Jennifer A Haythornthwaite, Professor
Johns Hopkins University W400 Wyman Park Building Baltimore, Md 212182680
Grant 3R21NS048593-02S1 from National Institute Of Neurological Disorders And Stroke IRG: ZRG1
Abstract: The proposed Johns Hopkins Center for Mind-Body Research (CMBR) will unite internationally recognized state-of-the-art expertise and a cross-disciplinary leadership structure to develop a strong, productive intellectual community for mind-body researchers. The themes for the CMBR include examining emotional and cognitive processes affecting health-related outcomes, psychobiological mechanisms linking these processes to health, the contribution of these processes to understanding health disparities, and interventions to change these processes. Our group is diverse and spread across three schools and two academic institutions in the Baltimore area. The proposed CMBR will bring together 35 faculty from 15 departments from medicine, dentistry, nursing, and public health. The proposed Center focuses on many health outcomes, consistent with current understanding that multiple emotional and cognitive processes are similar across diseases and have broad effects on health. Our current projects encompass a number of chronic illnesses, including asthma, cardiovascular disease, asthma, and rheumatoid arthritis, and health-related outcomes, including pain, fatigue, and disability. The CMBR will include Administrative/Planning, Training, and Measurement/Statistics Cores which will provide shared resources for conceptualizing, implementing, analyzing, and evaluating innovative research that integrates mental and physical dimensions of health. The Administrative Core includes a Project Development Program to facilitate collaborations both within and outside the CMBR. This Core will oversee the work of the Center and plan for Center growth and future collaborations. The Training Core will organize seminars, a Visiting Scholars program award Faculty Training stipends, and a Mentoring program. The Measurement and Statistics Core will provide innovative measurement and statistical technologies to CMBR faculty and trainees. We have generated strong institutional support for our developing Center by involving faculty from the highest level of the university in overseeing and advising the creation of this Center. The overall goals of the CMBR are to create a fertile intellectual community that facilitates productive cross-disciplinary collaborations in mind-body research and to apply innovative research methodologies to elucidate psychobiological mechanisms linking emotional and cognitive processes with health and illness and to foster the development and evaluation of mind-body interventions aimed at improving health.
Keywords: alternative medicine, behavioral medicine, education evaluation /planning, medical education, social psychology, attitude, health care personnel, mental health education, socioenvironment, behavioral /social science research tag, clinical research, human subject
Project start date: 2004-09-15
Project end date: 2007-08-31
3R21NS048593-02S1 (2006): $44272
Sponsored Links Excellgen http://Excellgen.com
Grants awarded to Jennifer A Haythornthwaite
BLOOD PRESSURE EFFECTS OF BEHAVIORAL STRESS / SODIUM LOADING
Jennifer A Haythornthwaite, Professor
Johns Hopkins University W400 Wyman Park Building Baltimore, Md 212182680
Grant 5M01RR000052-380402 from National Center For Research Resources
Abstract: This study examines the physiological and psychological factors associated with blood pressure elevations in normotensive adults. The long-term goal of this research is the development and refinement of preventative interventions for hypertension, either behavioral or dietary, that can be directed at those individuals who are most vulnerable to the synergistic blood pressure effects of behavioral stress and a high sodium intake. Medical students at Johns Hopkins University School of Medicine wore ambulatory blood pressure monitors during a lecture and during the examination while maintaining the high sodium and regular sodium intake. The stress of taking an examination was associated with a lowering of plasma potassium, an increase in plasma cortisol, and a tendency to increase plasma sodium. As expected, blood pressure and heart rate were elevated during the examination relative to the lecture period, but the magnitude of these elevations was not influenced by sodium intake. Timed urine samples were collected and the examination was associated with a reduction in urinary excretion rate, although both urinary cortisol and urinary norepinephrine tended to increase during the stressful examination. Urinary cortisol excretion during the examination was greater among the high sodium group, whereas urinary norepinephrine excretion tended to be lower in the high sodium group. Urinary sodium excretion data were used to identify subsets of individuals, including sodium retainers (48%; decreased urinary sodium excretion rate (Una) during the exam relative to the lecture) and sodium excreters (52%; increased Una). Sodium retainers showed higher sodium excretion rates during the control (lecture) conditions and lower sodium excretion rates during exposure to the stressor. These individuals also showed lower overnight sodium excretion before the stressful examination. Sodium retainers showed a tendency for greater blood pressure reactivity to the stressful examination, a tendency for higher levels of urinary norepinephrine excretion during the examination, and a tendency for higher resting levels of aldosterone collected 30 minutes before the exam. These findings suggest the importance of adrenocortical activation, particularly aldosterone stimulation, in response to behavioral challenges as a possible mediator of stress-related sodium retention.
Keywords: blood pressure, dietary sodium, psychological stressor, cardiovascular disorder prevention, cortisol, hypertension, neuroendocrine system, norepinephrine, behavioral /social science research tag, clinical research, human subject, nutrition related tag, urinalysis
Project start date: 1998-12-01
Project end date: 1999-11-30
Biobehavioral Interventions In Pain Management
Jennifer A Haythornthwaite, Professor
Johns Hopkins University W400 Wyman Park Building Baltimore, Md 212182680
Grant 5K24NS002225-05 from National Institute Of Neurological Disorders And Stroke IRG: NST
Abstract: This application for a MidCareer Investigator Award in Patient Oriented Research (K24) requests support for the candidate, who is an Associate Professor of Psychiatry and Behavioral Sciences and Director of the Behavioral Medicine Clinic, to integrate clinical trial research with the training of Junior and new clinical investigators interested in pursing patient oriented research on acute and chronic pain. The candidate has 15 years of experience conducting clinical research examining psychosocial factors that influence the experience of pain. Since joining the faculty at Johns Hopkins University, the candidate has mentored undergraduate students, postdoctoral fellows, and junior faculty in conducting, clinical pain research and contributed to the career development of junior faculty. The mentoring objectives for the K24 award include shifting the candidate s time from providing direct clinical services to providing training in clinical pain research, involving trainees and junior faculty in all aspects of the candidate s clinical research program, and attracting trainees and junior faculty to careers in clinical pain research. Through coursework and research, the K24 award will allow the candidate to refine her skills in conducting randomized, controlled clinical trials in pain management. The candidate will take courses focused on the application of multivariate analyses regression models and structural equation modeling to develop improved measures of outcome for use in pain clinical trials. These advanced statistical methods will be applied to existing databases and to databases created during, the execution of ongoing projects. The candidate s research plan includes a clinical trial to examine the separate and combined effects of opioids and cognitive behavioral therapy in treating neuropathic pain. As part of the plan, the candidate will work with multiple pain centers in developing structured protocols for measuring outcome, establishing opioid titration schedules, establishing methods for managing side effects, and developing a treatment manual for cognitive behavioral therapy for neuropathic pain. Once developed, these protocols will serve as the basis for a multi-center grant application for a clinical trial. Outcome measures will include pain, mood, function, and substance abuse. The longterm objective is to develop effective therapies, both alone and in combination, which reduce pain and improve function. A second goal of the candidate s research is to expand knowledge of outcome parameters for clinical pain research, including measures of pain intensity and global ratings of improvement, such that optimally sensitive and clinically relevant measures can be identified.
Keywords: cognitive behavior therapy, combination therapy, endogenous opioid, human therapy evaluation, neuropharmacology, pain, patient oriented research, psychopharmacology, clinical trial, cost effectiveness, emotional dependency, functional ability, longitudinal human study, outcomes research, pain threshold, patient care management, psychobiology, quality of life, social psychology, substance abuse related disorder, behavioral /social science research tag, human subject, placebo
Project start date: 2002-03-01
Project end date: 2008-02-28
5K24NS002225-05 (2006): $107240
5K24NS002225-04 (2005): $104526
5K24NS002225-03 (2004): $101906
5K24NS002225-02 (2003): $99373
1K24NS002225-01A1 (2002): $91180
Jennifer A Haythornthwaite, Professor
Johns Hopkins University W400 Wyman Park Building Baltimore, Md 212182680
Grant 5R21NS048593-03 from National Institute Of Neurological Disorders And Stroke IRG: ZRG1
Abstract: The proposed Johns Hopkins Center for Mind-Body Research (CMBR) will unite internationally recognized state-of-the-art expertise and a cross-disciplinary leadership structure to develop a strong, productive intellectual community for mind-body researchers. The themes for the CMBR include examining emotional and cognitive processes affecting health-related outcomes, psychobiological mechanisms linking these processes to health, the contribution of these processes to understanding health disparities, and interventions to change these processes. Our group is diverse and spread across three schools and two academic institutions in the Baltimore area. The proposed CMBR will bring together 35 faculty from 15 departments from medicine, dentistry, nursing, and public health. The proposed Center focuses on many health outcomes, consistent with current understanding that multiple emotional and cognitive processes are similar across diseases and have broad effects on health. Our current projects encompass a number of chronic illnesses, including asthma, cardiovascular disease, asthma, and rheumatoid arthritis, and health-related outcomes, including pain, fatigue, and disability. The CMBR will include Administrative/Planning, Training, and Measurement/Statistics Cores which will provide shared resources for conceptualizing, implementing, analyzing, and evaluating innovative research that integrates mental and physical dimensions of health. The Administrative Core includes a Project Development Program to facilitate collaborations both within and outside the CMBR. This Core will oversee the work of the Center and plan for Center growth and future collaborations. The Training Core will organize seminars, a Visiting Scholars program award Faculty Training stipends, and a Mentoring program. The Measurement and Statistics Core will provide innovative measurement and statistical technologies to CMBR faculty and trainees. We have generated strong institutional support for our developing Center by involving faculty from the highest level of the university in overseeing and advising the creation of this Center. The overall goals of the CMBR are to create a fertile intellectual community that facilitates productive cross-disciplinary collaborations in mind-body research and to apply innovative research methodologies to elucidate psychobiological mechanisms linking emotional and cognitive processes with health and illness and to foster the development and evaluation of mind-body interventions aimed at improving health.
Keywords: alternative medicine, behavioral medicine, education evaluation /planning, medical education, social psychology, attitude, health care personnel, mental health education, socioenvironment, behavioral /social science research tag, clinical research, human subject
Project start date: 2004-09-15
Project end date: 2008-08-31
5R21NS048593-03 (2006): $500637
5R21NS048593-02 (2005): $490500
Sponsored Links Excellgen http://Excellgen.com
1R21NS048593-01 (2004): $490500
Pain Management In Temporomandibular Joint Disorders
Jennifer A Haythornthwaite, Professor
Johns Hopkins University W400 Wyman Park Building Baltimore, Md 212182680
Grant 5R01DE013906-05 from National Institute Of Dental And Craniofacial Research IRG: ZRG1
Abstract: The primary goal of the proposed project is to test the efficacy of psychological interventions, a pharmacological intervention, and the combination of these interventions in reducing pain and improving function in persons with temporomandibular disorders (TMD). Since psychological interventions are costly and require expertise that is frequently unavailable in primary care settings, the proposed project will also examine the efficacy of a minimal contact/self help psychological intervention based on cognitive-behavioral therapy for pain management. In addition to examining the separate and combined effects of psychological and pharmacological interventions for TMD pain, the proposed study will examine whether the minimal contact cognitive-behavioral intervention can accomplish comparable reductions in pain and improvements in function relative to the therapist-administered treatment. Since patients with TMD pain show high utilization of health care services, this study will examine the cost-effectiveness of psychological and pharmacological treatments. The study will also examine whether individual patient characteristics, such as depression, predict response to treatment and whether treatment gains are maintained at 6-month follow-up. Persons with persistent facial pain due to TMD for 3 months or longer will be enrolled in this randomized controlled study which incorporates a 2 group (nortriptyline vs. active placebo - benztropine) by 3 group (cognitive-behavioral vs. minimal contact CBT vs. education and usual care) design. Following completion of the 8-week active phase of treatment, patients will enter a 6-month maintenance and follow-up period. Outcome measures will assess pain and physical and psychological functioning. Findings derived from this project will lead to further studies that determine which treatments, or combinations of treatments are effective for which subgroups of patients with TMD. Evaluation of a treatment approach combining commonly used psychological and pharmacological approaches promises to promote the development of truly effective pain management programs, contribute to the management of these individuals, and improve the quality of their lives.
Keywords: cognitive behavior therapy, combination therapy, human therapy evaluation, musculoskeletal disorder therapy, oral facial pain, patient care management, temporomandibular joint syndrome, benztropine, clinical trial, cost effectiveness, depression, health care cost /financing, health care service utilization, longitudinal human study, nortriptyline, outcomes research, psychotherapy, quality of life, self help, skeletal disorder chemotherapy, skeletal pharmacology, temporomandibular joint, behavioral /social science research tag, human subject, patient oriented research, placebo
Project start date: 2001-09-15
Project end date: 2007-08-31
5R01DE013906-05 (2005): $414643
5R01DE013906-04 (2004): $488597
5R01DE013906-03 (2003): $475488
5R01DE013906-02 (2002): $450504
1R01DE013906-01A1 (2001): $398915
3R01DE013906-01A1S1 (2001): $12263
Jennifer A Haythornthwaite, Professor
Johns Hopkins University W400 Wyman Park Building Baltimore, Md 212182680
Grant 1R24AT004641-01 from National Center For Complementary And Alternative Medicine IRG: ZRG1
Abstract: The Johns Hopkins Center for Mind-Body Research (CMBR) unites internationally recognized state-of-the- art expertise and a cross-disciplinary leadership structure to develop a strong, productive intellectual community of mind-body researchers. The CMBR brings together 34 faculty from 16 departments from the Schools of Medicine, Nursing, and Public Health. The scientific objectives for the CMBR are to understand emotional and cognitive processes affecting health and health-related outcomes, to identify the psychobiological mechanisms linking these processes to health outcomes, and to develop and evaluate innovative interventions to change these processes. The CMBR includes both Research Support Cores (Administration, Biostatistics, Biological Measures, Psychophysics, and Clinical Research Implementation) and a Developmental Infrastructure (Research Support and Education/Faculty Development) to support investigators research in accomplishing the Center s scientific objectives. During the first phase of our development, these broad objectives have been focused into three inter-related, overlapping, and multi- determined themes for which our Center has strong expertise negative emotions, sleep disturbance, and neurohormonal stress responses. To further organize our faculty and trainees to accomplish our goals, we have developed two disease/problem-based working groups one studying cardiovascular disease and the other studying pain. The Center provides shared resources for conceptualizing, implementing, analyzing, and evaluating innovative research that integrates mental and physical dimensions of health. We have generated strong institutional support for our Center through involvement of faculty from the highest levels within the university.
Project start date: 2007-09-30
Project end date: 2010-05-31
1R24AT004641-01 (2007): $991038
PSYCHOSOCIAL INTERVENTIONS FOR SCLERODERMA
Jennifer A Haythornthwaite, Professor
Psychiatry And Behavioral Sciencesjohns Hopkins University
w400 Wyman Park Building
baltimore, Md 212182680
Grant 5R01AR047219-02 from National Institute Of Arthritis And Musculoskeletal And Skin Diseases IRG: ZRG1
Abstract: Systemic sclerosis (scleroderma SSc) is a rare, disfiguring connective tissue disease characterized by inflammation vascular injury, and fibrosis. Despite the significant physical disability, pain, disfigurement, negative prognosis, and lack of a cure associated with SSc, no psychosocial interventions have been developed and tested to guide these individuals in managing the daily challenges of living with a chronic illness and improving the quality of their lives. The proposed research will examine the efficacy of two psychological interventions designed to target important areas of daily living pain, depression, and distress about disfigurement (Specific Aim #1). Individual differences in treatment outcome will be examined by determining whether clinical depression predicts the effects of professionally guide self-help materials (Specific Aim #2). Since psychological interventions requiring a trained professional can be costly and are often not available to the majority of patients, professional involvement in the proposed interventions will be minimal. Two hundred and one patients with systemic sclerosis who report symptoms of pain, depression, or distress about disfigurement will be recruited and randomized to one of three interventions individual cognitive-behavioral therapy, self-help cognitive-behavioral intervention facilitated by a Psychologist, or a disease/health education intervention. Measures of pain, functioning, distress about disfigurement, and mood will be collected at baseline and following the 8-week intervention period by an individual blind to intervention assignment. Both the cognitive-behavioral self-help materials and the educational materials (8 written chapters and audiotapes) will be designed for home use but will be supplemented by individual sessions (2) and telephone contacts (2) with the professional. Patients will be followed for one year after completing the active intervention phase (Specific Aim #3). It is hypothesized that the therapist administered CB intervention and the self-help CB intervention will result in greater declines in pain, depression, and distress about disfigurement both at the end of the active intervention and at one year follow-up as compared to the disease/health educational intervention. Depression is expected to reduce the efficacy of the CB self-help intervention. These findings will increase our understanding of the quality of life of individuals with scleroderma and determine whether self-help interventions can be used effectively to manage pain, depression, and distress about disfigurement
Keywords: human therapy evaluation, psychotherapy, scleroderma, social psychology cognitive behavior therapy, depression, health education, pain, quality of life, self help behavioral /social science research tag, clinical research, human subject
Project start date: 2000-08-01
Project end date: 2004-07-31
5R01AR047219-02 (2001): $317190
1R01AR047219-01 (2000): $318160
Sponsored Links Excellgen http://Excellgen.com
THE EFFECTS OF SOY PROTEIN SUPPLEMENTATION ON POST-THORACOTOMY PAIN
Jennifer A Haythornthwaite, Professor
Johns Hopkins University, 3400 N Charles St, Baltimore, Md 21218
Grant 5R21CA130279-02 from National Cancer Institute
Abstract: Preclinical studies indicate that soy-containing diets suppress the development of pain behaviors and hyperalgesia seen following nerve injury and recent data indicate a similar protective effect of a diet high in soy protein in inflammatory and bone cancer pain models. Very few studies have directly studied the effects of soy-containing diets on pain sensitivity in humans, but one recent randomized clinical trial suggests that dietary soy supplementation may reduce pain due to osteoarthritis. The proposed study will examine whether a soy protein supplement reduces the pain commonly experienced following thoracotomy for lung surgery. The growing recognition that greater acute pain leads to persistent pain following tissue healing underscores the importance of identifying viable strategies, including both non-pharmacological as well as pharmacological, for reducing the acute pain associated with surgery. Using a 2 group (soy protein supplementation vs. matched milk placebo supplementation) design, patients undergoing elective major open thoracotomy for lobectomy will be randomly assigned to one of these two treatment groups. Patients will begin taking the soy/placebo supplement 2-3 days prior to thoracotomy and continue daily consumption of the supplement for an additional 24 weeks. The feasibility/pilot study will examine the effects of soy supplementation on outcome measures during three post-operative time periods 1) the immediate post-operative period; and 2) during 2-12 weeks following surgery. Pain is the primary outcome domain of interest in this pilot study and measures will include pain severity ratings and pain medication use. Function and quality of life are the secondary outcome domains of interest and measures will include pain-related interference with daily activities, sleep, and health-related quality of life. Outcome measures will be collected bi-weekly throughout the study. The study aims to determine the feasibility and acceptability of soy supplementation in the period surrounding thoracotomy, determine level of adherence to soy supplementation over the 3-month period of follow-up, and estimate the effect size of soy supplementation relative to placebo in reducing significant pain following thoracotomy. The proposed study will provide the necessary groundwork to move towards such a larger randomized trial to evaluate the pain-reducing effects of soy protein supplementation following thoracotomy. This study will examine whether a supplement that contains soy protein reduces the pain patients experience following a thoracotomy, a common surgical procedure for lung tumors. Study participants will be randomized to take either a soy protein or milk protein supplement 2-3 days prior to and for 3 months following surgery. The effect of soy on pain and use of pain medications will be determined, as well as the acceptability of the supplement to patients under these conditions
Keywords: 3, 4-dihydro-3-(4- hydroxyphenyl)-(S)-2H-1-benzopyran-7-ol; 4`, 5, 7-Trihydroxyisoflavone; 4`, 7-Dihydroxyisoflavone; 5, 7-Dihydroxy-3-(4-hydroxyphenyl)-4H-1-benzopyran-4-one; Abscission; Absence of pain sensation; Absence of sensibility to pain; Ache; Active Follow-up; Acute; Acute Pain; Adherence; Adherence (attribute); Adverse effects; Analgesic Agents; Analgesic Drugs; Analgesic Preparation; Analgesics; Anodynes; Antinociceptive Agents; Antinociceptive Drugs; Area; Arthritis, Degenerative; Behavioral; Benign; Body Tissues; Burn injury; Burns; Cancer of Bone; Chronic; Chronic disabling pain; Clinical Trials; Clinical Trials, Unspecified; Collection; Complication; Consumption; Controlled Clinical Trials, Randomized; Data; Degenerative polyarthritis; Development; Diagnosis; Diaries; Diaries (PT); Diaries [Publication Type]; Diet; Dietary Soybean Proteins; Drops; Drugs; Excision; Excretory function; Extirpation; Feels no pain; Future; Genestein; Genistein; Genisteol; Goals; Healed; Health; Human; Human, General; Hyperalgesia; Hyperalgesic Sensations; Individual; Inflammatory; Intermediary Metabolism; Intervention; Intervention Strategies; Investigation; Literature; Lobectomy; Logistics; Lung; Lung Neoplasms; METBL; Malignant Bone Neoplasm; Malignant Osseous Neoplasm; Malignant Osseous Tumor; Malignant Tumor of the Bone; Man (Taxonomy); Man, Modern; Manuals; Measures; Medication; Metabolic Processes; Metabolism; Method LOINC Axis 6; Methodology; Milk; Milk Proteins; Modeling; Morbidity; Morbidity - disease rate; Movement; Multi-Institutional Clinical Trial; Multi-center clinical study; Multi-center clinical trial; Multi-site clinical study; Multi-site clinical trial; Narcotics; Neuropathy; No sensitivity to pain; Operation; Operative Procedures; Operative Surgical Procedures; Osseous Cancer; Osteoarthritis; Osteoarthrosis; Otomy; Outcome; Outcome Assessment (Health Care); Outcome Measure; Outcomes Assessment; PBO; Pain; Pain Control; Pain Therapy; Pain management; Pain, Postoperative; Painful; Participant; Patients; Persistent pain; Pharmaceutic Preparations; Pharmaceutical Preparations; Phase; Pilot Projects; Placebos; Post-Operative; Post-operative Pain; Postoperative; Postoperative Pain; Postoperative Period; Prevalence; Process; Proteins; Protocol; Protocols documentation; Protocols, Treatment; Prunetol; Pulmonary Neoplasms; QOL; Quality of life; RGM; Randomized; Randomized Clinical Trials; Randomized Controlled Clinical Trials; Recruitment Activity; Regimen; Relative; Relative (related person); Removal; Reporting; Research; Research Design; Respiratory System, Lung; SUBGP; Sample Size; Sampling; Segmental Mastectomy; Segmentectomy; Severities; Sham Treatment; Site; Sleep; Soy Proteins; Study Type; Subgroup; Supplementation; Surgical; Surgical Interventions; Surgical Procedure; Surgical Removal; Surgical incisions; TROTMY; Testing; Thoracotomy; Time; Tissues; Treatment Protocols; Treatment Regimen; Treatment Schedule; Treatment Side Effects; Trials, Randomized Clinical; Tumor of the Lung; Urinary System, Urine; Urine; analgesia; body movement; cancer pain; clinical efficacy; clinical investigation; cost; daidzein; degenerative joint disease; design; designing; diadzein; diaries; drug/agent; equol; excretion; experience; follow-up; gene product; healing; health related quality of life; human study; hyperalgia; hypertrophic arthritis; incision; incision of chest wall; incision of thorax; inflammatory neuropathic pain; innovate; innovation; innovative; interdisciplinary approach; interest; interventional strategy; multi center clinical study; multi center clinical trial; multi site clinical study; multi site clinical trial; nerve injury; neural injury; neuropathic; pain behavior; partial mastectomy; pilot study; pilot trial; pre-clinical; preclinical; preclinical study; prevent; preventing; primary outcome; protective effect; pulmonary; randomisation; randomization; randomized trial; randomly assigned; recruit; resection; secondary outcome; sham therapy; side effect; soy; study design; surgery; therapy adverse effect; treatment adverse effect; urinary
Project start date: 2008-05-01
Project end date: 2011-04-30
Budget start date: 1-MAY-2009
Budget end date: 30-APR-2010
PFA/PA: PA-06-510
5R21CA130279-02 (2009): $221400
BEHAVIORAL AND PHARMACOLOGIC MANAGEMENT OF PAIN IN SPINAL CORD INJURY
Jennifer A Haythornthwaite, Professor
Johns Hopkins University W400 Wyman Park Building Baltimore, Md 212182680
Grant 5P01HD033990-050003 from National Institute Of Child Health And Human Development
Abstract: Pain as a complication of spinal cord injury (SCI) has been identified as a primary determinant of quality of life. Although pain is a frequent complication of SCI, few studies have directly examined the effectiveness of various pain management interventions in this population. The primary goal of the proposed project is to improve the management of chronic pain in persons with SCI. Although all types of pain can occur in SCI, dysesthetic/deafferentation pain is the most common and disabling. The tricyclic antidepressant medications have been found to be most effective pharmacologic treatment for relieving deafferentation pain. Current research in chronic pain has demonstrated the importance of psychosocial factors, including cognition and emotions. Consequently, behavioral interventions have been successful in improving function and reducing disability and handicap. Multidisciplinary approaches utilizing combinations of treatment modalities, such as pharmacological and psychological interventions, are now recognized as the standard of care in chronic pain management. The proposed project will examine the efficacy of two primary interventions for managing chronic pain, nortriptyline or cognitive-behavioral treatment, and their combination in reducing SCI-related pain, disability, and handicap. In addition to comparing the relative effectiveness of medical and behavioral interventions, this project will examine whether individual patient characteristics, such as depression, predict responses to these treatments and whether treatment gains are maintained at 6-month follow- up. Persons with persistent pain for 6 months or longer following SCI will be enrolled in this randomized controlled study which incorporates a 2 group (nortriptyline versus placebo) by 2 group (cognitive-behavioral versus self-care eduction) design. After completing a baseline assessment, each patient will undergo 10 weeks of active treatment that will include weekly psychological intervention and daily use of medication. Following completion of the active phase of treatment, patients will enter a 6-month maintenance and follow-up period. Outcome measures will assess pain, physical and psychosocial function, use of medication for pain, and use of the health care system. Evaluation of a treatment approach combining commonly used psychological and pharmacological approaches promises to promote the development of truly effective programs. Findings derived from this project will lead to further studies that determine which treatments, or combinations of treatments, are effective for specific subgroups of SCI patients and other chronic pain populations. These results will advance the design of individual treatment programs and further improve treatment outcomes.
Keywords: analgesia, cognitive behavior therapy, combination therapy, human therapy evaluation, nervous system disorder chemotherapy, nortriptyline, pain, spinal cord injury, chronic disease /disorder, clinical trial phase II /III /IV, drug screening /evaluation, psychosocial rehabilitation, behavioral /social science research tag, clinical research, human subject, medical rehabilitation related tag
Project start date: 2000-08-01
Project end date: 2002-07-31
CLINICAL IMPLICATIONS OF PAIN PHENOTYPES IN SICKLE CELL DISEASE
Jennifer A Haythornthwaite
Johns Hopkins University, W400 Wyman Park Building, Baltimore, Md 21218
Grant 5R01HL098110-02 from National Heart, Lung, And Blood Institute
Abstract: In this proposal, our team of biobehavioral pain researchers joins with the Johns Hopkins Hospital team of adult SCD researchers to address the incredible challenge of pain management in SCD. Despite tremendous individual differences in clinical outcomes among patients with SCD and the clear widespread experience of almost daily pain, very little is currently known about pain phenotypes in SCD and how these phenotypes predict clinical outcomes. Our team seeks to demonstrate that individual differences in pain phenotypes occur in SCD, that inflammatory/immune responses to pain contribute to these phenotypes, and that these pain phenotypes predict important clinical outcomes in SCD. We propose two sequential studies Study 1 will characterize pain phenotypes using measures of mood, personality, and pain-related catastrophizing and measures of laboratory-based pain processing, including pain sensitivity and pain-evoked inflammatory/immune responses. In order to determine whether these pain phenotypes are specific to SCD, laboratory pain processing measures will be compared between African American adult SCD patients and a group of matched, healthy African American adults. In order to determine the clinical utility and predictive validity of the inflammatory/immune response elicited in the laboratory, level of inflammation and immune response during a vaso-occlusive crisis (VOC) requiring hospital care will be examined in the SCD patients. Study 2 will determine whether pain phenotypes prospectively predict clinical outcomes in SCD. Measures of clinical outcome will include average daily pain, frequency and severity of VOC, and unscheduled use of health care for pain management. Medical record data for participants in Study 2 who are admitted to the Johns Hopkins Hospital Sickle Cell Infusion Center for the management of VOC will be examined to determine opioid responsivity. The ability to identify standardized measures, such as pain sensitivity, pain-evoked inflammatory/immune responses, and psychosocial factors, that help explain patients´ clinical course, and especially their responses to opioid therapy, will have a dramatic effect on how health care providers approach pain management in these patients. Different people with sickle cell disease (SCD) have very different experiences of pain and respond differently to pain medications. Our project will use laboratory methods to study differences in pain sensitivity and determine whether these differences predict clinical outcomes, including the daily experience of SCD pain, the frequency and severity of vaso-occlusive crisis, and unscheduled use of health care for pain management. (End of )
Keywords: 21+ years old; 3-10C; AMCF-I; Accident and Emergency department; Acute; Address; Admission; Admission activity; Adult; Affect; African American; Afro American; Afroamerican; Age; American; Analgesic Agents; Analgesic Drugs; Analgesic Preparation; Analgesics; Anodynes; Antinociceptive Agents; Antinociceptive Drugs; Anxiety; B cell differentiation factor; B cell stimulating factor 2; B-Cell Differentiation Factor-2; B-Cell Stimulatory Factor-2; BCDF; BSF-2; BSF2; BSF2 (B cell stimulating factor 2); Black Populations; Black or African American; Body Tissues; CXCL8; Care, Health; Caring; Central Nervous System; Characteristics; Chronic; Clinical; Cohort Studies; Concurrent Studies; Contin, MS; Controlled Environment; Data; Diaries; Diaries (PT); Diaries [Publication Type]; Differentiation Factor, B-Cell; Dimensions; Drugs; Education; Educational aspects; Electronics; Emergency Department; Emergency room; Environment, Controlled; Euler-Gaddum Substance P; Female; Frequencies (time pattern); Frequency; GCP-1; GCP1; Goals; Guidelines; HOSP; HPGF; Hb SS disease; HbSS disease; Health Care Providers; Health Personnel; Healthcare; Healthcare Providers; Healthcare Systems; Healthcare worker; Hemoglobin S Disease; Hemoglobin sickle cell disease; Hemoglobin sickle cell disorder; Hepatocyte-Stimulating Factor; Home; Home environment; Hospitals; Hour; Human, Adult; Hybridoma Growth Factor; IFN-beta 2; IFNB2; IL-6; IL-8; IL6 Protein; IL8; IL8 gene; INFLM; Immune response; Individual; Individual Differences; Inflammation; Inflammatory; Infumorph; Infusion; Infusion procedures; Interleukin 6 (Interferon, Beta 2); Interleukin-6; Investigators; Ischemia; K60; Kadian; Knowledge; LECT; LUCT; LYNAP; Laboratories; Life Expectancy; MDNCF; MGI-2; MONAP; MSir; Matched Group; Measures; Medical; Medical Records; Medication; Methods; Monitor; Moods; Morphia; Morphinan-3, 6-diol, 7, 8-didehydro-4, 5-epoxy-17-methyl- (5alpha, 6alpha)-; Morphine; Myeloid Differentiation-Inducing Protein; NAF; Nervous System, CNS; Neuraxis; Nociception; Opioid; Oramorph; Oramorph SR; Organ; Outcome; PROV; Pain; Pain Control; Pain Therapy; Pain Threshold; Pain Tolerance Level; Pain management; Painful; Participant; Patient Self-Report; Patients; Personality; Pharmaceutic Preparations; Pharmaceutical Preparations; Phenotype; Phone; Plasmacytoma Growth Factor; Play; Process; Process Measure; Provider; Psychosocial Factor; QOL; Quality of life; Race; Racial Group; Reflex; Reflex action; Regimen; Reporting; Research Personnel; Researchers; Risk Factors; Role; Roxanol; SCYB8; SP(1-11); Self-Report; Severities; Sickle Cell; Sickle Cell Anemia; Statex SR; Stocks, Racial; Structure; Substance P; Systems, Health Care; TSG-1; Telephone; Testing; Tissues; Treatment Period; Trust; adult human (21+); analgesia; artificial environment; b-ENAP; base; biobehavior; biobehavioral; black American; chronic pain; chronic painful condition; diaries; diffuse noxious inhibitory control; disease phenotype; drepanocyte; drug/agent; experience; health care personnel; health care worker; health provider; healthcare personnel; host response; immunoresponse; indexing; inhibit pain; interest; interferon beta 2; medical personnel; neurokinin 1; nociceptive; pain inhibition; pain tolerance; prospective; psychosocial; psychosocial variables; race differences; racial difference; response; sex; sickle RBC; sickle cell disease; sickle disease; sickle erythrocyte; sickle red blood cell; sicklemia; social role; spinal reflex; standardize measure; treatment days; treatment duration; treatment provider
Relevance: Different people with sickle cell disease (SCD) have very different experiences of pain and respond differently to pain medications. Our project will use laboratory methods to study differences in pain sensitivity and determine whether these differences predict clinical outcomes, including the daily experience of SCD pain, the frequency and severity of vaso-occlusive crisis, and unscheduled use of health care for pain management
Project start date: 2009-09-20
Project end date: 2013-07-31
Budget start date: 28-AUG-2010
Budget end date: 31-JUL-2011
PFA/PA: RFA-HL-09-008
5R01HL098110-02 (2010): $457034
1R01HL098110-01 (2009): $488795
BLOOD PRESSURE EFECTS OF BEHAVIORAL STRESS AND SODIUM
Jennifer A Haythornthwaite, Professor
Psychiatry And Behavioral Sciencesjohns Hopkins University
w400 Wyman Park Building
baltimore, Md 212182680
Grant 5R29HL050548-02 from National Heart, Lung, And Blood Institute IRG: BEM
Abstract: High blood pressure is a major risk factor for cardiovascular and cerebrovascular disease. Evidence from the animal laboratory indicates that behavioral stress combined with a high sodium intake can have synergistic effects on tonic blood pressure levels and cause hypertension. Understanding the physiological mechanisms and identifying the psychological characteristics associated with this loss of regulatory control over blood pressure could lead to the development and refinement of effective preventative interventions for hypertension, either dietary or behavioral, that are directed at those individuals who are most vulnerable to the synergistic blood pressure effects of behavioral stress and high sodium intake. The first study will examine neuroendocrine and other regulatory responses (e.g., changes in plasma electrolytes) to high sodium intake administered during the period preceding a stressful event (NaCl x STRESS). Medical students will be administered supplemental sodium chloride (600 mg/4.5 kg/day) or placebo tablets using a double-blind method during the 14 days prior to an examination (High Stress) and during a period of low academic demands (Low Stress). Cardiovascular, neuroendocrine, and emotional variables will be measured at rest (High and Low Stress) and in response to the examination (High Stress only). It is expected that activation of the pituitary adrenocortical system will play a more important role in mediating the NaCl x STRESS blood pressure elevations than activation of the sympathetic nervous system and that larger cardiovascular, neuroendocrine, and emotional responses to the examination, suggesting greater stress, will be associated with larger NaCl x STRESS blood pressure responses. The second study will determine whether BP and neuroendocrine responses to laboratory stressors and personality factors, such as hostility and suppressed anger, are associated with a larger NaCl x STRESS BP response. Prior to the High Stress sodium loading period, cardiovascular and neuroendocrine responses to mental arithmetic, social challenge, and studying exam-related material will be measured. It is expected that suppressed anger and greater CV and neuroendocrine reactivity to laboratory stressors will be associated with larger NaCl x STRESS blood pressure responses. The third study will determine whether a concurrent high potassium intake reduces the blood pressure elevating effects of NaCl x STRESS. Subjects will be randomly assigned to receive potassium supplemental sodium chloride tablets. It is expected that the concurrent high potassium intake will blunt the NaCl x STRESS blood pressure response
Keywords: behavioral medicine, blood pressure, dietary sodium, neurogenic hypertension, stress angiotensin /renin /aldosterone hypertension, dietary potassium, emotion, neuroendocrine system, personality, psychological stressor blood chemistry, human subject, nutrition related tag
Project start date: 1993-09-01
Project end date: 1997-08-31
5R29HL050548-02 (1994): $145781
1R29HL050548-01 (1993): $108716
Sponsored Links Excellgen http://Excellgen.com
5R29HL050548-04 (1996): $100080
PSYCHOSOCIAL INTERVENTIONS FOR SCLERODERMA
Jennifer A Haythornthwaite, Professor
Johns Hopkins University W400 Wyman Park Building Baltimore, Md 212182680
Grant 5R01AR047219-04 from National Institute Of Arthritis And Musculoskeletal And Skin Diseases IRG: ZRG1
Abstract: adapted from investigator s ) Systemic sclerosis (scleroderma SSc) is a rare, disfiguring connective tissue disease characterized by inflammation vascular injury, and fibrosis. Despite the significant physical disability, pain, disfigurement, negative prognosis, and lack of a cure associated with SSc, no psychosocial interventions have been developed and tested to guide these individuals in managing the daily challenges of living with a chronic illness and improving the quality of their lives. The proposed research will examine the efficacy of two psychological interventions designed to target important areas of daily living pain, depression, and distress about disfigurement (Specific Aim #1). Individual differences in treatment outcome will be examined by determining whether clinical depression predicts the effects of professionally guide self-help materials (Specific Aim #2). Since psychological interventions requiring a trained professional can be costly and are often not available to the majority of patients, professional involvement in the proposed interventions will be minimal. Two hundred and one patients with systemic sclerosis who report symptoms of pain, depression, or distress about disfigurement will be recruited and randomized to one of three interventions individual cognitive-behavioral therapy, self-help cognitive-behavioral intervention facilitated by a Psychologist, or a disease/health education intervention. Measures of pain, functioning, distress about disfigurement, and mood will be collected at baseline and following the 8-week intervention period by an individual blind to intervention assignment. Both the cognitive-behavioral self-help materials and the educational materials (8 written chapters and audiotapes) will be designed for home use but will be supplemented by individual sessions (2) and telephone contacts (2) with the professional. Patients will be followed for one year after completing the active intervention phase (Specific Aim #3). It is hypothesized that the therapist administered CB intervention and the self-help CB intervention will result in greater declines in pain, depression, and distress about disfigurement both at the end of the active intervention and at one year follow-up as compared to the disease/health educational intervention. Depression is expected to reduce the efficacy of the CB self-help intervention. These findings will increase our understanding of the quality of life of individuals with scleroderma and determine whether self-help interventions can be used effectively to manage pain, depression, and distress about disfigurement.
Keywords: human therapy evaluation, psychotherapy, scleroderma, social psychology, cognitive behavior therapy, depression, health education, pain, quality of life, self help, behavioral /social science research tag, clinical research, human subject
Project start date: 2000-08-01
Project end date: 2005-07-31
5R01AR047219-04 (2003): $317190