Researchers in the Department of Psychology are exploring experimental pain management treatments for everything from headaches and degenerating discs, to fibromyalgia and cancer
Department of Psychology Chair Robert Gatchel won the American Psychological Association’s 2004 award for distinguished contributions to applied research and has a page-long list of other research honors. But he doesn’t spend his days in a laboratory.
“My research is translational,” he says. “Basically, I take what is found in the research lab and apply it to help develop more effective ways to help patients living with chronic pain.”
Dr. Gatchel, who also is program director of the Eugene McDermott Center for Pain Management at UT Southwestern Medical Center at Dallas, says that 80 percent of all health care visits are due to pain, from headaches and degenerating discs, to fibromyalgia and cancer.
“You name it, we deal with it,” he says, adding that great advances have been made in the last few years by mapping out the mechanisms that transmit pain.
The Department of Psychology’s Behavioral Neuroscience and Neurophysiology Laboratory, headed by Perry Fuchs and Yuan Bo Peng, is at the forefront of experimental research that promises additional advances. The laboratory uses behavioral and electrophysiological paradigms designed to explore the underlying relationship between neuronal function and behavior. Two of its objectives are the exploration of the relationship between supraspinal and spinal processing of sensory and affective pain processing and the characterization of behavioral symptoms and altered brain and/or dorsal horn physiology in neuropathic and inflammatory pain.
Dr. Fuchs works with the neuropharmacological aspect of mapping out pain transmission: the chemical pathways by which pain is transmitted and what drugs might be effective in blocking the signal.
“We hope our findings will lead to the development of new drugs to treat chronic pain,” he said. “At present, the options are limited and getting more [limited] since several drugs have been removed from the market.”
Dr. Peng, who is both an M.D. and a Ph.D., works with the neurophysiological aspect of mapping the pathways associated with pain.
“The TENS unit (transcutaneous electro-nerve stimulators) is one relatively well-known medical device that operates under the principle of blocking pain through neurophysiological channels,” Gatchel said, explaining that it works by stimulating the large fiber nerves so that they block the small fiber nerves associated with the transmission of pain signals.
A promising research area involves motor cortex stimulation, which has been shown to reduce pain such as from a nerve injury following a stroke. Spinal cord stimulators can be embedded, much like a pacemaker, with a wire connected to electrodes to block pain messages.
“The spinal cord acts as a gate,” Peng said. “When it is open, the pain signal can go from the body to brain.”
A one-size-fits-all solution to pain management remains elusive. Effective treatment appears to lie in tailoring the components to the individual.
With some patients, Gatchel must search for clues, like bracing or carefully executed movements, to evaluate the pain. Other patients have very limited coping skills, but cognitive behavior techniques can be used to increase them. And just as stress can accelerate pain, chronic pain can come with a wagonload of other problems—financial, career, family and lifestyle changes—mandating a biopsychosocial approach that addresses the needs of the total patient.
The approach focuses on physical as well as mental health disorders, the result of a dynamic interaction among physiological, psychological and social factors that perpetuates and may even worsen the clinical presentation. This biopsychosocial model is proving more effective than traditional medicine because many diseases, including hypertension, diabetes and asthma (and chronic pain), have no known cure. Biopsychosocial research is developing the best management approaches for such disorders.
Gatchel said patients must take an active role in their own treatment, and that means understanding their condition. And doctors don’t always have the answers.
“There are well-developed guidelines for treating low back pain, one of the most common types of chronic pain,” he said. “Unfortunately, most primary-care physicians do not follow the guidelines.
“Physicians have been educated to heal disease and often have very little understanding of managing pain, of treating pain not as a symptom but as a treatable illness.”
Information on the Internet can be immensely helpful, but a lot of bad information is out there, as well, Gatchel said. He favors sites like the North American Spine Society and the American Academy of Orthopedic Surgeons.
Physical activity is critical to keeping tissue and nerves healthy, yet an injured patient often fears using an injured limb or moving with a painful back, so the area around the injury does not stay conditioned and able to protect the weakened area. The type of exercise that works best varies with the pain, so, again, an individual approach is needed.
Across campus from the psychology lab, the College of Education’s Department of Kinesiology is working on that part of the equation with exercise research on rehabilitative activities in light of cultural, biomechanical, physiological, psychological and educational principles of human behavior.
Research findings do not always mean out with the old, in with the new. Acupuncture, mainstream medicine in China for centuries, has been found appropriate for some patients with chronic pain.
The importance of developing more effective ways to deal with pain goes beyond the well-being of individual patients. The 80 percent of all doctor visits precipitated by pain that Gatchel referenced will probably increase in the United States as the population ages.
“Older patients tend to suffer more pain due to age-related diseases,” he said.
The Population Resource Center reports that persons age 65 and older represent 13 percent of the U.S. population and that the number is expected to increase to 17 percent by 2020. By then it is estimated that almost 40 percent of a physician’s time will be spent treating the elderly.
— Sue Stevens