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Deirdre E. Logan, PhD
Children's Hospital Boston
Boston, USA

Copyright © 2017,
Special Interest Group on
Pain in Childhood,
International Association
for the Study of Pain®,

ISSN 1715-3956

Information appearing in Pediatric Pain Letter is not reviewed by, and is not necessarily endorsed by, the Special Interest Group on Pain in Childhood, nor by IASP ®.

Vol. 19 No. 2

June 2017


Translational research in pediatric pain: A new frontier

Christine B. Sieberg

printable version (PDF)

It was the Spring of 2011 and I was in the process of transitioning from being a postdoctoral fellow to an attending psychologist in the Pain Treatment Service at Boston Children’s Hospital. I had learned a great deal about treating complex, treatment refractory chronic pain in children during my fellowship. After all of the years of schooling and training, I was excited to become an independently functioning psychologist. Better still, I would be serving as an attending at the Mayo Family Pediatric Pain Rehabilitation Center (PPRC), a renowned day hospital program for youth with chronic pain and disability. Having devoted time during my fellowship at the PPRC, I knew firsthand how rewarding the work was – children come in with debilitating chronic pain and disability and for the most part, after 3 to 5 weeks of intensive physical and occupational therapy, along with psychological treatment and medical support, they get better, and they skip, run, and dance out of the program ready to pick up where they left off before chronic pain consumed them. Our treatment outcome research confirms the efficacy of this program (Logan et al., 2012a,b).

While this was all wonderful, I was left wondering, how do these children end up like this? How do they go from living their lives to not being able to cope and function? Many of our patients have missed months and in some cases years of school. They no longer see friends or engage in recreational and leisure activities, with many struggling to complete activities of daily living. As one patient of mine stated “I don’t have the strength to get to the bathroom”. On top of this the children and parents often present in significant psychological distress. As a psychologist, I am keenly aware of how psychosocial variables such as anxiety (Simons et al., 2012), fear of pain (Simons et al., 2011), catastrophizing (Caes et al., 2011), and parental distress and responses to child pain (Claar et al., 2008; Sieberg et al., 2011; Vervoort et al., 2011) contribute to the maintenance and exacerbation of pediatric chronic pain; however, what about the role of biology? It is clear that an individual’s genetic makeup contributes substantially to the experience of pain, with heritability estimates between 20-60% (Norbury et al., 2007), and animal studies showing a strong genetic propensity to develop chronic pain following nerve injury (Mogil et al., 1999). Clearly, the biological role in chronic pain is important to consider and many psychologists, myself included, underscore the importance of the biopsychosocial model (Gatchel et al., 2007) to conceptualize cases, explain human behavior and pathology, and formulate treatment plans. However, the processes through which the biological underpinnings interact with salient psychosocial variables to explain who is at risk for the development of pediatric chronic pain is not well understood. Examining the mechanisms that contribute to the transition from acute to chronic pain is necessary if we are going to propel the field forward and this will only be accomplished through translational research (Waldman & Terzic, 2008, 2010).

Translational research has two main purposes; to effectively translate new knowledge, mechanisms, and techniques generated in basic science laboratories into new approaches for prevention, diagnosis, and treatment of disease (Fontanarosa & DeAngelis, 2002) and to translate the results from clinical studies into everyday clinical practice and health decision-making (Sung et al., 2003). Translational research is conceptualized in levels T0-T5. At one end, T0 includes basic science discovery and at the other, T5 includes the global health impact (Waldman & Terzic, 2010). Pediatric pain psychologists are in a unique position to contribute to these important research endeavors in translational research. Yet how do we go about doing this? Well, we on the ‘bed’ side of medicine (T1-T5) need to work at forging collaborations with the ‘bench’ side (T0) and vice versa, with the backward translation from T1 (first in human phase trials) and T2 (clinical efficacy) to T0 as well, the forward translation from T0 to T2 in order to impact care (T3-T5) which is what I did. I reached out to Dr. Michael Costigan, a distinguished neurobiologist and pain geneticist at our hospital after he gave a presentation to our group. I was filled with trepidation when I entered the esteemed F.M. Kirby Neurobiology Center to meet with Dr. Costigan for the first time to discuss a potential collaboration. I had some research ideas of how we could collaborate but he is a world-renowned researcher who publishes in Neuron, Nature Neuroscience, and Cell. Would he really be all that interested in what a psychology fellow had to say? As it turned out, he was.

That meeting on May 17, 2011 was a pivotal moment in my career. It set the stage for a collaboration that has included preclinical and clinical models of chronic and persistent pain as well as presentations together at national and international conferences and collaborations around the globe. And we have both learned a lot from one another. Mike has shared that he now values the role of the environment on pain expression a lot more than before we met and in turn I have learned about how to set up and conduct animal models – never in a million years did I expect that I would be working with mice! We each bring a unique set of skills to this pain research marriage that allows us to ask questions and design studies that embody the biopsychosocial model. We are exploring the roles of biological sex, age, childhood stress, and genes on pain sensitivity with the hope that assaying the results of this environmental/genetic synergy will be to of great importance, especially in children where the risk of potentially lasting effects on neuronal plasticity is greatest. As a pediatric pain psychologist, the more I can understand the bench side of pain, the better equipped I will be at identifying patients at greatest risk and developing mechanistically based behavioral interventions for patients that are truly empirically based.

Some may ask – why mice? After all we have the perfect model, children themselves. The answer is that mice allow for us to control exactly the environment and the genome – both of which are crucial, as all diseases are the result of genetics and how the environment interacts with them. Being able to control the environment and the genome and selectively manipulate them is at the heart of scientific endeavor and we are able to conduct behavioral testing in mice that examines the key psychosocial variables of interest, such as anxiety (Open Field Activity) and social behavior (Social Interaction) (Crawley, 2004; Stanford, 2007). So even though rodents are not perfect models of patients, they are an essential piece of the translational landscape – one that should be constantly checked back to the patients and the issues that arise from their conditions. This collaboration, while amazing and transformative, has not always been easy. I have faced an uphill battle at times with some people questioning why I would pursue such research when I am not a trained lab scientist. I argue that my background in clinical psychology is an asset for the environmental and bed side component of this research. How do we truly move forward and integrate our research camps if such collaborations do not exist? Given that combining our unique skill sets is still novel, we have struggled with obtaining funding (but have recently been successful!) as well identifying publication outlets that are most appropriate for our work. Presenting our work to department chairs has been critical in conveying the importance of this work and gaining support for our continued collaborations. While our work is in the early stages, we know that our combined expertise and translational approach will only enhance our capability for developing individually tailored patient-oriented interventions (both at a behavioral and drug therapy level; T3-T4) and delivering them to at risk youth.

I once read a Robert Holden quote that said: “One new perception, one fresh thought, one act of surrender, one change of heart, one leap of faith, can change your life forever.” My career did change that day in May 2011 and I hope that my decision to reach out to a bench scientist will in turn be able to help the millions of children living with chronic pain.

Christine B. Sieberg, PhD
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine Boston Childrens Hospital; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
email: christine.sieberg[at]childrens.harvard.edu

Cite as: Sieberg CB. Translational research in pediatric pain: A new frontier. Pediatric Pain Letter 2017;19(2):20-23. www.childpain.org/ppl


This manuscript was supported by a Boston Children’s Hospital Career Development Fellowship Award, the Sara Page Mayo Endowment for Pediatric Pain Research, and the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children’s Hospital.


Caes L, Vervoort T, Eccleston C, Vandenhende M, Goubert L. Parental catastrophizing about child’s pain and its relationship with activity restriction: the mediating role of parental distress. Pain 2011;152:212-222. PubMed Abstract

Claar RL, Simons LE, Logan DE. Parental response to children's pain: the moderating impact of children’s emotional distress on symptoms and disability. Pain 2008;138:172-179. PubMed Abstract

Crawley JN. Designing mouse behavioral tasks relevant to autistic-like behaviors. Ment Retard Dev Disabil Res Rev 2004;10:248-258. PubMed Abstract

Fontanarosa PB, DeAngelis CD. Basic science and translational research in JAMA. JAMA 2002;287:1728.

Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 2007;133:581-624. PubMed Abstract

Logan DE, Carpino EA, Chiang G, Condon M, Firn E, Gaughan VJ, et al. A day-hospital approach to treatment of pediatric complex regional pain syndrome: initial functional outcomes. Clin J Pain 2012a;28:766-774. PubMed Abstract

Logan DE, Conroy C, Sieberg CB, Simons LE. Changes in willingness to self-manage pain among children and adolescents and their parents enrolled in an intensive interdisciplinary pediatric pain treatment program. Pain 2012b;153:1863-1870. PubMed Abstract

Mogil JS, Wilson SG, Bon K, Lee SE, Chung K, Raber P, et al. Heritability of nociception I: responses of 11 inbred mouse strains on 12 measures of nociception. Pain 1999;80:67-82. PubMed Abstract

Norbury TA, MacGregor AJ, Urwin J, Spector TD, McMahon SB. Heritability of responses to painful stimuli in women: a classical twin study. Brain 2007;130:3041-3049. PubMed Abstract

Sieberg CB, Williams S, Simons LE. Do parent protective responses mediate the relation between parent distress and child functional disability among children with chronic pain? J Pediatr Psychol 2011;36:1043-1051. PubMed Abstract

Simons LE, Sieberg CB, Carpino E, Logan D, Berde C. The Fear of Pain Questionnaire (FOPQ): assessment of pain-related fear among children and adolescents with chronic pain. J Pain 2011;12:677-686. PubMed Abstract

Simons LE, Sieberg CB, Claar RL. Anxiety and impairment in a large sample of children and adolescents with chronic pain. Pain Res Manag 2012;17:93-97. PubMed Abstract

Stanford SC. The Open Field Test: reinventing the wheel. J Psychopharmacol 2007;21:134-135.

Sung N S, Crowley WF Jr, Genel M, Salber P, Sandy L, Sherwood LM, et al. Central challenges facing the national clinical research enterprise. JAMA 2003;289:1278-1287. PubMed Abstract

Vervoort T, Huguet A, Verhoeven K, Goubert L. Mothers’ and fathers’ responses to their child’s pain moderate the relationship between the child’s pain catastrophizing and disability. Pain 2011;152:786-793. PubMed Abstract

Waldman SA, Terzic A. Clinical and translational science: from bench-bedside to global village. Clin Transl Sci 2010;3:254-257. PubMed Abstract

Waldman SA, Terzic A. Clinical and translational sciences: at the intersection of molecular and individualized medicine. Clin Transl Sci 2008;1:6-8. PubMed Abstract