Tag Archives: chronic pain

By Ted Boscia
Reprinted from Cornell Chronicle, November 4, 2014

Cornell’s Translational Research Institute for Pain in Later Life (TRIPLL), a New York City-based center to help older adults prevent and manage pain, has received a five-year, $1.95 million renewal grant from the National Institute on Aging.

The institute, formed in 2009 as one of 12 national Edward R. Roybal Centers for Translational Research on Aging, studies innovative, nonpharmacological methods to ease persistent pain, which is estimated to afflict nearly half of older Americans. TRIPLL unites social and psychological scientists at Cornell’s Ithaca campus, Weill Cornell Medical College researchers and community-based health care partners.

With the grant renewal, TRIPLL adds a focus on behavior change science, seeking to apply insights from psychology, sociology, economics and communications to develop optimal pain management techniques. For instance, knowing how and why older adults decide on various medications, therapies, exercises and other methods to limit pain can help individuals and their caregivers to weigh their preferred treatments. TRIPLL investigators also plan to explore how new communication tools, including social media and smartphones, can be harnessed to manage pain.

“In spite of how widespread chronic pain is among older adults, there are relatively few tested interventions to help people reduce their pain,” said TRIPLL co-director Karl Pillemer, the Hazel E. Reed Professor of Human Development in the College of Human Ecology. “Our new focus is exciting because we hope to translate findings into more effective interventions by deepening our understanding of human behavior and decision-making.”

More than 100 million Americans suffer from chronic pain, more than those affected by heart disease, diabetes and cancer combined. Yet relatively few researchers study pain management, with most focusing on well-known diseases. But untreated pain takes a physical, mental, social and economic toll on older adults, according to TRIPLL co-director Cary Reid, the Irving Sherwood Wright Associate Professor of Geriatric Medicine at Weill Cornell.

“Treating pain in older patients is challenging in many ways,” Reid added. “There are few studies that enroll typical older patients that can help to guide management decisions. Older adults are more sensitive than younger adults to medication-related side effects, and many older individuals (along with their health care providers) believe that pain is supposed to be present in later life.”

Despite these challenges, Reid said that preventive approaches are critical to lessen the many negative consequences – such as reduced mobility, depression and anxiety, sleep impairment and social isolation – of poorly controlled pain.

In its first five years, TRIPLL has funded 30 pilot studies on innovative treatments, policies and interventions for improved pain management. More than 100 investigators – faculty members and graduate students – have been mentored by TRIPLL investigators, including presentations of their work at monthly work-in-progress seminars.

The institute will continue to have strong community roots, said TRIPLL co-director Elaine Wethington, professor of human development and of sociology. In Ithaca and New York City, TRIPLL researchers are partnering with health care providers, hospice and home nurse agencies and older adults themselves to match interventions to their needs. Its translational focus seeks to move evidence-based techniques directly into clinical practices, programs and policies.

“The involvement of community organizations in every aspect of research project development – from conceptualization, design, participant recruitment and eventual dissemination – is one of TRIPLL’s strengths” said Wethington. “The input of community agencies and consumers leads to research that is more likely to be implemented successfully in diverse cultural settings.”

Affiliated with Cornell’s Bronfenbrenner Center for Translational Research, TRIPLL includes collaborating investigators at Weill Cornell Medical College, Cornell University (Ithaca campus) and the Hebrew Home at Riverdale. TRIPLL also maintains ongoing partnerships with Columbia University, the Hospital for Special Surgery, Memorial Sloan Kettering Cancer Center, Visiting Nurse Service of New York, and the Council of Senior Centers and Services of NYC.

Ted Boscia is director of communications for the College of Human Ecology.

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College of Human Ecology
Weill Cornell Medical College

By Karene Booker
Reprinted from Cornell Chronicle, February 19, 2014



A low-cost, six-week program that teaches people how to manage pain and stay active has proven to reduce arthritis pain and disability, yet few of the nation’s 50 million adult arthritis sufferers have used it. By enhancing the program’s content and delivery with the help of community partners, Cornell researchers report that attendance improved dramatically, and participants were significantly more likely to stay in the modified program compared to the original, while experiencing the same physical and mental health improvements.

“Effective health programs may not reach people who need them due to factors such as culture, language, age or income, but changing programs to meet the needs of new target populations can make a dramatic difference,” said study co-author Karl Pillemer, professor of human development in Cornell’s College of Human Ecology.

The study, which was published in February in the Musculoskeletal Journal of the Hospital for Special Surgery (Vol. 10:1), focuses on the Arthritis Self-Management Program, also known as the Arthritis Self-Help Course.



“To our knowledge, this is the first controlled study to directly compare the effects of an adapted chronic disease self-management program with the original,” said co-author Dr. M. Carrington Reid, associate professor in geriatrics at Weill Cornell Medical College. He added that rigorously evaluating modified programs such as this one to ensure they still deliver the expected benefits is rare, but critical.

To modify the underutilized program, Reid, Pillemer and his colleagues collaborated with a team of staff from local agencies and senior centers, older adults and program instructors. The team incorporated nearly 40 enhancements suggested by program participants and instructors, such as adding in-class exercise practice and individual action plans to make use of local health programs, expanding information on healthy eating and weight management, and simplifying reading materials.

The adapted and original versions were tested with 201 older adults, with baseline data collected at the beginning, at program completion and 18 weeks later. While both groups experienced equivalent relief in pain, stiffness and perceived disability, attendance in the adapted program improved by 46 percent, and participants were 26 percent more likely to stay in the modified program than in the original.

That means that the modified program could have significantly more reach and impact, the authors say. Their findings not only underscore the value of involving local stakeholders in tailoring interventions to specific populations, but also the importance of conducting controlled experiments to quantify the results, they say. Furthermore, they add, their findings highlight the potential of relatively simple programs to help build self-efficacy for arthritis management and improve quality of life.

The study, “Measuring the Value of Program Adaptation: A Comparative Effectiveness Study of the Standard and a Culturally Adapted Version of the Arthritis Self-Help Program,” was also co-authored by graduate student Emily Chen and senior research associate Charles Henderson of Cornell, and Samantha Parker of Tulane University School of Medicine. It was supported in part by the National Institute of Nursing Research and the National Institute on Aging.

Karene Booker is an extension support specialist in the Department of Human Development.

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By Karene Booker

Jessie Boas


Meghan McDarby


Two Cornell undergraduates have been pursuing their respective passions for working with older adults and solving problems in underserved communities by tackling the burden of chronic pain among minorities.

Over the past year, Meghan McDarby ’14 and Jessie Boas ‘13 delved into the research on how persistent pain affects different racial, ethnic and age groups under the guidance of sociologist Elaine Wethington, professor of human development in the College of Human Ecology and co-director of Cornell’s Translational Research Institute on Pain in Later Life (TRIPLL).

Their conclusion - minorities are at greater risk and are less likely to receive adequate care, and the problem may grow as America’s population ages and becomes increasingly diverse. The causes of the inequities are not simple, they found, ranging from factors like individual differences in pain sensitivity and beliefs about medical care, to provider factors like less effective pain assessment and communication with patients, to systemic factors like differing access to health care.

 “I think I have learned more about being a successful physician from this research than I have from any pre-med prerequisite,” said McDarby, a human development major and aspiring geriatrician. McDarby discovered her passion for older adults in high school through a chance volunteer experience at her local hospital and has pursued this passion through her coursework and activities at Cornell.

“This project sparked my interest in policy and public health issues,” she said. “I’ve realized that the sociological aspects of the practice of medicine are just as important as the biological and psychological principles.”

The students prepared their findings for a Pain Disparities Consensus Workshop, convened in December by TRIPLL, which brought researchers and practitioners together to develop strategies to address inequities in pain care in New York City.

“Our paper served as a springboard for collaborative and interactive discussion on pain disparities and related issues,” said Boas, a sociology major in the College of Arts and Sciences who hopes to join the Peace Corps when she graduates. “I want to have the skill set to effectively research the problems that plague communities, and be able to initiate programs to ameliorate them.” “Meghan and I were fortunate enough to attend this conference and to discuss pain disparities with top experts in the field.”

Now the students are writing an article with Wethington and TRIPLL Director Dr. Cary Reid at Weill Cornell Medical College highlighting their findings as well as the recommendations generated by the conference.

After spending months on the literature review, the highlight of the project came when she met Dr. Carmen Green from the University of Michigan, upon whose work the literature review was based. “Meeting strong, dedicated women like Dr. Green and Professor Wethington has given me the courage to move forward full-force into the healthcare field,” said McDarby.

 “Meghan and Jessie are outstanding examples of how involvement in research is one of the major advantages of a Cornell undergraduate education and a “win-win” for faculty and students,” Wethington said.  “They have brought incredible energy and intelligence to this project and their involvement has helped them apply what they have learned in the classroom to real world issues. Dr. Reid and I have benefited from their commitment and dedication and they have laid the groundwork for their future careers.”

Karene Booker is an extension support specialist in the Department of Human Development.

The Cornell Institute for Translational Research on Aging (CITRA) is pleased to announce continued funding of its Roybal Center. The new center will be called the Translational Research Institute on Pain in Later Life (TRIPLL), and will focus on improving the prevention and management of pain in later life. Cornell University and its medical college are joined by new partners including Columbia University’s Mailman School of Public Health, Memorial Sloan Kettering Cancer Center, the Hospital for Special Surgery and the Visiting Nurse Service of New York. Dr. Cary Reid will serve as Director and Dr. Karl Pillemer will serve as co-principal investigator. Dr Elaine Wethington, also co-principal investigator, will oversee the Pilot Study core component of the grant.

The focus on pain management in later life is particularly appropriate given that as many as 30 to 40 percent of older adults experience persistent pain, which can be a costly and frequently disabling disorder in later life. Effective solutions to the problem of later-life pain require moving basic behavioral and social science and medical research findings more rapidly into programs, practices, and policies targeting older adults. This Center will continue to take advantage of its research-ready senior center and agency network, based in the diverse multicultural environment of New York City. It will build on its earlier success in applying theoretical and empirical findings in the area of social integration and isolation, to understand barriers to diffusion of successful pain management programs, particularly self-management programs and strategies.

The mission of the center is to 1) translate the findings of basic behavioral and social science research into treatments, intervention programs, and policies that improve the health and well-being of older adults who suffer from or are at increased risk for pain, 2) promote translation of evidence-based practices, treatments, and interventions across
diverse venues to improve management of pain, 3) develop and test innovative methods, tools, and strategies that facilitate successful translation of evidence into practice and finally, 4) develop and maintain an effective infrastructure for conducting translational research on aging and pain.

For Further Information

Please email Karl Pillemer, kap6@cornell.edu, or Cary Reid, mcr2004@med.cornell.edu, if you have any questions or would like additional information about TRIPLL. A new website is in preparation and will be available shortly.

Human Development Outreach & Extension

Karl Pillemer

Cary Reid, Associate Professor of Medicine at Weill Cornell Medical College, and Karl Pillemer, Professor of Human Development and Director of Cornell Institute for Translational Research on Aging (CITRA) were awarded a grant of $450,000 from the National Institute for Nursing Research. The project, entitled “Taking Community Action against Pain," will conduct a trial of non-pharmaceutical interventions for chronic pain in older persons.

Over the past several years, CITRA has been developing a program of applied research and extension/outreach on the problem of chronic pain in older adults. Chronic pain is a common and costly disorder. Effective, evidence-based treatments in the form of self-management programs have been developed for use in the community, but have been underutilized. Numerous barriers to program use likely exist at the individual, program, and cultural levels. The project will use a community based participatory research approach to identify these barriers, develop and pilot test methods to successfully address the barriers, and then disseminate tools and resources.

Partnering with three senior centers in New York City (each serving a distinct race/ethnicity group), the interdisciplinary team will seek to answer the following key questions: 1) What are the major barriers to adoption of and adherence to an evidence-based pain-reduction protocol by seniors with chronic pain? 2) How can the pain protocol be adapted using a community based participatory research approach to better meet the needs of seniors from three distinct race/ethnicity groups: African American, Hispanic American, and non-Hispanic White Americans? 3) What is the effectiveness of this approach on pain management compared to a conventional chronic pain program?

A number of other activities relating to translational research on chronic pain are underway in CITRA. In addition to Reid and Pillemer, leadership in this area comes from Elaine Wethington, Associate Professor of Human Development and Co-Director of CITRA, and Anthony Ong, Assistant Professor of Human Development.

For Further Information

Cary Reid, mcr2004@med.cornell.edu

Karl Pillemer, kap6@cornell.edu

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