|Pain Research at a Threshold|
By Bob Shepard
The National Institutes of Health (NIH), the leading federal agency supporting and conducting medical research, covers a lot of ground. Among its 27 different units, doling out some $29 billion in fiscal year 2008, are institutes for cancer, vision diseases, mental health, and aging.
Yet there is not a single NIH division dedicated to pain management—which is surprising because “pain is the number-one reason why people come into the health-care system,” says Keith “Tony” Jones, M.D., professor and chair of UAB’s Department of Anesthesiology. His colleague, anesthesiology professor Timothy Ness, M.D., puts it even more simply: “Every doctor is a pain doctor.”
Researching pain is no simple task, however, because it’s subjective and almost impossible to recreate in a laboratory setting. For Jones, the solution is to adapt the investigative approach used for other medical conditions: Recruit a cadre of top researchers and clinicians from across the medical and scientific spectrum. Organize them in a comprehensive, interdisciplinary pain-management program. Give them the tools and the funding they need. And then stand back.
“One of my priorities is to establish a behavioral medicine pain-treatment facility that involves neurology, rehabilitation, psychiatry, anesthesia, rheumatology, and other fields,” Jones says. “Patients treated using this multidisciplinary approach become more functional, increase their productivity, and get back to work sooner.”
Jones says pain—and pain research—can be divided into two broad categories. Perioperative pain is induced by trauma—either controlled trauma, as in surgery, or uncontrolled, as in a car wreck. Management focuses on reducing the amount of pain so that patients can rehabilitate quickly.
The second category is chronic pain. Jones says that for about 15 percent of these cases, an interventional procedure can treat the pain. “But the other 85 percent is not amenable to an invasive procedure because the pain is not localized; it’s a systemic problem such as fibromyalgia,” he says. “This is where we really need an interdisciplinary team. When a direct intervention is not a solution, a behavioral medicine approach to therapy is required.”