The candidate's long-term career objectives relate to understanding the mechanisms underpinning psychosocial factors' impact on pain-related outcomes. This Career Development Award (K23) will provide the candidate the necessary training to develop this research program. Specific training aims of this K23 include development of expertise in the psychoneuroimmunology of pain and in-vivo assessment methods. The proposed research plan examines biopsychosocial aspects of pain in rheumatoid arthritis (RA), a chronically painful disorder with well-documented psychosocial and biological components. Among the most consistently important of the cognitive and affective variables impacting on the experience of pain is catastrophizing. While catastrophizing has been identified as an important predictor of chronic pain and disability, little is known regarding the mechanisms by which it produces its deleterious effects. Current theory suggests that 2 of the pathways through which catastrophizing operates are: (1) recruitment of social responses that reduce self-management of pain, and (2) direct negative effects on pain-regulatory pathways and other neurophysiological systems. Understanding catastrophizing's mechanisms of action will assist in the development of interventions designed to reduce its impact, improving the health-related quality of life of individuals with chronic pain. The proposed research plan involves parallel studies in patients with RA; a prospective observational study will examine the social dimensions of catastrophizing while a laboratory- based study will concurrently evaluate its psychophysiological and immunological consequences. The need for further research into catastrophizing's mechanisms of action is increasingly important in the context of an epidemic of chronic pain. The candidate's goal for the proposed project is to understand the pathways by which catastrophizing impacts pain-related outcomes in order to refine biopsychosocial models of pain and facilitate the development or enhancement of psychosocial interventions for chronic arthritis pain.
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