DETROIT (WWJ) — Professor April Vallerand has been appointed to the first Wayne State University College of Nursing Alumni Endowed Professorship. Vallerand is a nationally recognized expert in both pharmacology and pain research, whose work has received backing from the National Institutes of Health.

The new appointment will allow Vallerand monies for research needs, including the extension of a three-year study focusing on African Americans who experience cancer pain. The study is funded by a $1.1 million grant from the National Cancer Institute, and Vallerand intends to extend the Power Over Pain project to a fourth year, thanks to support from the college through the endowed professorship.

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“I am so honored to receive this professorship,” Vallerand said. “It recognizes my ongoing work in which I am testing an intervention for improving function among African Americans with cancer pain. We work to help both the patient and caregiver increase their perceived control over pain, which is key to managing both pain and being able to do the daily activities that are important to them. If you know what to do to control your pain, and are confident that what you do will make a difference, you can improve how you feel and what you are able to do.”

The professorship also recognizes Vallerand’s excellence in teaching and mentoring graduate students. She has chaired 10 doctoral dissertations and includes graduate students on her research team. The professorship will allow her to hire additional research assistants and pay for professional development opportunities for her students – such as attending the American Pain Society Meeting or presenting research at professional meetings.

“I was invited to present my research at the NIH Pain Consortium, and this was the perfect opportunity for my graduate research assistant, one of my doctoral students, to go, too, and I could pay for it,” she says. “This will really allow me to help students while continuing my research in areas where I didn’t have the money to do so.”

Vallerand’s research interests include the maintenance and improvement of function for patients with chronic pain; pain-related health disparities; cancer pain management; pharmacological management of pain; and self-treatment of pain in the community. Her previous studies of cancer patients in the Detroit area showed that race, ethnicity, income, and education level affect patients’ beliefs about and response to pain. She found that African American patients tend to “catastrophize” or use more negative coping, believing that pain is inevitable, will never go away, and that nothing can be done. Feelings of lack of control also often lead to depression.

Her current study is the first of its type to focus on African Americans. Of the 130 people who have enrolled in the study, 103 have completed it. This is about half of those needed for the study to be considered successful.

“We have recruiters in the waiting room at the Karmanos Cancer Institute who talk to patients and tell them about the study and ask if they’ve had pain in the last two weeks,” she said. “If someone is interested, we try to get in touch with them within 24 hours but it can be difficult to reach people. My nurses are calling repeatedly, at different times and days, trying to connect with them and sometimes the nurses feel like they may be annoying. Finally, one patient told us, ‘I heard every message you left but I didn’t feel well enough to pick up the phone. But just hearing that you cared enough to call over and over made me feel better.'”

Vallerand and her team have submitted an article detailing recruitment challenges, the uniqueness of the population, and factors that affect participation, including something as simple as lack of a working telephone.

“The average age of cancer diagnosis across the country is 66, but in our African American population it is 53,” she says. “You might picture this community as having large families and church support, but many are really socially isolated. Some people do have big families but maybe the family members aren’t available to take them to treatment because the family member is working three jobs or doesn’t have a car. I had a couple of patients who had advanced lung cancer and were walking to the bus, getting off at KCI, getting chemo, walking back to the bus and then walking home by themselves in the winter.”

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Nurses visit patient participants in their homes, providing the research team with an accurate view of how the patient is dealing with their cancer pain. The study has three components:

Medication management: ensures the patient is taking the right medication and in the most effective way;
Pain advocacy: teaches patients how to talk to their doctor about their pain. “Patients may say that something hurts real bad, but it’s more helpful to describe the effects of the pain as ‘I can’t sleep through the night,'” Vallerand says. Patients and caregivers also are taught how to effectively communicate with each other; and
Living with pain: encourages patients to continue participating in life despite pain and decreases negative coping while increasing and facilitating functioning. “What is important to the patient?” Vallerand says. “I don’t care if they go back to work. What does this pain keep them from doing? What’s meaningful to them? That’s what you target to get them back to.”

“The intervention patients have our phone numbers and can call us 24/7,” she said. “Doesn’t happen a lot, but we do get the 2 a.m. calls. If clinicians could see what we see, they would be shocked.”

This fall, Vallerand will interview participants to further document how the intervention has helped them. Her next study will focus on African American cancer survivors with pain and how they manage pain after treatment ends.

“We know that is a population that is struggling,” she said. “We don’t seem to manage pain as well with our African American population. Whatever the reason, we’re not giving patients a sense that they can do this, they can get through it and they have control.”

Vallerand’s interest in pain management began in graduate school at the University of Pennsylvania when she noted that patients dealt with pain in different ways. Some had significant pain but continued to function well, while others with what seemed to be similar pain levels were totally disabled by it.

“My other love is pharmacology, and I’m interested in pharmacologic pain management,” she said. “Pain management with available drugs should be done – no question. But I’ve moved to perceived control over pain because there’s a direct correlation between pain and function, and function is affected by perception of control over pain. It’s so important to give our patients that knowledge: If your pain gets worse, here’s what you can do.

“I love getting out with patients and seeing how we can help them,” Vallerand said. “This is what I live for, and I’m grateful that the endowed professorship will allow me to continue this work.”

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