Harmonized Healing: Personalized Music Interventions to Address Chronic Pain in People Living with HIV - PROJECT SUMMARY: With increasingly efficacious strategies to treat HIV, the paradigm continues to shift to conceptualize HIV as a chronic disease. This has resulted in people with HIV (PWH) aging and developing chronic disease. Among HIV comorbidities, chronic pain is common and undertreated. This is a significant problem because untreated, chronic pain results in worsening psychiatric disease, increasing exacerbations of pain, and substance use. Additionally, persistent chronic pain among PWH results in disengagement with HIV care and worsening adherence to antiretroviral therapy (ART). Despite the ubiquity of chronic pain in PWH, treatment consisting of pharmacotherapy or psychotherapy is suboptimal. Pharmacotherapy options for chronic pain are limited and fail to address common psychological underpinnings of chronic pain in PWH while psychotherapy may be difficult to adhere to or access, especially among resourced limited settings where many aging PWH may seek care. In response to these extant challenges in addressing chronic pain among PWH, we propose the use of music as a biobehavioral intervention that addresses both psychological and biological aspects of pain. Grounded in the biopsychosocial model of pain and the NCCIH Whole Person Health model, our music-based intervention leverages preliminary data where we demonstrated that individuals with pain will use music to address catastrophizing, anxiety and other behavioral inputs of pain, and that listening to self-selected music induces changes that increase pain threshold and tolerance. Among a pilot cohort of PWH with chronic pain, we also demonstrated that listening to brief, 15-minute sessions of music induces significant improvements in negative affect and that PWH identify music as an acceptable strategy to help address their experience of pain. Based on this preliminary data, this proposal seeks to first develop a treatment manual to standardize the programming and delivery of an app that draws from streaming music services personalized by individual selection to create custom playlists surrounding key triggers of pain. Next, we will conduct a pilot randomized controlled trial to test the feasibility and acceptability of our music-based intervention among PWH with chronic pain. As part of this work, we will assess the feasibility of completing key study measures that assess the potential psychologic and mechanistic pathways addressed by music. The ultimate impact will be to advance a manualized music intervention that addresses pain in PWH as a feasible intervention in preparation for a multisite NCCIH R01 clinical trial.
