Graduate school is the place to go if you're interested in "why" questions, a senior colleague told Chuck Griffis: "If you want to address these kinds of questions, you need to get a PhD because PhD researchers are trained to figure out the whys."

The particular why question that Chuck had in mind involved his patients at UCLA Medical Center. As a nurse anesthetist, Chuck spent a lot of time in surgery and following up afterward with patients, some of them with immune systems that had been compromised as a result of chemotherapy, leukemia, or AIDS. "Those folks never seemed to do as well after surgery, especially when they had a lot of pain," Chuck says, describing his anecdotal assessment. "They would not heal as well, would not start recovering as quickly, and they were the ones who would come back with recurrences," he says.

Wondering why, Chuck began an informal self-education project, and through his reading, he "became convinced that the pain itself was acting as a disease factor-it wasn't just a by-product or something to be endured," he says. In 2001, he decided to look for answers in graduate school. Dr. Patricia Kapur, Chair of the Department of Anesthesiology at UCLA, helped him work out a schedule that allowed him to work in the operating room part-time during his studies. "He is an exemplary clinical nurse-anesthetist," she says, "very highly skilled and knowledgeable and a clinical role model for the junior staff."

Today, Chuck has finished his coursework and has made a promising start on his dissertation research, which remains focused on the "why" question that began it all. In consultation with his faculty advisory committee, Chuck developed an experiment that explores the physical effects of pain in one particular area: how it acts to worsen inflammatory diseases like rheumatoid arthritis or irritable bowel syndrome.

Instead of working with patients already in pain as a result of disease or surgery, Chuck decided to start with 14 "healthy young folks, figure out a way to produce a non-injurious pain, and see what happens to their healthy immune system," he says. The pain is delivered via a small cuplike electrical stimulator that fits over the ear and causes a prickly pain of varying intensity. Blood samples are drawn before, during, and after the stimulation.

Reviewing the blood samples from the first four research participants showed "some very interesting changes going on," Chuck says. Even modest, short-term pain increased the amount of Interleukin 6 (IL6) in the bloodstream, and high levels of IL6 have been linked to hypertension and heart disease. Researchers believe that IL6 increases the production of cellular adhesion molecules (CAMs) in the blood. CAMs do good work: carrying white blood cells to sources of infection, where they help the body heal. However, when CAMs are overproduced-perhaps during excessive untreated pain-they might end up at other areas of inflammation, making diseases like rheumatoid arthritis more severe. Heart disease is another possible outcome.

Chuck's adviser, Dr. Peggy Compton, says his research "is unique in the pain field [and] is beginning to explore potential detrimental effects of pain on immune and inflammatory pathophysiological processes. . . . [His] findings could have significant implications for the management of pain states."

One outcome might be the use of antibodies to suppress CAMs after surgery, Chuck says, but the principal impact of his work is to underscore the relatively new medical view that pain is a pathogen itself. "'No pain, no gain' is definitely not our philosophy," Chuck says. "You should treat pain and get rid of it because pain itself may cause or worsen diseases."

Treating pain has been an element of Chuck's life ever since he was a small boy in Florida, helping his older brother and sister with their cuts and scrapes. When he started junior college, he began working as a hospital volunteer and then as an orderly. "I was just fascinated," he says. "The doctors would come in, do a couple of things, and leave a bunch of orders, but the nurses were the ones who were actually taking care of the patients," he says. "For me, that was always the more fun part."

Chuck studied for his registered nurse certificate and later for his bachelor's degree, working in intensive care units and cardiac care units, where he was inspired by his close encounters with anesthesiologists and nurse anesthetists. UCLA had one of the best master's degree programs for nurse anesthetists, and so Chuck moved to Los Angeles and never left.

He got his master's degree in 1981 and has worked continuously at the UCLA Medical Center, supplementing his duties as a nurse anesthetist with teaching responsibilities in the hospital and the School of Nursing. Now, he's ready to change the proportions of those activities.

Like many dissertations in the School of Nursing, Chuck's work will be presented in the form of three articles published in nursing journals, "not just one dusty document that will end up in the biomedical library," he says. The first, on the theoretical assumptions underlying his work, is almost ready to be published. Two other articles will discuss, respectively, the roles of CAMs and IL6.

Then Chuck hopes to "reinvent myself as a researcher and teacher and cut back on my clinical work," he says. With fewer hours in the hospital, he'll reduce the physical demands that clinical work requires, "and still contribute to the field that I love, in another way," he says. "I like to think I can have the best of both worlds."

Published in Fall 2004, Graduate Quarterly