This application for a MidCareer Investigator Award in Patient Oriented Research (K24) requests support for the candidate, who is an Associate Professor of Psychiatry & Behavioral Sciences and Director of the Behavioral Medicine Clinic, to integrate clinical trial research with the training of Junior and new clinical investigators interested in pursing patient oriented research on acute and chronic pain. The candidate has 15 years of experience conducting clinical research examining psychosocial factors that influence the experience of pain. Since joining the faculty at Johns Hopkins University, the candidate has mentored undergraduate students, postdoctoral fellows, and junior faculty in conducting, clinical pain research and contributed to the career development of junior faculty. The mentoring objectives for the K24 award include shifting the candidate's time from providing direct clinical services to providing training in clinical pain research, involving trainees and junior faculty in all aspects of the candidate's clinical research program, and attracting trainees and junior faculty to careers in clinical pain research. Through coursework and research, the K24 award will allow the candidate to refine her skills in conducting randomized, controlled clinical trials in pain management. The candidate will take courses focused on the application of multivariate analyses regression models and structural equation modeling to develop improved measures of outcome for use in pain clinical trials. These advanced statistical methods will be applied to existing databases and to databases created during, the execution of ongoing projects. The candidate's research plan includes a clinical trial to examine the separate and combined effects of opioids and cognitive behavioral therapy in treating neuropathic pain. As part of the plan, the candidate will work with multiple pain centers in developing structured protocols for measuring outcome, establishing opioid titration schedules, establishing methods for managing side effects, and developing a treatment manual for cognitive behavioral therapy for neuropathic pain. Once developed, these protocols will serve as the basis for a multi-center grant application for a clinical trial. Outcome measures will include pain, mood, function, and substance abuse. The longterm objective is to develop effective therapies, both alone and in combination, which reduce pain and improve function. A second goal of the candidate's research is to expand knowledge of outcome parameters for clinical pain research, including measures of pain intensity and global ratings of improvement, such that optimally sensitive and clinically relevant measures can be identified.
