Individuals suffering from chronic pain vary widely. The causes of the condition may be unknown, or if known, quite diverse. Individuals may seek treatment, avoid treatment, or pursue a variety of treatments. Medical care may succeed or fail for poorly understood reasons. In this confusing situation, it is difficult to prescribe rational and effective clinical therapy. To advance clinical pain management, we must develop clear diagnostic criteria to define and differentiate pain syndromes, identify factors governing choice of treatment, and document treatment efficacy. We propose to perform research in each of these areas.
Studies on the prevalence, incidence, course and progression of pain among persons in treatment and out of treatment will be an essential component of the Clinical Research Section. One focus will be on the classification of pain itself, including impairments and disabilities from different types of pain. Working with the world-renowned Psychiatric Epidemiology group, the Section will develop standardized assessments for non-clinical and clinical interviewers. Defining the impairment due to pain and characterizing the pain are essential steps to its management.
A second focus will be on health services research to understand the patient needs for alleviation of pain, the characteristics of persons who come for treatment, the types of care they seek and the barriers to care. The Section will also develop and implement studies of the outcomes of pain management techniques.
The strong clinical pain management practices at Barnes-Jewish Hospital and our affiliated community practice clinics will facilitate significant clinical drug trials activities. Some trials will be in response to pharmaceutical industry interest. We also will foster research collaboration between basic and clinical research, involving both animal studies of clinically used drugs and clinical trials inspired by observations made in basic research.
Other significant research will involve collaboration with the outstanding brain imaging group at Washington University. Studies of defined groups of patients will map alterations in brain activity in chronic pain and the actions of effective treatments on patterns of activity. These studies will explore alterations in higher brain function that may contribute to chronic pain conditions, and will powerfully influence basic research in animals.
Development of this Section will involve hiring additional individuals to conduct the research and provision of additional research facilities.