Publications
APS Bulletin • Volume 15, Number 4, Fall 2005
Past Presidents’ Perspectives
John L. Reeves II, PhD ABPP, Department Editor
An Interview with Richard Chapman, PhD, APS President, 1999-2000
How did you get into the field of pain, and who or what has influenced you the most?
After receiving my doctorate in 1969, I completed a postdoctoral fellowship at the Duke University Center for the Study of Aging and Human Development. This was my first encounter in a multidisciplinary research environment and the world of medicine. Ben Feather, a psychiatrist with a doctorate in psychology, agreed to be my mentor. One day, after reading an innovative paper on pain and signal detection theory by Crawford Clark, Ben encouraged me to undertake signal detection theory work. He knew that I had the skills for this work and he said that pain was a frontier and a good field for me to enter. I took his advice.
In Seattle, John Bonica was building a multidisciplinary pain center, and he wanted a research psychologist to work in the pain area. When Wilbert Fordyce went to the American Psychological Association convention, Dr. Bonica asked him to find a candidate. I attended that convention, and a mutual acquaintance introduced me to Bill, who in turn connected me to John Bonica. I spent the next 29 years in Seattle.
Without Crawford Clark, I would not be in the pain field. He did much more than jog the imagination of my mentor: Crawford treated me in a gracious and supporting way when I first visited him and he has continued to this day to encourage and inspire me with his ideas. John Bonica, of course, was also a major influence on my career. From him I learned that an interdisciplinary approach to pain, dedication to one’s goals, and perseverance are essential. Patience is, too, but I acquired that elsewhere.
What are you doing now?
Four years ago I moved to the University of Utah Department of Anesthesiology to establish and direct a pain research center. Our team consists of eight full-time doctorate-prepared investigators: David Bradshaw, Gary Donaldson, Robert Jacobson, Alan Light, Yoshi Nakamura, Akiko Okifuji, Ernest Volinn, and myself. By design, our research expertise ranges from neurophysiology to sociology/epidemiology. Currently, our group has nine grants sponsored by the National Institutes of Health (NIH). In addition to our anesthesiology pain physician colleagues, we have adjunct faculty members in the departments of emergency medicine, pharmacy practice, philosophy, and physiology. We are the nexus for pain research at the University of Utah.
What do you think the most significant contribution to the field of pain has been?
I have been in the field since its formal inception and have continuously tracked progress in all domains of inquiry—no single discovery or achievement stands out as the great breakthrough. Our collective progress has greater significance than any one breakthrough.
The strong interdisciplinary character of the pain field continues to impress me. One important aspect of this character is that we are truly translational. That is, an ongoing dialog exists between clinicians who see various pain problems and scientists who study mechanisms, psychological aspects, and social trends. Each side enhances and guides the understanding of the other. Another valuable aspect is that our science addresses the problem of pain at all levels, from molecular to epidemiologic. As researchers, we are able to respect and appreciate colleagues whose scientific focus and mode of inquiry differ markedly from our own. Moreover, we have developed an ability over the years to learn from one another. As I look back at how we related to one another across disciplines early in the history of pain research, I see a lot of constructive change. I like to think of this as evolution in our culture and I am very pleased at how this has unfolded and feel positive about our future trajectory.
How do you view current U.S. pain research and treatment?
Although we have come a long way, I think we have only trekked through the fog to the base of the mountain that we have set out to climb. The big challenge is right in front of us, and it is so large that it is hard to see.
Pain research does not exist in isolation. It is one aspect of a scientific frontier that we might call mind-body or brain-body medicine. NIH is beginning to fund research in this area, which is one of the domains-of-consciousness studies.
Physical health, including healing and recovery from injury, depends in part on what our brains do in the course of their continuous adaptation to the bodies they inhabit and to their physical and social environments. Cognitive and emotional processes involve massive neural, neuroendocrine, and immune system activity with direct physical consequences. Conversely, sensory processes, autonomic changes, and hypothalamo-pituitary-adre-nocortical (HPA) axis processes involved in stress and immune system activity, including cytokine production, govern somatic awareness and greatly influence emotional and cognitive states.
Three decades ago we were content to characterize pain as a sensory process delivering a modulated message of tissue trauma to the brain. Today we recognize that the nervous system, the HPA axis, and the immune system share a network of ligands and receptors that constitute a chemical language, and this language ensures that these systems respond in a coordinated way to nociceptive messages. This complex response determines the nature of pain as a subjective experience, the physical health of the injured person, and the vulnerability of that person to pain chronicity. This is the mountain that we must climb.
Pain is the ideal focus for brain-body interaction research and the multidisciplinary demands of the research fit the pain field nicely. However, our typical methodologies are not well suited for this type of investigation, and causal influences are multidirectional in brain-body studies. Brain processes have somatic effects, and bodily changes affect brain function. We will need to gather large samples and apply advanced quantitative methods, including modeling approaches that make use of the information in the correlations among the variables. I see this as the major challenge in our future.
What is the forecast for the future?
I think that we, as pain researchers and clinicians, have an opportunity to take the lead in brain-body medicine. I hope that we can seize this opportunity. If we fail to take the lead, we will have to adopt precedents that others set. If we take the lead, we can define the paradigm and set the precedents for others.
This will not come easily because we cannot engage a complex and multivariate measurement challenge with simple designs and univariate methods. Moreover, we will need to assemble teams of sensory neuroscientists, neuroendocrinologists, neuroimmunologists, neuropharmacologists, psychophysiologists, behavioral scientists, and social scientists who can work closely with statisticians or quantitative psychologists who have the requisite analytic and modeling skills to conduct multivariate studies. I can imagine significant advances in clinical practice emerging from progress in this type of research.
On a positive note, the funding opportunities are likely to be there if we are ready to undertake the work. The NIH and Congress are already behind brain-body medicine. On the negative note, the current economic climate for clinician reimbursement works against sustaining translational programs by pulling clinicians and researchers apart. It is a serious threat to the integrity of our field as a whole, and we need to consciously and strategically work to minimize its influence.
Overall, the field of pain has a bright future. It is no less exciting and challenging for a young person today than it was for me 35 years ago. In fact, it seems more exciting because we have so much more understanding and such wonderful technical and statistical tools to bring to bear on the problem. I am in no hurry to retire from this field. Why should I be? Crawford Clark is my role model and he is still publishing.
Richard Chapman, PhD, is professor of anesthesiology and director of the Pain Research Center at the University of Utah in Salt Lake City, UT.