Kristin Schreiber, MD, PhD, Translational Pain Research

Dr. Kristin Schreiber is Neuroscientist and Clinical Regional Anesthesiologist investigating the development of chronic pain after surgical injury. She is particularly interested in the mechanisms by which individual differences in psychosocial processing and nociceptive sensitivity lead to differential risk of chronic pain amongst individuals. Her current research uses the accurate measurement of psychosocial and psychophysical phenotype in preoperative patients to prospectively identify individuals at highest risk of pain persistence, so that the processes underlying this propensity may be averted. Other collaborative projects investigate how pain may be modulated by non-opioid analgesic techniques (regional anesthesia, yoga-based exercise, distraction, music, CBT, and open-label placebo).

Areas of Research

1. Prediction and prevention of postsurgical pain

The perioperative period is a unique opportunity, both clinically and scientifically, to translate the tremendous wealth of preclinical knowledge of mechanism into better patient outcomes. It affords the opportunity to evaluate existing and novel therapeutics in humans, in an increasingly frequent situation that involves injury occurring in a scheduled, organized setting (surgery), under the supervision of a highly trained modulator of the peripheral and central nervous system (anesthesiologist).

Her group's previous studies suggest that individual variation in psychosocial factors such as catastrophizing, anxiety, depression, somatization, and sleep quality play an important role in shaping an individual’s risk of developing chronic postsurgical pain. In several cohorts of surgical patients, they have observed that psychosocial and psychophysical differences account for a larger amount of the variability in postsurgical pain than surgical, medical, and demographic factors. These studies also revealed that those with greater generalized pain sensitivity (as measured by quantitative sensory testing, or QST) have greater prevalence of acute and chronic postsurgical pain.

Dr. Schreiber has also been collaborating nationally and internationally to define standard definitions, methods and measures of pain to unite the research and clinical efforts to understand, treat and prevent postsurgical pain, including measurement of these risk factors. Her goal is to implement a tailored preoperative assessment of those risk factors that empirically prove to be predictive, using portable, brief psychosocial and psychophysical assessment.

1. Spivey, TL, Gutowski, ED, Zinboonyahgoon, N, King, TA, Dominici, L, Edwards,RR, Golshan, M, and Schreiber, KL Chronic Pain After Breast Surgery: A Prospective, Observational Study, Ann Surg Oncol, 2018, in press
2. Abrecht CR, Cornelius M, Wu, A, Jamison RN, Janfaza D, Urman R, Campbell C, Smith M, Haythornthwaite J, Edwards RR, Schreiber KL. Prediction of pain and opioid utilization in the perioperative period in patients undergoing primary knee arthroplasty: psychophysical and psychosocial factors, Pain Medicine, 2018 Mar 7, PMID: 29522115.
3. Ende H, Soens, MA, Nandi M, Strichartz GR, Schreiber KL. Association of inter-individual variation in plasma oxytocin with acute and persistent post-cesarean incisional pain. Anesthesia &Analgesia, 2018 Jun 14, PMID: 29916862.
4. Kent, P, Belfer,I, Brennan,TJ,Bruehl,S, Brummett,C, Buckenmaier,C, Buvanendran,A, Cohen,R, Desjardins,P, Edwards,D, Fillingim,R, Gewandter,J, Gordon,DB, Hurley,R, Kehlet,H, Loeser,JD, Mackey,S, McLean,S, Polomano,R, Rahman,S, Raja,S, Rowbotham,M, Suresh,S, Schachtel,B, Schreiber,K, Schumacher,M, Stacey,B, Stanos,S, Todd,K, Turk,D, Weisman,SJ, Wu,C, Carr, D, Dworkin,RH, Terman, G. The ACTTION–APS–AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions, J Pain, 2017, 18 (5):479-489. PMID: 28495013.
5. Schreiber KL, Kehlet H, Belfer I, Edwards RR. Predicting, preventing and managing persistent pain after breast cancer surgery: the importance of psychosocial factors. Pain Manag. (2014) 4(6):445-59. PMID: 25494696
6. Schreiber KL, Martel MO, Shnol H, Shaffer JR, Greco C, Viray N, Taylor LN, McLaughlin M, Brufsky A, Ahrendt G, Bovbjerg D, Edwards RR, Belfer I. (2013). Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain. Pain 154(5):660-8. PMID: 23290256.
7. Belfer I, Schreiber KL, Shaffer JR, Shnol H, Blaney K, Morando A, Englert D, Greco C, Brufsky A, Ahrendt G, Kehlet H, Edwards RR, Bovbjerg DH. Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors (2013). J Pain.14(10): 1185-95. PMID: 23890847.

2. Evaluating alternative analgesic techniques to opioids

Good management of perioperative pain with little to no opioids is clearly of benefit to patients, both in terms of enhancing recovery and decreasing postoperative morbidity. Dr. Schreiber has conducted studies to understand the differences in self-administration of opioids, and identify problematic use patterns. In many cases, regional anesthetic techniques may be utilized to decrease pain and postoperative opioid consumption, as well as possibly decrease the risk of chronic postsurgical pain. Together with an excellent and collaborative team of regional anesthesia specialists, she and her team have been conducting a number of pragmatic clinical studies of the impact and practical application of regional techniques. They have also investigated individual differences in pain processing and efficacy of non-opioid techniques such as distraction, mindfulness, and exercise-based yoga in chronic pain patients.

1. Chai PR, Carreiro S, Innes BJ, Chapman B,Schreiber KL, Edwards R, Carrico AW, Boyer EW Oxycodone Ingestion Patterns in Acute Fracture Pain with Digital Pills Anesthesia & Analgesia 2017, 125(6):2105-2112. PMID: 29189367.
2. Chai PR, Carreiro S, Ranney ML, Karanam K, Ahtisaari M, Edwards R, Schreiber KL, Ben-Ghaly L, Erickson TB, Boyer EW. Music as an Adjunct to Opioid-Based Analgesia. J Med Toxicol. 2017. 13(3):249-254. PMID: 28646359.
3. Zinboonyahgoon N, Schreiber K, Zeballos J, Gareau R, Zaccagnino M, Beagan C, Janfaza D, Liu X, Vlassakov K. Continuous Femoral Nerve Block for Knee Arthroplasty: A Comparison of three evolving regimens. J Med Assoc Thai. 2017;100(9): 997-1006.
4. Schreiber KL, Campbell C, Martel MO, Greenbaum S, Wasan AD, Borsook D, Jamison RN, Edwards RR. Distraction analgesia in chronic pain patients: the impact of catastrophizing. Anesthesiology. 2014. 121(6):1292-301. PMID: 25264596
5. Schreiber KL, Jacques E. Chelly, R. Scott Lang, Ezeldeen Abuelkasem, David A. Geller, J. Wallis Marsh, Allan Tsung, Tetsuro Sakai. Epidural vs. Paravertebral nerve block for postoperative analgesia in patients undergoing open liver resection: a randomized, controlled clinical trial. Regional Anesthesia and Pain Medicine (2016) 41(4):460-8. PMID: 27501020
6. Schreiber KL and Sakai, T Perioperative Analgesia for Patients Undergoing Open Liver Resection: Epidural or Paravertebral? Editorial. J Pain Relief 1:e112 (2012).

3. Investigation of pain processing mechanisms

Recent studies have aimed at understanding the mechanisms underlying pain persistence in both humans and preclinical models. In particular, we investigated differential brain circuitry activation in individuals with or without painful after sensations (PAS) after a prolonged painful stimulus using fMRI. In animal models, previous studies have previously investigated the reciprocally amplifying interaction between immune and nervous systems, which leads to behavioral hypersensitivity and dysfunction in spinal cord and enteric nervous systems.

1. Schreiber KL, Loggia ML, Kim J, Cahalan CM, Napadow V, Edwards RR. Painful After-Sensations in Fibromyalgia are Linked to Catastrophizing and Differences in Brain Response in the Medial Temporal Lobe. J Pain. (2017) 18(7):855-867. PMID: 28300650
2. Schreiber KL, Beitz AJ, Wilcox GL Activation of spinal microglia in a murine model of peripheral inflammation-induced, long-lasting contralateral allodynia. Neurosci Lett. Jul 25;440(1):63-7 (2008). PMID: 18541374.
3. Schreiber KL, Price LD, Brown DR Evidence for neuromodulation of enteropathogen invasion in the intestinal mucosa.. J Neuroimmune Pharmacol. 2(4):329-37 (2007). PMID: 18040851
4. Schreiber KL, Brown DR.Adrenocorticotrophic hormone modulates Escherichia coli O157:H7 adherence to porcine colonic mucosa. Stress. 8(3):185-90 (2005). PMID: 16329163.
5. Fairbanks CA., Schreiber KL., Brewer KL., Yu CG., Stone LS. Kitto KF., Nguyen HO, Grocholski BM.,  Shoeman DW.,  Kehl LJ.,  Regunathan S.,  Reis DJ.,Yezierski RP.,  Wilcox GL Agmatine reverses pain induced by inflammation, neuropathy, and spinal cord injury. Proceedings of the National Academy of Sciences of the United States of America (2000) 97(19):10584-9. PMID: 10984543

Research Team