OU mHealth Project Aims to Address Native Americans’ Pain Disparity

TULSA, Okla. – Nearly one in three Native Americans live with chronic pain, more than any other segment of the U.S. population. But providing in-person relief has long been complicated by financial and geographic barriers.

A University of Oklahoma mHealth initiative seeks to reduce this pain imbalance.

Armed with a new five-year, $3.4 million grant from the National Institutes of Health, OU healthcare leaders are building the first chronic pain mHealth intervention app made with and for Native Americans.

“Oklahoma was the end of the Trail of Tears and other forced relocations,” said Jamie L. Rhudy, PhD, a professor in the OU Department of Health Promotion Sciences and site director for the TSET Health Promotion Research Center in Tulsa, which is leading the mHealth project. “Our location puts us in a unique position to address this work.”

Unlike episodic pain, chronic pain persists for more than three months and causes debilitating physical and psychological suffering. By one estimate, chronic pain results in more than $600 billion annually in lost wages and productivity. The condition affects more Americans than heart disease, diabetes and cancer combined.

Medications, while commonly prescribed for chronic pain, are also easily abused. Addressing underlying causes with psychological treatments changes how the brain processes pain, and research shows that when treatments are tailored to individuals and communities, response rates soar, said Rhudy.

“Native American communities have experienced intergenerational trauma, and they continue to experience contemporary traumas,” said Rhudy. “These are the types of experiences that can place our brains on high alert and amplify pain.”

But in-person treatments are often inaccessible to Native Americans, who are more likely to live in remote areas far from large health centers. While mobile health interventions can overcome access barriers, few validated mHealth pain interventions exist, and none are tailored for Native Americans.

The work at OU will address this shortcoming by integrating the psychological science of pain management with Indigenous knowledge. The app will be built on the Insight mHealth Platform, which was created by TSET Co-Director Michael Businelle, Ph.D., to help researchers create, test, and deploy smartphone- and tablet-based assessments and interventions.

Scholars have long known that Native Americans are more likely to suffer chronic pain than the general population.

Rhudy’s past research – including the 2013-2018 Oklahoma Study of Native American Pain Risk – has also identified reasons why: Native Americans experience greater rates of interpersonal discrimination, stress, high blood pressure and sleep disturbances, all factors that contribute to how pain is processed in the brain.

The current work will build on these findings to create an app that delivers tailored exercises and community-based lifestyle recommendations clinically proven to reduce chronic pain burdens.

“Sleep, stress and discrimination are not variables easily targeted by medications, but they do respond well to targeted psychological and behavioral interventions,” said Rhudy.

Creating the app will be a community effort. In partnership with co-investigator Joanna O. Shadlow, a member of the Osage Nation and a teaching professor of psychology at Oklahoma State University-Tulsa, and members of the Native American community, the research team will conduct focus groups and interviews with Native Americans living with chronic pain.

These findings will be used to inform the app’s treatment approach and design. Co-investigator Mark Lumley, Ph.D., a distinguished professor of psychology at Wayne State University and an expert in chronic pain interventions, will provide guidance on the integration of evidence-based pain management principles into the intervention content.

After building and testing an app prototype, the final phase will be a randomized controlled trial with the mHealth solution.

“With the team we have in place we’ll be able to bring all the necessary components together to develop, test and deploy a novel, culturally tailored chronic pain intervention that will be scalable,” said Rhudy.

While the specific mechanisms will be developed in partnership with the target communities, focus areas will include stress management, anxiety, sleep hygiene, physical health and even connecting to culture through diet. “All of these can be drivers and amplifiers of pain,” said Rhudy. 

He added: “Chronic pain is largely a construct of the brain. We’ve been taught that we have pain because maybe our joints wear out, or we have tissue damage. But everyone experiences pain differently, which our mHealth therapies will recognize and respond to.”

About the Project
The TSET Health Promotion Research Center and its activities are made possible through funding from the Tobacco Settlement Endowment Trust (TSET). The project, “Tailored Mobile Health Technology to Address Native American Chronic Pain,” is funded by the National Institutes of Health’s National Institute on Minority Health and Health Disparities Award No. R01MD021599.

About the University of Oklahoma
Founded in 1890, the University of Oklahoma is a public research university located in Norman, Oklahoma. As the state’s flagship university, OU serves the educational, cultural, economic and healthcare needs of the state, region and nation. For more information about the university, visit www.ou.edu.