Brainstorming about pain research

More than two dozen experts in pain research shared ideas and explored collaboration opportunities on July 14 at UTHealth Houston.

“Biobehavioral Approaches to Pain: Urban & Rural Issues” was the first event organized by the Cizik Nursing Research Institute (CNRI). UTHealth Houston established the institute in September 2024 to provide organizational support, infrastructure, and mentoring to advance nursing science. The daylong retreat brought together scientists from throughout the university with the goal of establishing multidisciplinary teams that can develop proposals for National Institutes of Health (NIH) grants to establish institutional research centers or training programs, said CRNI Director Carolyn Pickering, PhD, RN, a professor at Cizik School of Nursing at UTHealth Houston.

“The world has changed, and we need to think about how we can change,” said Janet Van Cleave, PhD, RN, FAAN, an associate professor whose Susie Conway Endowed Professorship in Nursing co-sponsored the event. “We need to think about how we can get the resources to help patients who are in pain.”

The retreat featured keynote addresses from Jane N. Bolin, RN, JD, PhD, associate director of the Southwest Rural Health Research Center; Chris Lominska, MD, an associate professor at the University of Kansas Department of Radiation Oncology; and Taichi Goto, PhD, RN, PHN, an assistant professor at Cizik School of Nursing. Bolin and Lominska focused on rural patient populations, and Goto described the development of the NIH Symptom Science Model (SSM).

Reaching rural research participants

Bolin, who holds senior appointments at Texas A&M University and the University of North Texas Health Science Center, is a multiple principal investigator on the project “Personalized Auricular Point Acupressure for Chronic Pain Self-Management in Rural Populations (UG3AT012728)” led by Jennifer Kawi, PhD, MSN, FNP-BC, CNE, FAAN, a professor at Cizik School of Nursing. The team is working toward launching a large-scale test of a mobile application to deliver a self-managed auricular point acupressure intervention in rural areas of Texas and South Carolina.*

Based at the University of Kansas Cancer Center, Lominska is a co-investigator on the project “Implementing the NYU Electronic Patient Visit Assessment (ePVA) for Head and Neck Cancer In rural and Urban Populations (R01CA282149)” led by Van Cleave.** His research focuses on treatment, survivorship, quality of life, and mental health comorbidities of people who have experienced head and neck cancers. He described research programs and resources across the cancer center’s sprawling rural catchment areas in Kansas and Missouri.

Lominska and Bolin touched on health disparities experienced by rural populations, which are often exacerbated by factors like poverty, race, seasonal employment, and lack of access to health care. For example, teen pregnancy, male suicide, and cancer mortality rates are all higher in rural areas.

However, no two small towns are the same, Bolin noted. “The cultures are as diverse as the people who settled them,” she said. “The economy and the social capital of each is very unique.”

Recruiting patients for research trials in rural areas requires analysis of each target location and lots of in-person field work, Bolin said.

Minimizing travel requirements is important when conducting research in rural areas, Lominska added. Projects that require frequent blood draws or close monitoring of novel medications can be impractical for patients who must travel hours to a doctor’s appointment.

Both fielded questions about opioids. Bolin indicated that while problems persist in some rural areas of Texas, newer regulations are helping reduce addiction.

Head and neck cancer survivors navigate long, difficult roads to recovery, Lominska said. The longer patients take opioids post-treatment, the more likely they are to continue using the drugs long term.

“Often, the people who remain on opioids, they are treating mental pain,” he said.

Symptom science evolves

Goto used cancer-related symptom research to illustrate the NIH SSM. The model was launched in 2015 and revised in 2022 to better incorporate social determinants of health and patient-centered experience, among other factors.

“The COVID-19 pandemic exposed deep disparities in health outcomes and health care access, which highlighted the urgent need for equity-driven, systemwide responses,” Goto said. “SSM 2.0 addresses these needs by enabling symptom research to extend beyond the lab, connecting directly to health policy, population health planning, and real-world implementation.”

He specifically discussed his research into how variants in the brain-derived neurotrophic factor gene correlate to fatigue and pain reported by prostate and breast cancer survivors.

Award winning posters
The retreat also featured breakout sessions, discussion groups, and a poster contest for graduate students and post-doctoral researchers. Poster contest winners were:

• Jungkyun Min of Cizik School of Nursing for her poster, “Adapting a Smartphone App-based Auricular Point Acupressure Self-Management Program for Rural Adults with Chronic Pain: A Qualitative Study in Two Southern States.” Co-authors were Bolin, Peiyin Huang of the University of South Carolina School of Public Health, Bora Rupsikha of Cizik School of Nursing, Hulin Wu of the UTHealth Houston School of Public Health, and Kawi.
  
  
• Cizik School of Nursing PhD student Sajini Thekkel for her poster “Pain Acceptance in Chronic Postoperative Pain: Concept Analysis.” Co-authors were Constance Johnson, Meagan Whisenant, and Deniz Dishman, all Cizik School of Nursing faculty.

*This project is funded by the National Center for Complementary and Integrative Health and the National Institute of Neurological Disorders and Stroke as part of the Helping to End Addiction Long-term^® Initiative of the NIH.

**This project is funded by the NIH/National Cancer Institute.