Determinants and effectiveness of non-pharmacologic pain interventions versus prescription opioids

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PROJECT SUMMARY I am a licensed occupational therapist and current PhD student in the Division of Rehabilitation Sciences at the University of Texas Medical Branch in Galveston, Texas. The purpose of this F31 proposal is to develop my knowledge, methodological proficiency, analytical skill, and research experience necessary to become a successful clinician-scientist. This proposal is important to achieve my long-term goals of obtaining a postdoc position, drafting a K99, and working in a Medical Rehabilitation Research Resource Network with the goal of using large data to improve equitable access to non-pharmacologic pain interventions. My F31 application focuses on comparing non-pharmacologic pain interventions, such as occupational and physical therapy, to prescription opioids for those experiencing surgical or chronic pain. My training as an occupational therapist has given me a strong understanding of multimodal pain interventions, care pathways, and disparities in healthcare access. My experiences as a researcher have provided foundational knowledge in using large data, studying behavioral interventions, and recognizing the importance of social determinants of health and public policy. During the F31 period, I will train in 2 areas that build upon my prior clinical and research experience: (1) Academic and Research training including: new data management and analytic methods, supplementary education on comparative effectiveness research, observational study design, social determinants of health and principles of clinical pharmacology; and (2) Professional Development training including: networking experiences at local and national conferences, improving scientific writing and verbal communication, and offering mentorship to occupational therapy students or PhD students. Training in these areas will make me a better researcher and will provide opportunities to use rigorous methods, effectively communicate findings, and translate research into practice via mentoring future health care providers. My training activities are integrated into a research project in which I use large data from the nationally representative Medical Expenditure Panel Survey (2011-2018) and Medicare claims (2015-2018) to complete the following aims: (A) Examine temporal changes—stratified by surgical and chronic pain--in the prevalence of prescription opioids compared to non- drug interventions, with emphasis on social determinants of health associated with better access to these services; and (B) Compare the effectiveness between prescription opioids versus occupational and physical therapy on measures of pain, mobility, and self-care in patients receiving home health. The expected findings of this research can identify disparities in access to pain interventions, which is important for our growing population of adults with chronic and disabling pain. The findings can also contribute to developing clinical practice guidelines for low-risk pain interventions. Completing the F31 training and research will provide me an opportunity to develop into a clinician-scientist using large data to facilitate equitable and effective care.