Research is an integral part of any successful pain management program. Such research helps clinicians stay in the forefront of modern scientific approaches to pain management.

The Comprehensive Pain Treatment Center has conducted research on a wide variety of scientific topics including male-female differences in presentation of chronic pain, factors that predict unsuccessful completion of a chronic pain treatment program and strategies for detox of patients from opioid medications.

Research studies of the second category focusing on the Center’s operations include Quality Assurance studies and Follow-up/Analysis of return to work and improved functioning. These studies have been presented at major national conferences and published in leading professional journals.

In addition, the Center provides a site for rigorously conducted student doctoral research projects. Two dissertation research projects have been carried out at the Pain Center. The first, Rosenblum, A., 1983 - Prediction of treatment response in chronic pain patients: The relationship between illness behavior and self concept explores the role of self concept in pain. A more recent study, Barron, W., 1996 - Pain Prone Theory Revisited: Interrelationships between Childhood Abuse History and Chronic Pain in Adults, explores the role of abuse in assessment and treatment of pain patients.

The Center has also published a number of review chapters that contribute to the body of knowledge on pain management. These chapters appear in both orthopaedic text books as well as specialized pain texts. A listing of these talks and publications is included at the end of this section. An abstract of current research being conducted is also included.



Editorial Activities

The Pain Medicine Journal Club Journal, expert analyst. (1996 - present)
The Journal of Acute Pain and Symptom Management: Index & Reviews, member.
(1997 - 1998)
Ad hoc reviewer for The Lancet, The Clinical Journal of Pain, Journal of Pain and Symptom Management. (1999)
Ad hoc reviewer for Analgesia, The Journal of Pain. (2000)
Current Pain and Headache Reports, Editorial Board, member. (2000)
Pain Practice, Editorial Board, member (2000)

Research Projects

1997 - 1999 NIH-PO1 HD33990/ co-PI in project 2
Pain management in persons with physical disability: A randomized, double blind, placebo-controlled, crossover clinical trial to determine the efficacy of mexiletine and controlled-release morphine in the treatment of post-amputation pain and phantom pain.
1994 - 1999 NIH-PO1 NS 32386-01/ co-PI in project 4
Studies of neuropathic pain. Randomized, double blind, placebo-controlled, crossover clinical trial to determine the efficacy of tricyclics (nortriptyline, desipramine) and long-acting oral opioids (controlled-release morphine, methadone) in the treatment of post-herpetic neuralgia.
1998 - 1999 JHH Neurosurgery Research Fund - RPN #96-12-19-01/ PI
Treatment trial of high concentration capsaicin for chronic intractable neuropathic pain and hyperalgesia (IND #43,939). Single-center study.
1998 - 1999 Glaxo - RPN #97-03-28-01/ PI
Imaging neurogenic inflammation in migraine patients. Single-center study.
1997 - 1999 Ortho-McNeal - RPN #97-08-18-04/ PI
A pilot study of topiramate in the treatment of postherpetic neuralgia. Single-center study.
1998-1999 Pfizer - RPN # 98-07-14-03/ co-PI
Phase II double blind, placebo-controlled, parallel 4-week evaluation of the efficacy and safety of multiple doses of CJ-13, 974 in subjects with moderate to severe chronic pain. Multi-center study.
1998 - 1999 Perdue Pharma - RPN #98-10-29-01/ co- PI
A randomized double blind, placebo controlled, efficacy, safety and outcomes trial of controlled-release oxycodone in painful diabetic polyneuropathy. Multi-center study.
2000 NIH-RPN# 00-CC-0086/ co-PI
Dynamic contrast enhanced MR imaging of the meninges during a nitroglycerin-provoked migraine headache.

Teaching Contributions

-Neurology Clinical Skills for Medical Students, Johns Hopkins School of Medicine tutor. (1995 - 1999)
-Pain Medicine Diagnostic Skills for Medical Students, Residents, and Fellows, Johns Hopkins School of Medicine, preceptor. (1995 - 1999)
-Neurology Clinical Skills for Medical Students, NYU School of Medicine, preceptor. (2000)
-Pain Medicine Diagnostic Skills for Medical Students, Residents, and Fellows, NYU School of Medicine, preceptor. (2000)

Bibliography: Original Articles

-Pappagallo M, Gaspardone A, Tomai F, Iamele M, Crea F, and Gioffre PA. Analgesic Effect of Bamiphylline on Pain Induced by Intradermal Injection of Adenosine. Pain, 53:199-204, 1993.

-Pappagallo M, Raja SN, Haythornthwaite JA, Clark M, and Campbell JN. Oral Opioid Therapy for the Management of Post Herpetic Neuralgia: a Prospective Survey. Analgesia, 1:51-55, 1994.

-Pappagallo M and Campbell JN. Chronic Opioid Therapy as Alternative Treatment for Post-Herpetic Neuralgia. Annals of Neurology, 35:S54-56, 1994.

-Gaspardone A, Crea F, Tomai F, Iamele M, Pappagallo M, Versaci F, Crossman DC, Chiarello L, Gioffre' PA. Substance P Potentiates the Algogenic Effects of the Intra-Arterial Infusion of Adenosine. Journal of American College of Cardiology, 24:477-482, 1994.

-Davis KD, Meyer RA, Turnquist JL, Filloon TG, Pappagallo M, and Campbell JN. Cutaneous Pretreatment with the Capsaicin Analog NE-21610 Prevents the Pain to a Burn and the Subsequent Hyperalgesia. Pain. 62:373-378, 1995. Davis KD, Meyer RA, --Turnquist JL, Filloon TG, Pappagallo M, and Campbell JN. Cutaneous Injection of the Capsaicin Analog, NE-21610, Produces Analgesia to Heat but not to Mechanical Stimuli in Man. Pain, 61:17-26, 1995.

-Lavin RA, Pappagallo M, and Kuhlemeier KV. Cervical Pain: a Comparison of Three Pillows. Archives of Physical Medicine and Rehabilitation. 78 (2): 193-198, 1997.
-Robbins WR, Staats PS, Levine J, Fields HL, Allen RW, Campbell JN, and Pappagallo M. Treatment of Intractable Pain with Topical High Large-Dose Capsaicin: Preliminary Report. Anesth Analg, 86(3): 579-583, 1998.

-Haythornthwaite JA, Menefee LA, Quatrano-Piacentini AL, and Pappagallo M. Outcome of Chronic Opioid Therapy for Non-Cancer Pain. J Pain Symptom Manage. 15:185-194, 1998.

-Pappagallo M. The Concept of Pseudotolerance. J Pharm Care Pain Sympt Control. 6(2): 95-98, 1998.

-Fuchs PN, Pappagallo M, and Meyer RA. Topical EMLA Pre-Treatment Fails to Decrease the Pain Induced by 1% Topical Capsaicin. Pain. Apr. 80 (3): 637-42, 1999.
Clark MR, Heinberg LJ, Haythornthwaite JA, Quatrano-Piacentini AL, Pappagallo M, Raja SN. Psychiatric symptoms and distress differ between patients with postherpetic neuralgia and peripheral vestibular disease. Journal of Psychosomatic Research 48:51-57, 2000.

-Pappagallo, M, Complex Regional Pain Syndromes. In Management of Neuropathic Pain Syndromes: Supplement to Neurology Reviews. March 2000.

-Pappagallo M, Oaklander AL, Quatrano-Piacentini AL, Clark MR, and Raja SN. Heterogeneous patterns of sensory dysfunction in postherpetic neuralgia suggest multiple pathophysiological mechanisms. Anesthesiology, Vol 92, No 3, Mar 2000.

Reviews and Educationally Relevant Publications

-Pappagallo M. Painful Neuropathies, In: Current Therapy in Neurological Diseases-4, Johnson RT (ed.), Mosby-Yearbook, 1993.

-Pappagallo M. Analgesics. Biomechanics. Vol.2, 7:26-30, 1995.

-Pappagallo M. Controlled Clinical Trial to Test Opioids in Neuropathic Pain. Neuroscience Forum. Vol. 5, 1:10-13, 1995.

-Pappagallo M and Campbell JN. The Pharmacologic Management of Chronic Back Pain. In: The Adult Spine: Principle and Practice, Raven Press, 2nd edition. Frymoyer JW, Editor-in-chief. pp 275-286, 1997.

-Pappagallo M and Campbell JN. The Medical Treatment of Chronic Back Pain: The Role of Opioid Therapy and the Use of Nonopioid Analgesics, In: Spine: State of the Art Reviews. Kostuik JP (ed). pp 1-13, Hanley & Belfus, Inc., Philadelphia, 1997.

-Pappagallo M and Heinberg LJ. Ethical Issues in the Management of Chronic Non-Malignant Pain. Seminars in Neurology. 17:3, pp 203-211, 1997.

-Pappagallo M. Commentary on: Migraine Associated with Head Trauma, by Russell MB and Olsen J. The Pain Medicine Journal Club Journal, Vol 3, No 2, pp 66-68, 1997.

-Pappagallo M. Water Pillow Softens Pain in the Neck. Modern Medicine, 65:5, pp 26, 1997.

-Pappagallo M. Commentary on: Intravenous Guanethidine in Patients with Reflex Sympathetic Dystrophy by Kaplan R, et al. The Pain Medicine Journal Club Journal, Vol 3, No 6, 278-280, 1997.

-Williams VB, Pappagallo M. Entrapment Neuropathies. In: Essentials of Pain Medicine. Raja SN, Benson HT (eds). In press, Churchill-Livingstone, New York, 1998.

-Williams V, Pappagallo M. Central Pain. In: Essentials of Pain Medicine. Raja SN, Benson HT (eds). In press, Churchill-Livingstone, New York, 1998.

-Pappagallo M. Water-Based Pillow for Relief of Neck Pain. Mature Medicine Vol 1, No 1, 34-35, 1998.

-Pappagallo M. Commentary on: Complex Regional Pain Syndrome Type I (RSD): -Pathology of Skeletal Muscle and Peripheral Nerve by van der Laan, L. et al. The Pain Medicine Journal Club Journal, Vol 4, No. 5, 184-185, 1998.

-Campbell, JN, Pappagallo M, Robbins W, and Staats P. Capsaicin revisited as a treatment for neuropathic pain. In: Novel Targets in the Treatment of Pain. IBC Publishers, Southborough, MA. 1999.

-Pappagallo M. Aggressive Pharmacologic Treatment of Pain. In Rheumatic Disease Clinics of North America. W.B. Saunders Co. Rheum Dis Clin North Am. Feb. 25 (1): 193-213, 1999.

-Pappagallo M. The Pain in Migraine is Not Mainly in the Brain. In: Johns Hopkins Physician Update. Volume 11:3, pg. 2, June 1999.

-Pappagallo M. Inside Answers On Migraine. In: The Johns Hopkins Health Insider. Volume 2:10, pg. 8, October 1999.

-Pappagallo, M. An Apparent Interventional Paradox: The Stimulation of the Motor Cortex, a New and Promising Treatment for Intractable Neuropathic Pain. In: Neurology Network Commentary. In press. January 2000.

-Pappagallo, M. Dickerson ED, Hulka S. Palliative Care and Hospice Opioid dosing guideline. In: American Journal of Hospice and Palliative Care. In press, 2000.

-Snow, B.R., Pinter, I., Gusmorino, P., Jimenez, A., Rosenblum, A. (1986). Incidence of physical and psychosocial disabilities in chronic pain patients: Initial report. Bulletin of the Hospital for Joint Diseases, 46, 22-30.

-Jimenez, A.C., Gusmorino, P., Pinter, I. & Snow, B.R. (1987). The use of Clonidine for the treatment of meperidine withdrawal in a multidisciplinary pain program setting: A case presentation. Bulletin of the Hospital for Joint Diseases, 47, 72-77.

-Snow, B.R., Gusmorino, P., Pinter, I., Jimenez, A. & Rosenblum, A. (1988). Multidisciplinary treatment of Physical and psychosocial disabilities in chronic pain patients: A follow-up report. Bulletin of the Hospital for Joint Diseases Orthopaedic Institute, 48, 52-61.

-Jimenez, A.C., Gusmorino, P., Pinter, I. & Snow, B.R. (1987). Brainstem auditory and visual evoked potential studies in patients with chronic cervical pain (1988). Bulletin of the Hospital for Joint Diseases Orthopaedic Institute, 48, 52-61.

-Gusmorino, P., Snow, B.R., & Pinter, I. (1988). Behavioral Medicine and the Geriatric Orthopaedic Inpatient: Assessment and Treatment. In J. Zuckerman, M.D. (Ed.). Comprehensive Care of Orthopaedic Injuries in the Elderly. New York: Urban & Schwarzenberg Medical Publishers, 595-605.

-Snow, B.R., Gusmorino, P., & Pinter, I. (1988). Chronic pain and the Geriatric Patient: Assessment and Treatment. In J. Zuckerman, M.D. (Ed.). Comprehensive Care of Orthopaedic Injuries in the Elderly. New York: Urban & Schwarzenberg Medical Publishers, 607-618.

-King, S.A. & Snow, B.R. Factors for predicting premature termination from a multidisciplinary inpatient chronic pain program. (1989) Pain, 39, 281-287.

-Snow, B.R., Gusmorino, P. & Pinter, I. Multidisciplinary treatment for a chronic pain patient returning to work: A case report, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute, 1990, 50, 200-204.

-Snow, B.R., Gusmorino, P. & Pinter, I. Behavioral Medicine and Clinical Guide. In M. Lewis (Ed.) Musculoskeletal Oncology, Orlando: W.B. Saunders, 449-463.

-Snow, B.R., Gusmorino, P. & Pinter, I. Hospitalization of the Chronic Pain Patient in M. Lefkowitz & AZ. Lebovits (Eds.). Handbook of Chronic Pain Management. New York. Little Brown, 1996.

Manuscripts in preparation

-Pappagallo, M. Wasserman, B., Esposito G., Szabo, Z. SPECT Imaging of Neurogenic Inflammation In Patients with Migraine Headaches, 2000.

-Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison, TG, Sabeen S, Royall RM, Max MB, A controlled trial on the analgesic and cognitive effects of opioids and tricyclic antidepressants in the management of postherpetic neuralgia, 2000.

Patents

-Application No. 08/746,207 Topical Administration of Capsaicin and its Analogues under Local Anesthesia for the Treatment of Chronic Pain. Inventors: M. Pappagallo, Wendye Robbins, and Peter Staats. (1996)

-Application No. 09/041,294 Patent No. 5962532 issued 10/5/99, Therapeutic Method with Capsaicin and Capsaicin Analogues. Inventors: JN Campbell, M. Pappagallo and Richard Meyer. (1999)

-Member, International Association for the Study Of Pain Task Force on Taxonomy, 2000-Present

-American Academy of Pain Medicine Liaison Secretary from the American Academy of Pain Medicine to the American Psychiatric Association, 1991-1999
-Member, Public Affairs Committee, 1994-Present

-Member, Residency Training Committee, 1995-Present

-Member, Undergraduate Education Committee, 1998-Present

-American Board of Pain Medicine Member, Examination Council, 1991-1992

-Consultant, Examination Council, 1993-1994

-Member, Practice Analysis Committee, 1996-Present

-Pennsylvania Cancer Pain Initiative Member, Steering Committee, 1997-2000

-Co-chair, Behavioral Medicine Committee, 1997-2000

-Representative to national meeting of State Cancer Pain Initiatives, 1998

-Member, U.S. Dept. of Health and Human Services Agency for Health Care Policy and Research Panel to Update Clinical Practice Guideline on Acute Pain Management, 1993-1996

-Peer Reviewer, U.S. Dept. of Health and Human Services Agency for Health Care Policy and Research Guideline on Headaches, 1995-Present

-Peer Reviewer, U.S. Dept. of Health and Human Services Agency For Health Care Policy and Research Clinical Practice Guideline on Cancer Related Pain, 1992-1994

-Peer Reviewer, U.S. Dept. of Health and Human Services Agency for Health Care Policy and Research Clinical Practice Guideline on Acute Pain Management, 1991

-Chair, American Psychiatric Association's DSM-IV Task Force Subcommittee on Pain Disorders, 1990-1994

-Chair, American Psychiatric Association’s DSM-IV-TR Task Force Subcommittee On Pain Disorders, 1998-2000

-Advisor, American Psychiatric Association Handbook of Psychiatric Measures, 1998-2000

-Member, American Board of Psychiatry and Neurology Subcommittee on Subspecialty Examination in Pain Management, 1999-Present

-Medical Consultant for Development of Employment Criteria, New York City Transit Authority, 1988

Abstracts

-1991 Pappagallo M, Belzberg A, Campbell JN. Successful Treatment of Erythromelalgia with High dose Cyproheptadine. APS.

-1993 Pappagallo M, Raja SN, and Campbell JN. Open Label Trial in the Management of Post Herpetic Neuralgia: Two and Six-Month Follow Up Results. APS.

-1993 Pappagallo M, Raja SN, and Campbell JN. Efficacy of Opioids in the Long-Term Management of Post Herpetic Neuralgia. IASP, 7th World Congress on Pain, Paris, France.

-1995 Menefee LA, Pappagallo M, Quatrano-Piacentini AL, Haythornthwaite JA. Psychological effects of long-acting opioids in the treatment of failed back syndrome. APS.

-1995 Menefee LA, Pappagallo M, Quatrano-Piacentini AL, Haythornthwaite JA. Psychological effects of long-acting opioids in the treatment of failed back syndrome. APS.

-1995 Meleka S, Pappagallo M, Raja SN, and Campbell JN. Evaluation of the role of alpha-adrenoceptor mechanisms in postherpetic pain. APS.

-1995 Slugg R, Pappagallo M, Staats P, Campbell JN. Treatment of AIDS neuropathic pain with high-dose capsaicin under epidural anesthesia. APS.

-1996 Raja SN, Kiri N, Pappagallo M, Clark MR, Haythornthwaite JA. Assessment of drug effects on pain and hyperalgesia in postherpetic neuralgia. AUA Satellite Symposium, Chatham, MA.

-1996 Kiri N, Raja SN, Pappagallo M, Clark MR, Haythornthwaite JA. Differential Somatosensory changes in postherpetic neuralgia. IASP, 8th World Congress on Pain, Vancouver, BC.

-1996 Clark MR, Haythornthwaite JA, Heinberg LJ, Raja SN, Kiri N, Pappagallo M. Psychiatric symptoms in postherpetic neuralgia. IASP, 8th World Congress on Pain, Vancouver, BC.

-1997 Raja SN, Pappagallo M, Clark MR, Haythornthwaite JA, Quatrano-Piacentini AL. Differential alterations in mechanical and thermal sensations in post-herpetic neuralgia. 3rd International Conference on VZV. Palm Beach, FL.

-1997 Fuchs PN, Pappagallo M, Meyer RA. Topical anesthesia does not eliminate pain to topical capsaicin. APS.

-1997 Pappagallo M, Quatrano-Piacentini AL, DeHaemer TK, Formaglio F, Accinelli J, Jackson K. Survey of the failed back patient population at the Johns Hopkins Pain Treatment Center: Opioid treatment compliance and functional issues, APS.

-1997 Raja S, Oaklander AL, Pappagallo M, Piacentini A. Differential alterations in mechanical and thermal sensations in postherpetic neuralgia. APS.

-1998 Pappagallo M, DeHaemer TK, Quatrano-Piacentini AL, Metrikat J, Accinelli J and Jackson C. Opioid Treatment Compliance and Social/Functional Issues in Chronic Pain Patients. Second Annual Conference on Pain Management and Chemical Dependency. New York, NY.

-1998 Haythornthwaite JA, Raja SN, Clark MR, Quatrano-Piacentini AL, and Pappagallo M. Long-Acting Opioid Treatment and Cognitive Function in elderly Patients with Post-Herpetic Neuralgia. American Pain Society, 17th Annual Meeting. San Diego, CA.

-1998 Haythornthwaite JA, Clark MR, Raja SN, Quatrano-Piacentini AL, and Pappagallo M. Pain Coping Strategies Predict Adjustment to Post-Herpetic Neuralgia. American Pain Society, 17th Annual Meeting. San Diego, CA.

-1998 Pappagallo M. Preliminary Experience with Topiramate in the Treatment of Chronic Pain Syndromes. American Pain Society, 17th Annual Meeting, San Diego, CA.

-1999 Pappagallo M., Stewart W, PhD, MPH, Woods M, MD. Constipation Symptoms in Long-Term Users of Opioid Analgesic Therapy. American Pain Society, 18th Annual Meeting, Fort Lauderdale, FL.

Papers, Reports, and Presentations

-Pinter, I., Snow, B,.R., Gusmorino, P. & Jimenez, A. Orthopaedic-Arthritis Pain Center: A multi-interdisciplinary team approach. International Association for the Study of Pain, Seattle, 1984.

-Snow, B.R., Pinter, I., Gusmorino, P., Jimenez, A., Rosenblum, A. & Adelglass, H. Sex differences in chronic pain: Incidence and causal mechanisms. American Psychological Association, Washington, D.C., 1986.

-Snow, B.R., Pinter, I., Gusmorino, P., Jimenez, A. Development and validation of a computerized pain history questionnaire in a comprehensive pain center. International Association for the Study of Pain, Seattle, 1984.

-Gerber, D.J., Jimenez, A., Snow, B.R., Pinter, I. Daily pain and mood ratings of inpatients of a chronic pain treatment program using visual analog scales. American College of Rehabilitation Medicine, Baltimore, 1986.

-Ernst, M., Gusmorino, P., Pinter, I., Snow, B.R. Absence of sympathetic effects by the sphenopalatine ganglion block. American Pain Society. Washington, D.C., 1986.

-Snow, B.R., Pinter, I., Gusmorino, P., Jimenez, A., Devine, P., Rosenblum, A. Use of McGill Pain Questionnaire as a clinical index of patient behavior. American Pain Society, Washington, D.C., 1986.

-Lamparter-Lang, R., Rosenblum, A., Solomon, G., Gusmorino, P., Snow, B.R., Pinter, I. & Winchester, R.J. Psychological differences in patients with different inflammatory Rheumatic Diseases. German Rheumatological Society Dusseldorf Ratingen, Germany, 1987.

-Jimenez, A., Dutkowski, L., Gusmorino, P., Pinter, I. & Snow, B.R. Sexual counseling in the chronic pain patient. A rehabilitative approach. American Academy of Physical Medicine and Rehabilitation, Orlando, 1987.

-Jimenez, A., Mohr, G., Gusmorino, P., Pinter, I & Snow, B.R. Quality of life of chronic pain patients, American Academy of Physical Medicine and Rehabilitation, Orlando, 1987.

-Barron, W., Snow, B.R. and Pinter, I. Chronic Pain Inpatients: Compensation, noncompensation and over 65 years: A comparison of self reported psychological, general and task specific activity variables. American Pain Society, November, 1993, Orlando.

-Gusmorino, P., Snow, B.R., Pinter, I. and Barron, W. Changing Patterns of health care utilization at six months and one year post discharge from a multidisciplinary inpatient chronic pain program, Hospital for Joint Diseases Health Care Conference, New York, September, 1993 and American Pain Society, November, 1994.

-Investigation of Subjective Pain Level, Perceived Control of Pain, Ability to Decrease Pain, Depression, Return to Work, and Medical Utilization, at preadmission, Discharge and One year Following participation in a Multidisciplinary Chronic Pain Inpatient Program. Park, K., Barron, W., Snow, B.R., Gusmorino, P. & Pinter, I. American Pain Society, 1995.