Stanford University School of Medicine, Systems Neuroscience and Pain Lab, Stanford, CA
I spent my summer working as a research assistant at the Systems Neuroscience and Pain Lab (SNAPL) at Stanford University. As a psychology major and neuroscience concentrator, this position allowed me to explore the area of clinical neuroscience I am most fascinated by: pain medicine. SNAPL is a lab under the Anesthesia department of Stanford Medicine, and has many ongoing clinical and laboratorial research projects. My research responsibilities were centered on EMPOWER (Effective Management of Pain and Opioid-free Ways to Enhance Relief). EMPOWER is a clinical study under private investigator Dr. Beth Darnall, a world-renowned Stanford pain psychologist and public speaker. Once enrolled in EMPOWER, patients first create a specialized opioid taper plan with an EMPOWER provider. This taper-program is slow, compassionate, and effective through considering the patient’s medication goals and personalized best treatment approaches. Patients are also randomized to one of three treatment groups; cognitive behavioral therapy, a pain self-management program, or a taper-only group. The random control trial aspect of the study allow us to compare the effectiveness of different complementary therapies to the opioid-taper process. Patients then have 12 months of participation, where they are asked to work with their clinician on their opioid-taper, and fill out weekly questionnaires that allow the EMPOWER researchers to track their progress and check in with any questions or concerns. The entire study will have over 800 participants, and is estimated to take over five years until completion. We are a multi-state clinical study, with EMPOWER clinics in California, Arizona, Utah, and Colorado. We are currently finishing up year one and are still in the recruitment and enrollment phase of the study.
As a research assistant, my tasks included recruiting and enrolling patients for EMPOWER, with a special emphasis on the observational cohort, which will act as a control group for the study. Through this process, I recruited patients at our Stanford Pain Management Center, screened for eligibility, and consented and enrolled for the study. Our primary database for collecting participant data is CHOIR (Collaborative Health Outcomes Information Registry). Created in partnership with the National Institute of Health, CHOIR is a unique healthcare system that allows us to tailor our research questions to pain research. Patients use CHOIR to complete a series of questionnaires focused on their taper process. These questionnaires screen patients for health information, and also ask more qualitative questions about their pain, health, and medication. Not only does this allow us to collect valuable self-report data for EMPOWER, but it also allows to closely monitor the patient and check in if they have any questions or concerns. I was responsible for walking patients through these questionnaires, and following up with check-in phone-calls.
My research took me both to the SNAPL offices and to the Stanford Pain Management Center. At the clinic, I was able to work closely with the EMPOWER providers and observe their practice in interdisciplinary pain medicine. I was already greatly interested in this approach to pain treatment, which combines a biopsychosocial model with advanced neuroscience research in order to treat patients. A patient is seen by their clinician, a physical therapist, a psychologist at the clinic, and may also be referred to other specialties in the clinic such as a sleep specialist or nutritionists. Interdisciplinary pain treatment aligns well with modern pain science; through new research, advanced cognitive theories and techno- logical innovations, the neurobiology of pain has reached new levels of insight and complexity. Researchers now consider pain to be a conscious and subjective experience derived from changes in the communication between brain and body. Many times at the clinic, clinicians will use the metaphor of a four-wheeled car (or sometimes a four-legged chair) to explain effective pain treatment. This meta- phor represents the many avenues for pain treatment, such as surgical intervention, trigger-point therapies, physical therapy, and pain psychology. The key is finding the right treatment for the patient and their health goals. I was also able to officially shadow many of the clinicians at the clinic hospital, which was a truly valuable learning opportunity. Through this experience I was most struck by the essentiality of kind and productive patient-communication in treatment and care, as well as clinical research.
Throughout my research I have learned more about the opioid crisis, and the day-to-day effects on providers, patients and their loved ones. The opioid crisis is a complex puzzle, with the involvement of insurance, pharmaceutical industries, medical providers, patients and their families and friends. I learned of the various side-effects of opioids and different pain medications, and the pros and cons of using one medication or the other. I learned of the effects of withdrawal, and how opioids affect the reward-system and our pain perception. Although many patients at the clinic were going through tremendous life challenges in addition to the challenge of EMPOWER itself, I was struck by the bravery, hope, and persistence that patients and their providers brought to the study. As I watched patients and providers working together to create a solution towards increased functionality and healthier lifestyles, I felt so fortunate to be a part of such an important study.
One of my favorite aspects of this position were the people; the researchers, clinicians, and patients that I met with throughout the study truly taught me so much and were such a pleasure to work closely with. As someone who unexpectedly spent the majority of last summer as a patient in the hospital, I felt deeply connected in experience with many of the patients I worked with through my research. My own patient experience has given me empathy and compassion, and my work this summer helped me become more confident in my dream to pursue a medical career.
For my senior year at Williams, I plan to continue in this line of research by working in the lab of our neuroscience professor, Dr. Shivon Robinson. We will be using a rat model to study the neonatal effects of maternal opioid abuse. I am excited to build upon my summer research, and now have first-hand knowledge of the clinical relevance of this research. This fall I will also be taking my two senior seminars in psychology and neuroscience, as well as a 300-level neuroscience class with Professor Matt Carter, Neural Systems and Circuits. I am looking forward to honing in on my favorite subjects, and learning from the work of other students and my professors and of their own topics of interest. After Williams, I hope to spend a year abroad in pain neuroscience research, before beginning the process of applying for medical school.
Finally, I would like to say thank you to the Williams Alumni Sponsored Internship Program, the Class of 1972, Dawn Dellea, and the ’68 Center for Career Exploration. My summer was a truly pivotal one that allowed me to participate in fulfilling research and gain insights on my future career. I feel so incredibly fortunate for this experience.
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