I am a clinician-scientist committed to performing high quality research on the causes, treatment and prevention of musculoskeletal diseases. As physical therapist with PhD training in orthopaedic biomechanics, I have rigorous training in the evaluation and treatment of how people move in order to reduce tissue injury and pain. An emerging field of research indicates that changes in the central nervous system (CNS) contribute to pain in patients with orthopaedic injuries, such as tendinopathy. Yet the current standard of care for Achilles tendinopathy does not evaluate or treat CNS pain mechanisms. We propose 2 independent studies to test how altered processing within the CNS contributes to chronic Achilles tendinopathy (AT) pain. K99 phase study:
Specific Aim 1. 1 compares measures of altered central processing in patients with chronic AT to adults without chronic pain;
Specific Aim 1. 2 determines which indicators of altered central processing persist after a local anesthetic injection eliminates peripheral nociception at the site of AT pain in patients with chronic AT. R00 phase study:
Specific Aim 2. 1 examines if the addition of pain education to an exercise program for AT is more effective at reducing pain and disability than exercise alone using an randomized controlled trial (RCT) design;
Specific Aim 2. 2 determines which indicators of altered central processing are improved by the addition of pain education to an exercise intervention. The University of Iowa is a research-intensive university that facilitates my ability to obtain mentorship from leaders in the field of pain research, to collaborate with experts in clinical care and biostatistics, and to work within an academic medical center to facilitate recruitment and data collection. The short-term goals for the K99 phase of this career development award are two-fold: first, to obtain much-needed didactic coursework and experience in the evaluation of pain mechanisms; and second, is to obtain training in the design and conduct of a high quality RCT using an educational intervention in combination with exercise to treat chronic tendinopathy pain. To achieve these goals I have identified 4 key objectives: 1) Gain greater knowledge about the neurobiology of pain mechanisms; 2) Gain experience in the conduct and design of an RCT; 3) Learn about psychological factors that contribute to pain & develop a pain education intervention; and 4) Learn about and participate in statistical analysis of RCT data. The long-term goal for the R00 phase is to implement the RCT techniques learned during the K99 phase. Thus, this career development plan is designed to help me succeed in my career goal as a tenure-track professor in a top-ranked, research-intensive institution. Ultimately, I would like to perform research that can improve clinical care of individuals with chronic musculoskeletal pain, to translate this research to clinical practice, and to train future clinician-scientists.
The standard of care for chronic tendinopathy primarily targets a localized area of tendon pain, but this strategy is ineffective for up to 40% of patients with chronic Achilles tendinopathy. This career development award trains a clinician-scientist to translate the latest research in pain mechanisms to revolutionize the current standard of care for tendinopathy. We propose a more global approach by evaluating and treating alterations in how the central nervous system processes chronic tendinopathy pain.
