Toolkit for Optimal Pain Management in the Emergency Department: A mind-body intervention for pain catastrophizing and pain anxiety among individuals with chronic pain in the Emergency Department - PROJECT SUMMARY In this K23 proposal I detail a 5-year training plan that will launch my career as an independent investigator focused on developing and testing effective mind-body interventions to bolster pain coping and reduce pain catastrophizing among patients with chronic pain in the ED and other acute care settings. I propose an innovative and clinically meaningful research and training plan that is tied to my career development goals. Background: Chronic pain (i.e., pain that persists for >3 months) is highly prevalent, engenders a significant economic burden, and is challenging to treat. Chronic musculoskeletal pain (CMP) is among the most common reasons individuals seek medical care, and is a primary reason for Emergency Department (ED) visits. EDs are not well-suited to address the complex needs of patients with CMP, and current treatment approaches for CMP in the ED fail to address factors that motivate patients to seek emergency care for their pain. Interventions addressing the cognitive (e.g., catastrophizing), emotional (e.g., worry), and behavioral (e.g., repeated ED usage) aspects of CMP may be vital to reducing the burden of CMP in the ED. Specific aims: The goals of the current proposal are to develop, refine, and establish the feasibility of a novel mind-body intervention, Toolkit for Optimal Pain Management in the ED (TOPMED), aimed at decreasing pain catastrophizing and pain anxiety among patients with CMP who seek care in the ED. My aims are three-fold: 1) Adapt established Toolkit for Optimal Recovery mind-body skills to address CMP in the ED using qualitative interviews with patients with CMP seeking pain care in the ED (N=~20) and individual interviews with ED medical stakeholders (N=20); 2) refine TOPMED through an open pilot (N=10) with exit interviews (for feedback) and pre-post assessments (for initial feasibility and acceptability); 3) test TOPMED for feasibility and acceptability (N=50) through a pilot randomized clinical trial (RCT) of TOPMED compared to a minimally enhanced usual care control. Training: My research aims are supported by three training goals: 1) advanced qualitative methods for mind-body intervention development; 2) mixed methods approaches and intervention and protocol refinement (integrating exit interview qualitative data with pre-post assessment quantitative data); 3) conduct of RCTs within the ED. My multidisciplinary mentorship team is led by Dr. Ana-Maria Vranceanu, a clinical health psychologist and expert in developing and refining mind-body interventions for pain, and Drs. Jeffery Dusek and Christine Sieberg, clinical psychologists and experts in integrative health clinical trials and pain measurement and outcomes research, respectively. My training goals are supported by 1) committed, multidisciplinary mentors, 2) a rich institutional environment at Massachusetts General Hospital and Harvard Medical School (MGH/HMS), and 3) targeted coursework, seminars and workshops, scientific meetings, and experiential learning. My proposal is in line with the NCCIH priority of “Whole Person Health” approaches. Impact: I am a T32 postdoctoral fellow at MGH/HMS. The research and training activities proposed for this K23 will support my transition to an independent investigator role. The results of the proposed project will inform a future multisite feasibility R01 trial. TOPMED has the potential to be a feasible and effective solution to the management of chronic pain patients in ED settings, with important implications for patients, providers, and the larger healthcare system.
