Understanding Pain, from Cells to Systems

A new center at UConn is devoted to finding answers to chronic pain.

Nursing professor Angela Starkweather at the School of Nursing, with a sensory analysis test underway in the background, on March 1, 2016. (Peter Morenus/UConn Photo)

Nursing researcher Angela Starkweather is director of a new center at UConn that is devoted to finding answers to chronic pain. (Peter Morenus/UConn Photo)

Angela Starkweather is on a mission. A professor of nursing and a Fellow of the American Academy of Nursing who joined UConn in August 2015, she was recently named to head the Center for Advancement in Managing Pain (CAMP), and comes armed with a longstanding distaste for the status quo.

“Why,” she asks rhetorically, “do we tolerate a condition that affects millions of people – when it impacts not only their quality of life but their personal relationships, their ability to go to work or school, all the important things most of us take for granted. If pain was a named disease, there would be much more focus on eliminating it.”

Starkweather points out that not all pain is bad: acute onset pain is our body’s way of telling us there’s something wrong. It’s when pain lasts far beyond a ‘normal’ duration, when it becomes disruptive to daily routines, that it becomes problematic.

“Pain is something that we definitely think about in the scope of health care,” she says, “but the problem is we don’t have reliable methods for identifying where the pain is coming from, or treatments that can target the specific underlying mechanisms. Oftentimes, we’ll have patients who get to the point where they have chronic conditions and there’s no easy fix. No silver bullet. This is equally frustrating to the patient and to the practitioner.

“Dealing with pain is so personal that it’s sometimes difficult to provide all the medical and emotional support a person needs,” she continues. “That’s a key reason why CAMP is so important. We’ll be studying pain from the cellular level to the systems level, in an effort to find answers.”

If pain was a named disease, there would be much more focus on eliminating it. — Angela Starkweather

CAMP is designated as a research center, although some of its work will take place in clinical settings both at the UConn John Dempsey Hospital in Farmington and at Connecticut Children’s Medical Center in Hartford. Among the Center’s staff are experts exploring such diverse areas as how sensory information is transmitted to the central nervous system, the genetics of hypersensitivity to pain, how to alleviate depressive symptoms across the age spectrum, and the role of pharmaceuticals in pain management.

Of the latter, Starkweather says that one of the obvious complications when dealing with pain is that current treatment often includes prescriptions for strong pain killers such as opioids: codeine, oxycodone, morphine, and the like. And while these medications can be life-savers, they are also associated with problems of misuse and addiction.

She says that in her role as a clinician, she has seen all the benefits and all the problems associated with the drugs that are put under the umbrella of ‘pain killers,’ and that’s one of the reasons pharmaceutical research along with psychological counseling and palliative care are considered to be in CAMP’s bailiwick.

“Issues related to pain are so complex that we have to take an interdisciplinary approach,” she explains, “and our goal [with CAMP] is to be truly inclusive. Whatever different people can bring to the table – whether it’s experience from bedside care or breakthroughs in a research lab – will help us to fit all the pieces of the puzzle together.”

Starkweather herself is currently a principal investigator on an NIH-funded study that is assessing predictors of persistent nonspecific low back pain, using measures of pain sensitivity, genetic variants, and gene expression profiles. Her research interests also include the bio-behavioral symptoms of pain among adolescents and adults who have chronic or life threatening conditions, with the goal of reducing symptoms, improving functionality, and enhancing the quality of life.

There are relatively few centers devoted to researching the causes and cures of chronic pain in the United States, and one of the things that makes CAMP unusual is that, although it reaches across many disciplines, it is officially a part of the School of Nursing.

Although relief from pain is the responsibility of everyone on a medical team, alleviation of pain is considered a core competency in UConn’s nursing program, and that is the reason Starkweather and many other members of the team are based there.

This is a natural fit, she say, because it is nurses who are often on the frontline of patient care, whether it’s in an emergency department, on inpatient floors, in nursing homes, in hospice situations, or even in physicians’ offices.

Last fall, the School of Nursing joined 10 other schools in being designated a Center of Excellence in Pain Education by the National Institutes of Health Pain Consortium. In the fall of 2016, it will begin awarding a post-baccalaureate Certificate in Pain Management. This, too, points to the commitment the School of Nursing brings to the endeavor.

Starkweather also points to the ‘value added’ by CAMP’s close association with UConn’s medical school and with the Institute for Systems Genomics, with its focus on personalized medicine.

“I can’t promise we’ll find the cure to chronic pain in the immediate future,” she says. “It’s a huge task and not an easy challenge. But we have assembled a powerful lineup and I’m confident that our work will lead to improvements in the care of individuals and families afflicted with pain and in the field of pain management.”