K12 Scholars

Pain Management Decision Making in Advanced Kidney Disease

Older adults with advanced chronic kidney disease (CKD, stages 4 and 5 and end-stage renal disease (ESRD)) often have chronic pain; however, chronic pain is difficult to treat in kidney disease due to changes in medication metabolism, limited medication options, and higher risk of medication adverse events. In addition, clinicians and patients often do not know how to approach complex pain management and make sure decisions reflect the patients’ priorities and personal tradeoffs. This proposed project will interview patients and clinicians to learn how they navigate these difficult conversations and survey patients on their preferences in pain management; the results of this study will inform the development of a decision support intervention to support clinicians and patients in these pain management conversations.

Impact of discrimination on pain management among adults with sickle cell disease

Pain is the hallmark symptom of sickle cell disease (SCD): adults with the disease experience acute and chronic pain that is often poorly managed, leading to disability, chronic opioid therapy, and compromised quality of life. To develop culturally adapted pain interventions and improve pain management, there is a critical need to better understand the influence of sociocultural factors on pain-related outcomes. The proposed project will examine the impact of multiple sources of discrimination on (1) psychological and behavioral factors, (2) pain severity and interference, and (3) treatment adherence and efficacy in this population.

STress REsponse Systems in Fatigue and Migraine Chronification (STREAM)

Fatigue is common in patients with chronic migraine but, the neurobiology of this relationship is not well understood. This project aims to identify changes in brain circuitry and stress responsivity that occur when pain becomes chronic, and fatigue develops. We hope this work advances the development of novel therapies that reduce the painful and non-painful symptoms of chronic migraine.

Response Inhibition in Opioid Use Disorder, Depression, and Chronic Pain

This application is aimed at investigating cognitive skills and symptom severity among individuals with cooccurring opioid addiction and depression as well as chronic pain. The ability to incorporate objective cognitive measures that may indicate increased symptom severity and relapse risk in this population is critical for future treatment studies, with a goal to assess cognitive skills to inform treatment implementation and improve outcomes for patients. Such research would move the field forward in offering personalized intervention approaches.

Longitudinal Assessment of Dry Needling Techniques in Individuals with Chronic Low Back Pain

Chronic low back pain (cLBP) affected approximately 619 million people globally in 2020, making it a leading cause of disability. While physical therapy (PT) is recommended by the World Health Organization, its precision in addressing cLBP is limited. Dry needling is a promising technique to treat cLBP due to its precision and effectiveness in pain management and health-related quality of life (HRQoL) improvements. This proposal aims to explore the impact of dry needling with and without percutaneous electrical nerve stimulation (PENS) on lumbar multifidus muscle activation, biopsychosocial factors, and long-term function and cortical activation in individuals with cLBP. The researcher's long-term goal is to become an independent researcher in rehabilitation research, focusing on chronic pain conditions to enhance patients' HRQoL and function through precise interventions.

Characterizing provider biases in physical therapy

Provider bias is a well-known problem that is particularly faced by Black Americans and women living with chronic musculoskeletal pain. Research on provider bias in medical care is well-documented; however, there is little understanding of provider bias presents in physical therapy, a key treatment for chronic musculoskeletal pain. The overarching goal of this project is to comprehensively evaluate racial and gender bias in physical therapy by surveying physical therapists and interviewing Black Americans with chronic musculoskeletal pain.

A Multicomponent Intervention for Patients with Lumbar Radiculopathy: Move- MORE

Lumbosacral radiculopathy (LR) is a spinal pathology that manifests as pain, weakness, and numbness in the lower extremity. Commonly referred to as “sciatica”, LR has a lifetime prevalence up to 43%, and can often become an intractable condition with long-term outcomes unimproved by conventional biomedical treatments such as surgery. Thus, we seek to develop a non-invasive and non-pharmacologic treatment for LR patients This study aims to 1) develop a multicomponent intervention that integrates Mindfulness-Oriented Recovery Enhancement and physical activity for patients with LR, 2) assess the feasibility and acceptability of this multicomponent intervention, and 3) evaluate preliminary efficacy of the intervention via self-report measures of pain, disability, kinesiophobia, and other psychosocial factors related to chronic pain. In addition, this study will use quantitative sensory testing (i.e., pressure and heat pain thresholds) as an objective measure of pain.