Pain and the need to manage it are constant features of the human condition. Too often, acute and chronic pain are thought of solely as medical problems and, thus, are treated solely by the medical profession. We all know from our personal experience that pain intensity can be magnified or reduced depending on what we’re doing, what we’re thinking, what we’re feeling and who is with us.
Our group studies the emotional, cognitive, social and physiological determinants of acute and chronic pain intensity. We strive not only to understand how thinking and feeling can influence pain, but also to study ways to better manage chronic pain, in particular, by changing peoples’ pain-related thoughts, feelings and behaviors and by improving their social relationships.
Principal investigator
John W. Burns, PhD
Professor
Department of Behavioral Sciences
RUSH Medical College
Our work
Anger regulation and pain
Over the past decade, we have been pursuing lines of research that examine how the regulation of anger impacts acute and chronic pain. At bottom, results indicate that expression or suppression of anger may exert effects on pain sensitivity in chronic pain patients and pain-free people through immediate and delayed effects on different physiological and affective responses. Results provide the foundation for future work to determine whether problematic anger regulation can be altered via psychosocial interventions.
'Precision medicine' and endogenous opioid function
Given the increasing use of opioid analgesics for the management of chronic pain, our aim in this line of research is to improve understanding of factors that influence opioid analgesic effectiveness and negative side effects as well as how opioid medication use can be reduced.
First, we found that suboptimal functioning of the endogenous opioid system is related to higher analgesic responses to morphine. Second, we are testing whether we can enhance endogenous opioid function with aerobic exercise to see whether such enhancement achieves adequate analgesia with lower opioid analgesic doses and with reductions in negative side effects. Results of this program could be used to develop new treatment approaches that target endogenous opioid function to increase pain relief via non-pharmacologic means.
Couples’ interactions and patient adjustment to chronic pain
An enduring interest for many pain researchers has been interpersonal processes that affect emotional and physical functioning of people with chronic pain. In our recent work using daily diary methods, we found the following:
- Spouse criticism/hostility negatively affects patient well-being.
- Patient anger expression negatively impacts pain and function.
- Patient anger expression toward the spouse can reduce spouse supportive responses.
- Patient pain catastrophizing may actually increase spouse supportive responses.
This research program lays the groundwork for targeting interpersonal processes in the management of chronic pain.
Therapeutic mechanisms in psychosocial treatments for chronic pain
Over the past decade, many alternative treatments for chronic pain have been developed and been shown to reduce pain and improve function. It is not clear how these psychosocial chronic pain treatments actually work. To address this question, we have launched a large treatment study to examine which specific, common and non-specific mechanisms work to make psychosocial pain treatments successful, and which are the most important. Results will reveal the core active ingredients of most psychosocial treatments, as well as which ingredients are redundant or inert, providing insights into how to develop compact and effective treatments.
PTSD and chronic pain
PTSD and chronic pain conditions are highly prevalent, take large emotional, functional and financial tolls on individuals and society—and frequently co-occur. This co-occurrence potentially magnifies distress, disability and substance abuse in chronic pain sufferers, and is understudied among inner-city women, especially African American women, in whom it may be most pronounced.
We are running a prospective study of how PTSD and other vulnerability and resiliency factors contribute to the development of chronic pain and increased substance abuse among 600 inner-city women presenting to the Rush emergency department with acute pain.
Funding
- National Institutes of Health (NIH) /National Institute on Drug Abuse (NIDA) R01 DA105520-01: Development of Co-Morbid PTSD and Chronic Pain Among Inner-City Women; Burns and Hobfoll (Multi-principal investigators).
- NIH/NIDA R01 DA037891-01: Reduced Opioid Analgesic Requirements via Improved Endogenous Opioid Function; Burns and Bruehl (Multi-principal investigators).
- NIH/National Center for Complementary and Integrative Health: Bright Light Treatment at Home to Manage Chronic Pain in U.S. Veterans; Burns & Burgess (Multi-principal investigators).
- NIH/National Institute of Nursing Research R01 NR013910: Mechanisms of Psychosocial Chronic Pain Treatments; Burns & Keefe (Multi-principal investigators).
- NIH/NIDA R01 DA031726: Predictors of Opioid Analgesic Responses and Common Endogenous Opioid Mechanisms; Burns and Bruehl (Multi-principal investigators).