PROJECT SUMMARY
Chronic pain (CP), a highly prevalent, costly, and disabling biopsychosocial condition, is being increasingly
addressed with cognitive behavioral interventions such as Acceptance and Commitment Therapy (ACT) and
Cognitive Behavioral Therapy (CBT). Such interventions seek to maximize physical, social, and occupational
functioning by changing how one manages pain via addressing pain-related thoughts, beliefs, and behaviors.
The current CP literature is limited by the use of between-subject designs and self-report measures that lack
ecological validity and may be subject to bias. One component of function, physical activity, is able to be
objectively measured in an ecologically valid way using accelerometry. In fact, prior research has combined
accelerometry and pain ratings collected using ecological momentary assessment (EMA) to better reflect the
real-time, real-world relationship between pain and physical activity. Such research has indicated cross-
sectionally a dynamic within-person pain-physical activity relationship. We hypothesize that this dynamic
relationship is alterable by cognitive behavioral intervention and seek to examine this research question in
Veterans with CP, as they represent an underserved and apt population for CP research given
disproportionately high rates of this condition. In Aim 1, we model the relationship between EMA-assessed
pain and objective physical activity over a 7-day baseline period, within-person, using parallel latent growth
curve modelling (LGCM). We hypothesize that at baseline, the growth trajectories of pain and physical activity
will be related such that increases in pain will be associated with decreases in physical activity. In Aim 2, we
use multigroup analysis to examine if participation in a cognitive behavioral intervention alters the relationship
between the growth trajectories of EMA pain and objective physical activity. We hypothesize that, post-
intervention, the relationship between the growth trajectories of pain and physical activity will be significantly
altered compared to baseline. In our Exploratory Aim, we conduct follow-up interviews to qualitatively explore
how treatment impacts how individuals relate to their pain. Therefore, the proposed research will examine the
relationship between pain and physical activity and if and how it changes after cognitive behavioral
intervention. The use of structural equation modelling (i.e., LGCM) and qualitative methods will be combined to
portray a more complete picture of the experience of CP and treatment. Thus, findings from this study will
address existing limitations in the understanding and conceptualization of function in CP, provide information
on how to improve function in individuals with CP, and promote the improvement and refinement of cognitive
behavioral interventions for the treatment of CP. Importantly, this project will advance the applicant’s long-term
goal of becoming an independent clinical researcher committed to applying advanced technological and
statistical tools to the improvement of treatments for CP.
