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Pain Prevention Center

Seeking solutions for pain prevention.

The societal impact of chronic pain is significant, and the effects on those who personally experience chronic pain can be devastating. Pain conditions, like low back pain and headache disorders, have been among the leading causes of disability for decades, according to the Global Burden of Disease Study. The overall annual cost of chronic pain in the US is estimated at $635 billion.

50M+

1 in 5 adults in the US (or 50+M people) live with chronic pain that affects their daily life

$134.5B

Neck and back pain comprised the highest amount of US healthcare costs in 2016

40%

Missing work due to low back pain accounts for 40% of workplace absences

The Pain Prevention Research Center at HSS is unique in its focus and commitment to studying the prevention of pain and associated deleterious outcomes. As the #1 ranked hospital for Orthopedics by US News and World Report for 14 years in a row, HSS has an unmatched level of expertise in both treating and preventing musculoskeletal pain. In 2023, our surgical teams performed over 41,500 orthopedic procedures and HSS clinicians provided over 500,000 nonsurgical consultations for musculoskeletal conditions. The large volume of patients seen at HSS combined with our long-standing commitment to clinical and basic science research aligns perfectly with the mission of the Pain Prevention Research Center to seek solutions for pain prevention.

Reframing Pain Treatment

There are limited safe and effective treatments for chronic pain. Most existing treatments are ineffective or only modestly effective for many people. Efforts to develop novel pain treatments have been largely unsuccessful. Given the high prevalence and complexity of chronic pain, as well as its significant personal and societal cost, a pivot in our approach to mitigating pain is critical. The most promising approach may be in its prevention.

We can define pain prevention as three different types: primary prevention, secondary prevention, or tertiary prevention. In the context of pain prevention research, we can define primary prevention as preventing a painful stimulus or preventing a pain condition before it develops, secondary prevention as identifying and treating pain early following a painful stimulus, and tertiary prevention as preventing the persistence or exacerbation of pain.

Primary Prevention

  • Prevent need for surgery (e.g., spine surgery for those unlikely to benefit)
  • Prevent pain condition (e.g., CRPS)

Secondary Prevention

  • Prevent acute postoperative pain, opioid use & functional impairment

Tertiary Prevention

  • Prevent persistence of postoperative pain, opioid use & functional impairment
  • Prevent persistence or exacerbation of chronic pain

Goals of the Center

The overarching goal of the PPRC is to build a collaborative, dynamic, accessible and inclusive research environment that spans acute and chronic pain, provides supportive and unique training opportunities, and produces clinically meaningful and informative findings that improve patient outcomes.

To that end, the specific goals of the center are to:

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Identify and evaluate existing approaches and develop novel evidence-based approaches for the design, analysis, and interpretation of clinical trials of the prevention of acute and chronic pain
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Conduct prospective observational and qualitative studies to identify risk factors and to inform timing and potential targets for intervention
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Conduct and disseminate high-quality clinical trials to test the efficacy of innovative interventions to prevent acute and chronic pain and their adverse consequences
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Leverage real-world data, plus computational and statistical approaches to generate real-world evidence of the effectiveness of pain prevention interventions
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Provide multidisciplinary pain research training and mentorship for trainees and early career investigators.

Impact on the Pain Continuum

The pain continuum spans several phases including acute, sub-acute, and chronic pain. Projects led by the PPRC aim to provide clinically impactful results that improve the pain management and clinical outcomes of patients in both the acute perioperative and chronic pain settings:

  • Acute perioperative pain
    • Clinical trials of non-opioid medications, such as Epidiolex (FDA approved cannabidiol (CBD)), to assess whether they improve pain management and reduce opioid needs after orthopedic surgery.
    • Peripheral nerve blocks are currently being studied to optimize their use to improve acute pain management and postoperative rehabilitation after orthopedic surgery for both adults and pediatric patients.
    • The HSS Perioperative Pain Service (POPS) provides care to patients who may have more complex pain management needs after orthopedic surgery. Ongoing research aims to identify risk factors and improve pain management at all phases of care: preoperative, intraoperative, and postoperative.
  • Chronic pain
    • Clinical trials assess the use of medications to treat chronic pain conditions (e.g., low-dose naltrexone for complex regional pain syndrome)
    • Real-world evidence of prescribing novel pain medications such as suzetrigine, to patients with chronic pain

Please navigate to the Highlighted Work tab to learn more about the PPRC's research.

Meet the PPRC Team

The Pain Prevention Research Center at HSS brings together a team of dedicated researchers, clinical scientists, and administrators. The vision of the team is to support innovative, high-quality research investigations focused on primary, secondary, and tertiary pain prevention through study design, research conduct, and biostatistical support from content experts.

If you are interested in learning more about the Prevention Research Center, email us at PPRC@hss.edu

Leadership

Alexandra Sideris, PhD
PPRC Director & Pain-Train Co-Director

Dr. Sideris is the C.V. Starr Director of Pain Research at Hospital for Surgery, Assistant Professor of Pain Research at Weill Cornell Medicine, and Assistant Scientist at the HSS Research Institute. She received her PhD in Neuroscience & Physiology from NYU School of Medicine and held instructor and research assistant professor positions in the Department of Anesthesiology, Perioperative Care and Pain Medicine. At NYU, Dr. Sideris studied the development and prevention of neuropathic pain in rodent models by targeting the endocannabinoid system, tissue-specific microRNA, and gap-junctions. She transitioned to clinical research in 2018 by joining the Department of Anesthesiology, Critical Care & Pain Management at HSS where she helped develop and expand the anesthesiology department’s research portfolio by assisting with the design and supporting the execution of numerous novel research studies with prolific and motivated clinicians at various levels in their career. She administratively oversaw over 70 studies and managed a team of 11 research staff. In her most recent endeavors, Dr. Sideris has coordinated the creation of two internal registries that capture pain outcomes of patients who are treated on an outpatient basis and who undergo more invasive surgical procedures at HSS.

These databases will help our research team better understand and predict severe pain and opioid consumption, and will facilitate the development of innovative, collaborative research strategies to prevent and mitigate patient complications. Given her long-standing research interest in cannabinoids and the significant interest expressed by patients and surgeons in cannabis’ therapeutic potential, she is also leading the first CBD pilot study in HSS orthopedic patients to estimate perioperative opioid consumption and pain levels. Her work has been published in several journals including the British Journal of Anaesthesia, Cannabis and Cannabinoid Research, Anesthesia & Analgesia, Anesthesiology, Neuroscience, Molecular Pain, and Experimental Neurology. In addition to being on the editorial board of Regional Anesthesia & Pain Medicine and serving as a reviewer for other journals, she is actively involved in supporting young scientists as a volunteer judge in the NYC Science and Engineering Fair, serves as a faculty member on the HSS-Macaulay Summer Scholars Research program planning committee, and is a member of HSS’ employee resource group Women Inspiring Success and Excellence (WISE).

Dr. Sideris on Google Scholar

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Director of Research, Anesthesiology
Jashvant Poeran, MD, PhD
Director of Research, Anesthesiology
Epidemiologist
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Anesthesiologist-in-Chief
Stavros G. Memtsoudis, MD, PhD, MBA
Anesthesiologist-in-Chief
Anesthesiologist
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Robert H. Dworkin, PhD
PPRC Chief Scientific Advisor and Pain-Train Faculty

Director, Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks and Pediatric Anesthesia Safety Initiative (ACTTION/PASI); Adjunct Senior Scientist, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery; Professor, University of Rochester

Dr. Dworkin is one of the leading chronic pain researchers today. His major research interests include methodologic aspects of analgesic clinical trials and prevention and treatment of acute and chronic musculoskeletal and neuropathic pain. Dr. Dworkin also has a keen interest in identifying risk factors for the transition from acute to chronic pain and in evaluating interventions that have the potential to prevent chronic pain. A particularly important and actionable finding is that patients with higher acute pain intensity are more likely to develop chronic pain, thus suggesting that effectively managing acute pain might prevent the development of chronic pain. Designing and conducting studies to test this hypothesis has been a major focus of Dr. Dworkin’s efforts.

With over 300 articles in peer-reviewed journals and an h-index of 104, Dr. Dworkin’s works have been cited over 58,000 times.  He is the Director ofACTTION/PASI, a public-private partnership with the FDA to improve the efficiency and informativeness of clinical trials of analgesic, anesthetic, and addiction interventions. Dr. Dworkin is an Associate Editor of Pain and serves on the editorial boards of Canadian Journal of Pain and TheJournal of Pain.  Among many other honors, Dr. Dworkin is the recipient of the John D. Loeser Prize for Distinguished Lifetime Achievement in the Clinical Science of Pain from the International Association for the Study of Pain and the Founders Award from the American Academy of Pain Medicine.

Dr. Dworkin on Google Scholar

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Vice Chief of Research & Education, Anesthesiology
Cephas P. Swamidoss, MD, MS, MPH
Vice Chief of Research & Education, Anesthesiology
Anesthesiologist
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PPRC Chief Financial Officer
Lila R. Baaklini, MD
PPRC Chief Financial Officer
Anesthesiologist
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Christopher L. Wu, MD
Anesthesiologist
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Dale J. Langford, PhD
Director, Research Development and Communications, Central Research Administration, PPRC Advisor & Pain-Train Co-Director

Director of Chronic Pain Research, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery

Dr. Langford Director of Chronic Pain Research at Hospital for Special Surgery and Associate Professor of Pain Management Research at Weill Cornell Medicine. She is a multidisciplinary pain researcher whose primary focus to date has been on understanding and identifying factors associated with the tremendous individual differences in the experience of pain. Her research and training background spans psychology, behavioral neuroscience, physiological nursing, epidemiology, biostatistics, and pain medicine.  Prior to transitioning to clinical pain research, Dr. Langford studied social communication and facial expressions of pain in laboratory mice with Jeffrey Mogil at McGill University. This work culminated in a first-author paper in Science, demonstrating evidence of rodent empathy for pain, and a first-author paper in Nature Methods, describing the development and validation of the Mouse Grimace Scale (MGS), a first of its kind facial expression coding tool for spontaneous pain in mice. The MGS has since been expanded for use in >10 mammalian species and is used for both research and animal care purposes.

Dr. Langford conducted her postdoctoral work with Christine Miaskowski at UCSF, where she studied phenotypic and genotypic factors associated with cancer-related pain and co-occurring symptoms (e.g., fatigue, sleep disturbance, depression) and where she received advanced training in clinical research methodology. Dr. Langford has held faculty appointments at University of Washington and University of Rochester where she worked or led numerous projects related to management or measurement of chronic non-cancer and cancer-related pain, and where she maintains affiliate and adjunct appointments, respectively. She is an engaged member the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership, as both Co-Chair of ACTTION’s Consortium on Pain Effectiveness and Safety Studies (COPESS), focused on optimizing outcome assessment for clinical trials of chronic pain treatments, and Director of the Center on Patient And Stakeholder Engagement for Trial Innovation and Quality (COPASETIQ), focused on patient engagement as research partners and disparities in clinical trial participation. Dr. Langford is on the Editorial Board of The Journal of Pain, Clinical Journal of Pain and regularly reviews for PAIN, The Journal of Pain, Regional Anesthesia and Pain Medicine, and Pain Medicine.

@djlPAINology  *  Dr. Langford on Google Scholar

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Research Members (Past and Current)

  • William Chan, Senior Project Coordinator
  • Tina Chen, Research Assistant
  • Angelina Colamarino, Research Volunteer
  • Tory Xu, Research Volunteer
  • Marlena Komatz
  • Justine Jorgenson
  • Thomas Ramos
  • Sharon Toor
  • Samantha Riebesell
  • Isabel Shklyar 

Academic Opportunities

NIH-funded Translational Pain Research Training Program (Pain-Train): Learn more about Pain-Train, a multidisciplinary, translational pain research curriculum to support trainees in orthopedics and engineering to incorporate pain research methodology into their research. 

Foundation for Anesthesia Education and Research (FAER) Medical Student Anesthesia Research Fellowship (MSARF) summer program: As a host site for the FAER MSARF summer program, HSS welcomes medical students with interest in conducting anesthesiology or pain research. In this program, fellows have the opportunity to lead a research project with mentorship from an experienced investigator, observe clinical researchers and clinicians, and present findings at the American Society of Anesthesiologists' (ASA) annual meeting.

HSS Macaulay Scholars Summer Research Program: Through this program, the PPRC provides mentorship and clinical research experience to a Macaulay Honors College undergraduate student. Clinical research experiences may include shadowing, extracting data from the electronic medical record, assisting with systematic reviews, and writing and presenting scientific work.

The PPRC provides research opportunities to trainees, including volunteers, interns, and fellows, at various stages of their academic and professional careers. For more information about available opportunities, please reach out to PPRC@hss.edu. 

Highlighted Work

Clinical Trials

Real World Evidence

  • Perioperative Pain Service Registry
    • Pharmacogenetics in Perioperative Pain Management: An Overview of Patient Characteristics, Test Results, and Outcomes
  • Outpatient Pain Registry
    • Complex Regional Pain Syndrome Case Characteristics and Treatment Patterns: A Retrospective Institutional Registry Study

Prospective Observational Studies 

Conferences

  • 2025 American Society of Regional Anesthesia and Pain Medicine (ASRA) meeting in Orlando, Florida 
  • 2025 United States Association for the Study of Pain (USASP) meeting in Chicago, Illinois
  • 2024 International Association for the Study of Pain (IASP) meeting in Amsterdam, Netherlands

Featured Publications

Chan W, Rim F, Liu S, Jules-Elysee K, Liu J, Memtsoudis S, Sideris A. Inpatient dronabinol utilization: an institutional retrospective study to determine prevalence and indications for clinical application. Br J Anaesth. 2024 Apr 30. doi: 10.1016/j.bja.2024.03.026. PMID: 38693005.

Langford DJ, Mark RP, France FO, Nishtar M, Park M, Sharma S, Shklyar IC, Schnitzer TJ, Conaghan PG, Amtmann D, Reeve BB, Turk DC, Dworkin RH, Gewandter JS. Use of patient-reported global assessment measures in clinical trials of chronic pain treatments: ACTTION systematic review and considerations. PAIN. 2024, In press. doi: 10.1097/j.pain.0000000000003270. PMID: 38743561.

Sideris A, Doan LV. An overview of cannabidiol. Anesth Analg. 2024 Jan 1; 138(1): 54-68. doi: 10.1213/ANE.0000000000006584. PMID: 38108806.

Sideris A, Lauzadis J, Kaczocha M. The basic science of cannabinoids. Anesth Analg. 2024 Jan 1; 138(1): 42-53. doi: 10.1213/ANE.0000000000006472. PMID: 38100799.

Rim F, Liu SS, Kelly M, Kim D, Sideris A, Langford DJ. Preoperative pain screening and optimisation by a perioperative pain service to support complex surgical patients: no patient left behind. British Journal of Anaesthesia. 2024 Feb; 132(2): 437-439. doi: 10.1016/j.bja.2023.11.024. PMID: 29049115

Zhong H, Poeran J, Cozowicz C, Athanassoglou V, Illescas A, Memtsoudis SG, Liu J. Does the impact of peripheral nerve blocks vary by age and comorbidity subgroups? A nationwide population-based study. Reg Anesth Pain Med. 2023 Jul 5; doi: 10.1136/rapm-2022-104150. PMID: 37407280.

Wu CL, Cho B, Gabriel R, Hurley R, Liu J, Mariano ER, Mathur V, Memtsoudis SG, Grant MC. Addition of dexamethasone to prolong peripheral nerve blocks: a ChatGPT-created narrative review. Reg Anesth Pain Med. 2023 Jun 9:rapm-2023-104646. doi: 10.1136/rapm-2023-104646. Epub ahead of print. PMID: 37295794.

Langford DJ, Baron R, Edwards RR, Gewandter JS, Gilron I, Griffin R, Kamerman PR, Katz NP, McDermott MP, Rice ASC, Turk DC, Vollert J, Dworkin RH. What should be the entry pain intensity criteria for chronic pain clinical trials? An IMMPACT update. Pain. 2023 Jun 7. doi: 10.1097/j.pain.0000000000002930. Epub ahead of print. PMID: 37288944.

Memtsoudis SG, Zhong H, Liu J, Poeran J, Cozowicz C, Sites B. Persistent opioid use after gender affirmation surgery. Br J Anaesth. 2023 Jan; 130(1): e1-e4. doi: 10.1016/j.bja.2022.09.024. PMID: 36376101.

Langford DJ, Lou R, Sheen S, Amtmann D, Colloca L, Edwards RR, Farrar JT, Katz NP, McDermott MP, Reeve BB, Wasan AD, Turk DC, Dworkin RH, Gewandter JS. Expectations for improvement; A neglected but potentially important covariate or moderator for chronic pain trials. J Pain. 2023 Apr; 24(4): 575-581. doi: 10.1016/j.jpain.2022.12.011. PMID: 36577461.

Holzer KJ, Veasley C, Kerns RD, Edwards RR, Gewandter JS, Langford DJ, Yaeger LH, McNicol E, Ferguson M, Turk DC, Dworkin RH, Haroutounian S. Partnering with patients in clinical trials of pain treatments: a narrative review. Pain. 2022 Oct 1;163(10):1862-1873. doi: 10.1097/j.pain.0000000000002600. Epub 2022 Jan 28. PMID: 35297799.

YaDeau JT, Mayman DJ, Jules-Elysee KM, Lin Y, Padgett DE, DeMeo D, Gbaje E, Goytizolo EA, Kim DH, Sculco TP, Kahn RL, Haskins SC, Brummett CM, Zhong H, Westrich G. Effect of duloxetine on opioid use and pain after total knee arthroplasty: a triple-blinded randomized controlled trial. J Arthroplasty. 2022 Jun; 37(6S): S147-S154. doi.org/10.1016/j.arth.2022.02.022. PMID: 35346549.

Kiani S, Poeran J, Zhong H, Wilson LA, Poultsides L, Liu J, Memtsoudis SG. Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty. Reg Anesth Pain Med. 2022 Jun 27:rapm-2022-103486. doi: 10.1136/rapm-2022-103486. Epub ahead of print. PMID: 35760515.

Zorrilla-Vaca A, Mena GE, Ramirez PT, Lee BH, Sideris A, Wu CL. Effectiveness of Perioperative Opioid Educational Initiatives: A Systematic Review and Meta-Analysis. Anesth Analg. 2022 May; 134(5): 940-951. DOI: 10.1213/ANE.0000000000005634. PMID: 34125081.

Stone AB, Zhong H, Poeran J, Liu J, Cozowicz C, Illescas A, Memtsoudis SG. Buprenorphine for chronic pain treatment and elective orthopaedic surgery: a US national database analysis. Br J Anaesth. 2022 Dec 22:S0007-0912(22)00650-X. doi: 10.1016/j.bja.2022.11.013. PMID: 36566125.
 
Raza MM, Zaslansky R, Gordon DB, Wildisen JM, Komann M, Stamer UM, Langford DJ. Chronic breast pain prior to breast cancer surgery is associated with worse acute postoperative pain outcomes. J Clin Med. 2021 Apr; 10(9): 1887. doi: 10.3390/jcm10091887.PMID: 33925567.

Sideris A, Malahias MA, Birch G, Zhong H, Rotundo V, Like BJ, Otero M, Sculco PK, Kirksey M. Identification of biological risk factors for persistent postoperative pain after total knee arthroplasty. Reg Anesth Pain Med. 2022 Mar;47(3):161-166. doi: 10.1136/rapm-2021-102953. PMID: 34921052.

YaDeau JT, Soffin EM, Tseng A, Zhong H, Dines DM, Dines JS, Gordon MA, Lee BH, Kumar K, Kahn RL, Kirksey MA, Schweitzer AA, Gulotta LV. A Comprehensive Enhanced Recovery Pathway for Rotator Cuff Surgery Reduces Pain, Opioid Use, and Side Effects. Clin Orthop Relat Res. 2021 Aug; 479(8): 1740-1751. PMID: 33720071.

Cozowicz C, Bekeris J, Poeran J, Zubizarreta N, Schwenk E, Girardi F, Memtsoudis SG. Multimodal Pain Management and Postoperative Outcomes in Lumbar Spine Fusion Surgery: A Population-based Cohort Study. Spine (Phila Pa 1976). 2020 May; 45:580-589. DOI: 10.1097/BRS. 0000000000003320. PMID: 31770340.

Kim DH, Beathe JC, Lin Y, YaDeau JT, Maalouf DB, Goytizolo E, Garnett C, Ranawat AS, Su EP, Mayman DJ, Memtsoudis SG. Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesth Analg. 2019;129:526-35.
Memtsoudis SG, Poeran J, Zubizarreta N, Cozowicz C, Morwald EE, Mariano ER, Mazumdar M. Association of multimodal pain management strategies with perioperative outcomes and resource utilization: a population-based study. Anesthesiology. 2018;128:891-902.

Soffin EM, Waldman SA, Stack RJ, Liguori GA. An evidence-based approach to the prescription opioid epidemic in orthopedic surgery. Anesth Analg. 2017 Nov; 125(5): 1704-1713. doi: 10.1213/ANE.0000000000002433. PMID: 29049115.

NIH-funded Translational Pain Research Training Program (Pain-Train)

Learn more about Pain-Train, a multidisciplinary, translational pain research curriculum to support trainees in orthopedics and engineering to incorporate pain research methodology into their research.

PPRC staff

Doctor visit

HSS Opioid Stewardship for Clinicians

At HSS, our surgeons, anesthesiologists, rheumatologists, physician assistants, nurse practitioners, pharmacists, and social workers have established a framework for assessing and treating opioid-naïve or -dependent patients, using prescription drug monitoring programs, and educating prescribers and patients on multimodal pain management.

Access resources for clinicians including CME credits, research and publications.

Other Research Initiatives

Our research into regional anesthesia for total joint replacement surgeries in the Department of Anesthesiology, Critical Care & Pain Management has contributed to an overall increase in regional anesthesia use throughout HSS.

Learn more about our achievements, researchers and publications.

Anesthesia Research Staff

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