Examining Interoceptive Awareness as a Mechanism of Change in Yoga for Chronic Low Back Pain

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PROJECT SUMMARY Chronic pain is a major public health concern and among the most common reasons adults seek medical care in the United States. Chronic pain is a complex biopsychosocial process modulated by psychological factors, including the perception, appraisal, and emotional processing of sensations. Chronic low back pain (CLBP) is increasingly common and is associated with poor physical and mental health. Pharmacological approaches are relatively ineffective for long term pain treatment and have high addictive and abuse potential. Given the myriad economic, psychological, and social costs associated with CLBP, mind-body therapies (MBTs) such as yoga have received growing attention and empirical support for its treatment. Still, less is known about how yoga improves pain outcomes for CLBP or how it compares to and whether it operates distinctly from other physical activity interventions commonly used to treat CLBP. One hypothesized mechanism of MBTs for improving chronic pain is through improvements in interoceptive awareness, or the awareness of one’s internal bodily sensations. To date research has not examined the mechanistic role of interoceptive awareness in MBTs for CLBP. Thus, building on an ongoing NCCIH-funded randomized controlled trial (RCT) comparing 12-week yoga and physical activity interventions for CLBP, the proposed predoctoral study aims to 1) test whether a yoga intervention results in greater changes in interoceptive awareness compared to physical activity; and 2) determine whether changes in interoceptive awareness account for the clinical benefit of yoga for individuals with CLBP as assessed by multiple measures of pain. This predoctoral study capitalizes on an ongoing clinical trial and adds a unique and important contribution by assessing participants’ interoceptive awareness at baseline, mid-treatment (6-weeks), and post-treatment (12-weeks). The proposed project will test the mechanistic role of interoceptive awareness on improvements in both self-report (i.e., pain severity and interference) and objective (i.e., pain sensitization) assessments of chronic pain. This research project will directly address three of NCCIH’s top research priorities by elucidating the mechanistic role of interoception in mind and body treatments for pain. If the mechanistic role of interoceptive awareness in yoga is supported, non-pharmacological mind-body pain therapies can be further optimized for enhanced effectiveness in relieving CLBP. The fellowship’s training aims align closely with the goals for the proposed research project. The individualized training plan will provide the applicant with specialized training in interoception, RCT methodology, MBTs, biostatistics, and professional development for a research career in behavioral medicine. The training plan will leverage existing resources available at the applicant’s primary institution, the University of Connecticut, with collaboration and mentorship from leading experts across the nation.