Hector Perez, MD, associate professor in the Division of General Internal Medicine, recently received his first R01 grant from the National Institutes of Health (NIH), a milestone for independent investigators. He will receive $3.7 million over five years to assess an intervention to address a critical need—support for patients who have both chronic pain and opioid use disorder (OUD). More than half of the six million Americans with OUD suffer from chronic pain and could stand to benefit from his trial, which will look at the effectiveness of a virtual reality therapy for mitigating pain and opioid cravings. Here, he talks about his journey in medicine and research.

“I grew up in Queens, the youngest of three boys. My mom is Puerto Rican and was born in Brooklyn, and my father was born in Puerto Rico and came to the United States in his twenties.

He wanted to be a doctor but he was the oldest of 15 siblings and helped his mother care for his brothers and sisters, so that path wasn’t available to him. That desire was passed down to his sons. He ultimately became a social worker for the city of New York and would visit patients in the community who were older. He screened and evaluated them, including cognitive assessments and home safety, and helped connect them with services like food deliveries and home health aides.

He was a big influence on me and my brothers, helping us with our science fair projects and our education. My oldest brother, who is 15 years older than me, knew from an early age that he wanted to become a doctor and entered medical school while I was still in high school. My middle brother decided later in life to go into medicine as well. He went to a prestigious medical school in Cuba before returning to the U.S. to practice. Both are family medicine doctors.”

Finding my path

“Inspired by my oldest brother, I became interested in medicine fairly early. I'm a person who stutters. It comes and goes depending on the situation, and at times it's hard for me to talk. And patient care is all about talking to other people. In college, despite my interest in medicine and my aptitude for science, I felt like the barriers to becoming a doctor were vast. I had a lot of fear.

Because of my stuttering, I thought my life in medicine was going to be bench research. I was going to be in a lab pipetting, and I wasn’t sure that was right for me.

I had a professor who was a well-known medical anthropologist. For him, creativity and knowing a patient in a full way were important parts of being a physician. It was a perspective I hadn't heard before. My fears about speaking started to reduce around this time as well, and my professor encouraged me. I wanted to be a doctor for the whole patient, to see them over time, to see them when they were sick and when they were healthy as well. I realized there was a path for me in medicine, but it took the help of a mentor to see it.

I went on to medical school and I had the opportunity to come here to Monte after I graduated. I did my residency training in the primary care and social medicine program, and I knew I wanted to incorporate research as well. I had a lot of questions about how primary care is delivered and I was excited to explore novel interventions.

After a research fellowship at NYU, I returned here as a faculty member. In 2016, I received what's called an NIH Diversity Supplement. These are provided to junior investigators to pursue work as part of a larger, preexisting NIH-funded study led by a more seasoned researcher, in this case, Dr. Joanna Starrels. I focused on Hispanic patients and how language concordance between doctor and patient, and acculturation to the U.S., affect chronic pain.

In 2017, I received an NIH K award, where junior faculty work under a mentor on their own project. That study focused on patients with chronic pain who were prescribed opioids for long periods of time. I lost my uncle to overdose over 10 years ago now, and during my primary care training here, it was impossible to ignore the significance of substance use disorders, including alcohol and stimulants as well as opioids.

I wanted to look at people suffering from pain who were at high risk of developing opioid use disorder (OUD), and see how we could potentially lower their dose to make it safer for them. We did a lot of qualitative and quantitative research in preparation for a clinical trial, and then the COVID-19 pandemic happened. That threw a wrench in any non-COVID related research, and we had to table that study.”

Pursuing new solutions for a pervasive problem

“I decided that rather than working to get people with chronic pain to lower their opioid use, I wanted to be able to offer an alternative. I've always been interested in virtual reality (VR). I've had a VR device for more than 10 years, and the idea that VR can promote healthy behaviors and health change came naturally to me.

Through some colleagues I met a group of researchers in California who were doing work in this area. They had done a successful study looking at a mindfulness VR application, RelieVRx, in patients with chronic pain. Over about two months, it lowered patients' perceptions of their pain, how much pain interfered with their lives, and how much pain affected their sleep and mood.

I proposed and received grant funding to do a small pilot trial here. We studied patients with chronic pain and opioid use disorder who were taking methadone at Montefiore. We had some fairly successful results in our patients, indicating that the intervention could lead to a reduction in pain and a reduction in cravings for opioid use.

Based on this I applied for and received my first NIH R01 grant, in July 2024. We’re planning to start our large randomized control trial of RelieVRx in patients with chronic pain and opioid use disorder in early 2025. We are hoping to recruit around 200 participants who will receive either our intervention or a sham VR program, twice a week for eight weeks.

As a researcher, it's one thing to ask a question. It's another thing to find a successful intervention. This is always the challenge. There are so many questions in the world that interest me, but you have to conceptualize your questions into things we can change. Ultimately, if you want to make a difference, proposing and testing interventions can help answer important questions and lead to further advances in medicine.”