Determining Mechanisms of Pain Reduction in Chronic Widespread Pain After Rapid Weight Loss in Non-Hispanic Black and Hispanic/Latino/a/x Adults

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Project Summary/Abstract Chronic widespread pain (CWP) is a chronic pain subtype that affects multiple body sites, and is strongly associated with poor function and disability. Although CWP is highly prevalent in adults with obesity, CWP outcomes are disproportionately worse in non-Hispanic Black (NH Black) and Hispanic/Latino/a/x adults. Thus, the obesity-related health disparity in CWP could augment existing racial and ethnic pain disparities in these populations. Bariatric surgery is often prescribed to treat obesity and musculoskeletal pain comorbidities. However, there is significant variability in weight loss and pain trajectories after bariatric surgery. Moreover, many patients experience recurrent or unresolved pain after bariatric surgery that can inhibit weight loss or facilitate weight regain. There are critical gaps in our knowledge of the primary driver(s) of CWP outcomes and how driver(s) of CWP respond to weight loss, particularly in racial and ethnically diverse groups. As such, the main objective of the proposed mentored project for the Mentored Patient-Oriented Research Career Development Award (K23) is to fill these knowledge gaps by: 1) comprehensively characterizing pain at rest and movement- evoked pain (MEP) in NH Black and Hispanic/Latino/a/x adults after bariatric surgery, and 2) identifying potential key driver(s) of intra-group variability in the resolution or maintenance of pain after bariatric surgery. We will focus on pain sensitivity, joint motion and mechanical loading biosignatures, and psychosocial factors. The aims proposed in this K23 application feature highly innovative methods that synergize mechanism-based pain phenotyping with obesity and health disparities research approaches. The methodologies employed represent a substantive departure from static, self-reported pain assessment to the integration of rigorous assessment and measurement multiple dimensions of pain at rest and MEP using precise quantification of nociceptive processing and joint motion and loading biosignatures in ethnically diverse populations. For the K23, I have assembled a strong interdisciplinary and multicultural cadre of highly successful clinical, basic, and translational scientists who have a strong and demonstrable commitment to the successful implementation and completion of my career development plan and research project milestones. The primary training goals that are the linchpin of my research training and career development are: 1) developing expertise in the integration of weight loss and lifestyle change evaluations with pain phenotyping data, 2) to develop and implement clinical trial designs that identify and address pain disparities, and 3) to enhance training in advanced statistical methods to inform clinical trial design to examine pain disparities. New York University (NYU) and the University of Florida are very strong incubators of pain, obesity, and rehabilitation research. Furthermore, these institutions are robust research environments that have the resources available to me to build on my previous training to foster independence in research that is focused on improving pain management in racially and ethnically diverse adults with obesity.