ORCID

0000-0002-3122-4483

Date of Award

6-25-2024

Author's School

Graduate School of Arts and Sciences

Author's Department

Psychology

Degree Name

Doctor of Philosophy (PhD)

Degree Type

Dissertation

Abstract

Chronic back pain impacts over 20 million adults in the United States and represents the costliest condition in our healthcare system. Treatments for chronic back pain range from cognitive-behavioral therapy to opioid pain medications and spine surgery. At present, it is extremely difficult to determine which treatments are likely to maximize benefit and minimize risk for a given patient. As such, the goal of this study was to examine whether individual differences in the cognitive-behavioral model of chronic back pain were associated with baseline characteristics or surgical outcomes. Patients (N = 95) with chronic back pain who were receiving spine surgery completed baseline self-report questionnaires and three weeks of mobile health monitoring, which included ecological momentary assessment and activity tracking. Multilevel dynamic structural equation models were used to examine individual differences in dynamic relationships among physical, emotional, and cognitive symptoms. Results indicated substantial between-person variability, such that no lagged relationships were statistically significant for > 28% of participants. Although there was evidence that many dynamic relationships between subjective experiences (i.e., pain and depressed mood) were weakly associated with symptom severity at baseline, they were not associated with surgical outcomes. However, dynamic relationships between activity and subsequent subjective reports emerged as larger and more robust predictors of postoperative improvement. Specifically, I observed greater postoperative improvements in pain interference among patients for whom increased activity was more strongly associated with subsequent pain interference (r = -.40, p < .001), pain severity (r = -.39, p < .001), and catastrophizing (r = -.36, p = .003) preoperatively. These findings suggest there is significant potential for dynamic relationships, particularly those involving objective monitoring, to be harnessed to develop and test precision interventions for chronic back pain.

Language

English (en)

Chair and Committee

Thomas Rodebaugh

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