Christine Sieberg, PhD, didn’t set out to become a pain researcher. She went to college thinking she’d be a grade-school teacher, but a student-teaching placement at a school for children with severe emotional and behavioral disorders set her on a new course.

As an undergraduate, the experience “fundamentally changed” her perceptions of developmental psychology and laid the groundwork for a career-long focus on parsing the biological and psychological aspects of chronic pain in young people making the transition to adulthood. The teacher in her persists, through her work both as faculty for Harvard Catalyst and as a mentor with Career Catalyst and the Grant Review and Support Program (GRASP).

In addition to grant-funded research and clinical work, Sieberg is a licensed clinical psychologist at the Center for Health Outcomes & Interdisciplinary Research (CHOIR) in the department of psychiatry at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School.

This is part one of a two-part Q&A.

Do you think the mind-body connection is seen by some in medical science as a little  “woo-woo”?

Descartes proposed mind-body dualism, separating the mind and the body, and unfortunately we still see remnants of that mindset in medicine today. Chronic pain is a powerful example of why that separation doesn’t reflect reality. We know that biological, psychological, and social factors all interact to shape the experience of pain. Why do some people develop chronic pain while others don’t, even after similar injuries or surgeries? How can we help people live meaningful, values-based lives despite chronic pain or disability? Those questions require us to think about the whole person. That integration is what really drew me to this field as both a clinician and a scientist.

In every doctor’s office, we hear: What’s your pain rating, on a scale of one to ten? But even that is subjective. Two people can report the same pain intensity, but one person’s six out of ten might be completely debilitating and they can’t get out of bed while another person may say six is a good day. Those two people can also have very different underlying biology and psychological experiences. That’s really interesting to me. We’re trying to understand whether different subgroups or phenotypes predict the pain experience.

As a pain psychologist, I’m interested in more than pain intensity. It’s an important metric, one that is important in the acute phase of surgery or recovery. I work clinically with patients living with chronic pain and my research is in chronic pain. In that world, many people live with disability and chronic pain, often for many years, and the reason for their pain may be unclear. It’s multifactorial. I want to understand their pain experience and how it interferes in their life, because it might help us predict the correct treatment path.

Interdisciplinary care is key. We want to see physicians working with clinical psychologists like me, but also physical therapists, neuroscientists, and engineers. This is literally who I collaborate with. I work with many psychologists, but my immediate team is an electrical engineer who does computational neuroscience and neuroimaging and a physical therapist by training with a doctorate in pediatric pain. I also work closely with Dr. David Borsook, an emeritus MD/PhD pain physician and neuroscientist, who has been both a longstanding collaborator and a key developmental mentor throughout my career. Because pain is complex and subjective, these interdisciplinary collaborations are vital. We need to all communicate.

“Because pain is complex and subjective, these interdisciplinary collaborations are vital. We need to all communicate.”

You’re also examining the role of stress in chronic pain. What are you learning?

One of the things we’re trying to understand is how different measures of stress fit together. We compare what patients tell us about their experiences with what their biology and their brain are telling us. For example, we’ve studied self-reported stress and resilience in both childhood and adulthood, measured long-term stress using hair cortisol concentrations before and after surgery, and used experimental pain paradigms and brain imaging to better understand how the nervous system processes painful stimuli.

One thing we’ve learned is that stress itself isn’t inherently good or bad. Some degree of manageable stress is a normal part of development and may help build resilience. The question isn’t simply whether someone experiences stress but how their nervous system responds to it and what protective factors they have. Those individual differences may help explain why some people develop chronic pain after an injury or surgery while others recover.

I think about many of the adolescents I worked with who were incredibly high-achieving and perfectionistic. For some, not getting into an AP class felt like the biggest stressor they had ever experienced. Their distress was absolutely real, but it also highlighted how differently people process and respond to stress. In some individuals, the nervous system can become amplified or dysregulated, contributing not only to emotional distress but also to headaches, chronic pain, and other physical symptoms.

One of the biggest unanswered questions is how stress interacts with resilience, biology, and the brain over time. Understanding those relationships could help us identify who is at greatest risk for developing chronic pain and, ultimately, develop more personalized approaches to prevention and treatment.

Have we made any progress in understanding the psychology of chronic pain?

I’ve been in this field for almost 20 years. It’s evolved, but we don’t have a great understanding of the complex biopsychosocial mechanisms contributing to chronic pain. We understand little about young people living with chronic pain while transitioning to adulthood, especially in cases of untreated pain.

When I was in the clinic at Boston Children’s Hospital working with so many adolescents and young people with pain, I would tell the parents that it’s wild to me that we can be doing a double-lung/heart transplant across the street but we can’t always figure out exactly why their child is experiencing persistent pain.

I’d love to have answers. This is still a newer science, especially in younger people. As recently as 1980, the year I was born, we thought that babies didn’t experience pain because the nervous system was immature. As a result, infants in neonatal intensive care units often underwent painful procedures with little or no pain management. We now know that those early experiences can influence how the nervous system develops, and long-term studies have found altered pain sensitivity later in life. That’s where we were less than 50 years ago.

Pain research focused on comparing developmental stages, say from early adolescence into adulthood, as I’ve been doing in my recent funded grants, is novel. I don’t think many people are doing it. We want to understand the trajectories of chronic pain and the risk factors. We want to help people live well and age well. Chronic pain is a significant social, humanitarian, and socioeconomic burden in this country and in the world, and a barrier to people being able to live and age well.

“Chronic pain is a significant social, humanitarian, and socioeconomic burden in this country and in the world, and a barrier to people being able to live and age well.”

What’s needed to change the trajectory and accelerate progress?

Students in veterinarian programs get more training in pain than medical students. So we need to really take it back to the education system. We need to take it back to medical schools to be training about pain as an interdisciplinary science going beyond pain ratings.

Doctors can get very overwhelmed with patients with chronic pain, and the healthcare system is not really designed to help them. You get 15 minutes, and the doctor is supposed to address this unrelenting chronic pain and associated disability and life interference that can come with it. It is challenging all around.

This is what motivated my whole research track. People were coming to me saying their doctors didn’t know what was wrong with them or thought they were crazy. They were being told it was all in their heads, that they were making it up. I know that’s not true from all our science and neuroscience and behavioral science research.

I tell my mentees that when they’re interviewing for medical school all the doctors and deans are going to like their work in my lab, because they’ve been in those positions with their patients. It’s a system-wide problem in this country.

What led you to this line of work?

My path is a little different than typical researchers, especially in my field of clinical psychology and behavioral sciences. There were many twists and turns along the way. I come from a very working-class family, and I don’t think I understood all the options that would be available to me.

Growing up, I loved working with young people — babysitting, things like that. I knew I wanted to study education and maybe be an elementary school teacher, and I received a nice scholarship to attend Boston College in the School of Education. Over time, I started taking more psychology classes. I really liked developmental psychology in particular.

As part of my student teaching requirement, I was placed at a therapeutic day school for children and adolescents with pretty severe emotional and behavioral disorders.  I was working with families, children and adolescents with multiple risk factors, including childhood trauma and violence. The experience fundamentally changed the way I thought about health and development. I became interested in how early life experiences shape both mental and physical health over the lifespan. That curiosity ultimately led me to pediatric psychology and, eventually, chronic pain research. I wanted to better understand why some young people develop persistent pain while others don’t, and how we can intervene earlier to improve their lives.