Understanding the ways in which sex, gender, race, ethnicity, and age affect patients with chronic pain

In the medical world, pain is divided into two categories - acute pain and chronic pain. Acute pain is when there is a sudden onset of pain that resolves with the healing of its underlying cause while chronic pain persists for weeks, months, and sometimes years even after the initial cause of the pain has healed. The effects of chronic pain on the U.S. population alone are startling. Chronic pain represents the most prevalent and costly health condition in the United States. 100 million people experience chronic pain, which produces annual costs exceeding $600 billion. This cost surpasses the combined costs of cancer, AIDS, and heart disease. For these reasons, understanding the causes of chronic pain, the contributing risk factors, and the populations most at risk has become urgent.

Dr. Roger Fillingim of the University of Florida seeks to better understand chronic pain. More specifically, he is interested in the ways in which sex/gender, racial/ethnic groups, age, and genetic factors influence pain and analgesic responses. In other words, how do groups that are differentiated by specific characteristics develop chronic pain and respond to treatments differently? As Dr. Roger Fillingim comes closer to answering this critical question, he and his team will be able to develop individualized treatments for specific subgroups within the chronic pain patient population thereby extending health and wellness to millions of people.

Dr. Roger Fillingim's research is seeking to understand the multiple factors that contribute to individual differences in the experience and neurobiology of chronic pain thereby allowing him and his team to develop specific treatments involving both the psychosocial and biological factors. Previous and current findings include:

  • In addition to stress being a risk factor for developing chronic pain, Dr. Fillingim and his associates have found that stress also interferes with the effectiveness of pain relieving treatments. Therefore, researchers are now able to concentrate on ways to decrease stress for patients. By decreasing stress for patients, preventative care and treatments can flourish.

  • Dr. Fillingim, along with other researchers, are conducting a prospective study that identifies risk factors for patients with temporomandibular disorders, a disorder that causes both acute and chronic facial pain. The study found that clinical and psychological factors were relatively strong predictors for this type of facial pain. Based upon these findings, Dr. Fillingim is currently seeking to better understand what factors may lead to chronic versus acute facial pain.

  • Because the same painful event or stimulus produces wildly different pain experiences from person to person, Dr. Fillingim's study of biopsychosocial factors is necessary to understand this immense variability. We know that women, members of disadvantaged minority groups, and older adults tend to experience more frequent pain, and greater levels of disability. By focusing on the subgroups of patients that most often experience chronic pain, Dr. Fillingim's research hopes to find both preventative and therapeutic methods for combating the silent chronic pain epidemic.

    The best way to treat chronic pain is to prevent it from ever happening. Dr. Roger Fillingim's research aims to prevent acute pain from transitioning to chronic pain. His research therefore seeks to understand the fundamental biological and psychosocial systems that drive mechanisms towards chronic pain. While we don't have the resources to provide preventive services to everyone in the population, improved knowledge of the subgroups of the population that are at risk for chronic pain will allow us to provide targeted prevention to the people who need it. This could move us much closer to alleviating the distress caused by chronic pain and the disabling financial burden it puts on many patients and their families.

Bio

As a graduate student in psychology, Dr. Fillingim was fascinated by the notion that psychological and behavioral processes could directly impact human health. This concept was the foundation for the burgeoning field of behavioral medicine at the time. As he learned more about health conditions in which psychologists were making important contributions, chronic pain came to the forefront. As a developing scientist-practitioner, he was impressed to see that psychological interventions could have robust impact on pain and functioning in people suffering from chronic pain. After completing his training, he provided full-time clinical service for a few years, but sorely missed the opportunity to ask and answer important and clinically relevant scientific questions to address the problem of chronic pain. So, he completed a postdoctoral fellowship in psychophysical pain research and has since devoted his career to understanding individual differences in the experience of pain.

Dr. Fillingim's research investigates biological, social, and psychological factors that may influence the experience of pain. Pain is perhaps the most widespread and expensive health problem in the United States. His research uses standard psychophysical, or sensory testing, procedures to assess individual differences in responses to pain.

One major line of research in Dr. Fillingim's laboratory focuses on how women and men experience pain differently. Women generally report more pain in daily life than men, and they also show lower pain thresholds. His research is interested in understanding the reasons for these differences, which probably include psychosocial factors (e.g. mood, coping, sex roles) as well as physiological variables such as hormone levels and other neurobiological systems. In addition, he is studying whether pain-relieving medications work differently for women and men. Specifically, he would like to identify genetic markers that are associated with analgesic responses, and whether there are different genetic markers of medication response in women versus men.

Dr. Fillingim is also investigating whether people from different ethnic and racial groups experience pain differently. Some evidence suggests that ethnic minorities may experience higher levels of pain and disability compared to whites. He is trying to determine whether ethnic differences in pain processing contribute to these differences in clinical pain. In this research, he is also exploring the contribution of sociocultural and psychological factors to ethnic differences in pain. He is also interested in the contribution of inflammatory and genetic factors.

Dr. Fillingim and his team are also involved in a multicenter prospective cohort study designed to identify risk factors for development of orofacial pain. This study is called OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment), and more information can be found at: www.oppera.org. Dr. Fillingim's research is primarily funded by the National Institutes of Health.

Awards

Basic & Behavioral Sciences Teacher of the Year

Outstanding Alumnus Award

American Pain Society's Wilbert E. Fordyce, Clinical Investigator Award

Champion of Diversity Award

American Pain Society

President