PREventing Pain after Surgery: A feasibility and acceptability study of Acceptance and Commitment Therapy for the prevention of chronic post surgical pain (PREPS)

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Summary/Abstract This proposal responds to NOT-AR-23-015 by both generating supportive evidence toward a future innovative study for the prevention of chronic postsurgical pain (CPSP) and expanding the current project by collecting data on immune mechanisms of pain and social determinants of health (SDoH) through a new collaboration. A large subset of patients who undergo spine surgery experience chronic post-surgical pain, a problem that is more prevalent among Black compared to White patients. This may be due, in part, to the interaction between SDoH and genetics. Differential DNA methylation (DNAm) is associated with chronic post- surgical pain as well as SDoH and thus may help to explain race differences chronic post-surgical pain. Moreover, there is evidence that mind-body interventions may confer benefit by modifying DNAm patterns. There is a need to better understand the role of DNAm in the development of CPSP and the extent to which it serves as a mechanism of Acceptance and Commitment Therapy on the prevention of CPSP. The present project will capitalize on a randomized, controlled trial of Acceptance and Commitment Therapy + treatment as usual compared to treatment as usual in 100 patients scheduled to undergo spine surgery. In this proposal we will determine the extent to which DNAm patterns are associated with SDoH, examine the relationship between DNAm patterns and CPSP, and explore the extent to which effects of Acceptance and Commitment Therapy are associated with changes in DNAm patterns. This approach will allow us to better understand the mechanism of CPSP including the complex interaction between SDoH and genetic processes. Moreover, we will further elucidate biological mechanisms of mind-body interventions such as Accetance and Commitment Therapy in the prevention of chronic pain. Together, results of this study will inform interventions aimed at reducing pain disparities and inequities.