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As a physician-researcher, I am committed to translating scientific discoveries into real-world pain relief. Translational research bridges laboratory findings (in humans) and patient care and is at the heart of my work. I aim to make significant strides in understanding and treating pain, impacting lives positively.

Research Paths

My journey in pain research involves multiple paths converging to better understand pain. By integrating different research areas, in a team-science approach, I aim to create comprehensive solutions for pain management. My ultimate goal is advancing precision pain care – tailoring the best treatment to the patient at the right time and making that care broadly available.

Decoding Pain through Brain Imaging 

Utilizing tools like fMRI (which tracks brain activity by measuring blood flow) and EEG (which records electrical activity in the brain), I explore how the brain generates, amplifies, and maintains the uniquely subjective experience of pain. From this I have contributed to our understanding how how the brain and spinal cord is involved in the magnification and persistence of pain - and the reductions through various treatments. These insights are vital in developing targeted treatments, directly impacting patient care.

Biomarkers: The Future of Pain Diagnosis 

Identifying objective biomarkers is crucial for precise pain diagnosis and treatment. Biomarkers are measurable indicators of the severity or presence of some disease state. We published some of the earliest work demonstrating the feasibility of brain-based biomarkers. More recently, as part of an NIH-supported grant, I am developing multimodal pain biomarkers using neuroimaging, blood tests, self-reporting, activity monitoring, and sensory testing. We can tailor treatments to individual needs by pinpointing these biomarkers, revolutionizing pain care.

CHOIR: Pioneering a Learning Health System in Pain Management 

CHOIR is a groundbreaking approach to collecting high-quality patient data. Our HIPAA-compliant digital health system helps us understand pain better in real-world settings and continuously improve treatment strategies. We also use CHOIR to perform research studies in real-world patients to generate more generalizable findings than those achieved in typical, homogenous clinical trials.

More recently, I have been integrating into CHOIR brief behavioral therapies (e.g., Empowered Relief®, developed by Stanford Professor Beth Darnall. We now can provide such “all-purpose” pain treatments to everyone at scale. Moreover, we can offer targeted treatments based on a patient’s unique characteristics while tracking progress and adjusting as needed.

Looking Ahead to Advance Precision Pain Care

My future goals include integrating our pain biomarkers into CHOIR. With this, we combine our mechanistic and biomarker knowledge into our learning health system (CHOIR) to better assess and optimally treat our patients with pain. We are also integrating data from wearables into CHOIR. These devices offer new ways to track health data, providing insights that drive personalized treatment plans. We are building systems for patients to view and learn from their data. Moreover, patients can use that data with their clinicians to choose the best therapies.

Making Precision Pain Care Accessible for All

In our pursuit of advancing pain care, we are developing the PRECISE platform, stemming from the foundations of the CHOIR system. This initiative is a commitment to democratize comprehensive pain care, extending it beyond the confines of large academic medical centers. Our vision with PRECISE is to establish a national digital health platform that offers free, data-driven care to all patients. This platform will harness data to personalize digital therapies, foster new treatment developments, and ensure equitable pain care for everyone. This effort resonates deeply with the objectives of the US National Pain Strategy, highlighting my dedication to inclusive and effective pain management.

Conclusion

With a vision to transform pain management, I am dedicated to improving lives through innovative research and patient-centered care. My research represents a step forward in making pain relief precise, accessible, and effective for everyone.

Acknowledgements

Funding for much of this work has come from a combination of either federal grants (NIH, FDA, PCORI) or philanthropic support from people who shared our vision for a better future for those in pain. This effort involves numerous dedicated researchers, clinicians, and people with lived experiences at Stanford and beyond. I extend my deepest gratitude to my collaborators and patients. Their contributions and insights are invaluable in advancing pain research.