In this inaugural edition of our Research Feature Series, we are proud to feature Benedict Alter, MD, PhD, Assistant Professor of Anesthesiology and Perioperative Medicine and Director of Translational Pain Research at the University of Pittsburgh. Get to know Dr. Alter and learn more about his research and experience at Pitt and UPMC:
Can you share a bit about your current funded research program and its primary aims?
My research group explores how the brain modulates pain and how the body’s pain dampening systems can be leveraged clinically to better treat pain. We are focusing on common chronic pain conditions, such as knee osteoarthritis, chronic low back pain, and fibromyalgia. These conditions are often treated with a focus on the body part that hurts, such as the knee, without considering all the other factors that contribute to the experience of pain. Our recently awarded R01 takes a “whole-person” approach to the problem of knee osteoarthritis pain and functional impairment, measuring not only pain modulation in the brain but also psychosocial drivers of pain, such as mood disorders and social functioning. The aim of this study is to identify patterns of factors that contribute to knee pain with walking, setting up future studies to reduce pain by addressing those factors and ultimately improve people’s walking ability.
What inspired you to pursue this line of research, and what impact do you hope it will have on patient care or the field of specialty?
I was inspired to study how the brain modulates pain after observing how differently people experience pain even with similar severity of tissue damage. This became clear to me in residency seeing patients for post-operative pain management and then again in fellowship when seeing patients with chronic pain. For example, the same degree of degenerative change in a joint could be associated with debilitating pain or no pain at all. Changes in the nervous system are likely to contribute, and currently, they are not easy to measure in patients, limiting progress on pain management. Our research program seeks to address this. So, the real impact would be to identify changes in the nervous system that drive the most debilitating pain and then treat patients in an individualized and logical way that targets an identified nervous system mechanism. One example of this is an NIH-funded clinical trial of duloxetine, an FDA-approved drug that reduces knee osteoarthritis pain in patients but not all. Duloxetine may improve the brain’s natural pain inhibitory functions. In our current trial, we will test whether duloxetine improves the brain’s inhibitory function and if that improvement is associated with pain relief and functional improvement.
What are the key innovations or methodologies your team uses that make your work distinctive?
The idea that pain may have more to do with the brain than the joint that hurts sounds pretty innovative, although many are expanding our understanding of pain mechanisms to include the nervous system and other important body systems. Two distinctive methods that we use are quantitative sensory testing and ambulatory brain imaging. The sensory testing we do rigorously assesses sensory functions of the nervous system, giving us insight to how individuals sense and process painful stimuli like heat or pressure. Several approaches are brand new, adding unique information. We also measure brain activity using functional near-infrared spectroscopy, which allows people to move while measuring brain activity. This provides unique insight into brain function not only during sensory testing but also during real-world activities, like walking or climbing stairs. Putting it all together to capture a multifaceted view of chronic musculoskeletal pain is truly innovative.
Do you find it easy to build collaborative partnerships to support your research within Pitt and UPMC and beyond?
Absolutely. University of Pittsburgh has been a very collaborative environment. I work closely with many in our department, including Drs. Ajay Wasan, Keith Vogt, and Senthil Sadhasivam, around the university, and even down the street at Carnegie Mellon University (CMU). Pilot grants have been critical in sparking many of these collaborations, including our department’s seed grant program, run by Dr. Yan Xu, and the Pain Challenge grants. This early funding has allowed several exciting, but preliminary, ideas grow into promising projects truly built on collaborative partnerships.
How has the Department of Anesthesiology and Perioperative Medicine supported your success as a funded PI?
Time and money. It takes a good amount of both to get extramural funding. The Department’s academic mission to foster developing researchers, like myself, by providing protected research time and funds has been so critical to my success. I also benefited by being supported by Dr. Xu’s T32, which provided not only time and money but also training and mentorship opportunities. Of course, my primary mentor during my post-doctoral work, Dr. Wasan, has continued to be a tremendous source of support and help in establishing an independent research program.
One remarkable thing the Department does is provide competitive compensation for young clinician-scientists. After receiving a foundation grant (IARS Mentored Research Award) and then a K grant, the Department supported the remainder of a competitive salary. Although I was committed to an academic research path, having compensation for clinician-scientists similar to clinicians helped me and my family maintain my commitment to the research job. This type of support is rare in academic medicine, and so I am quite thankful for the Departments support in this way. More generally, this helps keep clinician-scientists on a research track, so it’s great for academic anesthesiology as a field.
Can you share a recent success story from your lab or team?
One recent success story is the addition of our post-doc, Dr. Sarah Margerison, in the fall of 2025. She’s also supported on Dr. Xu’s T32 and has been a joy to have on the team. She’s already finding that brain activity during painful walking seems to be different than brain activity during rest. Although these patterns were perhaps expected to be different, this physiologic evidence shows how truly different pain with movement is from pain at rest. These brain differences may also explain why it’s difficult to treat pain with movement. This line of work will open new directions in how best to treat pain that limits people’s function.
What's a personal moment – an interaction, observation, or milestone – that reminded you why this research matters?
In a word, failure. I keep seeing patients again and again report that pain only occurs with walking, then asking “can’t you do something about that?” and then me failing to treat this pain with our current pain management approaches. This failure highlights gaps in our knowledge and really motivates me to figure it out and improve our current clinical practice. Pain with movement versus rest is just one example. There is so much we need to understand about chronic pain to treat it better.
What upcoming projects or directions are you most excited about in the next 3–5 years?
I’m very excited to see the results of our the “whole person” observational study examining walking pain in knee osteoarthritis (“Leveraging inter-individual differences in walking pain and impairment to elucidate whole-person mechanisms of knee osteoarthritis”). This will help us identify factors which could be intervened upon to improve pain with walking in this population. I am also excited about my collaboration with Dr. Pulkit Grover at CMU to develop a novel noninvasive brain stimulation technique to help manage chronic pain. We are developing the technology and conducting a feasibility trial right now. Eventually, we aim to create a brain stimulation device that could be used at home to treat pain.
What do you enjoy most about working within Pitt/UPMC’s research community?
My colleagues are the best. It is incredibly enjoyable to work together with shared research interests and goals of improving clinical care. For example, it has been rewarding to work with Dr. Becky Seal and others to bring all of our colleagues together for an annual research symposium we call “Pain Day.” We are extending this to further promote collaborative work with real impact in the Pittsburgh Pain Consortium which aims to spark collaboration through interactions with colleagues. I also enjoy learning about topics that are not directly in my area of expertise. For me, this happens regularly at our Department Research Rounds with Dr. Vogt, at seminars from the Pittsburgh Center for Pain Research, and more.
What message would you send to potential collaborators, donors, or trainees considering joining the department?
We’re a collaborative community with shared purpose that thrives on scientific interaction. The Department of Anesthesiology and Perioperative Medicine is a truly special place that fosters a strong academic community.