Tailored Mobile Health Technology to Address Native American Chronic Pain - Project Summary/Abstract Chronic pain is a pervasive and debilitating condition that affects millions of Americans and Native American (NA) communities experience a significantly higher pain burden than other segments of the U.S. population. For example, our longitudinal research shows that 28% of pain-free NAs develop chronic pain within 5 years of follow-up, compared to 12% of non-Hispanic Whites. Our prior research has identified key predictors of chronic pain in NAs, including sensitized pain pathways linked to social determinants of health (eg, unfair treatment, trauma), stress, stress physiology (allostatic load), sleep disturbance, and cognitive-emotional amplifiers of pain (catastrophizing, pain-related anxiety). Psychological treatments for pain are efficacious, and tailored treatments are even more efficacious. But these treatments are often inaccessible to NAs due to geographic, financial, and social barriers. Mobile health (mHealth) interventions can provide effective pain self-management, overcome access barriers, and easily scale up given widespread use of smartphones among NAs. Yet, few validated mHealth pain interventions exist, and none are tailored for NAs. This proposal will develop and test the feasibility of the first mHealth chronic pain intervention specifically designed for NAs that integrates the psychological science of pain with Indigenous knowledge. Our team brings deep expertise in NA pain/health (Rhudy, Shadlow), psychological treatments for pain (Lumley), and mHealth app innovation (Businelle). Guided by a community- engaged framework, we will co-develop and test the intervention with input from NA team members, NAs living with chronic pain, NA community advisory board, NA community partners, and tribal IRBs to ensure cultural relevance and scientific integrity. In Aim 1, 2 talking circles (6 NAs experiencing chronic pain per circle) led by NA team members will co-create treatment content that is grounded in validated psychological approaches to pain management, with treatment targets informed by our 15 years of mechanistic pain research. A novel treatment component will be developed to enhance cultural connectedness (CC), a NA protective factor associated with resilience to stress and pain. In Aim 2, treatment content and app design will be optimized through 3 iterative usability studies (N=6 NAs living with chronic pain per study) to ensure engagement and cultural fit, as well as to reduce barriers to uptake and retention. In Aim 3 we will establish treatment feasibility through a single-arm trial (N=125 NAs living with chronic pain) with follow-up to 3 months post-treatment. This will evaluate recruitment, retention, engagement, acceptability, usability, quality, and preliminary signals of efficacy (ie, validated pain and functional measures). This innovative, precision-medicine intervention will be cost-effective and culturally-grounded and directly responds to PAR-25-379 by developing and testing the feasibility of a novel mHealth intervention for NA chronic pain that integrates Indigenous knowledge with psychological pain science. By targeting shared mechanisms across chronic conditions, such as stress and sleep disturbance, this intervention may also yield health benefits beyond pain.
