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Joining forces to ease chronic pain

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triplllogo-smallerBy Sheri Hall for the BCTR

Pain relievers are some of the most commonly-used medicines among older adults. But a Cornell-based organization called the Translational Research Institute on Pain in Later Life, or TRIPLL, is exploring alternative ways to alleviate pain in older adults.

TRIPLL is one of the most active and long-standing collaborations among the Cornell campuses — comprising researchers and graduate students at the Bronfenbrenner Center for Translational Researcher (BCTR), Weill Cornell Medicine, and Cornell Tech, plus dozens of community organizations serving seniors in New York City.

“It’s a very broad and deep collaboration,” said Karl Pillemer, TRIPLL co-director and director of the BCTR. “Because of our use of video conferencing, Skype and frequent meetings, it’s honestly not much different than if we were all in the same building. A number of us work with our TRIPLL colleagues even more than with people on our own campuses.”

TRIPLL was founded in 2009 with a grant from the National Institute on Aging. It is one of 12 federally-funded Edward R. Roybal Centers for Translational Research on Aging across the nation; each one focuses on a different aspect related to the health and well-being of older Americans.

TRIPLL brings together faculty from a variety of disciplines, including clinical medicine, epidemiology, gerontology, the social and behavioral sciences, computer science to focus non-pharmacologic methods of pain relief.

“Pain is a huge problem — it’s one of the things that keeps people homebound,” says Riverdale Senior Services director Julia Schwartz-Leeper, who regularly uses the institute’s webinars to train her staff. “The work that TRIPLL does is critically important.”

Karl Pillemer and Elaine Wethington

Karl Pillemer and Elaine Wethington

As the American population ages, the issue of treating pain in older adults is only getting more pressing. TRIPLL co-director Dr. Elaine Wethington, a medical sociologist and an associate director at the BCTR, notes that one-third of older adults has chronic pain — “and the majority of those find inadequate relief.”

Effective, evidence-based alternatives to pharmaceuticals are needed because many older adults have pre-existing conditions, such as heart failure or kidney problems, that pain medicines can exacerbate. The epidemic of opioid abuse also complicates matters. Fear of addiction may discourage older people from taking pain drugs. And reducing the number of opioid prescriptions keeps the drugs out of a medicine cabinet where they could be misused by family members or others, Pillemer said.

“Our inability to deal with chronic pain through non-drug methods is a huge problem,” he said. “In terms of an issue that makes the largest number of people miserable, chronic pain is at the top. But it’s not a high-profile problem that has an easy cure, so it doesn’t attract as much research funding.”

In an effort to combat the problem, TRIPLL’s researchers award grants for pilot studies; hold monthly seminars linking researchers on the various campuses; mentor graduate students, post-docs, fellows and junior faculty; and serve as a resource to New York City community service agencies, whose tens of thousands of clients provide a deep bench of volunteers for research studies.

“For years there’s been a consensus among researchers that pain is not just a biological phenomenon, it’s also a social and a psychological one, but there are few centers in the United States that look at pain from this biopsychosocial perspective,” Wethington said. “Our commitment is to understand these aspects as completely as we can — to get really smart people working on them, to publish papers in places where they’ll have an effect on practice.”

This story is adapted from an article that was first published in Weill Cornell Medicine, Vol. 16, No. 1.

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Networking event on pain in later life sparks new connections

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TRIPLL co-director Elaine Wethington speaking with Information Sciences grad student Alex Adams (l) and Communications associate professor Jeff Niederdeppe (r)

TRIPLL co-director Elaine Wethington speaking with Information Sciences grad student Alex Adams (l) and Communications associate professor Jeff Niederdeppe (r)

On October 21st the Translational Research Institute on Pain in Later Life (TRIPLL) hosted a networking event for over 30 invited researchers at the Statler Hotel on Cornell campus.  TRIPLL, an NIH-funded Edward R. Roybal Center, fosters multidisciplinary collaborations among researchers from Weill Cornell Medical College, faculty at Cornell’s Ithaca Campus, Cornell Tech, and the Bronfenbrenner Center for Translational Research (BCTR), with the goal of understanding and treating pain in older adults.

An introduction by TRIPLL director Cary Reid (Weill Cornell Medical College) noted key challenges in the field. “Up to half of all older adults live with chronic pain,” Reid said, “but diagnostic and treatment approaches have yet to catch up to this reality.” To address this concern, Reid highlighted a range of resources offered by TRIPLL to engage new researchers in the field, including pilot funding, webinars, feedback on project proposals, matchmaking with potential collaborators, and access to participant populations.

“Promising new approaches to treat pain may come from wide variety of fields,” said TRIPLL co-director and interim BCTR director Elaine Wethington. She continued, “for this event we reached out to researchers in social, behavioral, economic, environmental, biological, communication, and information sciences. Basic scientists can sometimes feel daunted when trying to extend their work to clinical settings and patient populations. TRIPLL provides the guidance and resources to help secure study participants.”

Current and past TRIPLL pilot investigators spoke about the support TRIPLL gave them, helping them secure local and federal support for their research.

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The BCTR (and Urie!) in Human Ecology Magazine

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news-chemagspr15-inpostThe spring issue of Human Ecology Magazine features the BCTR prominently - including a cover story on Urie Bronfenbrenner, for whom the center is named. Also inside are: a story on BCTR director Karl Pillemer's new book, 30 Lessons for Loving (p.28); briefs on the Translational Research Institute on Pain in Later Life and the new Obesity Prevention Center in the Division of Nutritional Sciences with multiple BCTR ties (p. 10 and p. 11, respectively); a photo of John Eckenrode with Bronfenbrenner Lecturer Richard Lerner and one of Iscol Lecturer Maria Pacheco (p. 51).

As a child on walks with his father in the woods, they played a game, guessing why certain plants grew in certain places and not others - light, water, and soil determining which plants thrived where. These early hikes with his amateur botanist father were fundamental in forming Urie's perspective that human development must be viewed in a wider context of interacting influences to be understood. The HE Magazine cover article expands on Urie's forming his ecological systems theory of human development, his influence as a professor on today's top thinkers in the field, his passionate and open work ethic, and his strong conviction that research must engage with and affect policy and practice. BCTR director Karl Pillemer notes,

We have the good fortune of being named after an individual whose life and career epitomizes the work our center does. People working in agencies, health care settings, and social services help scientists set scholarly priorities, find the most interesting research questions, and help us get our research findings out to people who can actually use them. Urie modeled that.

 

Human Ecology Magazine - Spring 2015

 

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TRIPLL’s National Institute on Aging funding renewed

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The BCTR's Translational Research Institute for Pain in Later Life (TRIPLL) has received a five-year, $1.95 million renewal grant from the National Institute on Aging. In this next phase, TRIPLL adds a focus on behavior change science, applying insights from psychology, sociology, economics, and communications to develop optimal pain management techniques. TRIPLL investigators also plan to explore how new communication tools, including social media and smartphones, can be harnessed to manage pain.

TRIPLL co-director Karl Pillemer notes,

In spite of how widespread chronic pain is among older adults, there are relatively few tested interventions to help people reduce their pain. 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.

TRIPLL, based in New York City, is one of 12 national Edward R. Roybal Centers for Translational Research on Aging. TRIPLL unites social and psychological scientists at Cornell’s Ithaca campus, Weill Cornell Medical College researchers, and community-based health care partners.

 

Funding renewed for aging and pain research center - Cornell Chronicle

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TRIPLL researchers receive Community Collaboration Award

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Pillemer, Reid, Wethington

Pillemer, Reid, Wethington

This April, researchers from the BCTR's Translational Research Institute on Pain in Later Life (TRIPLL) were awarded the Faculty Excellence in Community Collaboration Award from Cornell Engaged Learning + Research and the Office of Academic Diversity InitiativesKarl Pillemer, Cary Reid, and Elaine Wethington were the recipients. The award recognized TRIPLL's unique approach to researcher-community partnerships and its involvement of students in engaged research.

TRIPLL is an academic-community collaboration among investigators at Weill Cornell Medical College, Cornell-Ithaca, Columbia University Mailman School of Public, the Hospital for Special Surgery, the Visiting Nurse Service of New York (VNSNY), and the Council of Senior Centers and Services of New York City, Inc. TRIPLL's model of translational research involves an ongoing cycle of basic science, health-relevant findings, human health application, intervention, diffusion to practice, and public health impact.

TRIPLL engages graduate and undergraduate students through research assistantships, internships, seminars, and workshops. Students' areas of research include advance care planning, music therapy, social isolation, disaster preparedness, and use of opioids for pain.

Service-learning event honors student, faculty projects - Cornell Chronicle

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A new approach to managing arthritis pain

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Karl Pillemer

Karl Pillemer

Although they had developed a program that was proven to help people manage arthritis pain, Cornell researchers found that participants were having trouble attending all of the training sessions. In a recent Cornell Chronicle article, the BCTR's Karl Pillemer, co-director of  the Translational Research Institute on Pain in Later Life (TRIPLL), described the disconnect:

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.

To figure out ways to ensure better attendance, researchers Cary Reid, Karl Pillemer, and their colleagues met with community practitioners, arthritis sufferers, and program instructors. They ultimately incorporated over 30 suggested changes to create new guidelines for implementing the program. Results of the study were published in the Musculoskeletal Journal of the Hospital for Special Surgery this February.  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 BCTR graduate research assistant Emily Chen, Cornell senior research associate Charles Henderson, and Samantha Parker of Tulane University School of Medicine. The study was partially funded by the National Institute of Nursing Research and the National Institute on Aging. Adapted arthritis program boosts participation - Cornell Chronicle

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TRIPLL announces webinar series on pain management

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news-tripll-logo-inpostThe BCTR's Translational Research Institute on Pain in Later Life (TRIPLL) is offering a series of webinars on pain management, pain care, and pain disparities. The webinars are free, but registration is required for each. Please contact Marcus Warmington at Weill Cornell Medical College for more information and to register. Further information can also be found on the TRIPLL web site.

TRIPLL is an academic-community collaboration among investigators at Weill Cornell Medical College, Cornell-Ithaca, Columbia University Mailman School of Public, the Hospital for Special Surgery, the Visiting Nurse Service of New York (VNSNY), and the Council of Senior Centers and Services of New York City, Inc. TRIPLL is also allied with the Weill Clinical and Translational Science Center (an NIH-funded CTSA) and the Weill Center for Research Excellence in Health Disparities.

The full schedule of talks:

February 24 | 3:00-4:00PM
Quality Pain Care for Older Adults: Progress & Future Directions
Keela Herr, PhD, RN; Co-Director, John A. Hartford Center for Geriatric Nursing Excellence, University of Iowa College of Nursing
Assuring quality pain care to older adults regardless of setting is a goal for most clinicians and researchers. This TRIPLL webinar will describe the current state of pain care for older adults, including prevalence of untreated pain and key challenges to quality pain care in older adults. Progress toward improving pain practices in older adults will be highlighted discussing current efforts and future research and clinical directions.

March 24 | 3:00-4:00PM
Management of Osteoarthritis in Older Adults: The Rheumatologist's Perspective
Una Makris, MD; Assistant Professor of Internal Medicine, UT Southwestern Medical Center
Osteoarthritis is the most common type of musculoskeletal related pain; it is highly prevalent in older adults, leads to significant morbidity and related costs. The objectives for this webinar presentation are to 1) briefly review the epidemiology of osteoarthritis, 2) review non- pharmacological and pharmacological management of osteoarthritis, and 3) review surgical referral when appropriate. This presentation will focus on hand, knee, hip, and generalized osteoarthritis.

April 28 | 3:00-4:00PM
The Problem & Consequences of Multisite Pain in Older Adults
Suzanne Leveille, PhD; PhD Program Director and Professor, Department of Nursing, University of Massachusetts Department of Nursing
This webinar will review the current evidence about the problem of multisite musculoskeletal pain in older persons. Consequences of chronic pain include loss of mobility, reduce ability to perform daily activities, and risk for falls. By the end of the seminar, participants will understand the scope of the problem of pain, how elders are managing their pain in general, and functional difficulties elders experience as a result of living with chronic pain.

May 19 | 3:00-4:00PM
Identifying the Continuum of Contextual Factors Contributing to Pain Disparities
Tamara Baker, PhD; Associate Professor, School of Aging Studies, University of South Florida College of Behavioral & Community Sciences
Disparities in the management of pain is often described at the peripheral level, thus only highlighting descriptives that differences occur. There are, however a myriad of social and cultural issues that not only describe these differences, but more importantly, define why such disparities occur and continue to exist. This webinar will define how cultural, social, and societal issues contribute to inequities in pain management among diverse populations (beyond just race). Understanding pain disparities from a life course (historical) perspective will be addressed, while highlighting current initiatives designed to ensure equal treatment for all.

June 23 | 2:00-3:00PM
Treating Chronic Refractory Pain in Older Adults: What are the issues?
Cary Reid, MD, PhD; Director of TRIPLL, Irving Sherwood Wright Associate Professor and Director of the Office of Geriatric Research in the Division of Geriatrics and Palliative Medicine at Weill Cornell Medical College

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2013 student showcase sparks cross-project discussions

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Vicky Atzl presenting

The BCTR offers students across campus the opportunity to learn about and participate in research techniques and data collection and analysis as research assistants in many of the center's projects. The annual student showcase gives some current BCTR students an  opportunity to present on their work with the center.

The 2013 showcase was held on May 6th. Over 30 people attended, including graduate students, undergraduate students, and BCTR and College of Human Ecology staff. Presentations prompted discussions between center projects about their similar research interests. For example, the issue of parent (or other care-giving adult)/child communication was a recurring subject across presentations and subsequent discussions. Both the Cornell Research Program on Self-Injurious Behavior and the Nurse Family Partnership are considering the best ways for caregivers and children to connect. Multiple center projects are also looking at the "secondary suffering" of parents or caregivers, which applies to those caring for self-injurious youth or elders.

2013 Presenters

  • Using Research to Guide the Perinatal Home Visiting System in NY State
    Victoria Atzl, HD ‘14
    Nurse Family Partnership
  • Secondary Suffering in Caregivers of Youth With Non-Suicidal Self Injury
    Feven Fisseha , Psych ‘14
    Cornell Research Program on Self-Injurious Behavior
  • The Limitations of Hospice Care in Rural Areas: An Analysis of the Evidence and Implications
    Meghan McDarby, HD ‘14
    Translational Research Institute on Pain in Later Life
  • An Exploratory Study of Parent-adolescent Communication, Mindful Parenting, and Non-suicidal Self-injury (NSSI)
    Rebecca Morgan, HD ‘13
    Cornell Research Program on Self-Injurious Behavior
  • How Certain Aspects of a Child’s Personality Connect to Resiliency and Healthy Development in Later Life
    Sierra Shumate, Psych ‘14
    Cornell Research Program on Self-Injurious Behavior
  • Self-Injury: Participant Feedback Report
    Rachel Siegfried, HD ‘13
    Cornell Research Program on Self-Injurious Behavior

 

More information for students interested in becoming involved with BCTR research projects can be found in the For Students section.

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Talks at Twelve: Emily Chen, Thursday, April 11, 2013

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0089_12_136.jpg

Measuring the Value of Program Adaptation: A Comparative Effectiveness Study of a Standard vs Culturally Adapted Arthritis Self-Help Program
Emily Chen, Ph.D. candidate, Human Development

Thursday, April 11, 2013
12:00PM-1:00PM
Beebe Hall, 2nd floor conference room



Lunch will be served. This event is open to all. Parking is available in the metered lot of The Plantations across Forest Home Drive.

Adapting evidence-based programs to match the needs of local settings sounds like a great idea: what could be wrong with tailoring a program to fit users better? But program adaptation can be costly and time-consuming, especially when using community-based participatory methods. What does research tell us about the value of program adaptation? Do adapted programs (compared to the originals) produce better outcomes? Are we sure that adapted programs are as good as the original? In short, is program adaptation “worth it”?

In her talk, Emily Chen will share and discuss the results of a Translational Research Institute on Pain in Later Life (TRIPLL) study that examined the effects of an adapted (vs. the original) version of the Arthritis Self-Help Program (ASHP) among 201 older adults in eight New York City senior centers. Participants in the adapted (vs. original) ASHP had significantly better attendance records and were less likely to drop out of the program.

Continued use of self-management exercises after the program ended was similar in both groups. Significant positive physical and psychosocial outcomes were documented in both programs.

The adapted ASHP improved program attendance and retention, while maintaining improvements in physical and psychosocial function. The results highlight the need for comparative studies of adapted vs. original evidence-based programs, both to quantify the benefits of adaptation and to ensure that the adapted programs are as effective as the originals.

Emily Chen is a Ph.D. candidate in Human Development. She works with Karl Pillemer and Cary Reid (Weill) on projects related to chronic disease and aging, including a recent focus on palliative and end-of-life care.

After graduating from Bryn Mawr (’03) Emily sought to work in an area that would address the issue of getting good research into the hands of people who make decisions or implement policies. She is specifically interested in issues related to health and chronic disease of older adults in the United States because she believes that understanding how to improve quality of life for this population, even in small or incremental ways, has the potential to help many people. She received her M.A. in Developmental Psychology from Cornell in January 2012. Emily is planning a dissertation that will explore issues related to palliative care and end-of-life care planning by older adults.

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HD Today features undergrads’ work with TRIPLL

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A new article in HD Today describes work Jessie Boas HD ‘13 and Meghan McDarby HD ’14 have been doing examining research from the BCTR's Translational Research Institute on Pain in Later Life (TRIPLL) with the guidance of Elaine Wethington, professor of human development and co-director of TRIPLL. Meghan describes the impact of this work, saying,

“I think I have learned more about being a successful physician from this research than I have from any pre-med prerequisite.”

The full article by Karene Booker can be read here.

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