Virginia Tech researchers seek to reduce chronic pain for rural adults

Older adults commonly struggle with chronic pain, with an estimated 36 percent of U.S. adults over the age of 65 reported experiencing pain most days or every day, according to the Centers for Disease Control and Prevention. That pain can be even more challenging for those living in rural communities, with less access to pain specialists and healthcare resources.

Huaiyang Zhong, assistant professor in the Grado Department of Industrial and Systems Engineering, is looking to solve this issue. With a $460,260 grant from the National Institute on Aging at the National Institutes of Health, he and his team will use artificial intelligence methods to improve pain assessments, identify risks, and support better clinical decision making to reduce pain and pain-related complications for older patients in rural communities. 

“I became interested in chronic pain because it's incredibly common, but also incredibly complicated,” Zhong said. “Pain is not just a single diagnosis, and it's not a number on a scale like a lot of medical diagnoses. Pain itself can affect mobility, mental health, sleep, cognitive functions, and overall quality of life. It's a multidimensional thing.”

The primary goal of the research is to understand pain better. Zhong hopes to learn how chronic pain evolves, which patients are increasingly vulnerable to poor outcomes, and how healthcare systems can intervene effectively.

That starts with data. Valuable information about a patient's pain experiences may be buried in clinical notes, as opposed to structured electronic health records. The researchers will use machine learning and natural language processing to extract that information systematically. They'll use the data to create risk dashboards that allow clinicians to recognize when a patient has a greater chance of complications, such as depression or cognitive impairment.

“I ultimately want to help clinicians move toward more personalized pain management,” Zhong said. “This means understanding not just how much pain somebody has, but the broader health context surrounding that pain.”

Research partners

To ensure the research on his first National Institutes of Health grant has the most clinical impact, Zhong has brought together an interdisciplinary team of faculty and clinicians from medicine, computer science, statistics, and whole health. They include:

• Robert McNamara, associate professor in the Virginia Tech Carilion School of Medicine (VTCSOM) Department of Psychiatry and Behavioral Medicine and clinical psychologist at Carilion Clinic
• Tina Savla, director of the Whole Health Consortium, professor in the Department of Human Development and Family Science, and researcher at Virginia Tech's Center for Gerontology
• Robert Trestman, chair of psychiatry and behavioral medicine at VTCSOM and Carilion Clinic
• Anita Kablinger, program director and professor of psychiatry and behavioral medicine at VTCSOM and vice chair of research in Carilion Clinic’s psychiatry and behavioral medicine department 
• Margaret Rukstalis, associate professor of psychiatry and behavioral medicine at VTCSOM and Carilion Clinic physician
• Alexandra Hanlon, director of the Center for Biostatistics and Health Data Science and professor in statistics at Virginia Tech
• Elizabeth Russo-Stringer, assistant professor in surgery at VTCSOM and chief of interventional pain management in Carilion Clinic’s Department of Surgery 
• Kwok Tsui, professor in the Department of Industrial, Manufacturing, and Systems Engineering at the University of Texas-Arlington and former professor in industrial and systems engineering at Virginia Tech
• Donald Penzien, professor in Wake Forest University School of Medicine’s Department of Psychiatry and Behavioral Medicine
• Xuan Wang, assistant professor in Virginia Tech's Department of Computer Science

“Our team is grateful to be awarded support to investigate the medical complexities experienced by rural older adults experiencing chronic pain,” said McNamara, a VTCSOM and Carilion Clinic collaborator on the project. “We foresee this work leading to early, actionable insight for providers in rural areas, enabling appropriate intervention and referral, and ultimately improving quality of life for this vulnerable population.”

Zhong believes industrial and systems engineering (ISE) is uniquely positioned to do research that can help solve overarching healthcare problems. The discipline is fundamentally about improving complex systems, healthcare being one of the most complex systems in the world.

“Machine learning can tell us which patients are at elevated risk, but as ISE researchers, we ask the next questions: What should we do with that information? How should limited healthcare resources be allocated? How does this information feed into clinical workflows? How does using this actually improve clinical outcomes?” Zhong said. “That decision-oriented, systems-level perspective is what ISE uniquely brings to healthcare.”