Optimizing pain-related outcomes following orthopedic trauma: testing novel risk factors and determining the feasibility of a new pain psychology intervention

PROJECT SUMMARY
The long-term goal of this K23 Career Development Award is to prepare the PI (Rachel Aaron, PhD) for
an independent research career that aims to promote adaptive recovery for individuals who survive orthopedic
trauma. Orthopedic trauma, resulting in severe injuries such as multiple fractures or amputation, occurs in
around 3 million people annually in the United States; about half of survivors experience persistent pain and
psychological distress in the year following injury, and most report substantial disability 7 years post trauma.
There is an urgent need to identify factors that underlie pain and psychological distress following orthopedic
trauma and to develop targeted psychological interventions to treat these potentially disabling symptoms.
The broader literature suggests that difficulties with emotion regulation (i.e., identifying one's emotions
and engaging in strategies to up- or down-regulate them) and central sensitization (i.e., alterations in the
endogenous modulation of pain) lead to poor pain-related outcomes. Using a theory-driven assessment of
emotion regulation, and gold-standard, laboratory-based assessment of central sensitization (quantitative
sensory testing [QST]), Study 1 will examine emotion regulation difficulties and central sensitization at 6 weeks
post trauma as predictors of persistent pain, distress, and opioid use 6 months post trauma. Study 2 will test
the feasibility of assessing and delivering Emotional Awareness and Expression Therapy (EAET) to people
who endorse persistent pain (i.e., clinically significant pain, present most days for the past 3 months) at 6
months post trauma. EAET is a novel chronic pain psychology intervention that treats pain and distress by
targeting trauma-related emotion regulation process. Trauma exposure is ubiquitous among orthopedic trauma
survivors; thus, EAET may be ideally suited for those with persistent pain post trauma. However, the feasibility
of delivering EAET is unclear due to established barriers engaging this population in mental health treatment.
Proposed research and career development activities will take place at Johns Hopkins University
(JHU), a renowned research environment. JHU is dedicated to the success of its junior faculty and provides
unique access to orthopedic trauma patients. The PI has formed a strong team of content experts in central
sensitization (including QST), psychological intervention (including EAET), and orthopedic trauma. Immersed
in JHU's rich training environment, the PI will achieve the following career goals through dedicated mentorship,
didactic experiences, and professional development opportunities: (1) develop expertise in the assessment of
central sensitization, including QST; (2) gain foundational skills for intervention development, implementation,
and analysis; and (3) learn to lead impactful orthopedic trauma clinical research. The completion of this K23
proposal will provide the necessary training and preliminary data for the PI to obtain independent grant funding
and systematically pursue a line of research to improve outcomes for survivors of orthopedic trauma.

Grant Number: 5K23HD104934-04
NIH Institute/Center: NIH
Principal Investigator: Rachel Aaron