Social & Behavioral Rhythms in Chronic Pain

The overall goal of this study is to gather preliminary data, focusing on behavioral rhythms
in patients with chronic pain as well as the relationship between behavioral rhythms and the
pain-related clinical symptoms. Additionally, this study will provide preliminary data for
the feasibility, acceptability, and treatment effects of repurposing interpersonal social
rhythm therapy (IPSRT) along with light therapy for patients with chronic pain exhibiting
significant rhythm dysregulation, sleep disturbances, and mood symptoms. The deliverables at
the end of this project will include 1) preliminary evidence concerning the prevalence of
behavioral rhythm disturbances in patients with chronic pain; 2) the association between such
behavioral rhythm disruptions and the symptom cluster of pain-sleep-fatigue-mood; 3)
feasibility and acceptability of a prototype IPSRT repurposed for chronic pain patients along
with bright light therapy. The specific aims of this proposed study are as follows:

Aim 1: To evaluate regularity of social and behavioral rhythms (SBR), disruption of circadian
activity rhythms (CAR), and the relationship of SBR and CAR with clinical symptoms of
pain-sleep-fatigue-mood in chronic pain patients compared to healthy control.

Hypothesis 1: Patients with chronic pain will show high degrees of SBR and CAR disruption
compared to controls.

Hypothesis 2: Patients with increasingly dysregulated SBR and attenuated CAR will exhibit
worse clinical symptoms.

Hypothesis 3: SBR will be associated with CAR in patients with chronic pain and in controls.

Aim 2: To assess feasibility and acceptance of interpersonal social rhythm therapy repurposed
for chronic pain patient population along with bright light therapy provided to patients
exhibiting SBR disruption with significant sleep and mood symptoms.

Hypothesis 1: The IPSRT will be well tolerated and accepted by the patients

Hypothesis 2: Descriptive data will suggest improvement of SBR, CAR, and the pain-related
symptoms and functioning.

Inclusion Criteria:

All participants (patients and controls):

- 18-65 years of age with

- reading/writing proficiency in English.

Aim 1:

Patients must:

- have had persistent pain for more than 1-year at a consistent body part or diffuse
body pain (e.g., fibromyalgia) that is stable rather than progressive in nature

- report experiencing pain for more than 70% of the waking hours in any given week

- under current medical care by a physician for a pain diagnosis

- able remain stable on any of their medication (as prescribed) for the duration of the
8-day evaluation involved in Aim 1

Control subjects must:

- be pain-free for the past 1-year

- no prior treatment for a chronic pain condition

- in overall good health

Aim 2:

Patients must:

- have current symptoms of insomnia (Insomnia Severity Index (ISI), ISI>8)

- have depression (Patient Health Questionnaire-9, PHQ-9>10)

- exhibit significant circadian activity rhythm dysregulation during the 8-day
evaluation (defined as Amplitude<0.9)

Control subjects must:

- be pain-free for the past 1-year

- no prior treatment for a chronic pain condition

- in overall good health

Exclusion Criteria:

Aim 1:

- patients/controls who underwent surgery in the last 6-months

- shift workers

- dementia

- current drug abuse/dependence

- receiving treatment in methadone clinic

- current cardiac conditions

- untreated sleep apnea

- untreated restless legs syndrome

- neurodegenerative disease

- bipolar disorder

- psychosis

- suicidal ideation

- have changed time-zones in the last 7 days

- experienced a significant life change in the last month (e.g., death in the family,
loss of job, traumatic event)

Aim 2:

- patients/controls who underwent surgery in the last 6-months

- shift workers

- dementia

- current drug abuse/dependence

- receiving treatment in methadone clinic

- current cardiac conditions

- untreated sleep apnea

- untreated restless legs syndrome

- neurodegenerative disease

- bipolar disorder

- psychosis

- suicidal ideation

- have changed time-zones in the last 7 days

- experienced a significant life change in the last month (e.g., death in the family,
loss of job, traumatic event)

- receiving psychotherapy

- significant photophobia

- chronic migraines