Publications
APS Bulletin • Volume 17, Number 1, 2007
Topics in Translation
Christine Sang, MD MPH, Department Editor
Research Achievements Translated to Clinical Practice
Robert P. Yezierski, PhD, Debra B. Gordon, MS RN FAAN
For the past 20 years there has been a significant investment in research devoted to studying the mechanisms of acute and chronic pain. These efforts have produced advances in the understanding of the anatomy, physiology, pharmacology, biochemistry, molecular biology, and genetics of the pain system. Now, we can safely say that our understanding of the biopsychosocial components of pain is at a level never anticipated by the likes of Holmes, Head, Adrian, Lewis, Hardy, and Livingston. Recent advances in understanding mechanisms of pain have resulted largely from the development and application of new technology as well as novel multidisciplinary research strategies that target every component of the peripheral and central substrates involved in the human experience of pain.
Today, a significant challenge in the field of pain research is the clinical application of data resulting from clinical and preclinical studies. Whether it is the discovery of a new therapeutic target, development of a novel intervention, creation of a behavioral strategy, or a new diagnostic procedure, the goal is always to provide a direct benefit to those affected by acute and chronic pain. In contemporary parlance this is referred to as translation, a conceptual creation that has emerged as the benchmark of successful research. The definition of translational research is open to debate but has been defined as “the transfer of knowledge gained from basic research to new and improved methods of preventing, diagnosing, or treating disease, as well as the transfer of clinical insights into hypotheses that can be tested and validated in the basic research laboratory” (Huxley 2002). Whether or not we accept this bidirectional definition, the fact remains that the term translational research was not even in our vocabulary 20 years ago. In today’s “road map” environment, an emphasis is being placed on clinical benefits, thus making researchers accountable for the investments of funding agencies. Although there has been a historical emphasis on understanding basic mechanisms of pain transmission and processing, this is not to say that these efforts provided little in the way of a foundation for therapeutic strategies that are used today. As we move into more contemporary times there is an even greater need for the translation of our understanding of pain mechanisms to the clinic. It is well documented that 50 to 60 million people in the U.S. are affected by chronic pain. The challenge to develop new therapies and strategies of pain management is ever present and it is important to continue to develop new avenues of research that will lead us to the discovery of novel interventions.
As the Decade of Pain Control and Research soon draws to an end, we reflect on the past 20 years to identify research advances that have led to significant progress in accomplishing the goal of effective pain management. Reflecting on what has been accomplished, and alternatively identifying those promising areas of study that have failed or have yet to become fruitful to clinical practice, may help us identify gaps in translation and flaws in the system and provide a framework for future progress that will meet the needs of patients. With this in mind, the APS Bulletin is pleased to announce a new series that will highlight significant breakthroughs and advances in pain research that have led to innovations in clinical practice.
To help launch the new series, an informal poll of 26 “seasoned” APS members was taken. Those polled were asked to list three to five achievements or breakthroughs in pain research (basic or clinical) that have had a significant impact on the management of acute or chronic pain. Those advances in the understanding of pain mechanisms that have yet to produce clinical progress or that failed to result in advances in pain management will be deferred to a later date. An APS task force narrowed a list of more than 40 ideas to six initial topics that include explanatory and or descriptive models and methods of treatment that have a solid research basis and have been translated, researched, and now routinely applied to clinical pain. These include (a) spinal delivery of opioids and other analgesics, (b) the gabapentin story (study design and modern era of FDA approval), (c) adjuvant antidepressant analgesia, (d) the biopsychosocial model of pain, (e) the fear/avoidance model of chronic pain related disability, and (f) contemporary perioperative pain management. Initial topics span acute and chronic pain conditions as well as pharmacological and nonpharmacological interventions.
The series will be launched with an overview article about translational research. The initial list of topics is only a beginning. Ideas for additional topics and suggestions of authors are welcome from all APS members. The Bulletin offers our society a unique venue to discuss this important multidisciplinary, collaborative pathway to reduce human pain and suffering. Please forward your ideas to Steve Sanders at ssanders@siskinrehab.org.
Reference
Huxley, T. H. (2002). The promise of translational physiology. American Journal of Physical Regulatory Integrative Comp Physiology, 282, R1259–R1260.
Robert P. Yezierski, PhD, is director of the Comprehensive Center for Pain Research and professor of orthodontics, neuroscience, and anesthesiology at the University of Florida.
Debra B. Gordon, MS RN FAAN, is senior clinical nurse specialist at the University of Wisconsin Hospital and Clinics in Madison, WI.