Seeking relief

Led by the pioneering research of nationally recognized faculty members, UT Arlington is exploring ways to ease the anguish of chronic pain sufferers

By O.K. Carter

Pain is Dorothy Anderson’s constant companion. Rheumatoid arthritis has rendered her favorite hobbies—cooking, gardening and crossword puzzles—too arduous to enjoy. At times she struggles to walk. “I manage the best I can,” the 74-year-old retired schoolteacher says. “But my quality of life leaves a lot to be desired.” Help may be on the way for Anderson and the more than 30 million Americans who suffer from unrelieved chronic pain. UT Arlington has emerged as perhaps Texas’ foremost research institution in pain mitigation.

Led by Department of Psychology Chair Robert Gatchel, an internationally recognized authority on pain, the University has secured millions of dollars in grants from such entities as the National Institutes of Health and the Department of Defense. In addition to Dr. Gatchel, numerous other UT Arlington researchers from a range of disciplines are pursuing breakthroughs in pain-related issues.

Dr. Robert Gatchel

Dr. Robert Gatchel has assembled a team of researchers who are seeking solutions using neuroscience and applied applications on humans.

Forefront of pain research

A recipient of the American Psychological Association’s Award for Distinguished Contributions to Applied Research, Gatchel says pain is the No. 1 reason people visit doctors.

“Chronic pain is becoming a major problem, especially with this country’s aging population,” he says. “Management of the pain involved with chronic illnesses has become a long-standing quality-of-life issue.”

You’d think such a widespread problem would draw considerable research interest. But that hasn’t been the case.

“If you look at the history of the NIH, it’s easy to determine from a review of the organization’s requests for research applications that their interest is related to diseases that kill you,” he says. “But the modern reality is that there are now many serious diseases that we can survive—for example, cancer in a lot of cases. But many patients are left with a heavy symptom burden—pain. The chemotherapy or radiation treatments may have created pain problems, as would leftover scar tissue from surgery.”

The result is that many NIH research requests now involve closer looks at pain management. So much so that Gatchel predicts the NIH will soon have a pain institute as part of its organizational structure.

“We’re also seeing much more congressional interest in pain management issues, the result being more of a focus—and research funding—from federal agencies,” he says.

Gatchel has been way ahead of the curve. He received his first NIH grant for chronic pain management more than 20 years ago.

“We’ve made tremendous advancements in terms of neuroscience and a better understanding of pain mechanisms, the nervous system, markers for pain and particularly in identifying those who might be more susceptible to pain, brain imaging and the brain centers associated with pain,” he says. “I’ve tried to gather a cluster of pain experts in the Psychology Department who will cover the wide range of pain research from neuroscience all the way up to applied application on humans.”

Gatchel is finalizing research on low back pain through a series of NIH grants totaling $3.5 million. About 20 percent of low back pain sufferers consume 80 percent of related health care dollars. The unanswered question is which patients are among those high-dollar 20 percenters.

“We’ve developed a way of identifying those acute low back pain patients who are at risk of developing chronic pain, and we can identify low-risk patients as well. The low-risk patients will get better on their own. The high-risk group under the old system would end up having surgeries, medications and often more surgeries. We can now identify those folks and promote early intervention for them right at the get-go. We found that they were back at work 85 percent of the time.”

Cost is clearly an issue. The early detection system Gatchel helped develop delivered a high recovery rate but also consumed only half the health care dollars incurred by high-risk folks who were on their own. The evaluation tool, essentially a self-report index, took 15 minutes to perform and predicted with 90 percent accuracy those who would have chronic lower back problems.

Indeed, those results were so impressive—and so efficient in reducing health dollar expenditures—that the NIH has since awarded $6.5 million to Gatchel to study almost 700 patients with jaw pain.

“The typical treatment with surgery poses risks of scar tissue as well as vascular problems if the problem isn’t fixed the right way,” he says. “Chronic pain can result.”

He and other researchers are still fine-tuning the study, but the evaluative testing has been fast, inexpensive and able to determine which patients need early intervention with 91 percent accuracy.

Holistic approach

Given such outcomes, it’s no surprise that the Department of Defense became interested in similar studies, since data indicate that about 40 percent of military personnel end up with muscular-skeletal pain disorders, typically involving the back or knees. Ground troops carry bulky packs or work with heavy equipment; pilots fly in cramped positions and experience multiple gravity situations.

“Pain management in the military has been a bit old-fashioned,” Gatchel says. “The general premise has been to either operate or give an injection. Or a discharge. It can be expensive, particularly when it involves highly technical people. It costs the government, for instance, an estimated $2.5 million to train a pilot.”

Gatchel is now working on his second Department of Defense grant—a $1 million study—to evaluate those most likely to develop chronic pain with resultant early intervention. Another DOD grant for $2 million examines the consequences of a combination of pain and post-traumatic stress and the necessity of treating both conditions at the same time.

“Without surgery we can accomplish function restoration, boots back on the ground and on active duty, with about 90 percent of those identified as needing early intervention,” he says.

Since Gatchel is a psychologist, his research begs the question: Is pain a mental issue—a head problem?

“No, no,” he says adamantly. “We never use the term psychology. It’s behavioral medicine. It is interdisciplinary, using physical therapy, occupational therapy, stress management, biofeedback, all supervised by a physician. The chronic pain issue has to be looked at and treated in a holistic way.”

New ways to spell relief

UT Arlington’s pain research is widespread. That’s good because chronic pain problems increase as people age. According to the Population Resource Center, people 65 and older represent 13 percent of the population, with an expected 4 percent increase by 2020. By then, it’s estimated that physicians will spend 40 percent of their time treating the elderly.

Psychology Associate Professors Yuan Bo Peng and Perry Fuchs hope to limit that trend. They are experts on mapping the neuropharmacological (chemical) pathways of pain transmission and determining what drugs effectively block such signals.

The researchers use optical imaging, electrophysiological techniques and behavioral methods to examine pain treatment in multiple sclerosis patients and other chronic conditions. Along with UT Arlington biomedical engineering Professor Hanli Liu, they are collaborating with UT Southwestern Medical Center Assistant Professor Qing Lu on a Multiple Sclerosis Foundation grant.

Dr. Fuchs is a member of the University’s Behavioral Neuroscience and Neurophysiology Laboratory, which includes Dr. Peng and psychology Assistant Professor Linda Perrotti. They explore underlying relationships between the nervous system and behavior.

“It’s an integrative approach,” Fuchs says, “involving the use of molecular biology, biochemistry, immunity chemistry, neurophysiology, anatomy and a wide range of behavioral methodology to understand the function of the nervous system.”

Though much of their focus is on pain, the researchers also examine conditions such as anxiety, depression and mechanisms underlying drug abuse and addiction.

Peng, a medical doctor and psychologist, also works with electrical engineering Professor J.C. Chiao, an expert on radio-frequency identification sensors. They want to use the technology to block chronic pain signals in the nervous system. Drs. Chiao and Peng have received two grants to study pain inhibition by wireless neurostimulation via RFIDs and have demonstrated success in blocking chronic pain signals by as much as 85 percent.

“The implications of RFIDs for this kind of use are enormous,” Chiao says. “They include treatments for diseases as varied as Parkinson’s tremor control, migraines, cancer and chemotherapy pain damage, or any of hundreds of conditions involving chronic pain and the depression that often comes with it.”

Beyond the science and engineering disciplines, kinesiology Associate Professor Judy Wilson uses hyperbaric oxygen therapy (administered in a chamber with 100 percent oxygen at greater-than-normal atmospheric pressure) to treat a variety of ailments, including chronic conditions and carbon monoxide poisoning. Early results show potential for reducing pain and inflammation similar to that occurring with rheumatoid arthritis.        

Other researchers include nursing Clinical Instructor Alean Royes, an authority on pain control for terminally ill patients, and industrial engineering Associate Professor Sheik Imrhan, who explores the maladies associated with extensive computer use. Dr. Imrhan’s book, Preventing Aches and Pains in the Computer Workplace, outlines how to prevent the headaches, blurred vision and sore muscles that often result from such repeated activity.

“Many people develop pains at work as a result of physical overexertion,” he says. “Such pains can be prevented by redesigning the workplace, the method of performing the tasks, the physical environment or work equipment to minimize physical effort. This kind of ergonomics intervention requires the lead of management and the willingness of workers to change some old habits.”

Pain and the brain

Chronic pain does more than create discomfort. It can lead to depression, fear of more injury and a gradual deconditioning.

“Under stress, the brain produces secretions related to pain. That brain activity is good for fight-or-flight activities. But if you have chronic secretions related to pain, they will eventually break down healthy muscles and joints,” Gatchel explains.

“We need to be able to measure not only a patient’s self-report of pain but also brain imaging and release of stress hormones. We’re also looking at genetic markers that basically evaluate a person’s susceptibility to certain types of pain thresholds.”

It’s a new frontier, and Gatchel plans to be at the forefront.

“Some people are genetically wired to experience pain greater or less than the normal. Some people are programmed so that pain medications might not work. Some individuals may be hypersensitive to pain prescriptions; they work too well and the patient becomes habituated. The answers have to be found in a holistic, interdisciplinary way.”

There is no one-size-fits-all solution to chronic pain relief. But the pioneering work of UT Arlington researchers offers hope. And for that, pain sufferers like Dorothy Anderson are thankful.

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