What Will be Done to Control Patients’ Pain?

Established in 2013, the University of Florida Pain Research and Intervention Center of Excellence, or UF PRICE, is an interdisciplinary center with scientists, clinicians and trainees working together to improve understanding and treatment of pain. Part of the UF Clinical and Translational Science Institute, it has never been more relevant than it is today — with opioid addiction and deaths having reached a crisis point in the United States. Government regulators, medical professionals and law enforcement are struggling to gain control of the problem, while experts on pain management worry about the effects that increased regulations will have on patients who suffer from chronic pain.

Dr. Robert FillingimExperts like Roger Fillingim, Ph.D., a professor in the UF Department of Community Dentistry and Behavioral Science, and the director of UF PRICE, are concerned that the national conversation focuses only on controlling access to pain medicine without addressing what will be done to control patients’ pain once access to medicine has been cut off. Fillingim has studied pain for 30 years, trying to understand the psychological and physical triggers that create and relieve pain. As the director of UF PRICE, he collaborates with 28 UF researchers representing all six UF Health colleges, the UF College of Health and Human Performance, and the UF Institute on Aging. His goal is to “insinuate” pain research into more areas of research, ultimately leading to a greater understanding of pain.

How did you become a pain researcher?

It was kind of by accident. I was studying clinical psychology in graduate school at the University of Alabama at Birmingham in the mid-1980s at a time the field was becoming newly aware of the effects that psychological and behavioral factors have on medical outcomes. I was wondering how I could translate my field of study into a job after graduation. I read a book about symptom perception in patients. It showed that manipulating what people were paying attention to could change their perception of various physical symptoms. It was intriguing and prompted me to seek clinical training in pain management. After a few years in clinical work, I returned to school to pursue postdoctoral training in pain research.

How have you seen the pain research field change over the years?

When I started, behavioral and clinical psychology for pain treatment was in its heyday. There was some great scientific and clinical work being done, with excellent results for patients, using interventions like relaxation, behavioral activation and distraction to treat pain. But this kind of treatment, to be effective, takes time and needs to be delivered in the context of a multidisciplinary care approach. Today’s more fragmented health care treats pain like a symptom of a problem: If you identify the problem and treat it, the pain will go away. But that isn’t true, especially in the case of chronic pain.

Are opioids a good treatment for chronic pain?

We don’t always know what causes chronic pain. Regardless of its etiology, chronic pain can have disruptive and devastating effects on the people who suffer from it. The use of opioids for pain control has certainly increased but, in truth, there remains very little evidence that long-term use of opioids is effective for chronic pain, despite this being one of the primary treatments used today. Opioids may be effective for pain in the short-term, but we need more effective long-term treatments for those who suffer from chronic pain. When we take opioids away, not only could the original pain return, but patients could also experience withdrawal, which in turn creates more pain.

Is there a light at the end of the tunnel?

Currently the National Institutes of Health awards about $400 million for pain research. Stop Pain is a bill that has been introduced in Congress that calls for a $5 billion investment to address the opioid crisis in support of pain treatment and research. If approved, that kind of funding will be transformative. It will allow for the development of more tools in our toolbox to treat pain, and make it possible for the existing tools to be readily accessible to more patients.

What do you see as the future for treating pain?

One approach is learning how to harness the ability that our brains have to control pain. UF researcher Mike Robinson, Ph.D., is looking at how our expectations about pain affect our brain’s response to pain. His work is showing that we can engage our brain’s pain control centers to alleviate pain.

We have also somewhat stumbled into new medications that were developed for other reasons that turn out to be effective pain treatments. For instance, duloxetine was developed as an antidepressant but has shown to be a good weapon against pain as well. While this is encouraging from a treatment perspective, it also tells us that we need to better understand the mechanisms of pain and to use the knowledge to develop more effective pain therapies.