Applying a just-in-time adaptive intervention framework to understand and treat dynamic, symptom-maintaining stress among individuals with comorbid obesity and pain

Miriam Hospital, Providence RI

Investigators

Linked publications, trials & patents

Abstract

Chronic pain and obesity are costly, highly comorbid, and contribute to significant personal suffering. Chronic pain is the leading cause of disability world-wide and most expensive health condition in the U.S. Over 40% of U.S. adults have obesity, which increases risk of chronic pain and worsens chronic pain outcomes. Stress early in life is a significant risk factor for obesity and pain in adulthood and daily experiences of stress are robust momentary risk factors for activating obesity-maintaining behaviors (high fat/sugar food intake, inactivity) and pain states (pain intensity, interference with daily life). Thus, stress is a unifying and modifiable risk factor for comorbid obesity and pain. There is growing evidence that stress, obesity-maintaining behaviors, and pain states, and the relationships between them are dynamic— meaning that they vary across individuals and contexts and change over time. While evidence-based treatments for obesity, pain, and stress exist, they tend to only target one of these conditions at a time and overlook the dynamic nature of each of these treatment targets. Importantly, patients report desiring integrated, personalized treatments to support them during daily life. Just-in-time adaptive interventions (JITAIs) can address these unmet needs of individuals with comorbid obesity and pain. By leveraging smart phones and wearables to monitor individuals in daily life, the right type and amount of evidence-based support can be delivered in real time when people need it. To leverage the JITAI approach for targeting stress among those with comorbid obesity and pain, the critical first step is to identify which features and under what circumstances stress moves an individual into a period of high risk for experiencing pain symptoms and/or engaging in obesity-maintaining behaviors. This information guides other key features of the intervention---who needs intervention, when do they need it, and what type of intervention will best meet their needs in the moment. The goal of this STAR COBRE Research Project is to conduct formative intensive longitudinal data collection to guide design of a novel JITAI targeting stress to reduce obesity-maintaining behaviors and pain states. First, a community advisory board of adults with comorbid obesity/pain will be established to provide input on all aspects of the following research procedures. We will then recruit n=30 adults with obesity and pain to complete assessments at baseline and at 12-wks (including 7 days of ecological momentary assessment and actigraphy, REDCap surveys, and anthropometrics). Multilevel modeling will be used to identify which features of stress and context are the strongest predictors of obesity-maintaining behaviors and pain states. A repository of evidence-based strategies will be developed based on these predictors and translated into a format for momentary/digital delivery. By completion a blueprint of the JITAI and supporting technology will be finalized. This will position the new and early-stage investigator Dr. KayLoni Olson, PhD, to pursue R01-level funding for a micro-randomized trial testing the efficacy of the JITAI to address comorbidity of obesity and pain by targeting the critical role of stress processes