Research Magazine 2006
Winning the battle against pain

Wounded soldiers are benefiting from Robert Gatchel’s program that combines physical rehabilitation with treatment for post-traumatic stress disorder.

Robert Gatchel’s research could revolutionize how the military cares for wounded soldiers. It might help thousands of disabled veterans transition back into civilian life. He may rewrite the rules on holistic health care.

But he never planned to do any of that. He just wanted to be Duke Snider.

Young Bob was a spellbound 7-year-old living on Long Island when Snider and his Brooklyn Dodgers upset the rival New York Yankees in the 1955 World Series. From then on, he dreamed of playing big-league baseball. And he was on his way, before fate redirected him to the big leagues of scientific research.

Dr. Robert Gatchel

Dr. Robert Gatchel, Professor and Chairman, Department of Psychology

These days, Dr. Gatchel is the Duke Snider of psychophysiology.

Now 61, he is chair of UT Arlington’s Department of Psychology and one of the world’s foremost researchers of how chronic stress and pain affect the mind and body. His work has won numerous awards. He has published 23 books, 92 book chapters and 275 journal articles and garnered tens of millions of dollars in funding.

Now his research is providing better care for injured veterans.

Before any of this, Gatchel was a two-sport prep star in Port Jefferson, N.Y., who severely injured his knee playing football as a senior. That cost him a college baseball scholarship and forced him to re-evaluate his future.

“I thought my world was ending,” he says. “But I learned that the universe is going to take you where it takes you. You just sort of have to go with it and make accommodations.”

In his case, the accommodation was an Introduction to Psychology course at the State University of New York at Stony Brook. By the time Gatchel graduated, he had become “very enthralled” with psychology and enrolled at the University of Wisconsin to begin graduate work in 1969.

That same year, young men fresh out of college began being drafted for the Vietnam War. Gatchel, the son of a Navy veteran, had no problem going if called. That’s a good thing, since his draft number was 49. But on the morning he was to report for a physical, his reconditioned knee began bothering him for the first time in years.

“The doctor took a look at my knee and said, ‘What are you doing here? You’re 4-F!’ So I got back home and there was no problem at all with my knee. I swear I was not faking it. But that really gave me firsthand experience of how psychological factors can affect physical response. So, see, my first major trauma turned out to open a new door for me. It kept me from the war. It kept me in graduate school. It basically directed me to psychology.”

Specifically, it directed him to focus on the physiological bases of psychological processes. In other words, how pain (like he felt in his knee) and stress (like he felt on draft day) affect how the brain and body perform.

This branch of psychology, called psychophysiology, or cognitive neuroscience, began in the 1970s, when Gatchel first argued that you must do more than treat a physical injury; you must treat the whole patient. Repairing the physical damage of a knee injury may get a patient walking again, but it ignores the depression he might feel from being homebound. And it does nothing to alleviate the stress as medical bills pile up while he’s out of work. Gatchel calls it functional restoration through a “bio-psychosocial” approach.

“Whether you know it or not, your conscious or subconscious can affect how you feel physically and emotionally. I was down after my injury. I was depressed. So it drove me to develop a lot of empathy for working with people like this, because I had gone through it myself.”

Veterans with knee and other injuries are finding relief with Gatchel’s holistic approach to pain.

Eventually, Gatchel’s functional restoration approach became a preferred treatment. And he found a new application for his research when the United States began its war on terror in 2001. Because it was a new kind of war, the Army needed more mobile soldiers, which meant they had to carry everything they’d need with them. Consequently, more soldiers began suffering from back problems and injuries to the arms, shoulders, knees and ankles. Gatchel found that as many as 40 percent of soldiers out of action had been injured in this way.

“They were losing a lot of soldiers to disability or medical leaves, which with a volunteer Army and a numbers crunch was becoming a big issue. And they didn’t have a very effective program for dealing with it. They used sort of a traditional pain-management program: very palliative, not very active.”

The Department of Defense awarded Gatchel a $1.5 million grant to see if his brand of treatment might prove more effective. He took the bio-psychosocial approach to San Antonio’s Wilford Hall, the Air Force’s large triage hospital, where he treated patients by reconditioning them. He showed them how to deal with stress, pace themselves and progressively increase their strength, range of motion and aerobic capacity.

“All those things that, obviously, if you’re a soldier you have to do,” he says.

In short order, troops who had been out of action for two years were back on their feet. “The results were very spectacular in terms of demonstrating that we can get these injured soldiers back to active duty, which is the prime goal of the military.”

As the wars in Afghanistan and Iraq went on, large numbers of troops began suffering from post-traumatic stress disorder, the disabling psychological syndrome that accompanied their physical injuries. A recent Rand Corp. report estimates that more than 300,000 PTSD cases could emerge from the current conflict. In August 2008 Gatchel received another $1.5 million grant and installed a program that combined physical rehabilitation with PTSD treatment.

His project is one of eight in the Department of Defense’s $30 million Strong Star Consortium, which includes researchers from Harvard, Georgetown, the University of Pennsylvania, UT Health Science Center at San Antonio and elsewhere. Other projects in the consortium concern genetics, system functions, long-term vs. short-term consequences of injuries and individual difference injury healing.

“Unfortunately, for those who have pain conditions and PTSD symptoms, treatment becomes much more complex,” says Don McGeary, associate director of Health Psychology Service at Wilford Hall. “The work being pioneered by Dr. Gatchel is one of the first major efforts to confront an extremely difficult treatment problem for the U.S. military.”

In Gatchel’s program, injured soldiers are evaluated upon arrival at Wilford Hall, both physiologically (measuring strength, range of motion and aerobic capacity) and psychologically (evaluating for PTSD and measuring coping mechanisms for anxiety, depression and social support). This bio-psychosocial profile provides a starting point for the soldier’s treatment.

Once a soldier’s psychophysiological state is determined, Gatchel tailors a program specific to the soldier’s needs. It lasts 6-8 weeks and includes checkups to make sure the treatment is working. Once the program is complete, Gatchel’s team monitors the patient before it’s determined whether the soldier can return to active duty, can be accommodated elsewhere in the military or will be medically discharged. Those who must be discharged are transitioned out of the program into Veterans Affairs.

“In the old days, we just sort of threw them in the hospital and hoped for the best, and it was very uncoordinated care,” Gatchel says. “This is very coordinated. The physicians, the physical therapists, the psychologists, the occupational therapist, they all know what each other is doing. Every part of that individual’s health care is taken care of in a coordinated manner.”

Gatchel’s next step is to gather data and appraise the treatment program. Given its effectiveness in the civilian population, he believes it will work for the military, too. If it does, he hopes to make it common practice beyond Wilford Hall.

McGeary believes it will.

“We anticipate that the outcomes of this clinical research effort will be utilized at the highest military levels to outline clinical practice guidelines for military treatment facilities,” he says. “Furthermore, Dr. Gatchel’s work may contribute to effective mechanisms for preventing the chronic onset of pain and PTSD symptoms.

“Unfortunately, once pain and PTSD become chronic, treatment becomes more difficult. Earlier treatment and intervention will likely save thousands of patients from suffering chronic pain and PTSD problems and will also save billions of dollars in annual treatment and indirect costs. One cannot stress how important this work will be for the U.S. military.”

UT Arlington is benefiting from the research, too. Ron Elsenbaumer, the University’s vice president for research and federal relations, says Gatchel is “putting UT Arlington on the national map” as a leader in psychophysiological research. “Additionally, his work is a distinguishing factor that sets UT Arlington apart from many others in that he not only is creating new knowledge but also developing that knowledge into useful practice.”

And that, Gatchel says, is what’s so rewarding. “I think the real joy is helping people. This has been the highlight of my career.”

Not bad for a man who just wanted to play baseball.

- Danny Woodward