September is Pain Awareness Month and it is worth reflecting on how serious a health issue chronic pain is.

It affects approximately 100 million adults in the United States, with an estimated annual cost of up to $635 billion.

Over the last seven years, as a faculty member and scientist at the University of New England College of Osteopathic Medicine, and an active member of the Center for the Excellence in Neurosciences, I have devoted my basic science research to better understanding the underlying mechanisms of neuropathic pain, one of the most devastating kinds of chronic pain and one in which current treatments have limited effectiveness. Although the long-term goal of our investigation is to develop medication that have improved therapeutic profiles for neuropathic pain, there are other non-pharmacological alternatives that should be incorporated.

UNE faculty and students were introduced to the Mercy Pain Center and their staff of physicians and other healthcare professionals several years ago. The Pain Center is one of southern Maine’s comprehensive, full-spectrum pain management clinic. During the last six months, I have had the unique opportunity to shadow Dr. Stephen Hull, the director of Mercy’s Medical Pain Service and Living Life Well Pain Rehabilitation Program. This experience has undeniably provided me with new perspectives regarding chronic pain, chronic pain patients, and chronic pain management.

The Living Life Well Pain Rehabilitation Program provides patients with tools to cope with their pain beyond prescription medications. In this 12-week, group based program they learn how to use behavioral therapy and physical exercise to combat their pain. This approach not only addresses the physical component of chronic pain, but also aims to improve the daily function and overall wellbeing of the patients. After participating in this program myself, I look forward to helping Dr. Hull analyze the outcomes data he has collected regarding this program.

One of the primary barriers for chronic pain management is a lack of clear communication between those suffering from chronic pain and their medical providers. Various pain scales are widely used to allow patients to rate their pain levels and help health care providers to determine treatment plans. However, many symptoms are associated with chronic pain and it is not clear which symptoms are taken into consideration when patients rate their levels of pain and its impact on their wellbeing. Further, patients and their providers may not agree on how to rate the level of pain, which may affect the selection of effective management approaches. In collaboration with a UNE medical student, we have developed an ongoing survey study to tackle this issue.

In shadowing Dr. Hull, I also observed the economic challenges facing many people who have chronic pain. A large number of them became disabled or unemployed due to their chronic condition and many have to rely on MaineCare to cover their medical expenses. This encouraged me to start a database-based study to look at the impact of socioeconomic factors on the prevalence of chronic pain in Maine. This study furthered collaboration between various colleges within UNE, as members of our research team included individuals from the College of Osteopathic Medicine, the College of Pharmacy, and the School of Community and Public Health.

A better understanding of the transition from acute pain to chronic pain will help improve management strategies post-injury/surgery, which may improve long-term outcomes. This “new” direction is closely related to what we are currently studying in the laboratory, the role of microglia in chronic pain conditions. Microglia are considered the early responders after nerve injury, hence specific modulation of microglial activity may lead to a reduction in the likelihood of developing chronic pain following an acute pain condition.

Although pharmacological methods are the major component of chronic pain management, I am more and more convinced that an integrated, multidisciplinary approach is the best way of managing chronic pain. I am confident that research at Mercy Hospital and UNE will lead to better methods of diagnosing and treating chronic pain.