Efficacy of Mind-Body Approaches for the Treatment of Chronic Pain with Psychological Comorbidity

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Chronic pain (CP), defined as persistent (>6 months), non-malignant, musculoskeletal or generalized pain, is a prevalent and costly public health problem. CP is highly prevalent among Veterans; 30-40% of Veterans have moderate to severe CP. CP has a significant negative impact on mental health and quality of life. CP is associated with declines in physical and social functioning, decreased activity levels, anxiety, negative mood, and depression. Approximately 1.6 million Veterans Health Administration (VHA) enrolled Veterans have CP and psychological distress associated with mental health comorbidities, including posttraumatic stress disorder (PTSD; ~50%), depression (~25%), and anxiety disorder(s) (~25%). Despite this urgent clinical need and extraordinary economic and societal costs, there are currently no evidence-based psychosocial interventions that simultaneously target comorbid mental health symptoms and CP interference in Veterans. The proposed CDA-2 will include a randomized controlled trial (RCT) to evaluate the efficacy of Cognitively-Based Compassion Training for Chronic Pain with Psychological Comorbidity (CBCT-CP+). The trial will compare CBCT-CP+ to Health Education while Living with Pain (H.E.L.P.) control condition, in a sample of 126 Veterans with CP conditions and psychological comorbidities at the VA San Diego Healthcare System (VASDHS). The rationale for the proposed study of compassion meditation for CP with psychological comorbidity is motivated by (1) a pressing clinical need, (2) a clear theoretical model, and (3) initial evidence of its safety, feasibility and potential positive clinical effect for improving psychiatric conditions among Veterans. This research is of direct relevance to multiple VA stakeholders (i.e., investigating the efficacy of complementary and integrative health approaches for the treatment of complex physical and mental health problems). Findings from the proposed RCT will inform clinical practice and policy by investigating whether a compassion-based intervention targeting both CP and psychological comorbidities will improve treatment outcomes for Veterans. The proposed CDA-2 will provide me with an important training opportunity to merge my primary research interests and areas of expertise (psychosocial interventions for chronic pain and related mental health conditions and complementary and integrative health approaches, including meditation). I will be mentored by leading experts who specialize in CP treatment and assessment, RCT design and implementation, complementary and integrative health approaches, particularly meditation, mechanisms of meditation-based pain relief, and biostatistics. The proposed work will be conducted within a leading VA research center (VASDHS) and world-renowned research institution (UCSD School of Medicine). The proposed trial will also allow me to obtain the necessary training for achievement of my long-term goal to become an independent researcher within VA. Scaffolded training and mentorship in RCT design and execution and biostatistics, advanced training in complementary and integrative health approaches, and professional development will help propel me to independence as a VA intervention research scientist. Finally, results of the trial will lay the groundwork for multi-site studies that would attempt to determine efficacy of CBCT-CP+ across VA clinics and formally investigate putative mechanisms of treatment effects. This work could ultimately lead to better care for Veterans, greater patient and therapist satisfaction, and lower costs to VA.