Perspectives on Pain Research

NCCIH colleagues and I recently participated in the American Pain Society Scientific Meeting in Milwaukee, Wisconsin. The meeting centered on the theme “Combating the Opioid Epidemic Through Innovations in the Treatment of Pain” and offered a valuable forum for sharing scientific findings and insights into the complexities of treating pain. Many NCCIH staff shared their expertise and were available to answer questions about our Center’s role in pain research.

During my presentation, I focused on the importance of reconnecting the brain and the body in pain research. Over the past few decades, spectacular advances in neuroscience have greatly strengthened our understanding of chronic pain as a “disease of the brain.” Although neural mechanisms are undeniably important, it is also imperative that we continue efforts to understand the role played by peripheral tissues, especially for common musculoskeletal conditions such as low-back pain. Research on complementary and integrative treatments encourages a “whole person” approach, and by deepening our understanding of the complex array of processes between the brain and the body, NCCIH can establish the crossdisciplinary and integrative thinking needed to address pain in more comprehensive ways. Especially important is research directed at the interfaces between the brain and body silos: between brain function and behavior, between behavior and tissue structure, between the musculoskeletal and immune systems, and between musculoskeletal tissues and the nervous system.

The urgency of research that leads to new tools and new thinking to tackle the problem of chronic pain is evident in the growing public health burden. According to data from the 2016 National Health Interview Survey, approximately 20 percent of U.S. adults had chronic pain and 8 percent had high-impact chronic pain—meaning pain that limited at least one major life activity. More than 2 million Americans have opioid use disorder (OUD), and millions more misuse opioids, taking opioid medications longer or in higher doses than prescribed. Many are anxious to find options to address chronic pain without the side effects and risks related to opioid use.

As I have championed the concept of bringing the brain and body together in pain research during my first 5 months here at NCCIH, I’m proud of NCCIH’s engagement in multiple research initiatives and collaborations with other agencies within and beyond the National Institutes of Health (NIH) to explore new nondrug options for treatment and management of pain aimed at giving clinicians and patients more options. Several areas of NCCIH’s work are part of the trans-NIH HEAL (Helping to End Addiction Long-term^SM) Initiative, launched just last year, including:

• Our work with the NIH Back Pain Research Consortium (BACPAC), focused on exploring the ways that complementary health approaches may modulate the mind and body mechanisms of back pain and be incorporated into patient care.
• The Pragmatic and Implementation Studies for the Management of Pain To Reduce Opioid Prescribing (PRISM) initiative, which will support multiple “real-world” trials to help determine the effectiveness of interventions for pain, such as acupuncture for chronic low-back pain in older adults, and assess the impact of implementing interventions to improve pain management.
• The Behavioral Research To Improve Medication Assisted Treatment (BRIM) initiative, which will study whether select behavioral interventions such as mindfulness meditation, cognitive behavioral therapy, or multidisciplinary rehabilitation improve adherence to medication assisted treatment, improve outcomes, and reduce relapse in people seeking treatment for OUD.

While NCCIH’s participation in HEAL is part of a timely response to the opioid crisis, NCCIH also has many longstanding initiatives in pain research.

• As active members of the NIH Pain Consortium, we work with other NIH institutes and centers to build an evidence base on the effectiveness and safety of complementary modalities for treating chronic pain.
• NCCIH is leading the NIH–Department of Defense–Department of Veterans Affairs Pain Management Collaboratory, which is carrying out large-scale projects to develop, implement, and test nondrug approaches for managing pain and related conditions in the military and veteran health care delivery organizations.
• NCCIH’s Division of Intramural Research is leading critical work to understand the brain’s role in perceiving, modifying, and managing pain.

Another promising area of emerging research is exploring natural products, including cannabinoids and animal venoms, for potential applications as nonopioid analgesics.

Through my own research lab, hosted and supported by the National Institute of Dental and Craniofacial Research, I am exploring the role of connective tissue in chronic pain and the mechanisms of acupuncture and manual and movement-based therapies.

It’s important to note that NCCIH’s ability to be responsive to the public health crisis is a byproduct of longstanding work by the Center to establish and refine rigorous methods for exploring mind and body approaches and natural products—modalities that can present unique research challenges. Bravo to the Center for yielding the research infrastructure that’s urgently needed now to explore pressing research questions on pain!

The opportunity for NCCIH’s research to improve people’s lives is clear. A better understanding of the mechanisms of action of nondrug pain management and how to effectively integrate nonpharmacologic approaches into care will help support the self-management that is increasingly being recognized as an important part of the overall treatment strategy for chronic pain. NCCIH’s work to discover the underlying mechanisms of pain will help researchers design better treatments and predict which people are most likely to respond. And our continued investment in translational research that transfers knowledge from the bench to the clinic is critical, especially for NCCIH-supported researchers testing the safety and efficacy of pain management interventions.

With the commitment and focus of multiple NIH institutes and centers, other Federal agencies, and research institutions to deepen our understanding of pain, including the complex array of connections between the brain and the body, I am confident that, together, we can reshape how we think about pain and generate much-needed solutions.