DESCRIPTION (provided by applicant): Pain is the primary reason that people seek medical care. Unfortunately, under-treatment of pain is well- documented in cancer (Cohen et al, 2003; Deandrea et al., 2008) and other medical conditions (Boulanger et al., 2007; Hadjistavropoulos et al., 2006). While medication continues to be the first line of defense against pain, empirical support for the effectiveness of cognitive-behavioral pain management (CBPM) techniques continues to grow. Used alone or in conjunction with pharmacological treatment, CBPM techniques such as diaphragmatic breathing, progressive muscle relaxation, and guided imagery have been shown to significantly reduce both cancer- and non-cancer-related pain. Currently, however, a lack of cultural adaptation and provider training are barriers to the more wide-spread use of these treatments, especially in rural and tribal clinics that treat American Indians (AIs) and Alaska Natives (ANs). Research indicates that cultural appropriateness is important to the acceptability of cognitive behavioral interventions vis-a-vis minority patients. Therefore, this Fast-Track application proposes to create an internet-delivered, culturally- tailored multimedia training to teach empirically-supported CBPM techniques to providers serving rural communities and AI/ANs, so that these providers, in turn, can teach these techniques to their patients. The proposed product, PATINA (Pain Management Training in Native American Communities), is innovative in its web- and internet-based approach to training CBPM techniques, in its cultural specificity, and in its use of telehealth to conduct formative and evaluative research in rural hospital and tribal clinic settings. Primary customers will be rural healthcare providers and those treating AI/AN patients. Continuing education units will be awarded for completing the training. Combining the best features of books and classes, web-based training is low cost, convenient, and offers interactivity, feedback and practice opportunities. PUBLIC HEALTH RELEVANCE: Cognitive-behavioral pain management (CBPM) techniques are strongly endorsed by several national organizations as an important component of a comprehensive pain management approach. However, lack of access to provider training is a major barrier to their more wide-spread use, especially in rural areas and clinics that serve American Indians and Alaska Natives. This proposal seeks to improve public health by creating an internet-delivered, culturally-tailored multimedia training to teach CBPM techniques to providers serving rural areas and American Indians and Alaska Natives, so that these providers can teach these techniques to their patients.

7. Project Narrative/Relevance Cognitive-behavioral pain management (CBPM) techniques are strongly endorsed by several national organizations as an important component of a comprehensive pain management approach. However, lack of access to provider training is a major barrier to their more wide-spread use, especially in rural areas and clinics that serve American Indians and Alaska Natives. This proposal seeks to improve public health by creating an internet-delivered, culturally-tailored multimedia training to teach CBPM techniques to providers serving rural areas and American Indians and Alaska Natives, so that these providers can teach these techniques to their patients.