The overall goal of this 4-year K23 proposal is to support Jessica Merlin, MD, MBA to become an independent investigator in the field of HIV and chronic pain, with a focus on health psychology/mental health and chronic pain behavioral intervention development and testing. Chronic pain is a chronic condition with a unique neurobiologic basis, which has a substantial impact on physical and emotional function. Chronic pain in HIV-infected patients is common, and associated with serious health consequences, including up to 10 times greater odds of impaired physical function. Many pharmacologic therapies, including opioids, often do not lead to improved pain and function, and carry significant risk. Evidence-based behavioral interventions are among the most effective and safe non-pharmacologic chronic pain treatments investigated in the general medical population. Therefore, behavioral interventions to improve pain, physical, and emotional function in HIV-infected patients are needed. There is much to be learned from existing interventions. However, the success of a behavioral intervention is heavily influenced by how well it is tailored to the target population's biological, psychological, and social environment. Therefore, the Specific Aims of this proposal are:
Aim 1 : Use intervention mapping to systematically develop and pre-test a tailored behavioral intervention for chronic pain in HIV-infected patients.
Aim 2 : Conduct a two-arm pilot randomized controlled trial of the behavioral intervention compared to routine HIV and pain care, to determine feasibility, acceptability, and preliminary impact. Based on preliminary studies, our proposed intervention targets include depression/anxiety, substance use, and use of prescription opioids for pain management; new targets may emerge during the intervention mapping process. The proposed research represents the first study to address chronic pain as a chronic disease in HIV-infected patients, and to develop and test a behavioral intervention specifically tailored to this population. At the completion of the pilot trial in Aim , the intervention will be ready to be tested in an R01 to evaluate its efficacy. This proposal represents a 4-year comprehensive mentoring, training, and research plan to transition the candidate, Dr. Merlin, to a career as a successful independent investigator. By the end of the award period, Dr. Merlin will have contributed substantially to the field of HIV and chronic pain behavioral research. Already an expert on biomedical approaches to chronic pain in HIV-infected individuals, she will be positioned to become a leader in developing and testing behavioral interventions in this area, including conducting behavioral clinical trials.
Due to its specific pathophysiology and impact on health outcomes, the Institute of Medicine has described chronic pain as a complex chronic disease and a national public health crisis. The unique neurobiological basis and psychosocial context of chronic pain in HIV-infected patients underscores the importance of developing a behavioral intervention specifically tailored to this population. The project described in this application will develop and pilot test such an intervention, which can then be further tested in an R01- supported randomized controlled trial.
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