Q&A with Paul Geha, M.D.

May. 24, 2019

Paul GehaThis spring, Paul Geha, M.D., joins the University of Rochester as an assistant professor in the Departments of Psychiatry and Neuroscience. Geha went to medical school in Lebanon before completing a post-doctoral fellowship at Northwestern University and going on to Yale University for a fellowship, residency, and faculty appointment. His Pain and Perceptions laboratory at UR will focus largely on chronic pain and understanding how patients’ brains change as a result of prolonged exposure to pain. We caught up with Geha before his arrival on campus to find out what drew him to Rochester.

Del Monte: Where do your research interests lie and what will you will be focused on when you arrive at UR?

PG: My main area of research is chronic pain, branching out into the interaction of chronic pain and addiction. I'm hoping by joining the faculty at Rochester to be able to continue to work on understanding how the brain of patients with chronic pain changes as they experience the chronic pain, or as they transition from acute to chronic pain. We have accumulated a lot of evidence over the years, thanks to advances in imaging, that the brain does not just sit there and receive the pain signals from the periphery; it changes with the experience of pain over time. This can teach us a lot about the nature of the experiences that patients are going through and help us understand how the chronic pain experience is generated. It also helps us identify areas of the brain that we could target with treatments like psychotherapy or drug therapy, and understand the vulnerabilities that these patients run into, such as overeating or getting hooked on opioid pills.

How did you initially become interested in science, and then more specifically in chronic pain research?

Before medical school, I went into philosophy for a year, and I was really interested in the Philosophy of Mind. In medical school, I was very drawn to understanding how the brain comes up with the mind.

My interest in chronic pain happened by accident. I had a professor in medical school that was working on pain and neuroimaging in Chicago, and so I ended up in Dr. Apkar V Apkarian’s lab at Northwestern University for five years. At the time, brain imaging was still in its early years, and we were doing all these cross-sectional studies just to understand what's going on in the brain of patients with chronic pain. I did some of the first open label imaging studies on the brain’s response to analgesia, where you give a patient a drug and look at how their pain changes with time, imaging them before and after. And, interestingly enough, almost 15 years ago, we started noticing that the areas of the brain that respond the most to analgesic drugs were also involved in emotion processing, or what we call the limbic system.

Are there any departments or centers at UR that you're looking forward to collaborating with?

Definitely. Neurosurgery, Orthopedics, Neurology, the Eastman Institute for Oral Health (EIOH)… Pain is a complaint that is common to many, many different diseases, and chronic pain can occur in multiple systems in the body. Despite almost 25 years of brain imaging, we still don't understand a lot of chronic pain conditions. Since I focus a lot on chronic back pain, I will be working closely with Dr. John Markman in Neurology and Neurosurgery, and Dr. Robert Dworkin in Anesthesiology. The different departments offer crucial and critical collaboration that will help me translate some of my ideas into the clinic. Another collaboration I'm really looking forward to is working with people who have chronic temporomandibular joint (TMJ) pain, which is a chronic pain of the joint between the cranium and the mandible (lower jaw). EIOH cares for thousands of patients and a lot of them come for treatment of chronic TMJ pain. We have some hypotheses about the role of a specific area or circuit in the brain that could actually identify someone as at risk for chronic TMJ pain.

What really drew you to the UR when you decided to make the move?

I worked closely with the chair of UR’s Psychiatry Department, Dr. Hochang (Ben) Lee during his time at Yale as director and chief of Psychological Medicine Service. He understands what kind of infrastructure team research needs and clearly this can be done at the University of Rochester given all the departments and their efforts in clinical pain research. And, of course, being a part of the Del Monte Institute, where I can collaborate with a lot of cognitive neuroscientists who are working on the brain and imaging other conditions.

What do you like to do for fun outside of your lab?

I’m very into soccer. I'm not a professional in any way, but I really like the sport and I watch it a lot. I also like to hike and one thing I'm looking forward to doing in Rochester is to learn how to ski. People have told me it’s the place to be if you want to ski in the winter. Another thing that was very attractive about the city is that there is a good cultural scene. I love to go to the theater and music festivals, and my wife is actually a filmmaker—she created a festival for short movies before moving to the U.S.—so she's also looking forward to exploring the arts and culture scene.

This article appeared in the Spring 2019 issue of NeURoscience.