In November of 2021, University of Maryland, College Park President Darryll J. Pines, MS, PhD, and University of Maryland, Baltimore President Bruce E. Jarrell, MD, FACS, named eight professors as the inaugural MPower Professors. This award from the University of Maryland Strategic Partnership: MPowering the State (MPower) recognizes, incentivizes, and fosters faculty collaborations between the College Park and Baltimore campuses.
Luana Colloca, MD, PhD, MS
Selected for her commitment to interdisciplinary and interprofessional collaboration, Luana Colloca, MD, PhD, MS, serves as professor of Pain and Translational Symptom Science and director of the Placebo Beyond Opinions (PBO) Center at the University of Maryland School of Nursing. Colloca has conducted pioneering groundbreaking studies that have advanced scientific understanding of the psychoneurobiological bases of endogenous systems for pain modulation in humans. As a result, she has developed an international reputation as a leading scientist for advancing knowledge of the neurobiological mechanisms of placebo and nocebo effects with a multifaceted approach including psychopharmacological, neurobiological, and behavioral aspects.
Her research has been published in top-ranked international journals including Biological Psychiatry, Pain, JAMA, NEJM and Lancet Neurology. The impact of her innovative work is clear from her high citation rate and more than 240 invited lectures. Her research has also been featured in National Geographic, The New Scientist, Washington Post, Science Daily, Boston Globe, The New York Times, Nature, The Guardian, Wall Street Journal, News and World Reports, COSMOS (Australia), Le Monde (France), La Repubblica (Italy), The Australian, and USA Today. Dr. Colloca has been honored with prestigious awards such as the Dubner Award and Patrick Wall International Award from the International Association for the Study of Pain (IASP). She serves on leadership roles internationally within the International Association for the Study of Pain (IASP, Chair of the PAIN and PLACEBO SIG) and the Society for Interdisciplinary Placebo Studies (SIPS, Treasurer) and locally as the CTSA TL1 Program Director at the University of Maryland. She is also a field Editor for the Journal of Pain and Section Editor for the PAIN and PAIN Reports journals.
Can you briefly describe the type of research you do?
The opioid epidemic in the U.S. and worldwide compels us to discover novel mechanisms and therapeutic approaches to alleviate acute and chronic pain. A growing line of laboratory research has focused on the neurobiological mechanisms underlying placebo analgesia in both health and pain study participants affected by idiopathic and neuropathic pain, lower back pain, knee osteoarthritis, irritable bowel syndrome, and migraines. We investigate facial pain alone and in association with chronic overlapping pain disorders. Our research centers on the concept that the brain has the ability to modulate pain experience by releasing endogenous substances (e.g. endogenous opioids) and activating neural modulatory systems. In fact, placebo effects depend on the release of substances such as endogenous opioids, endocannabinoids, dopamine, oxytocin, and vasopressin in descending pain modulation systems.
Placebo effects are powerful and commonly encountered in clinical trials and practices. Through an understanding of placebo mechanisms, strategies promoting placebo effects can optimize therapeutic outcomes in clinical practice. We have been among the first teams to discover critical aspects of placebo effects in terms of learning mechanisms, their neurobiological signatures and clinical phenotypes. We demonstrated that placebo effects observed in the orofacial and temporomandibular disorder (TMD) population are of large magnitude, with a number needed to treat (NNT) similar to healthy controls. We have also found that placebo effects in TMD participants do not extinguish over time and depend on prior therapeutic experience. Moreover, placebo effects are predicted by learning patterns and affected by racial, ethnic, and sex differences.
With the MPower-based collaborations, we built upon this well-established knowledge on placebo effects, social learning and in general, pain modulation to create a research portfolio on non-pharmacological adjuvant interventions that could improve our understanding of the common and distinct neural mechanisms. In particular, we study digital therapeutics with a focus on immersive virtual reality (VR) and its underlying mechanisms and applications to pain. VR has been seen as an intervention for alleviating chronic (and acute) pain, but there was a paucity of mechanistic research, especially regarding TMD participants. We use a multidisciplinary approach to VR to present novel opportunities for reducing pain and suffering by using an immersive, aesthetic, and multisensory stimulation.
How do you gather data or conduct studies for your research?
Currently, we have three main lines of research in healthy and chronic pain participants. We study the behavioral and neural mechanisms of social learning, VR, and placebo effects. For example, we were among the first labs to show that observing others, which begins at birth, is a powerful way to gain information to reduce pain experiences. We (and other labs) showed that social learning (changes in behaviors and outcomes related to the observation of others) elicits placebo analgesic effects comparable in magnitude to those induced by direct experiences. Our goals are to identify the psychoneurobiological underpinnings of observational learning using well-validated paradigms with sophisticated tools and techniques, including immersive VR, fMRI, EEG, and combined EEG/fMRI approaches.
During the pandemic, we started conducting ‘virtual’ trials to reach out to pain participants directly at their homes. We shipped VR and other therapeutic digitals to study clinical pain, mood, anxiety, and sleep patterns when chronic pain patients were using VR (and/or control) interventions. This represents another unique example of how we gather data and conduct research studies for our research working closely with pain patients. It is a great way to apply VR, Ecological Momentary Assessments, and telemedicine to gather data in an innovative way in the era of digital medicine. Finally, we are interested in determining how racial/ethnical and disparities affect placebo effects. Having a lab in the greatest area of Baltimore allows us to conduct research committed to enhance diversity, equity, inclusion and accessibility.
What drives you to do this research?
As an expert and researcher in placebo effects and pain modulation, my and our lab’s goal is to work with passion and enthusiasm to advance the state of scientific knowledge in these areas, elevating the breadth and depth of our knowledge of the field to outstanding levels. To do this, we pursue innovative approaches to understand the endogenous pain modulation mechanisms and their clinical implications. Our research approach is careful, rigorous, innovative, and highly collaborative. We strive to be a team of remarkably open-minded and flexible thinkers, refreshingly non-dogmatic or reductionist while being productive and hardworking, with an inexhaustible energy, tirelessness, and perseverance. In the midst of the opioid epidemic, we thrive to help mitigate pain experiences and disabilities across pain disorders.
What did it mean to you personally to be named an MPower Professor?
As an Italo-American woman in science, I felt humbled and honored by being named MPower Professor. The morning I received the call from Dean Kirschling and President Jarrell is still a vivid and wonderful memory and further boosts my desire to conduct groundbreaking and seminal work in the area of human endogenous pain modulation systems, including placebo and nocebo effects, learning mechanisms, observation, and virtual reality among other pain interventions.
How do you collaborate with researchers outside of your discipline?
I have been highly intrigued by interdisciplinary themes and collaborations. I combined medicine, neuroscience, and bioethics as a trainee, to continue today with collaborations that bridge many different disciplines. In particular, the recent research on virtual reality mechanisms applied to pain, funded first by MPowering the State and then by the National Center for Complementary Health (NCCIH) and the National Institute of Dental Craniofacial Research (NIDCR), brought us to work closely with engineers, psychologists, physicians, musicians, and ultimately chronic and acute pain patients. It is insightful and rewarding to see the same topic through distinct technological and translational lenses.
Why is this collaboration important to you?
Collaborating with other researchers is always stimulating, especially when many brains tune in to solve problems, think outside the box, and promote rigor and innovation. It is often ‘fun’ to learn from one another. We are social beings, and through collaboration, we value diversity, pursue innovation, and empower science to serve, help, and mitigate pain suffering.
Please name the researchers you have worked with on MPower collaborations:
Researchers with whom I have worked with on MPower collaborations include but are not limited to:
- Amitabh Varshney, MS, PhD – College of Computer, Mathematical, and Natural Sciences, Department of Computer Science, Institute for Advanced Computer Studies, University of Maryland, College Park
- Barbara Brawn, MS – Department of Computer Science, Institute for Advanced Computer Studies, University of Maryland, College Park
- Craig Kier – Maryland Opera Studio, University of Maryland, College Park
- Sarah Murthi, MD, FACS – Shock Trauma Center & Maryland Blended Reality Center, University of Maryland, Baltimore School of Medicine
- Nicholas Morris, MD – Department of Neurology, University of Maryland School of Medicine
- Asaf Keller, PhD – Department of Anatomy, University of Maryland School of Medicine
I also wish to mention:
- Adrianne Arthur –MPower Initiatives
- Several trainees and students from all our labs for their valuable work.
How do the funds awarded from MPower support your research and help facilitate collaborations with other researchers?
Using the funds awarded from MPower, we created the Colloca Summer Fellowship and established the Placebo Beyond Opinions (PBO) Center. The Colloca Summer Fellowship is based on the MPower Distinguished Professorship, and aims to recognize the earliest steps towards a successful scientific career with young scholars at the high school level. This year, two scholars have been selected based on diversity and merit.
The newly created PBO Center aims to promote rigorous and systematic research on the mechanisms of placebo effects, how placebo effects influence variability in symptoms, treatment responses, and the perception of clinical encounters based on socio-economic factors, disparities, and diversity related to understudied populations. The PBO Center capitalizes on interdisciplinary research and higher research programs.
What are the next steps for your research?
Placebo effects are ubiquitously present in clinical settings. Investigating the fundamental neurobiological bases of endogenous pain modulation systems can potentially have clinically relevant applications contributing to the improvement and development of therapeutic tools and strategies to help patients alleviate their pain. We will continue working on large dataset, interdisciplinary approaches and in-depth clinical phenotypes to help discover why some people benefit from inner healing processes and an activation of the endogenous pain modulatory systems and some don’t. This is likely the main challenge ahead of us, and we hope to shed light on the distinct phenotypes promoting personalized approaches and therefore precision medicine.
To learn more about Dr. Colloca’s work, please visit the following link or follow her on Twitter at @Colloca_Luana: