Modified Project Summary/Abstract Section This K23 award will support the candidate’s growth toward an independent clinical research career focused on developing and testing psychosocially-oriented mind-body interventions to improve the quality-of-life and treatment outcomes of chronic pain and postsurgical pain populations. Lumbar spine pain affects over 50 million individuals in the United States (US). The rate of spine surgeries performed in the US is the highest in the world. Yet, up to 40% of patients experience poor pain-related, functional, or quality of life outcomes after surgery. Despite the limited efficacy and high risks associated with long term opioid use, up to 50% of patients are prescribed opioids for up to 12 months following lumbar spine surgery. Nonpharmacological approaches addressing psychosocial risk factors for poor post-surgical outcomes are understudied and underutilized during postsurgical recovery. The proposed project aims to 1) adapt and refine a mindfulness-based intervention (MBI) for one-on-one telehealth delivery (live videoconference) to patients recovering from lumbar spine surgery by conducting a preliminary test of the MBI and collecting patient feedback using mixed methods; 2) conduct a two-arm pilot randomized controlled trial (RCT) of the postsurgical telehealth MBI vs. an education control to evaluate the feasibility and acceptability of the interventions and research procedures; and 3) summarize trajectories of pain-related outcomes (pain interference, opioid usage) and treatment targets (pain-related beliefs, mindfulness, psychophysical measures), within intervention groups and within key patient subgroups (levels of preoperative negative affect and opioid use status). The proposal targets career development in several areas: 1) developing and testing mind-body interventions utilizing mixed methods and longitudinal data collection and analysis; 2) randomized clinical trial design and methodology; 3) psychophysical testing of pain modulatory systems; 4) content knowledge in postoperative orthopaedic pain and opioid use; and 5) grant-writing skills. The candidate’s training goals will be achieved with the support of a multidisciplinary team of accomplished mentors and contributors, through targeted course work and seminars, culminating in completion of the proposed research project and dissemination of results. Training will take place in a resource-rich academic medical center with a top-performing surgical center and existing infrastructure for the prospective study of patients undergoing lumbar spine surgery. The findings will help tailor a telehealth MBI for an orthopaedic postsurgical population and provide preliminary data to optimize a well-powered RCT. This K23 award will promote the early career candidate in establishing an independent research program focused on optimizing telehealth mindfulness interventions in postsurgical and pain populations to inform the science and delivery of personalized pain management practices. The goals of this project are strongly aligned with NCCIH scientific priorities to address the widespread burden of chronic pain and the ongoing opioid epidemic.

PROJECT NARRATIVE The proposed study will address the significant and complex public health problems of postsurgical chronic pain and the opioid epidemic utilizing a biopsychosocial paradigm that is recommended but not yet well-integrated in orthopaedic surgical practice. Effective nonpharmacological treatment options that address pain and common psychosocial risk factors after spine surgery are needed but have not been tested and widely disseminated. The proposed study will adapt and refine a telehealth mindfulness-based intervention that addresses the unique pain concerns facing the large number of patients who undergo lumbar spine surgery and will provide important data on feasibility to inform the development of future trials investigating efficacy, mechanisms, and predictors of treatment response.