Research

Pain Treatment Decision-Making

We are interested in how patient, provider, and contextual factors influence pain assessment and treatment decisions. In this work, we often use computer-simulations, which allow us to manipulate and test hypotheses about key characteristics that influence the clinical encounter. For example, we conducted a randomized controlled trial using computer-simulated (“virtual”) patients to reduce racial and socioeconomic disparities in pain care delivered by real-life providers. In another study, we conducted a pilot clinical trial using virtual providers and individual coaching to help Black patients with pain engage in shared decision-making with their real-life providers. 

Computer-simulated patients depicting a Black patient of high socioeconomic status (left) and a White patient of low socioeconomic status (right)

Complementing our computer-simulations, we also use full-motion videos of real patients with pain engaging in functional tasks (e.g., getting out of bed, picking up items off the floor). For example, we have used these stimuli to examine how patient weight and gender impact observers’ pain judgments and treatment recommendations, and the factors that mediate these relationships. 

 

All of these methodological approaches allow us to better understand potential mechanisms that underlie disparities in pain care and use this knowledge to develop targeted interventions that improve providers’ pain treatment decisions and patients’ self-management.

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Computer-simulated providers that help patients clarify and communicate their treatment goals.

Clinical Trials

We conduct clinical trials of new interventions that are designed to help patients with pain live more satisfying lives and get the most out of their healthcare. We frequently collaborate with colleagues in Medicine and Veterans Affairs (VA) to conduct these trials. For example, we completed a randomized clinical trial of a coaching intervention to increase patient activation and communication self-efficacy among Black Veterans with chronic pain. We are also testing new interventions to increase the use of non-pharmacological pain treatments (NPTs) among patients with chronic pain. In these trials – conducted separately in the VA and an urban safety-net hospital – we employ a Decision Aid and individual coaching to help patients identify the NPTs that best fit with their lifestyle and overcome the barriers to sustained use. 

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Sidney and Lois Eskenazi Hospital

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Roudebush VA Medical Center

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IU Health University Hospital

Pediatrics

We are interested in how psychological factors (e.g., pain-related injustice, coping, and resilience) and social factors (e.g., caregivers’ catastrophizing and injustice perceptions) influence pain and functioning in children/adolescents with pain. 

 

Through our connection to the Pain Clinic at Riley Children’s Hospital, we use longitudinal clinical data to examine the influence of pain-related injustice and catastrophizing (measured in both children and caregivers) on pain and functioning in children/adolescents with pain.

We have also created computer-simulated children and caregivers to use in research examining psychosocial factors that facilitate and impede the delivery of guideline-concordant care for children/adolescents with pain. For example, we have used virtual pediatric patients to examine (1) how providers’ pain assessment and treatment decisions vary by child race and gender, (2) the extent to which providers’ racial and/or gender biases (implicit and explicit) influence their pain decisions, and (3) the relationship between providers’ gaze patterns (measured with eye-tracking technology) and their pain decisions.

Pediatric patient and caregiver stimuli. Each color represents a participant's eye-tracking. Circle size indicates how long the participant looked at certain parts of the stimuli.

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Riley Hospital for Children

Quantitative Sensory Testing

In our laboratory-based research, we use quantitative sensory testing—a group of procedures that assess perceptual responses to systematically applied and quantifiable sensory stimuli in order to characterize somatosensory function—on healthy laypersons to examine the interaction of biological, psychological, and social factors related to pain.

 

For example, we have conducted a series of studies examining how differences in pain-related coping (e.g., use of prayer) contribute to race differences in pain sensitivity during a cold pressor task. In a separate series of studies, we are examining the extent to which participants’ beliefs (implicit and explicit) about race differences in pain sensitivity are related to actual race differences in pain sensitivity.

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Advanced Thermosensory Stimulator

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Application of thermal stimuli

Cold pressor task