Joseph Riley III, Ph.D.
Department of Community Dentistry and Behavioral Science
2004 Mowry Road, Room 2227
Ph.D., University of Florida, 1996
I received the degree of Ph.D. in Clinical and Health Psychology from the University of Florida in 1996, with a training focus in the area of behavioral medicine/dentistry. I have also completed a one-year clinical internship at the Gainesville Veterans Administration Medical Center funded by Geriatric Research Education and Clinical Center followed by a two-year fellowship in Behavioral Dentistry funded by the National Institute of Dental Research through the Claude D. Pepper Center for Research on Oral Health in Aging.
Academic appointment: Professor in the Division of Public Health Service and Research of the College of Dentistry with an affiliate appointment in the Department of Clinical and Health Psychology
My overarching research interests revolve around the study of behavioral, emotional, and cognitive responses to pain. The most recent focus has been on quantifying how these factors differ across social and ethnic groups and reflect behavioral differences that may be associated with oral health disparities. My program of research represents the convergence of several areas of pain research; the integration of models of pain as a complex multidimensional experience, models of health behavior related to pain, and oral health disparities.
Most of my early work involved identification of the interrelationships between pain, negative affective responses to pain, coping strategies, and clinical outcomes among patients seeking care for chronic pain. A number of these studies involved patients receiving care in an orofacial pain clinic. These research projects demonstrated that the pain experience is complex and that in addition to intensity, temporal, and spatial descriptors; factors such as negative affective response, longer-term cognitive processes that relate to the meanings or implications of pain are important components of pain treatment outcome. Another important contribution of my work has been to increase the focus on adaptation and behavioral response to pain. A limitation of these earlier studies that examined linkages between domains of the pain experience and health behaviors has been the sampling bias inherent in persons that have initiated treatment in pain clinics.
The next phase of my career involved a series of studies that documented oral pain in samples of community-dwelling adults. This has allowed me to take my expertise in measuring pain and its impact and apply them to the study of orofacial pain epidemiology in community samples. Pain is a commonly reported impact of oral disease and is more strongly associated with perceived need for care, actual dental care, and diminished quality of life than other objective or subjective signs or symptoms. As the dental public health literature has tended to focus on objective signs, rather than subjective signs, that are more likely to predict initial patient driven behavior, one of my contributions has been to focus on health behaviors that are a response a specific symptom, orofacial pain.
Imbedded in the decision to seek oral health care is the choice concerning where and with whom to visit. Health care visits with non-dental health professionals (i.e., physicians, nurse practitioners, or chiropractors) have been poorly documented. My research has found that adults typically seek care for toothache from a dentist, but from physicians for painful orofacial symptoms not directly associated with the teeth. Another study found that self-initiated care for orofacial pain is common and may serve as a substitute for or supplement to formal health care services for some adults. We also found interesting race and sex differences in self-care. Recently, I have published several manuscripts that have incorporated variables not heretofore studied in the context of pain; how attitudes and beliefs about disease and the efficacy of care influence health care contacts and the role of the social environment in health seeking behaviors. Another study documented ethnic differences in measures of pain unpleasantness and pain-related emotion in a large sample of patients seeking treatment.
The community-based studies that I have conducted provide evidence that US minority adults are at increased risk for orofacial pain and are less likely to use oral health services in response to pain. I have been awarded NIH funding (RO1) for a project that refined and integrated the aims of my earlier studies. T he overall aim of this project is to test how the impacts of orofacial pain interplay with individual, social, and economic characteristics as determinants of action taken for orofacial pain across minority populations. As culture can have a significant impact on the subjective experience of illness, differences in response to painful symptoms may help explain differences in behavioral options considered (or not considered) in response to oral disease. This project is examining the mechanisms underlying decisions to seek care or self-manage orofacial pain with a sampling strategy that will allow for comparisons among race and ethnic subgroups. Along with African-Americans, Hispanic adults have been targeted, a group that is particularly understudied regarding painful oral symptoms, given that they represent the fastest growing ethnic group in America . This information has important health policy implications for reducing the racial and ethnic disparities in oral health through interventions that facilitate access to care and utilization of appropriate services.
Clinical studies involving patients with painful conditions.
In collaboration with the Department of Pediatric Dentistry and Pediatric Hematology I am examining the increased risk of orofacial pain and decline in oral health in children and adolescents with sickle cell disorder (SCD). This study uses a case control design to test the hypothesis that children with SCD will be at increased risk for oral pain, tooth caries, pulp necrosis, degeneration of bone tissue, and prevalence of malocclusions when compared to non-SCD sibling controls. This study has potential to make a significant contribution to the understanding of associations between SCD and oral health and will be the first to use siblings as controls.
I have completed the data collection phase of a study of clinical patients at the Parker Mahan Facial Pain Center documenting pain related self-care behaviors in a clinical sample of Myofascial Pain Disordered (MPD) patients. This was part of a longitudinal study that assessed pain, mood and sleep across a 30-day time period. This study assessed perceived relief from pain and the control of pain for each of the self-care behaviors and whether patients view each as an acceptable treatment for their pain condition. In addition we tested whether the frequency and efficacy rating of each self-care behavior is associated with changes in pain, depression, and sleep quality sleep across the 30-day time period from the baseline clinical visit to a structured telephone interview.
Studies that involve laboratory induced painful stimuli.
Over the past year with funding from the College of Dentistry Seed Grant Program and in collaboration with Dr. Mauderli ( Prosthodontics), I have developed several experimental pain protocols that engage endogenous pain modulation systems. These protocols involve pain stimuli with the potential to study the effects of pain inhibitory and facilitatory mechanisms over time. The future purpose of this activity is to perform comparative studies between health controls and groups thought to dysfunctional pain regulatory systems and include persons with chronic pain condition and older adults. I will also be collaborating with by fellow Public Health colleague Dr. Fillingim and Dr. Horgas (Nursing) on the comparative projects.
In collaboration with Dr. Fillingim, I am involved in several additional experiment pain studies. First is a study that is examining the magnitude and mechanism of differences in pain responses between Non-Hispanic Whites and minority adults. In addition, I am also working with Drs. Fillingim, and Verne (Medicine) in a recently funded 4-year project related to pain modulation dysfunction in IBS patients and gulf war veterans. These two projects are funded with RO1 grants (Fillingim and Verne respectively as PIs).
Community-based study of heath behaviors taken for orofacial pain
My NIH funding (RO1) for a project titled “Oral Health Disparities: Actions taken for pain” is now underway. We have successfully completed the pilot phase of the project and expect to begin the baseline phase in June of 2005. Collaborators on this project include Drs. Heft (Oral Surgery), Duncan (Health Services Research), and Zsembik (Sociology).
Riley 3rd, J.L., Gilbert, G.H., & Heft, M.W. (2003 ). Socioeconomic and demographic inequalities in orofacial pain. Journal of Public Health Dentistry, 63, 166-173.
Price, D.D., Riley 3rd, J.L., & Vase, L. (2003) Reliable differences in placebo effects between clinical analgesic trials and studies of placebo analgesia mechanisms. Pain, 104, 715-716.
Riley 3rd, J.L., Gilbert, G.H., & Heft, M.W. (2004). Oral health attitudes and communication with laypersons about orofacial pain among middle-aged and older adults. Pain, 107, 116-124.
Riley 3rd, J.L., Tomar. S.L., & Gilbert, G.H. (2004). Smoking and smokeless tobacco: Increased risk for oral pain. Journal of Pain, 5, 217-222.
Hastie, B.A., Riley 3rd, J.L., & Fillingim, R.B. (2004). Ethnic and Gender Differences in Pain Coping: Factor Structure of the Coping Strategies Questionnaire and the CSQ-R. Journal of Pain, 6, 304-316.
Riley 3rd, J.L., Gilbert G.H., & Heft M.W. (2005). Orofacial pain: patient satisfaction and delay of urgent care. Public Health Reports, 120, 140-9.
Hastie, B.A., Riley 3rd, J.L., & Fillingim, R.B. (2005). Ethnic differences and responses to pain in healthy young adults. Pain Medicine, 6, 61-71.
Riley 3rd, J.L. & Gilbert, G.H. (in press). Childhood dental history and adult dental attitudes and beliefs. International Dental Journal .
Hastie, B.A., Riley 3rd, J.L., Robinson, M.E., Glover T., Campbell, C.M, Staud, & R., Fillingim, R.B. (in press). Cluster Analysis of Multiple Experimental Pain Modalities. Journal of Pain.