Modeling of inter-individual differences in chronic pain using holistic measures of pain SEveRity, strEss, cogNITion, bodY and mind awareness (SERENITY) - PROJECT SUMMARY In the U.S., 21% of the population suffers from chronic pain, with chronic low back pain (cLBP) being one of the most common, and chronic neuropathic pain affecting 69% of those with a spinal cord injury (SCI). The bi- opsychosocial chronic pain model points to additional variables accompanying chronic pain, e.g., pain interfer- ence on function, which is a clinically meaningful outcome. However, the between-subject heterogeneity of pain interference has not been identified. In addition, the correlational or the causal relationships between ho- listic variables accompanying chronic pain, and pain interference have not been investigated. Our premise is that without this information on person-specific holistic variables associated with or causing pain interference, treatment selection is unfocused, non-specific, and may limit effectiveness. Identifying person-specific varia- bles associated with or causing pain interference, using NIH HEAL core pain domains, is a critical next step toward enhancing pain treatment outcomes in personalized pain medicine. This study will quantify inter-individ- ual differences in SERENITY measures, i.e., pain SEveRity, strEss, cogNITion, bodY and mind awareness, affect, and agency (i.e., control over pain and life) at the individual level in relation to pain interference, by col- lecting and analyzing intensive longitudinal data (ILD) in adults with cLBP or SCI-related neuropathic pain. Our preliminary ILD collected through Ecological Momentary Assessment (EMA), for 3 weeks in 10 adults with cLBP and 34 adults with SCI-related neuropathic pain showed high between-person heterogeneity in correla- tional and causal relationships between SERENITY measures and pain interference. Our long-term goal is to use personal causal models from a person’s ILD to guide their chronic pain treatment plan. The primary ob- jective of this project is to characterize heterogeneity in adults with SCI-related neuropathic pain or cLBP, by quantifying inter-individual differences in SERENITY measures, associated or causality related to pain interfer- ence. We will recruit 200 adults with cLBP and 200 with SCI-related neuropathic pain who receive medication or manual therapy as pain treatment. and collect SERENITY measurements through EMA for 3 weeks, 4x/day. We will recruit at least 30% of adults with diverse race/ethnicity. Our multidisciplinary team will examine be- tween-subject heterogeneity in 3 different ways with these aims: (AIM 1) Test and quantify between-subject heterogeneity of SERENITY measures contributing to pain interference within each pain group (i.e., cLBP, SCI-neuropathic pain), (AIM 2) Characterize heterogeneity in pain interference within each pain group by clus- tering pain profiles and identifying key SERENITY measures that differentiate individuals between clusters in each pain group; and (AIM 3) Explore causal relationships between SERENITY measures and pain interfe- rence for each pain group, to identify interventions that target measures found to be causal. This research will guide future development of personalized interventions for chronic pain relief and its interference on function.
