PROJECT SUMMARY: Chronic pain is a complex, medically unexplained disorder that poses enormous burden to both the patient and the healthcare system. In the face of the opioid epidemic, the need for better scientific understanding of the neuro- and psycho-biological underpinnings of chronic pain to guide improved treatment approaches is clear. Non-pharmacological interventions, including contemplative and integrative practices, have shown efficacy in improving pain and bolster efforts to reduce opioid-ergic medical management. These interventions often target the processing of internal painful and non-painful sensory signals, referred to as interoception. Neural processing of interoceptive stimuli overlaps with many of the regions altered in chronic pain, and self-report interoceptive questionnaires and tasks show diminished interoceptive performance in pain patients. However, the translational relevance of interoceptive functioning in pain treatment trajectories has been hindered by the lack of clear tasks and questionnaire measures of interoception. The overall objective of this proposal is to establish whether neural processing of non-painful interoceptive stimuli, namely the heartbeat, is altered in chronic low back pain patients at various stages of treatment and predictive of non-response to invasive peripherally-targeted treatments compared to healthy adults. This NRSA project will identify how electrophysiological dynamics (EEG/ECG) are related to interoceptive processes and pain treatment response using two newly developed, validated, and rigorously controlled interoception tasks that assess neural responses to the heart (Heartbeat-Evoked Potential, HEP). I will systematically test the hypothesis that chronic pain patients will display diminished modulation of the HEP during attention to their heartbeat compared to healthy controls (Aim 1) and impaired interoceptive-exteroceptive integration when an exteroceptive tone previously synchronized with the heartbeat is unexpectedly omitted (Aim 2). I will also test that these measures at baseline can predict non-response to pain intervention. Together, these data will establish whether neural markers of non-painful interoceptive processing could be clinically relevant biomarkers for guiding treatment selection in chronic low back pain, and would have broad implications for the incorporation of behavioral interventions targeting interoceptive processing. In preparation for this NRSA, I have sought out mentors who have expertise in interoceptive tasks, electrophysiology (EEG and ECG) data acquisition, analysis and interpretation, clinical interventional pain management, and complementary and integrative pain care. This proposal was designed to give me the training needed for a future profession as a Pain Management physician conducting research on interoceptive dynamics in chronic pain, and their relation to healing with integrative medicine modalities.