Scientists and Clinicians Join Forces to Battle Pain
Nancy Gambill, MS, CRNP, of the Greenebaum Cancer Center, and Susan G. Dorsey, PhD, RN, of the School of Nursing, show a patient how she can log any pain she experiences on a digital device, for a study the two nurses are leading jointly.
The nurses who deliver chemotherapy to patients at the University of Maryland Medical Center’s Stoler Pavilion see it often: Some of the drugs that kill cancer cells can cause a side effect known as peripheral neuropathy (pain or numbness) in the hands and feet. It can start as pins and needles, but get bad enough to seriously affect a patient’s quality of life or even halt the therapy. The pain often goes away after the therapy stops, but not always.
Two nurses are leading a team investigating whether exercise or other factors might play roles in reducing this type of neuropathy. Their research partnership is part of a larger one between the Medical Center and the University of Maryland School of Nursing.
Susan G. Dorsey, PhD, RN, assistant professor and co-director of the School of Nursing’s Developing Center of Excellence in Disorders of Neuroregulatory Function, has dedicated her career to the study of pain. She is working at the basic science level in a laboratory.
Dorsey has joined with Nancy Gambill, MS, CRNP, manager of ambulatory nursing for the UM Marlene & Stewart Greenebaum Cancer Center, as co-principal investigators of this study. They and their respective teams are designing a project they hope will lead to more ways to treat and reduce peripheral neuropathy associated with chemotherapy.
“We’re all very excited about it, especially if we can come up with some sort of solution for these patients,” says Todd Milliron, RN, lead ambulatory interventional nurse in the infusion clinic, and one of Gambill’s staff working on this study. “We’ve had patients who are involved in clinical trials, but for us to be carrying out the research from the beginning is new.”
“It’s important for us to tie into the academic environment at the School of Nursing,” Gambill says. “We have nurses who are pursuing advanced degrees, and some who are interested in research – but not necessarily if it means leaving patient care. So this partnership is the kind of thing that keeps giving nurses an opportunity to have greater impact, whenever they are ready to branch out.”
The new partnership between the Medical Center and the School of Nursing will encourage and facilitate more such research projects. This particular project led by Dorsey and Gambill was cultivated by Karen Johnson, PhD, RN, director of nursing research for the Medical Center. Johnson’s position is new this year, and is a dual appointment: Half of her salary is paid by the Medical Center, and half by the School of Nursing. She serves as a coordinator to foster and encourage more research among nurses at the Medical Center who have clinical expertise, in collaboration with faculty at the School of Nursing who have expertise in research.
The teams led by Dorsey and Gambill have been meeting regularly. They created an electronic site to share articles and engage in discussion. Their goal is to begin the study in the next several months, and they are in the process of developing a protocol for the University of Maryland Institutional Review Board.
Dorsey’s lab studies the molecular and cellular mechanisms of how chronic pain develops and persists. In particular, Dorsey was studying the increased sensitivity to pain that can be a side effect of chemotherapy drugs.
Recently, Dorsey’s lab discovered the novel finding that exercise significantly reduced pain behavior in mice after they received a variety of chemotherapeutic agents. The exercise was in the form of voluntary running on a wheel. An interesting fact: The mice will run for a total of 6K (about 4 miles) in one night.
Dorsey and Gambill discussed how the findings in laboratory mice might be worth exploring in humans.
“At this point, we are not suggesting any therapeutics or interventions, including exercise,” Dorsey says. “It is premature. First, we need to understand more about the potential molecular and cellular mechanisms and pathways that underlie the peripheral nerve damage and the pain behaviors that can be caused by these drugs.”
In the lab, Dorsey and her colleagues will examine changes in gene expression in the mice and examine nerve conduction to evaluate the degree of nerve damage caused by the chemotherapeutic drugs. Then, they will correlate these findings with the “nocifensive” (pain-avoidance) behaviors by the mice.
“In patients, we can examine the same types of outcomes,” Dorsey says, including gene expression, genotype and nerve-fiber conduction. But with the patients, it will be correlated with their reports of pain and how well they are functioning, using a small device that is like a personal digital assistant (PDA) and functions as a daily pain log.
“Once we understand more about the underlying mechanisms, then we would try to identify novel therapeutic opportunities that can be tested in patients, including the possible use of aerobic and resistive exercise training,” Dorsey says.