Efficacy and Mechanistic Testing of a Self-Management Intervention for Managing Chronic Pain with Cancer Survivors

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PROJECT SUMMARY/ABSTRACT The proposed K23 award supports the career development of Dr. Linda Eaton into a successful nurse scientist capable of leading multidisciplinary teams in advancing symptom science. Her long-term goal is to improve patient outcomes by developing effective symptom self-management approaches and to understand the biological and psychological mechanisms for these interventions. The initial step is to establish the efficacy of a recorded hypnosis intervention (RHI) for chronic pain reduction. This K23 proposal supports this goal by providing Dr. Eaton with training in (1) team science, (2) biomarkers that predict response to pain management approaches, and (3) further research skills, including mediator-moderator analysis, to evaluate interventions. Dr. Eaton’s primary mentor, Dr. Ardith Doorenbos (nursing), and co-mentors, Dr. Margaret Heitkemper (nursing), and Dr. Mark P. Jensen (rehabilitation), provide expertise in symptom science, team science, biomarker research, and use of hypnosis for pain reduction. The proposed research addresses a critical need to develop safe and effective pain management strategies. Chronic pain affects more than a third of the nearly 16 million cancer survivors in the U.S. Symptom self-management interventions – such as hypnosis – have demonstrated efficacy for many non-cancer chronic pain conditions, seldom have adverse effects, and may be an alternative or complementary approach to pharmacotherapy. However, because of its inconvenience and cost (e.g., the need for multiple appointments with an experienced clinician), hypnosis is rarely used for chronic pain management. The RHI offers an alternative delivery method with the potential to reduce pain with cancer survivors who have completed active treatment and no longer have evidence of disease. The mechanisms of this intervention need to be identified so it can be applied with precision for chronic pain management among cancer survivors. The scientific aims of this randomized control trial will (1) evaluate the efficacy of the RHI in reducing self-reported pain intensity (primary outcome), pain interference, anxiety, depression, fatigue and sleep disturbance (secondary outcomes) at 4 weeks compared to the attention control condition (music recording); (2) examine if psychological factors (hypnotic suggestibility, mental absorption, treatment outcome expectancy, and fear of cancer recurrence) moderate the relationship between RHI and pain intensity at weeks 0, 2, and 4; (3) compare brain states as measured by qEEG in cancer survivors receiving the RHI relative to the attention control condition at weeks 0, 2, and 4; and (4) explore the mediation effects of brain states (theta activity) on pain intensity at weeks 0, 2, and 4. Structured interviews will be conducted with participants to understand facilitators and barriers related to undergoing qEEG at three time points. Findings will be used to inform a larger scale R01. The focus of this proposal is consistent with the strategic plan of the National Institute of Nursing Research to advance symptom science and support the career development of the next generation of nurse scientists.