inventory in a multisite sample of children and adolescents with chronic pain. J Pain 14:689-98
Cunningham, Natoshia Raishevich; Kashikar-Zuck, Susmita (2013) Nonpharmacological treatment of pain in rheumatic diseases and other musculoskeletal pain conditions. Curr Rheumatol Rep 15:306
Verkamp, Emily K; Flowers, Stacy R; Lynch-Jordan, Anne M et al. (2013) A survey of conventional and complementary therapies used by youth with juvenile-onset fibromyalgia. Pain Manag Nurs 14:e244-50
Sil, Soumitri; Lynch-Jordan, Anne; Ting, Tracy V et al. (2013) Influence of family environment on long-term psychosocial functioning of adolescents with juvenile fibromyalgia. Arthritis Care Res (Hoboken) 65:903-9

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