Overview

Millions of Americans suffer from adverse symptoms such as pain that can inhibit their ability to lead normal lives. Pain can be a debilitating symptom of chronic illness such as arthritis and diabetes, and pain can itself become a chronic condition. Throughout its history, the National Institute of Nursing Research (NINR) has supported symptom science research on new and better ways to manage the symptoms of illness, including research on the biological and behavioral aspects of pain, with the goal of developing new knowledge and new strategies for improving patient health and quality of life. More recently, research supported by NINR has focused on the full range of symptom science, from symptom management to understanding the underlying mechanisms that cause symptoms, including pain. The broader focus on the mechanisms that cause pain and other symptoms will lead to more personalized symptom management.

The Institute supports symptom science research at universities, hospitals, and other institutions across the Nation, as well as an intramural research program on the NIH Campus in Bethesda, Maryland. Taken together, NINR’s extramural and intramural pain research focuses on: 1) improving understanding of the underlying biological mechanisms of acute and chronic pain; 2) illuminating the biological and behavioral processes through which patients respond to pain management interventions; and, 3) developing and testing effective pain management interventions. Finding new and better ways to manage adverse symptoms, including pain, is vital to improving quality of life for patients and their families and caregivers. From the bench to the bedside, and from the clinic to the home, NINR supported research on pain and other symptoms is developing evidence-based management strategies that reflect basic science translated into clinical practice.

This webpage provides a broad overview of NINR’s activities in pain research, highlighting recent research findings, program initiatives, and other research efforts. For more information on NINR’s portfolio in pain research, links to staff contacts are provided.

Biology of Pain:

• A team of researchers discovered that women who had a particular variant of the serotonin transport gene were more likely to experience nausea and vomiting long after hospital discharge following surgery. These women also reported higher levels of pain and anxiety. (http://www.ncbi.nlm.nih.gov/pubmed/?term=24578078)
• Scientists determined that patients with fibromyalgia had lower levels of particular cytokines. The findings support the hypothesis that inflammation plays a role in the chronic pain syndrome of fibromyalgia.  (http://www.ncbi.nlm.nih.gov/pubmed/?term=24741634) 
• A group of researchers tested the use of repetitive transcranial magnetic stimulation (rTMS) in gastric bypass surgery patients. The stimulations did not reduce use of pain medication, but the investigators found that the stimulations lowered some affective and sensory dimensions of pain. (http://www.ncbi.nlm.nih.gov/pubmed/?term=24527503)
• A group of scientists identified patient subgroups with and without arm/shoulder pain following breast cancer surgery.  Patients who had more pain were younger, had higher body mass index and had more breast pain prior to surgery.  They also had higher levels of depression, anxiety and sleep disturbance. (http://www.ncbi.nlm.nih.gov/pubmed/?term=24485012)
• Researchers working with children who had sickle cell disease found clear differences in the genes that provide the coding for an enzyme that helps metabolize nonsteroidal anti-inflammatory drugs. Such differences might impact the dose of nonsteroidal anti-inflammatory medications needed to treat pain in persons with sickle cell disease.  (http://www.ncbi.nlm.nih.gov/pubmed/?term=24889181)
• NINR intramural scientists conduct clinical research at the NIH Clinical Center. Please see this feature on the discovery of biomarkers of chronic abdominal pain in children as an example of intramural symptom science advances supported by NINR. (https://www.ninr.nih.gov/researchandfunding/dir/biomarkers-children-ab-pain) (http://www.ncbi.nlm.nih.gov/pubmed/23516176)

Assessment and Management of Pain:

• Scientists tracked the pain self-care practices of patients in end-stage liver disease, and found that one of the self-care practices (pain medication intake) differed according to the eligibility of the patient for a liver transplant. Understanding individuals’ experience of pain and pain management practices is vital to the care of this population.(http://www.ncbi.nlm.nih.gov/pubmed/?term=24826441)
• Young adults with sickle cell disease will often delay seeking clinical treatment of their pain.  In this sample of young adults with sickle cell disease, the majority waited to seek care until their pain levels were an average of 8.7 (on a 1-10 scale).  They felt that time was important in their lives and they preferred to treat pain at home, avoid the emergency department because of past experiences, and avoid admission to the hospital. (http://www.ncbi.nlm.nih.gov/pubmed/?term=23343879)
• Scientists determined the accuracy of multidimensional pain scales in the diagnosis of severe pain. The researchers were able to quantify cutoff points that indicated severe pain with two different measurement scales.  The scales were determined to be highly sensitive in measuring pain. (http://www.ncbi.nlm.nih.gov/pubmed/?term=25068188)
• Scientists have developed a telehealth intervention that allows health care providers and patients with chronic pain to receive consultation from pain specialists.  The goal of the study is to improve pain assessment and management in non-academic medical centers. The trial is ongoing, and may soon lead to a promising new model of facilitating pain and other symptom management with hard to reach populations, such as those in rural areas. (http://www.ncbi.nlm.nih.gov/pubmed/?term=24846620)   

Other NINR Pain Research Activities