Corey Simon, DPT, PhD, is a researcher and assistant professor of Orthopedic Surgery. He is on the Center for Geriatric Surgery faculty and is a senior fellow in the Duke Center for the Study of Aging and Human Development. Earlier this year, he was named a UCSF/AGS Tideswell Emerging Leaders in Aging Scholar.
Tell us about your work.
I am a geriatric pain researcher focused on developing ways older adults with persistent pain conditions can recover from their pain; or manage it in a way that keeps them from succumbing to disability.
I am working to identify factors that put certain people most at risk for pain and/or disability. Through that, we hope to use a precision medicine approach to target individualized treatment pathways and get the best results. We have a major pain epidemic in our country; there are 100 million people who are dealing with pain and 40 million have pain most to all days. Not to mention, an opioid epidemic due in part to poor pain management.
Why is your research focused on older adults?
Older adults are more susceptible to persistent pain conditions. Just like hearing and vision – a person’s internal pain-relieving system declines over time. Also, there is significantly less research on older adults with pain compared to younger adults; since traditionally, clinical trials excluded people over the age of 65. But people are living much longer now which is contributing to a growing, global disability crisis among older adults – many from pain.
What is next for this work?
I am interested in studying the intersection of pain and stress. What is it about life stressors that can alter our stress and coping physiology, contribute to pain occurring or recurring, or keep older adults from recovering from pain? There are physical stressors, psychological stressors, social stressors, inequitable stressors – factors like poor access to good health care, transportation constraints, socio-economic challenges, to name a few.
The prevalence of persistent pain in older adults is extremely high – almost 30% in the U.S. But that doesn’t mean that every adult with persistent pain succumbs to disability. Our broader hypothesis is that how older adults cope stressors in their lives is the mediator for pain contributing to disability. So, older adults who cope well stressors poorly are likely more susceptible to pain-related disability. But if we can figure that out, we are on our way towards personalized treatments that work. We envision this being both physical interventions and psychological interventions - treatment at the intersection of physical therapy and psychology.
How does your research enrich your teaching?
DPT students benefit from every faculty member’s scholarly pursuits because we share the most up to date evidence, which translates into best practice. It’s important to note that best practice starts with knowing how to educate – and we have one of the strongest educational research faculty in the nation guiding stellar educational delivery. Pair that with those of us doing clinical research, and it’s a unique, cool team to be a part of.
My specific research helps students understand that pain is a biological, physiological, psychological, cognitive, social, and cultural phenomenon. And as such, effective meaningful care must track these influences. One example is Psychologically Informed Practice, or PiP, which we teach in the foundational course, Pain Science; and, in an advanced practice course, Integrated Pain Management. Learners approach pain management not from a dualistic approach – rather, from a seamless integration of the physical with the psychological. So, it expands their understanding of how a person thinks, copes, behaves as they move through life in real time; and how by providing feedback, they can help people learn to cope and manage in the face of painful activity.
What drew you to this work?
Two things. First was my grandfather who lived into his 90s and with whom I was very close. He had debilitating low back pain and osteoarthris-related spinal deformity. In a particularly awful bout, which I will never forget, he told me he would rather die than keep fighting the pain. But he did fight it - with over-medication, injections, and spinal fusion in late life. He functioned but I’ve always suspected the care was as stressful as his pain.
The second was as director of an outpatient PT/OT facility. I had just passed fellowship in orthopaedic manual therapy but paradoxically, my outcomes for older adults with persistent pain were no better than when I was a new clinician. They were just a difficult sub-population to treat, and it was extremely frustrating. When I scoured the literature, I realized that the body of evidence for older adults with persistent pain was poor. This ignited a pursuit to better understand rehabilitation science and pain mechanisms in the field of science.
What brings you joy?
Family, for sure - my partner Maria and I have two daughters, Kennedy, 17 and Jayden, 15, and a one-year-old mutt, Moose. Outside of that, mid-life dad hobbies like trail running, music and guitar, and sports. As a native Buffalonian, I can say I love the Bills, but they don’t always bring me joy.