Understanding the Mechanisms Behind Chronic Pain

At Cincinnati Children's, the Pediatric Pain Research Center brings together clinicians and researchers from anesthesiology, neurology, behavioral medicine, gastroenterology and other specialties to advance understanding of pediatric chronic pain. "With the Pediatric Pain Research Center, we seek to understand pain both at very mechanistic levels as well as at very human levels. With the close integration of basic scientists, translational scientists, and clinician scientists, we have the ability to relate the disruptions of the nervous system that are associated with pain to the tremendous impact that they have on the individual and their families," says Robert Coghill, PhD, director of the Pediatric Pain Research Center.

A major example is BRIDGE (Biopsychosocial Risk Influences on the Development and Generation of Early-Onset Chronic Pain), a multidisciplinary study using biological, psychological and social data to better understand the mechanisms that contribute to chronic musculoskeletal pain in children.

This approach is reshaping how research is conducted. Investigators are studying differences in inflammatory signaling, neural activity and other biological factors across patient populations to better understand why children with similar symptoms may experience pain differently and respond differently to treatment.

"Historically, we have grouped patients based on a diagnosis or where their pain occurs. BRIDGE starts from a different premise: children with similar symptoms may have very different underlying mechanisms contributing to their pain. Understanding those differences is critical if we want to deliver more effective, individualized care," says Christopher King, PhD, of Cincinnati Children’s Division of Behavioral Medicine and Clinical Psychology.

"We anticipate that BRIDGE will move us beyond focusing on the patient's diagnosis and toward a future where treatment decisions are informed by a deeper understanding of the biological and psychosocial processes contributing to their pain. That has the potential to improve outcomes, reduce unnecessary treatments, and make the journey easier for families," King says.

Translating Research into Treatment

While BRIDGE is focused on identifying the mechanisms that contribute to chronic pain, Cincinnati Children's is also applying current knowledge about pain biology and behavior to the development of new treatment models. These efforts share the goal of better matching treatment approaches to patient needs.

One example is FIT (Fitness Integrative Training) Teens, which combines cognitive behavioral therapy (CBT) with structured movement training. The program was developed because, while many patients with chronic pain learn effective coping strategies, they often continue to struggle with physical activity because of fear of movement and deconditioning.

"In the FIT Teens program, we implement a step-by-step exercise training plan that improves posture, balance and strength in performing fundamental movements," says Susmita Kashikar-Zuck, PhD, associate director of the Pediatric Pain Research Center. "These exercises, along with psychological support and coping skills, help youth with chronic pain build confidence in managing pain so that they can return to their daily activities. The treatment sessions are group-based, so teens can learn from and receive support from peers with similar conditions. This is hugely motivating for them and helps them stay engaged and focused during their recovery."

FIT Teens has demonstrated improvements in function and engagement in multicenter clinical trials and has been adapted for telehealth delivery, expanding access to care.

Similar results have been seen in pediatric headache care, where combined behavioral and medical treatment continues to outperform medication alone. Across pain conditions, evidence increasingly supports multidisciplinary approaches that improve both symptoms and function.

A Continuum of Care for Patients with Chronic Pain

Cincinnati Children's offers a continuum of care that is built to match patient needs.

• Specialty clinics, including headache and gastrointestinal pain clinics, embed behavioral health providers directly within subspecialty care starting at the first visit.
• Outpatient pain psychology services help patients develop skills to manage pain, improve function and enhance quality of life through a biopsychosocial approach.
• The Functional Independence ReSToration (FIRST) Program provides intensive interdisciplinary treatment for patients with severe functional impairment who require a higher level of care.

For referring providers, this structure creates clear care pathways. Children with mild to moderate functional limitations can access evidence-based outpatient treatment, while those with more significant disability can transition to intensive interdisciplinary care without navigating multiple systems.

"When talking with families about behavioral medicine for chronic pain, it's important to emphasize that the goal is restoring function as research indicates that function needs to improve before pain can improve," says Kendra Homan, PhD, pain psychologist in the Division of Behavioral Medicine and Clinical Psychology and clinical director of the Functional Independence Restoration (FIRST) Program. "A nuanced understanding of the functional approach, and confidence in its effectiveness, helps providers identify when outpatient treatment is appropriate and when a higher level of interdisciplinary care may better support a patient's recovery."

Collaboration is built into the care model, with behavioral health providers working alongside subspecialists within specialty clinics to support coordinated assessment and treatment planning. Ongoing research initiatives also create opportunities for eligible patients to participate in clinical studies.

Refer a Patient

Refer patients through Cincinnati Children’s referral process. For the Pain Management Center, call 513-636-7768. For Behavioral Medicine and Clinical Psychology, call 513-636-8107. For urgent provider-to-provider consultation, call the Physician Priority Link at 513-636-7997 or 1-888-987-7997.

(Published August 2026)

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