Smith, Yang, Knisely and Colleagues Resubmit NIH R21 Multi PI Application

Kudos to Sophia Smith, associate professor; Eric Elbogen, professor (SoM); their co-investigators: Qing Yang, assistant professor; William Maixner, professor of anesthesiology (SoM); Mitchell Knisely, assistant professor and their entire team for the resubmission of their NIH R21 Multi-PI application entitled “Integrating Technological Approaches for Pain Management in Cancer Patients." This project requests funding for a two-year period with a start date of July 1, 2019.

Cancer survivors frequently suffer from severe chronic pain and co-occurring posttraumatic stress disorder (PTSD) symptoms resulting from curative therapies. Although it is critical to treat pain effectively in cancer survivors, pharmacological treatments present increased risk of opioid abuse and adverse clinical outcomes. To compound these challenges, cancer survivors with chronic pain and PTSD are also more vulnerable to negative outcomes associated with pain medication. While non-pharmacologic therapies such as cognitive behavioral therapy (CBT), neurofeedback, and other clinic-based treatments are effective in treating pain and PTSD, they are often unavailable or difficult for patients to access. Mobile health technology offers a platform for pain management that is cost-effective, accessible and reduce these barriers to care.

A growing body of evidence suggests that pain and PTSD symptoms in cancer survivors can be effectively managed via mobile technology. This project will be the first to test the efficacy of such interventions in cancer survivors with chronic pain and PTSD symptoms. Our research team has shown that: 1) a CBT-based mobile app (Cancer Distress Coach) reduces PTSD in cancer survivors; and, 2) a mobile neurofeedback app to regulate brain waves and facilitate a relaxed physiological state leads to reduced pain intensity in chronic pain patients.  The current R21 study combines the two into a single Integrated Pain Management (IPM) mobile app that offers a comprehensive approach to reducing pain and PTSD symptoms. We will develop and test the usability, feasibility, and initial effectiveness of IPM to reduce pain among cancer survivors. We will examine IPM usability among 10 breast and head and neck cancer survivors with moderate to severe chronic pain and PTSD symptoms. Data includes observation of participant use and feedback through interviews and surveys. 

We will then seek to determine feasibility of IPM using a randomized controlled trial among N=54 breast and head and neck cancer survivors who have completed active treatment and are living with chronic pain and PTSD symptoms. Intervention arm participants will be encouraged to use multiple CBT components and engage in mobile neurofeedback using IPM at least 4 times a week for 3 months.  Feasibility will be assessed by testing differences between intervention and control groups in measures of pain and PTSD symptoms administered at baseline (pre) and monthly (post) as well as by intervention arm usage collected within IPM.

Findings from this study have potential to improve pain and other clinical outcomes, such as PTSD symptoms, among cancer survivors using CBT and neurofeedback delivered via mobile technology. This study addresses one of the ten National Cancer Moonshot recommendations – symptom management – in a manner that reduces barriers to access, particularly among underserved populations.  In summary, IPM will offer a cost-effective self-management strategy for pain and PTSD symptom management, enhanced access to care, and reduced risk of side effects associated with traditional, pharmacological interventions.