Integrating mind body skills with physical activity to improve physical and emotional outcomes in patients with heterogeneous chronic pain This is a new investigator R34 application that follows the recently released IMMPACT criteria, and the International Classification of Functioning, Disability and Health (ICF) framework to adapt a multimodal, theory grounded mind body program (The Relaxation Response Resilience Program; 3RP) with prior success in patients with medical illness in pilot and effectiveness studies, for the needs of patients with chronic pain and to specifically target increased physical activity (p3RP), with the Fitbit, a digital monitoring device (DMD) which provides an objective, real time measurement of increased activity (e.g., number of steps, number of active minutes) with built in reinforcement (p3RP-DMD). Available psychosocial interventions for chronic pain are failing in critical outcomes with effect sizes for physical and emotional functioning that are small and fade over time. Although physical activity is associated with increased health outcomes in patients with chronic illness including pain, physical activity programs are difficult to implement in this population due to barriers associated with motivation, adherence, mood, and ineffective coping skills. The arrival of user friendly DMDs with high adherence represents an opportunity to increase physical and emotional functioning in patients with chronic pain, by incorporating quota based walking within mind body treatments, thus problem solving barriers to increased activity. DMDs allow both addressing and objectively assessing improvements in function. Our guiding hypothesis is that the synergistic interaction between the evidence-based 3RP program (that includes mindfulness meditation, adaptive thinking and positive psychology skills) which we plan to adapt for the needs of patients with chronic pain including increased physical activity, with the Fitbit DMD to reinforce quota-based pacing and engagement in meaningful daily activities, is the most effective and efficient way to improve both physical (self report, objective and performance based) and emotional (depression and anxiety) function in chronic pain patients. In a subsequent R01, we plan to test the hypothesis that the p3RP-DMD is superior to the p3RP and to an educational control, the pain specific Health Enhancement Program (pHEP) in improving and sustaining improvements in physical and emotional outcomes. Using the R34 NCCIH mechanism, we propose to use an iterative mixed methods strategy to adapt the 3RP for the specific needs of chronic pain patients including increased activity, and for incorporation of the Fitbit DMD, to maximize their feasibility, acceptability, and credibility. HEP, a dose and time matched educational control developed by our team and adapted for chronic pain (pHEP) is already used in our Pain Clinic and does not require further feasibility testing.
. Chronic pain is prevalent and costly, and current available psychosocial treatments fail to provide sustained improvement in outcomes. Although mild physical activity like walking is associated with improvements in outcomes in patients with chronic illness including pain, current mind body interventions do not directly address or assess improvements in activity. Incorporating small, user friendly and inexpensive DMDs that provide real time reinforcement of activity into mind body interventions represents an opportunity to bolster both physical and emotional function in patients with chronic pain, which is consistent with recommendations from new IMMPACT 2016 criteria for pain trials.
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