September is Pain Awareness Month. We all experience pain from time to time, but for many Americans pain is a chronic and difficult-to-treat condition. In my prior experience as a practicing neurologist, I witnessed the immense suffering that severe chronic pain causes. The most indelible memory is of a teenager with syringomyelia, a progressive enlargement of the spinal cord’s central canal, who was partially paralyzed but worse, experienced continuous severe burning pain. Imagine how frustrating to know that nothing helped the pain. It is estimated 25 million have daily pain, and 8 million have pain so severe that it interferes with daily function. All of us have friends or loved ones for whom pain is a debilitating part of life. One of the most effective analgesics are the opioid medications. Unfortunately, the use of prescription opioids has skyrocketed in the past decade and in many cases people transitioned from using prescription opioids for managing acute pain to chronic abuse. Now the public health crisis of opioid misuse, addiction, and overdose deaths is devastating lives and communities across our country. The CDC estimates that more than 50,000 people in the US died of opioid overdose in 2016, a rate of death that approaches the mortality at the peak of the AIDS epidemic. We as a nation are struggling with these two parallel crises of pain and opioid abuse, and understand that we cannot effectively treat the epidemic of opioid misuse without also treating the underlying problem of chronic pain and ineffective pain management. Everyone from family physicians to professional organizations and advocacy groups to the highest levels of government are mobilized and working towards scientifically-sound, innovative, and effective solutions. I would like to take the opportunity of this Pain Awareness Month to share some of the NIH’s activities.
In June and July of this year, NIH hosted a series of meetings, led by NIH Director Dr. Francis Collins, that brought together experts from government, industry, and academia. These meetings focused on new ways for these partners to work together to address all parts of the opioid crisis, including understanding the neurobiology of pain, which is crucial to improving the treatment of people with painful conditions while reducing reliance on opioids. The initial plan for this initiative was recently laid out by Dr. Collins and National Institute on Drug Abuse Director Dr. Nora D. Volkow, in the New England Journal of Medicine. We look forward to building this public-private partnership to advance the understanding and non-addictive treatment of pain. For example, pain diagnosis and research are hampered by lack of objective measures of pain. This was highlighted as an important area of research for a public-private partnership.
Understanding how to prevent the transition from acute to chronic pain and development of an objective measure of pain also were highlighted as some of the major priorities of the newly-developed Federal Pain Research Strategy (FPRS). A group of experts in pain management and research collaborated for over a year to develop the FPRS, a series of recommendations to guide federal pain research in the coming years. In June of this year, NIH hosted a public forum to share the draft priorities established by the process and to take public comments. At this meeting, we received some excellent feedback from advocacy groups, professional organizations, and the public. I was encouraged by the public engagement in this meeting and hope that it will continue. Please view the draft research priorities (pdf, 279 kb). An additional priority emphasized in the FPRS and public-private partnership meetings is the need for better research through clinical networks. As a physician, I appreciate the great value of an experienced caregiver team in pain care. Most patients receive their pain care from general practitioners and as opposed to other branches of medicine, there is a lack of adequate access to pain experts for the referral of difficult cases. Establishing networks for training physicians and for running quality clinical trials is an important step toward more effectively helping patients, decreasing the stigma associated with chronic pain, and advancing the understanding of the neurobiology of pain.
The pain-care and research communities have long recognized that the inadequate treatment of pain is a serious public health issue. In 2016, the Department of Health and Human Services released the National Pain Strategy (NPS), a plan for improving pain management in the US. In May of this year, the Office of the Assistant Secretary for Health in the Department of Health and Human services, in conjunction with the NIH, hosted a public forum to share information about implementation activities associated with this plan. In an all-day stakeholders meeting, broadcast as a public webinar, government offices, professional organizations, advocacy groups, and pain management experts shared activities that they are involved in to advance the mission of the NPS. The enthusiasm and spirit of collaboration among all involved parties was encouraging at this critical moment in time. Please visit NPS Implementation Webinar to read the final report (pdf, 257 kb) of the meeting.
To learn more about pain-related efforts led by the NIH, please visit our NIH Pain Consortium website.