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Pain Studies Enhance Precision Medicine

By Andrew Schwartz    |   UCSF.edu | August 30, 2013

Pain Studies Enhance Precision Medicine

Christine Miaskowski, RN, PhD

In the 1980s, Christine Miaskowski, RN, PhD, was working as a clinical nurse specialist in a pain management center at the University Hospital of the Albert Einstein College of Medicine in New York.
 
"One day this woman walked in who couldn’t move her shoulder," says Miaskowski. "She talked about the pain she’d experienced since her radical mastectomy, about how her surgeon kept telling her she was healed, and how she’d been hospitalized in a psychiatric institution as a crazy postmenopausal woman. She said if we didn’t help her, she would kill herself. We were able to tell her she wasn’t crazy – we knew the pain was real, a neuropathic, postsurgical pain syndrome – but as we began to explore these cases, nearly every surgeon I called told us this wasn’t a real problem for their patients."
 
Her patients’ ordeals and that of Miaskowski’s own father – "who died in intractable pain from this same postsurgical syndrome" – have driven a career that has made Miaskowski an internationally respected pain researcher.
In December 2012 her work came full circle, when she and a diverse team of experts published the results of a major study in The Journal of Pain. The work established that after breast cancer surgery, about 25 percent of women experience persistent breast pain and 35 percent of women experience persistent arm and shoulder pain.
"It’s rewarding to complete that work," says Miaskowski, now the associate dean for Academic Affairs at UC San Francisco's School of Nursing and co-director of the Research Center for Symptom Management, one of the only such centers housed at a school of nursing in the country.
 
The rewards may grow if the research team she has assembled with her primary collaborator, geneticist Bradley Aouizerat, PhD, can show that incorporating genomics into a much broader group of potential factors – including environmental and psychosocial components – can help clinicians better understand which patients are at greatest risk for persistent postsurgical pain and how to better prevent or treat it.
 
The result would be an important refinement and broadening of the precision medicine concept, which could in turn reduce a considerable amount of human suffering and billions of dollars in health care costs.
 
100 Million People with Persistent Pain – And Few Effective Therapies
According to a 2011 report from the Institute of Medicine, 100 million Americans live with persistent pain, the treatment of which costs $635 billion every year in medical bills and lost productivity. The report was a culmination of how awareness of persistent pain as an important medical condition has grown over the last decade or so.

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