Electrical engineering professor J.-C. Chiao doesn’t have to look far to find inspiration for helping the 100 million Americans living with chronic pain. He’s one of them. Not only does Dr. Chiao have constant pain from slipped discs and pinched nerves in his neck, he also witnessed a family member suffer after chemotherapy for prostate cancer. Chiao’s uncle used an implant device to electrically stimulate his spinal cord and relieve the pain. The technology was the best available, but he had to manually change the stimulation dosages every 15 minutes.
“How can you work? How can you sleep?” asks Chiao, the Janet and Mike Greene Professor and Jenkins Garrett Professor in the College of Engineering’s Electrical Engineering Department. “He has passed away, but he had a miserable year before that because of this pain.”
The U.S. Institute of Medicine estimates that chronic pain costs $560-$640 billion annually. The institute’s 2011 “Relieving Pain in America” report called on public and private sectors to create better ways to prevent and manage pain.
Chiao and other UTA researchers are working to develop knowledge, methods, and technology across disciplines. Several partnerships in the College of Engineering, College of Science, and College of Nursing and Health Innovation have garnered millions of dollars in research support.
Chiao and psychology Professor Yuan Bo Peng have worked since 2006 to create a closed-loop pain treatment system. Dr. Peng devised the technology, which has received funding from the National Science Foundation, Texas Medical Research Collaborative, Texas Higher Education Coordinating Board, and Intel’s telehealth initiative.
It starts with a device similar to the one Chiao’s uncle used. But the researchers are adding wirelessly networked implants, a computerized algorithm, and advanced flexible implantable devices that can document the subjective feeling of pain quantitatively and eliminate the need for manual operation. The device takes patients out of the equation, treating their pain in the background as they go on with their lives.
FEELING THE EFFECTS
Easing pain doesn’t just help individuals, it also impacts families and workplaces. Robert Gatchel, who holds the Nancy P. and John G. Penson Endowed Professorship in Clinical Health Psychology at UTA, has researched the topic for 30 years. Because of his extensive work in this area, he has just been appointed as a Co-Chair of an National Institutes of Health (NIH) Work Group which will address research related to the "Prevention of Acute and Chronic Pain."
“People in chronic pain develop a lot of depression because they can’t do the things they used to do," he says. “They develop a lot of anxiety. They are really struggling to make a living, which then spreads to the family, so the family is also struggling.”
Dr. Gatchel co-developed the first interdisciplinary pain management program, called functional restoration. It’s a team approach that requires psychologists, physicians, physical therapists, and other treatment providers to meet regularly, coordinate their methods and goals, and report progress.
As the leader of UTA’s Center of Excellence for the Study of Health and Chronic Illnesses, Gatchel has led two large, federally funded research projects over the past five years. In one, supported by the Department of Defense, he applied the principles of functional restoration to treating military veterans suffering post-traumatic stress and chronic pain. In the other, funded by the NIH, he worked with dental clinics to identify, treat, and record results from 600-700 sufferers of temporomandibular joint and muscle disorder, or TMJ.
He is also collaborating with UNT Health Science Center on the Precision Texas project, which involves collecting a large biobank of back pain patients' genomic profiles in order to assess what genotypes, combined with lifestyle factors, will predict the development of chronic back pain.
“Musculoskeletal pain problems are more prevalent than all the other diseases or are part of those other conditions,” he says. “There are a lot of us in this who are very passionate because we see the human suffering as well as the financial cost associated with pain.”
Gatchel hopes to work with Christopher Ray, associate dean for research and an associate professor of kinesiology in the College of Nursing and Health Innovation, to evaluate the influence of gait/walking changes in older adults. The aging population often incurs chronic pain that affects mobility.
“There are a lot of us in this who are very passionate because we see the human suffering as well as the financial cost associated with pain.”
— Dr. Robert Gatchel
Gatchel also is part of a team from the College of Science and College of Engineering that recently received a $374,998 National Science Foundation grant. The researchers plan to use big data analytics to develop a predictive model for how chronic pain patients will react to certain treatments and how to optimize health care decisions for the best cost-effective results.
Jay Rosenberger, an associate professor of industrial, manufacturing, and systems engineering, leads the project. The effort will use data from patients at the Eugene McDermott Center for Pain Management at UT Southwestern, where Gatchel is a clinical professor.
“The idea is to support the physician to try to make good treatment decisions,” says Dr. Rosenberger, who directs UTA’s Center on Stochastic Modeling, Optimization, and Statistics, or COSMOS. “Our data include not just what’s happened in the past with their decision-making, but what other physicians have seen with their patients. In that sense, it can see through certain human judgment biases.”
The interdisciplinary team includes professors from the Electrical Engineering and Computer Science and Engineering Departments.
“In many research institutions, researchers often work in silos where they’re doing their own research. They don’t necessarily walk down the hall or into another building,” Rosenberger says. “Here we are building a team that works really well together.”
Collaboration also is essential to pinpointing the basic sensory components of pain and how it’s processed or felt. Psychology Professor Perry Fuchs has studied these aspects since the early 1990s, developing behavioral research methods that can be applied in laboratory studies.
“Our understanding of the system has increased tremendously over the past 20 to 30 years,” he says. “There’s a dramatic increase in methodology that has been driven primarily by our increased understanding of underlying biological mechanisms that are related to pain.”
In early 2015, Dr. Fuchs and physics Assistant Professor Samarendra Mohanty published a study in the journalPLOS One that showed how to inhibit pain perception in the anterior cingulate cortex region of the brain. In their optogenetic stimulation method, genes for light-sensitive proteins are delivered to neurons and then activated by a laser.
The study demonstrated that optogenetic stimulation could be more accurate and effective than current ways of delivering stimulation for pain relief. It also enabled the researchers to see how different types of pain activated neurons in the brain’s thalamus.
“The optogenetics helps you to dissect the neural circuitry,” Dr. Mohanty says. “That could also help with drug discovery.”
Funding for pain research remains problematic. The American Pain Society, which released its “Pain Research Agenda for the 21st Century” in December 2014, compared research spending on pain with that of other prevalent diseases. Pain research accounted for just 1 percent of the National Institutes of Health budget or about $4 per affected person, considerably less than the $431 a person for cancer and $2,562 for HIV.
Some researchers are attracting dollars from private institutions and companies. Cynthia Trowbridge, an associate professor of kinesiology in the College of Nursing and Health Innovation, has done sponsored research to explore how cryotherapy, thermal therapy, and electric stimulation can ease pain.
Her work reveals how to best relieve muscle tissue pain in different body types, improving on the old “ice it for 20 minutes” advice.
“Movement is the key,” Dr. Trowbridge says. “So getting people back moving and using their body how it’s intended to be used instead of compensating, that is the goal. We want to improve function, but we can’t do that until we relieve the pain.”