Resilience Factors, Pain, and Physical Activity in Adolescent Chronic Musculoskeletal Pain

PROJECT SUMMARY AND ABSTRACT:
Chronic musculoskeletal pain (CMSKP) is common in adolescents. Participation in regular physical activity (PA)
is effective in reducing CMSKP but PA participation is still below recommended levels. There is a need to better
understand ways to better promote PA in adolescent CMSKP (e.g., decreasing sedentary activity vs. increasing
moderate to vigorous PA), factors that affect PA (e.g., resilience, pain modulation, stress dysregulation), and the
mechanistic underpinnings of how these factors affect PA and pain. This knowledge may lead to the development
of improved interventions for CMSKP. Psychological resilience factors that build on positive attributes, such as
self-efficacy, motivation, and psychological flexibility may help adolescents to engage in PA. While resilience
factors are important for overall pain coping, they only recently are being considered as predictors for PA. The
overall goal of this proposal is to develop and pilot a feasibility study of an intervention that increases resilience
for PA in adolescents with CMSKP. This is significant because the development of such an intervention may
lead to improved PA and subsequently improved chronic pain for adolescents with CMSKP. This study first
evaluates pathways of resilience factors on PA and pain in adolescents with CMSKP (Aim 1), and the modulation
of pain and stress. 60 adolescents with CMSKP will complete self-report measures of resilience and vulnerability
factors, and objectively measured PA, pain (Quantitative Sensory Testing), and stress (Cortisol Awaking
Response). We will evaluate whether endogenous pain modulation and stress regulation mediate the
relationships between resilience and PA. This study also will consider resilience factors that are significant in
predicting less sedentary PA as intervention targets, and it will develop, refine (Aim 2) and (Aim 3) conduct a
pilot feasibility and acceptability study of a resilience-focused chronic pain intervention for youth (Pain REsilience
Promotion for Youth [PREP-Y]). The manual will be developed based on an established treatment program for
adolescent CMSKP in adolescents (i.e., FIT Teens) and modified to target resilience mechanisms and sedentary
activity. This will be done with integrated feedback from content experts in pediatric pain and CMSKP patients.
The intervention will then be provided to 30 patients in groups of 4 to 6. This project will be implemented as part
of a strong career development plan consisting coursework, experiential training, and intensive mentorship from
a team of experts in pediatric behavioral intervention development and evaluation, psychological factors of
pediatric pain, physical activity intervention, and pain physiology and assessment. Completion of this study will
occur across two academic medical centers with a joint department of pediatrics, a well-establish pain treatment
service, and research institutes to promote the growth and development of research faculty. This study and
career development plan will promote the establishment of independent, extramurally funded clinical-research
program focused on improving clinically meaningful outcomes for adolescents CMSKP.

Grant Number: 5K23AR078337-06
NIH Institute/Center: NIH
Principal Investigator: William Black