Chronic spinal pain is associated with loss of function and significant disability. When spine pain is comorbid with fibromyalgia, symptom severity and disability are amplified. Interventions capable of improving functional status, reducing symptoms, and enhancing well-being are critically needed. Both medications and cognitive- behavioral therapy (CBT) have demonstrated similar, modest effects for reducing symptoms in chronic pain. Behavioral treatments for chronic pain like CBT act predominantly by decreasing negative states rather than by Resilience-based interventions target the enhancement of positive emotions and well-being rather than focusing solely on negative emotions and behaviors. Although relatively under-used in chronic pain populations, resilience-based interventions have been used successfully in other clinical settings including depression, cardiovascular disease, diabetes, and HIV. promoting positive states associated with resilience. Thus, adding resilience-enhancing strategies to CBT for pain holds promise for further enhancing the effectiveness of CBT. In addition, most current behavioral interventions require specialized training and as such are not widely available. Medical assistants (MAs) are well-positioned in the healthcare system to play a pivotal role in helping individuals with chronic pain improve their functional abilities through innovative self-management strategies. The MA-led self-management programs proposed herein leverage the unique training and capabilities of MAs, while considering minimizing costs and maintaining the flow of clinical practice. The benefits of resilience- enhanced CBT that targets increasing patient well-being are also expected to extend beyond pain to potentially include genomic effects. Telomere shortening is predictive of disease and mortality and is considered an index for premature cellular aging. Our pilot data suggest that in addition to age and other physical and psychological stressors, inadequately managed pain can also affect telomere attrition. Thus, in addition to demonstrating the efficacy of online CBT self-management with resilience-enhancing activities (CBTRE), this application seeks to evaluate the impact of CBTRE on telomere health. Our central hypothesis is that our MA-supported CBTRE program will demonstrate superior efficacy to standard MA-supported online CBT self-management (eCBT) alone (Aim 1) through the enhancement of well-being (Aim 2). Both the CBTRE and eCBT interventions will improve telomere health with greater benefits being attributable to the CBTRE condition due to the mediating benefits of well-being (Aim 3). Therefore, we will conduct a randomized controlled trial of 300 individuals with spinal pain who also meet fibromyalgia criteria to investigate the effectiveness of the CBTRE program in promoting functional status, improved symptoms, and genomic health using resources already in most medical settings (i.e., MAs). By demonstrating the ability of this self-management intervention to improve physical function, pain and other symptoms, as well as telomere health, we hope to improve the options available for the care of millions of people who suffer with chronic spinal pain.

Public Health Relevance

Public Health Relevance: Chronic pain affects as many as 100 million Americans and is associated with significant disability. Medical assistants are in an excellent position to assist patients with self-management strategies, but need access to effective and engaging programs. Successful completion of this study would result in the establishment of an appealing and effective program that combines a proven therapy with an intervention that promotes well-being and thus could affect cellular aging. A program such as this could be truly transformative in how chronic pain is addressed and could greatly affect the quality of life of millions of Americans.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Tully, Lois
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Neville, Stephen J; Clauw, Andrew D; Moser, Stephanie E et al. (2018) Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis. Clin J Pain 34:909-917