Yoga for Persistent Post-Surgical Pain

PROJECT SUMMARY This K01 career development award will position the candidate to become an independent translational re- searcher studying mind-body movement therapies (MBMT) for chronic pain conditions linked to chronic inflam- mation, beginning with persistent post-surgical pain (PPSP) as a model. BACKGROUND. Incidence of PPSP varies according to surgical type, with clinically meaningful pain developing in roughly 30% of patients. PPSP has physiological, cognitive, and emotional effects and is associated with reduced quality of life. Within the do- main of chronic pain, PPSP is a unique pathological entity that combines nerve injury and inflammatory pro- cesses. PPSP involves peripheral surgical injury of skin, connective tissue, and myofascial-associated tissues, as well as peripheral and central pain sensitization. A growing body of research supports the benefit of MBMT, such as yoga, in treating chronic pain conditions; however, little attention has been devoted specifically to spe- cific needs of individuals with PPSP. This K01 proposes a pilot translational RCT of yoga for PPSP with two research Aims. AIM 1: To design and conduct a pilot feasibility RCT of yoga in individuals with PPSP. This aim contains three specific sections: Aim 1a will adapt a validated yoga program to individuals with PPSP. Aim 1b will assess recruitment, retention, adherence, and acceptability. Aim 1c will assess feasibility of collecting bio- logical and clinical outcomes of PPSP. Exploratory AIM 2: To explore the longitudinal relationship between yoga or an education control group on changes in PPSP-related inflammatory markers and other known psy- chophysical and psychosocial modulators of PPSP. TRAINING. The candidate will achieve a well-defined set of training goals leveraging a resource-rich institutional environment and a cohesive training plan to develop and acquire expertise in: (1) the biological basis of PPSP, (2) the design and conduct of translational clinical trials, and (3) longitudinal analytic experience for translational research. In addition to ongoing mentorship meetings and experiential training through the research plan, the candidate will complete targeted coursework, didactic training and clinical shadowing, present at conferences, and publish in peer-reviewed journals. MEN- TORSHIP. The candidate will be supported by an interdisciplinary mentoring team with requisite expertise in: developing and delivering MBMT interventions for pain conditions, quantitative assessment of pain, analysis of multiple mediators of inflammation, and assessment of patient-centered outcomes relevant to chronic pain con- ditions, and academic career development. The team includes: Drs. Peter Wayne and Kristin Schreiber (co- primary mentors) and Gloria Yeh, Pamela Rist, Robert Saper, Michael Irwin, and Karen Kilgore (co-mentors). IMPACT. The current K01 proposal aligns with NCCIH’s scientific objective to advance the fundamental sci- ence and methods development relevant to MBMT. This K01 will combine didactic, mentoring, and hands-on experience that will facilitate my transition to an independent clinical-translational scientist and lay the founda- tion for broadly studying the used of MBMT for managing and preventing chronic pain conditions.