CoverStory
“The Hidden Epidemic”
100MILLION MORE THAN
ADULTS IN AMERICA SUFFER FROM CHRONIC PAIN
CHRONIC PAIN COSTS SOCIETY
$635BILLION / MORE THAN
YR
MORE THAN THE COST OF CANCER, HEART DISEASE AND DIABETES, COMBINED
Dr. William Maixner testified at the U.S. Senate’s HELP Committee hearing in 2012, titled “Pain in America: Exploring Challenges to Relief.” Watch the full hearings: TinyURL.com/SenatePain2012
The team I’ve hand-picked from across the nation is able to work all the way from fundamental molecular science, discovering novel pathways involved in pain, development of new analgesics and pain processing, to individuals who can tease apart the molecular systems in pain patients that mediate the science and symptoms they experience.” The CTPM further expands Duke Anesthesiology’s existing clinical and research program in innovative pain therapies by bringing together, under one umbrella, leading basic scientists, clinicians and clinical researchers – a comprehensive team made up of about 40 faculty and researchers, and five basic science labs. Its guiding principal is the recognition that patients suffering from painful conditions require a multidisciplinary, multidimensional approach for diagnosis and treatment.
“Chronic pain is one of the last bastians of patient care that has gone unrecognized as a priority. We are providing a unique model of pain medicine to treat a group of individuals who often feel marginalized by society and their health care provider(s).” Richard L. Boortz-Marx, MD, MS Medical Director
“Dr. Maixner now leads what one could argue is the finest translational scientific team in the country, if not the world,” says Dr. Thomas Buchheit, chief of the Division of Pain Medicine whose role in the CTPM is to build collaborative and translational research projects, casting a wide net to bring solutions and protocols to clinical deployment. “I think the CTPM can and will bring about some of the solutions to the opioid crisis in America. We’ve seen very little changes in our therapies over the past decades; pain medicine has relied fairly heavily on steroid injections and medications. I believe the advances that Dr. Maixner’s team is going to bring are critical to advancing the field. They are in fact the future of pain medicine in this country.” For Dr. Buchheit, the unanswered question is, how 20
|
DUKE ANESTHESIOLOGY
4¢/PAIN PATIENT LESS THAN
SPENT EACH YEAR ON PAIN RESEARCH, NATIONWIDE
does pain “chronify?” Part of the research at the CTPM is devoted to understanding the epigenetic processes and signatures of what causes acute pain to become chronic. He believes once they can understand what drives the “chronification” of acute pain, they should be able to intervene to reduce the burden of chronic pain. “Pain is a multidimensional sensation that is important for our survival. However, in some cases, the pain outlasts the stimulus and becomes chronic, which then becomes a disorder in and of itself,” adds Dr. Andrea Nackley, CTPM researcher and lab director. She says researchers at the new center’s labs focus on three main objectives: to determine the factors that put people at risk for maladaptive chronic pain conditions, elucidate the mechanisms whereby genetic, biological and environmental factors drive chronic pain, and improve pharmacologic management of pain. Labs operating under the CTPM integrate molecular genetics, patient-relevant animal models and clinical epidemiologic measures in effort to reveal pathogenic processes. “Conventional therapies such as opioids, antidepressants and anticonvulsants have poor efficacy for managing persistent pain, as well as central side effects, including altered mental states, addiction and life-threatening depression. We are focused on identifying therapies that will provide more immediate pain relief and reduce the physical and emotional burden that accompanies the ‘trial and error’ approach.” In order to move discovery from concept to reality, Dr. Maixner notes that there must be an established team, such as the CTPM, that can handle large data that originates from multiple sources, including patient populations, genetic data, human genetic association studies, and the progress of data from the benchtop to bedside – all requiring the collection and management of big data sets. In the past year, nearly two-thirds of the CTPM team has been put in place, new labs have been constructed, behavioral units created, the biorepository is near comple-