Co-design of a gamified, attention-based intervention for chronic pain and chronic dizziness

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Chronic pain, affecting almost 28 million UK adults (NICE,2021) and causing moderate-to-severe disability for almost 8 million of these (Fayaz et al, 2016), is a well-documented and well-studied public health concern. Chronic dizziness is less documented or studied, yet a UK population-based study found that 4% of all patients registered with a general practitioner experience chronic dizziness, and most are incapacitated by their symptoms (Nazareth et al, 1999).On the surface chronic pain and chronic dizziness may appear to be entirely distinct conditions. Yet, in both conditions the chronic symptoms are not well explained by injuries or damage to bodily tissue. Instead, new research indicates that a core brain-based mechanism underlies both conditions: somatosensory hypervigilance.Somatosensory hypervigilance is characterized by the tendency to pay heightened attention towards certain bodily sensations and being unable to disengage from those sensations. This can alter the way that these sensory signals are processed, meaning that innocuous sensory input is misinterpreted by the brain to indicate the presence of a threat (e.g., pain, dizziness) (Eccleston, 2015). Three decades of research on chronic pain, including by the Primary Supervisor, has shown that somatosensory hypervigilance towards painful and sub-painful sensation scan maintain and exacerbate chronic pain. This has been observed behaviorally and at the level of the brain. In support of theoretical models (Popkirov et al., 2018), new research conducted by the Secondary Supervisor similarly suggests that somatosensory hypervigilance (but towards sensations associated with balance rather than pain) may also underpin chronic dizziness. Finding that a similar mechanism underpins both conditions brings an exciting opportunity: drawing from established research on chronic pain could rapidly advance our understanding of chronic dizziness. Likewise, emerging research on chronic dizziness could bring undiscovered insights into chronic pain.The proposed project will leverage this opportunity by bringing together adults with chronic pain and adults with chronic dizziness to co-design a somatosensory hypervigilance intervention, with the aim of improving symptoms and quality of life across both conditions. The project will begin with the student interviewing patients with chronic pain and patients with chronic dizziness, and clinicians treating these conditions (physicians, psychologists, physiotherapists) to capture initial feedback on which intervention parameters are relevant and acceptable for both conditions. These findings will be used to inform a co-designed somatosensory hypervigilance intervention that will be piloted in two samples of adults with chronic pain (sample 1) or chronic dizziness (sample 2)and evaluated using a mixed-method approach. This project is in partnership with a health technology start-up company that has developed a prototype of the gamified, home-based somatosensory hypervigilance intervention that has shown promise in pilot studies of adults with chronic pain.