Identifying modifiable biopsychosocial factors that can reduce the high proportion (>20%) of injured patients who transition from acute pain (AP) to chronic pain (CP) could reduce the burden and disability from this condition. Maladaptive cognitive-behavioral strategies (e.g., fear-avoidance beliefs; catastrophizing) and emotional factors (e.g., general distress) are consistently associated with post-injury pain, especially in patients with pre-injury psychological vulnerabilities. However, it is unknown whether these psychological processes are causal in the transition from post-injury AP to CP, and are thus a target for CP prevention. For this K01 proposal, I will conduct a prospective cohort study in 200 motor vehicle crash patients with musculoskeletal injury to determine the temporal associations between maladaptive psychological processes and the development of CP. Preliminary data support the feasibility of recruitment and retention, the use of electronic communication, and collection of longitudinal data among trauma patients.
We aim to: 1. Examine the concurrent association of psychological and physiological (heart rate activity and 24-hour activity patterns) processes with average levels of injury-related pain intensity throughout 3-months post-injury; 2. Determine the time windows when specific maladaptive cognitive-behavioral and emotional processes appear during the transition from injury-related AP to CP; and 3. Assess the biopsychosocial moderators of the transition from injury-related AP to CP. We will intensively examine interactions of cognitive-behavioral and emotional factors from the point of injury (emergency department) to acute (< 4 weeks), subacute (? 4 to 12 weeks post-injury), and chronic (> 12 weeks post-injury) time periods. We will augment traditional retrospective self-report surveys with prospective ecological momentary assessment (EMA) via text messages and biomarkers of distress via Fitbit devices. This project will foster career development through hands-on training in: 1. The design and conduct of rigorous prospective research on the transition to CP/disability after musculoskeletal injury and on clinical trial design for secondary pain prevention; 2. The use of multimodal techniques to measure and monitor post-injury maladaptive psychological and physiological responses and pain-related processes; 3. The data management, analysis and interpretation of a prospective, longitudinal study with intensive data collection; and 4. Grantsmanship skills. These proposed research and training activities will capitalize on the multidisciplinary environment at the University of Pittsburgh to advance strategies for pain prevention. This goal is well-aligned with the NIAMS Long-Range Plan for FY 2015-2019 to use multidisciplinary, multilevel, and non-pharmacological approaches to prevent chronic pain (CP) in the injury population at large. This K01 application will help the PI launch an independent program of impactful patient- oriented research to become an independent investigator with expertise in: 1) the psychological contributors to CP, and 2) prevention efforts to reduce the burden of CP and improve recovery after acute physical injury.
Preventing the transition from acute pain to chronic pain would reduce individual suffering and provide huge societal savings for hundreds of thousands of injured patients across the country seeking treatment in emergency departments. Identifying the specific psychological responses to traumatic physical injury that contribute to the development of chronic pain and the specific times when these transitions are strongest will inform the design of treatment and prevention strategies. Given that psychological processes are potentially amenable to intervention during the acute and subacute injury phase and are more consistently related to pain outcomes than injury severity, research informing non-pharmacological psychological interventions has the ability to shift the paradigm of post-injury pain management strategies from a largely biomedical and pharmacological approach to a multimodal approach that may serve to reduce opioid overuse yet deliver effective pain relief.
