Burel R. Goodin, Ph.D. - US grants

Project Summary/Abstract Chronic pain affects more than 100 million people in the United States and produces annual costs up to $635 billion. While pain affects all segments of the population, the burden of chronic pain and associated disability disproportionately affects non-Hispanic Blacks (?Blacks?) compared to non-Hispanic Whites (?Whites?) as well as individuals with low socioeconomic status (SES) compared to those with high SES. Blacks often experience more frequent, severe and disabling chronic pain compared to Whites. Further, SES factors, such as lower levels of education, low income, and unemployment are associated with higher rates of chronic and disabling pain. Despite growing documentation of racial differences in chronic pain outcomes, relatively little research has focused on differences in the experience of chronic low back pain (cLBP) between Blacks and Whites in a socioeconomic context. This is concerning because cLBP is one of the most prevalent and severely disabling painful conditions, yet it remains unclear whether specific disadvantaged subgroups of society such as Blacks with low SES may be at heightened risk for poor cLBP outcomes. The proposed hypotheses are based on the theory of fundamental causes as a socioeconomic framework for explaining why cLBP severity and disability, as well as the factors predicting these outcomes, may differ as a function of racial background. Guided by the theory of fundamental causes, the overall aim of this study is to characterize racial and SES differences in cLBP severity and disability. Further, we aim to examine important biopsychosocial predictors of racial and SES differences in cLBP outcomes. To explore this overall aim, we will first characterize racial and SES differences in cLBP clinical symptoms, perceived disability, and functional performance. Next, we will invoke endogenous pain inhibitory and facilitatory processes using quantitative sensory tests of conditioned pain modulation and temporal summation, respectively. Biologically-driven factors including sleep, vitamin D, oxytocin, and C-reactive protein, in addition to psychosocial factors including depressive symptoms, racial discrimination, perceived injustice, access to social support, and psychological resilience will then be assessed. We will determine whether endogenous pain modulatory processes, as well as important biopsychosocial factors differentially predict cLBP outcomes for Blacks and Whites, and whether the strength of prediction varies according to SES. This study will be the first to directly and comprehensively apply a socioeconomic framework to the study of racial differences in cLBP outcomes. The findings will also provide novel and important information regarding biopsychosocial predictors of racial and SES differences in clinical pain responses and related disability among those with cLBP. Whether these biopsychosocial predictors may subsequently serve as viable treatment targets for cLBP tailored to meet the specific needs of disadvantaged population subgroups can then be addressed in future research.

Project Summary/Abstract Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both, despite adequate opportunity for sleep attainment. As a result, people with insomnia may get too little sleep and/or have poor sleep quality. Insomnia is a common and debilitating sleep disorder in persons living with HIV (PLWH), with prevalence estimates ranging from 30-73%. Insomnia is increasingly viewed as a risk factor for the onset and/or worsening of pain symptoms and physical functioning deficits. Insomnia has been found to promote enhanced pain sensitivity (also known as hyperalgesia), which is critical to the etiology of pain in everyday life. This is particularly relevant for PLWH because recent evidence attests to the fact that pain symptoms are quite prevalent in the daily lives of PLWH. Whether insomnia is a risk factor for the experience of pain and poor physical functioning in PLWH is a topic that has received minimal attention to date; therefore, additional research is needed. Inflammatory processes represent an important biologic mechanism linking insomnia to pain and physical function. Insomnia promotes systemic inflammation as well as inflammatory reactivity to physical stressors like pain. Research conducted with non-HIV samples has shown that inflammation can substantially increase sensitivity to painful stimuli in the laboratory setting, as well as exacerbate pain symptoms in everyday life and physical disability. Taken together, insomnia may drive pain and physical function in PLWH through the proliferation of inflammatory mediators. There is currently a need to elucidate mechanisms and mediators of sleep disorders in PLWH, and the consequences and influences of these disturbances on other HIV-related comorbidities. Accordingly, the overall objective of this proposal is to investigate the impact of insomnia on pain, physical function, and inflammation in PLWH. We will accomplish our overall objective by addressing the following specific aims: 1) determine whether insomnia promotes increased experimental pain sensitivity and exaggerated inflammatory reactivity to painful stimuli in PLWH, and 2) determine if fluctuations in insomnia burden over time drive inflammation and pain in everyday life, and physical functioning among PLWH. These aims will be addressed using study methods developed and rigorously refined by our research team, and which have previously yielded promising preliminary results suggesting that insomnia may indeed promote pain and inflammation in PLWH. This approach is innovative because the impact of insomnia on pain and pain-related inflammatory processes has never before been directly examined in PLWH. Furthermore, the incorporation of objective as well as subjective measures of sleep and physical function, experimental pain testing, and a wide array of pro- and anti-inflammatory biomarkers also contributes to the innovation of this proposal. The proposed research will be significant because, if our hypotheses are confirmed, we will identify: 1) insomnia as a major driver of pain and physical functioning in the laboratory and in everyday life among PLWH, and 2) inflammation as an important insomnia-related mediator of pain in PLWH.

Project Summary/Abstract This administrative supplement, in response to PA-18-906: ?Research Supplements to Promote Diversity in Health-Related Research (Admin Supp ? Clinical Trial Not Allowed)?, will expand the parent project (R01HL147603, PI-Burel R. Goodin), and provide research and career development support for Dr. Shameka L. Cody, a tenure track junior faculty member at The University of Alabama Capstone College of Nursing in Tuscaloosa, AL. Numerous reports of co-occurring symptoms such as poor sleep quality and pain exist among people living with HIV (PLWH) which can negatively impact quality of life. Insomnia, which is characterized by difficulty falling asleep, staying asleep or both, has been reported among 70% of PLWH compared to less than 35% of the general population. Similar to insomnia, over half of PLWH are likely to experience recurring pain symptoms. Pain is a growing concern for PLWH and has been associated with poor sleep quality. Laboratory- based studies have shown that sleep deprivation is associated with increased inflammatory effects, and these same inflammatory effects are associated with increased pain sensitivity. The parent grant for this Diversity Supplement has been designed to examine the impact of insomnia on pain and pain-related inflammatory processes in PLWH. Substance use is another mechanism by which insomnia may promote pain and inflammatory effects in PLWH. Nearly 50% of PLWH report current or past histories of drug or alcohol disorders. Substance use is associated with increased systematic inflammation, and in PLWH, these effects may be more profound and hasten disease progression. Exploring the impact of insomnia on pain and pain-related inflammatory processes in substance users with HIV will enhance the parent study, and represents an innovative training opportunity for a junior faculty. The scientific goals of the supplement are to: (1) augment the parent study with recruitment of PLWH and substance use, (2) examine whether the impact of insomnia on pain and pain-related processes differ by HIV+ substance users, (3) identify the interaction of substance use and insomnia in predicting increased pain sensitivity and elevated inflammatory biomarker levels (i.e., IL-6, TNF-?, and C- reactive protein). This supplement also has three career development goals for Dr. Cody, a promising junior faculty with a background in Nursing, HIV and aging, and sleep quality: (1) acquire expertise in clinical and translational research training in Sleep Medicine; (2) advance her knowledge of poor sleep quality in PLWH and its effects with substance use on quality of life determinants; (3) learn how to build multidisciplinary research teams, present at national and international conferences, develop first-author peer-reviewed manuscripts, and develop a competitive proposal for an early-career investigator R01.