2020 International Congress on Integrative Medicine and Health

Wednesday, April 29, 2020

9:30 a.m. - 10:15 a.m. - Plenary

Plenary Session 02: Whole Person Health

NCCIH speaker: Helene Langevin, M.D.

10:45 a.m. - 12:00 p.m. - Concurrent Sessions

Conducting Pragmatic Trials within Health Care Systems: Design Considerations and Using Patient Reported Outcomes

The public and scientific community are seeking clinical research results that directly inform health care systems, and pragmatic trials are one way to address this need. Researchers who partner directly with health care systems can embed their trials directly into routine medical care answering two important questions: 1) does the intervention maintain its effectiveness when delivered in the health care setting?; and 2) can the health care system deliver the intervention in a sustainable manner?. The proposed symposium will describe the important distinctions between embedded pragmatic trials and the classic explanatory randomized controlled trial. The symposium will begin with Dr. Weber describing examples of pragmatic trials with individual randomization and cluster randomization, including stepped-wedge designs. Dr. O'Brien will discuss the benefits and challenges of using patient reported outcomes in pragmatic trials. Dr. Goertz will describe several trials that vary in the degree of pragmatic elements in the design, emphasizing the balance between rigor and generalizability that must be navigated when designing pragmatic trials. Dr. Debar will describe methods she employed to overcome the challenges of including patient reported outcomes of pain in a large pragmatic trial evaluating integration of multidisciplinary services within the primary care. Dr. Yu will highlight the statistical considerations that need to be addressed in pragmatic trials, such as approaches to trial design and randomization; strategies for modeling clustering, time trends, and missing data from the electronic health records; and accounting for patient reported outcomes which may have a higher rate of missing data and collected along varying timepoints. Finally, Dr. Wendy Weber will provide a summary of resources developed by the NIH Health Care System Research Collaboratory for investigators who are planning and conducting pragmatic trials (www.rethinkingclinicaltrials.org). The session will close with a moderated panel discussion with all presenters to answer questions from the audience.

NCCIH speaker: Wendy Weber, N.D., Ph.D., M.P.H.

The Science of Acupuncture and Its Roles in Pain and Inflammation

Acupuncture is an ancient medical technique originated in China. By inserting thin needles into the body at specific anatomical locations, improvements in a range of symptoms, especially painful conditions, have been reported empirically and in many meta-analyses of clinical trials. However, the therapeutic value of acupuncture for pain and other medical conditions, such as inflammation-related disorders, are fraught with controversy, largely due to difficulty in dissociating specific effects of acupuncture needling techniques from nonspecific therapeutic effects such as placebo effects and social interaction as well as ambiguity in acupuncture’s effects on clinical outcomes. As the United States is combating an opioid crisis and the underlying challenges of pain management, acupuncture has emerged as a prominent potential complementary solution. Better understanding of how and whether acupuncture works is now critical as we consider the possibility of its broader usage for pain and other disorders. This session will be chaired by Dr. Wen G. Chen from NCCIH/NIH, who oversees NCCIH’s acupuncture research portfolio. In addition, the session will bring three speakers to cover a wide range of topics related to acupuncture research. Dr. Qiufu Ma from Harvard Medical School will present cutting edge neural circuitry analysis of acupuncture in systemic inflammation in animal models; Dr. Richard Harris from the University of Michigan will discuss research on brain correlates of acupuncture in chronic pain patients; and Dr. Claudia Witt from the University of Zurich in Europe will present work on the efficacy and effectiveness of acupuncture clinical trials.

NCCIH speaker: Wen Chen, Ph.D.

Non-NCCIH speakers: Richard Harris, Ph.D., University of Michigan; Qiufu Ma, Ph.D., Harvard Medical School; Claudia M. Witt, M.D., M.B.A., University of Zurich

3:15 p.m. - 4:15 p.m. - Concurrent Sessions

Sleep Away Your Pain: Complementary and Integrative Health (CIH)-Based Sleep Modulation for Pain Relief

Chronic pain is a major public health concern. The management of chronic pain has relied on opioids, which have significant risks for adverse events, and misuse. Sleep disorders commonly co-occur with chronic pain. There is not only substantial evidence that chronic pain states can disrupt sleep but, also, that sleep disturbances contribute to pain, and treating sleep disturbances can reduce pain. In addition, the presence of sleep disturbances may help predict the transition from acute to chronic pain. Therefore, modulation of sleep may offer a potential therapeutic strategy for pain prevention and pain relief. The symposium will highlight recent advances on the science of sleep modulation strategies as they relate to pain, as well as challenges and opportunities in researching sleep-based pain treatment. After a brief overview and introduction by Dr. Inna Belfer, Dr. Michael Smith will speak on the science of nonpharmacologic sleep modulation in pain patient population. Dr. Adam Krause will discuss the brain mechanisms underlying altered pain processing following sleep deprivation. Dr. Chloe Alexandre will present a recent study in which sleep loss in healthy mice increased sensitivity to noxious stimuli, and this effect was reversed by a natural product, caffeine. Dr. Belfer will provide a summary of research findings on CIH-based sleep modulation for pain relief as well as current knowledge gaps. She will moderate the symposium presentations and the general discussion.

NCCIH speaker: Inna Belfer, M.D., Ph.D.

Non-NCCIH speakers: Michael Smith, Ph.D., Johns Hopkins University School of Medicine; Adam Krause, B.A., University of California, Berkeley; Chloe Alexandre, Ph.D., Beth Israel Deaconess Medical Center, Harvard Medical School

Thursday, April 30, 2020

10:45 a.m. - 12:00 p.m. - Concurrent Sessions

Behavioral Approaches for Opioid Use Disorder and Chronic Pain Management

Behavioral interventions complementary to and integrated with MOUD may increase adherence to MOUD and address comorbid conditions including the treatment of chronic pain. Recognizing the need to examine the impact of behavioral and social interventions designed to improve adherence to MOUD and for the management of chronic pain, the National Institutes of Health (NIH), under the HEAL (Helping to End Addiction Long-term) initiative issued a funding opportunity announcement to support additional research to address this need. To highlight the promising work being done, this ICIMH symposium will bring together researchers addressing these important issues brought to light by the national opioid crisis and addressed, in part, through the NIH HEAL initiative. Dr. Dave Clark will introduce the session, give a brief overview of the NIH HEAL initiative and highlight the potential benefits of behavioral interventions to improve adherence, abstinence, and self-management of OUD and chronic pain. Dr. Garland will discuss the impact of Mindfulness-Oriented Recovery Enhancement (MORE) on medication assisted treatment (MAT) of individuals prescribed opioids for pain management. MORE leverages complementary skills to target three core therapeutic mechanisms, metacognitive awareness (i.e., mindfulness), emotion regulation (i.e., reappraisal), and amplification of natural reward processing (i.e., savoring), to remediate the hedonic dysregulation underpinning the downward spiral linking chronic pain to OUD and relapse. Dr. Park will present data on a mindful yoga intervention that blends physical and didactic activities to improve self-management of OUD and MAT adherence. Dr. Ilgen will highlight the potential benefit of psychosocial interventions in an OUD population receiving MAT. This psychosocial pain management intervention (PPMI) is delivered by telephone and assesses the impact of randomization to PPMI on MAT retention, pain level, pain-related functioning, frequency of opioid use in a Veterans population. Dr. Edwards will moderate the presentations as well as the general discussion section.

NCCIH speakers: Emmeline Edwards, Ph.D.; Dave Clark, Dr.P.H.

Non-NCCIH speakers: Mark Ilgen, Ph.D., University of Michigan; Eric Garland, Ph.D., University of Utah College of Social Work; Crystal Park, Ph.D., University of Connecticut

12:45 p.m. - 1:45 p.m. - Concurrent Sessions

NCCIH Strategic Vision for 2021 and Beyond

The National Center for Complementary and Integrative Health (NCCIH) is developing its Strategic Plan for Fiscal Years 2021-2026. Dr. David Shurtleff, Deputy Director; Dr. Emmeline Edwards, Director of the Division of Extramural Research; and Mary Beth Kester, Director of the Office of Policy, Planning and Evaluation will moderate the Town Hall and invite feedback from the ICIMH community. We want to hear your thoughts on the strategic directions of the NCCIH. What are areas of scientific opportunity? Where are the gaps in the research areas supported by NCCIH? How can NCCIH foster a diverse workforce of integrative health researchers and clinicians?

NCCIH speakers: Mary Beth Kester, M.S.; Helene Langevin, M.D.; David Shurtleff, Ph.D.; Emmeline Edwards, Ph.D.

2:00 p.m. - 3:00 p.m. - Concurrent Sessions

Virtual Reality: a Complementary and Integrative Approach for Pain Management and Well-being

The over prescription of opioids for the treatment of chronic pain is a major contributing factor to the growing opioid epidemic in the United States. With access to chronic pain management programs lacking, immersive virtual reality (VR) shows great promise as a transformative solution, through collaboration of industry and academia, for low-risk, nonpharmacologic intervention modality for pain. Recently interdisciplinary research has begun to examine the physiological and behavioral mechanisms by which VR exert its positive effect on pain tolerance and mood and anxiety state. This proposed NCCIH-sponsored symposium will bring together leaders in the field of pain, well-being and VR technology to discuss progressive findings as well as gaps in science and technology as related to VR as a therapy. The first speaker, Dr. Beth Darnall, will present the potential for VR to function as a combination of immersive and behavioral medicine for acute and chronic pain. The second speaker, Dr. Michael DiCesare, will discuss the application of VR with biofeedback to guide users through diaphragmatic breathing technique for relaxation and pain management in an outpatient or home setting. The third speaker, Dr. Branch Coslett, will present VR treatment with multimodal feedback for phantom leg pain. The fourth speaker, Dr. Luana Colloca, will discuss the mechanistic basis of VR interventions to optimize its applications to improve pain tolerance, vagal and mood responses. The symposium will conclude with a discussion moderated by the Chair, Dr. Merav Sabri.]

NCCIH speaker: Merav Sabri, Ph.D.

Non-NCCIH speakers: Beth Darnall, Ph.D., Stanford University; Michael DiCesare, B.A., ZEPHYRx; Luana Colloca, M.D., Ph.D., M.S. University of Maryland School of Nursing; Branch Coslett, M.D., University of Pennsylvania

Glymphatic-Lymphatic Clearance and Complementary and Integrative Health Approaches

A glial cell-dependent lymphatic system, called glymphatic system, is a brain-wide perivascular pathway that facilitates the recirculation of cerebrospinal fluid through the brain and promotes the clearance of solutes and wastes, including the pathogenic protein amyloid beta and inflammatory cytokines, from the brain interstitium. The meningeal lymphatic system in dura mater may then transport the wastes to the lymphatic system for clearance. Therefore, the glymphatic and meningeal lymphatic systems play critical roles in removing solutes and waste products from the brain. Preclinical studies have suggested that glymphatic-meningeal lymphatic clearance pathways are suppressed in many neurological diseases/conditions and the aging brain. Moreover, improvement of glymphatic-lymphatic functions may mitigate these diseases and conditions. Recently several studies have begun to examine the mechanisms by which complementary approaches may regulate glymphatic-lymphatic flow and functions, as well as the impact of complementary approaches on glymphatics-lymphatics in different diseases and conditions. This symposium will bring together leaders in the fields of glymphatics-lymphatics and complementary approaches to discuss cutting-edge findings in glymphatics-lymphatics research, and to explore the potential connections between glymphatics-lymphatics and diseases/well-being, as well as the potential of complementary approach strategies in modulating glymphatic-lymphatic systems. Dr. Maiken Nedergaard at the University of Rochester, who is most well-known for discovering the glymphatic system, will present her current theory and research on glymphatics and pain and in the context of complementary approaches. Dr. Justin Rustenhoven at the University of Virginia will present recent findings on lymphatic-glymphatic connection, lymphatic-glymphatic-BBB Interaction and modulation of meningeal lymphatic system. Dr. Selda Yildiz, a K99/R00 awardee funded by NCCIH/NIH in the Oregon Health & Science University Department of Neurology, will present her research on yogic breathing, sleep, and noninvasive MRI-based measures of cerebrospinal fluid circulation. The session will conclude with a question/answer and discussion period moderated by Dr. Yisong Wang, program director at NCCIH.

NCCIH speaker: Yisong Wang, Ph.D.

Non-NCCIH speakers: Justin Rustenhoven, Ph.D., University of Virginia; Selda Yildiz, Ph.D., Oregon Health & Science University; Maiken Nedergaard, M.D., D.M.Sc., University of Rochester Medical Center

Friday, May 1, 2020

10:30 a.m. - 12:00 p.m. - Concurrent Hot Topics

The Science and Practice of Cannabinoid-Based Therapies

The endogenous cannabinoid system is involved in regulating multiple physiological processes, including appetite, pain-sensation, mood and memory, as well as contributing to aspects of motivation and reward of locomotor activities, such as runner's high. The cannabis plant (Cannabis sativa L.), a cannabinoid-containing plant, can modulate the endogenous cannabinoid receptors and has been used to treat a variety of health conditions for at least 3,000 years. The goal of this symposium is to discuss the state of cannabis-related science and cannabinoid-based therapies. The symposium will highlight how cannabinoid-based therapies are used, their clinical effects, and the therapeutic potential of the constituents of cannabis including the minor cannabinoids and terpenes. Dr. Laurie Mischley will present a cross-sectional study on the patterns of medical cannabis use as a substitute for a variety of prescription drugs. Dr. Kevin Hill will discuss the clinical effects and challenges of these treatments. Dr. Judith Hellman will discuss how to potentially address challenges by molecularly dissecting the cannabis plant. Dr. David Shurtleff will serve as a discussant and will provide a brief summary of NCCIH-supported research that can better inform the most challenging medical issues of the present time. Dr. Inna Belfer and Dr. Angela Arensdorf will serve as the co-moderators for the symposium presentations as well as the general discussion.

NCCIH speakers: David Shurtleff, Ph.D.; Inna Belfer, M.D., Ph.D.; Angela Arensdorf, Ph.D.

Non-NCCIH speakers: Kevin P. Hill, M.D., M.H.S., Beth Israel Deaconess Medical Center; Laurie K. Mischley, N.D., M.P.H., Bastyr University Research Institute; Judith Hellman, M.D., University of California, San Francisco

Investigating the Promise of mHealth for Complementary and Integrative Health Approaches

Increasingly, researchers are incorporating mobile health (mHealth) technologies to remotely deliver interventions, including mindfulness, yoga, guided imagery, and other complementary and integrative health interventions. These mHealth and remotely delivered interventions may utilize telephone, mobile apps, video, web-based platforms, wearable devices and other modern technologies. The rapid expansion of mHealth technologies makes it possible to transmit participant data digitally from remote areas to centrally based researchers and interventionists, deliver feedback, and capture all interactions in a database. The use of mHealth and remotely delivered interventions has the potential to increase the reach and access of evidence-based complementary and integrative health interventions to harder to reach populations. Many commercially available approaches already exist to facilitate scalability. However, rigorously designed research is needed to test the usefulness and safety of these approaches. In this discussion session, panelists will briefly present their experiences conducting research with complementary and integrative health interventions utilizing a variety of mHealth formats, including online video, mobile app, and telephone-based approaches. The moderator will guide a panel discussion on pros and cons of different mHealth approaches, utilizing commercially available products vs. creating your own, and fully remotely delivered intervention designs vs. hybrid in-person and remote designs. Research design options and funding opportunities to support research on mHealth and remotely delivered complementary and integrative health research will also be discussed. Attendees will have ample opportunities to pose their own questions throughout all discussion topics. An expert discussant will summarize the session and highlight key points from the panel.

NCCIH speakers: Lanay Mudd, Ph.D.; Pamela Jeter, Ph.D.

Non-NCCIH speakers: Inbal (Billie) Nahum-Shani, Ph.D., University of Michigan; Christopher Cox, M.D., Duke University; Jennifer Huberty, Ph.D., Arizona State University; Judith Gordon, Ph.D., University of Arizona

2:00 p.m. - 3:00 p.m. - Concurrent Sessions

The NIH BRAIN Initiative: Intersecting with Complementary and Integrative Health Research

In April 2013, former President Obama announced the launch of the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative® - a bold, new initiative focused on revolutionizing our understanding of the human brain. New tools and technologies developed through BRAIN are shedding light on the complex links between brain function and behavior. This symposium will highlight the potential of applying such technologies to study whether and how complementary health approaches directly modulate or modify the structure and/or function of the nervous system and other associated physiological systems. Dr. David Shurtleff, NCCIH/NIH will give a brief overview of the BRAIN initiative and present a framework for leveraging BRAIN technological advances to increase mechanistic understanding of complementary and integrative health approaches. Dr. Bin He, Carnegie Mellon University, will highlight the promise of Brain-Computer Interfaces (BCI) as therapeutic clinical tools, and present research on the use of mind-body awareness training (MBAT) to improve competency in controlling BCI. Dr. Julie Brefczynski-Lewis, West Virginia University School of Medicine, will discuss the development of a wearable positron emission tomography (PET) mobile device that can image the brain in real time and potentially inform the mechanistic understanding of complementary and integrative health approaches. Dr. Michael Garwood, University of Minnesota, will share information about his project that is providing and testing the first-ever small, lightweight, and portable head-only magnet magnetic resonance imaging (MRI) scanner. Dr. Emmeline Edwards, NCCIH/NIH, will serve as the moderator for the symposium presentations as well as the general discussion.

NCCIH speakers: Emmeline Edwards, Ph.D.; David Shurtleff, Ph.D.

Non-NCCIH speakers: Michael Garwood, Ph.D., University of Minnesota Medical School; Julie Brefczynski-Lewis, Ph.D., West Virginia University School of Medicine; Bin He, Ph.D., Carnegie Mellon University