NINDS Advancing Pain Research Through The NIH HEAL Initiative

September is Pain Awareness Month, and amid a dual national crisis of inadequate pain management and opioid misuse and addiction, it is important to remember that those suffering from pain face a deeply personal crisis. Millions of Americans suffer pain every day; for some, the intensity of that pain interferes with daily routines like work, household chores, and social activities. Members of the pain care and pain research communities have long sought to improve pain management without the risk of addiction or dangerous side effects. The opioid crisis has brought the importance of this goal into stark reality, as we face the devastating human and financial costs of relying too heavily on medications that can be addictive, with death from overdose as the ultimate side-effect. I have treated patients in various stages of chronic pain and, having personally dealt with months-long bouts of pain due to orthopedic trauma, I know firsthand the progress that must be made in addressing the challenges of pain management.

In 2018, the NIH announced an unprecedented opportunity to advance the field of pain research and reduce reliance on opioid medications: the Helping to End Addiction Long-termSM Initiative, or NIH HEAL InitiativeSM. As the lead institute for pain research at the NIH, NINDS helped to develop the pain management pillars of the initiative. I wrote about HEAL last year to describe the planning process, cornerstone projects of HEAL, and NINDS contributions to pain research. The National Institute on Drug Abuse (NIDA) is leading programs on the prevention and treatment of opioid use disorder.

The call to action for the NIH HEAL Initiative has required all hands on deck, and NINDS is the hub for several programs that will accelerate the development of new therapies. We support programs to discover novel targets for pain treatment, to optimize the development of non-addictive drugs and technologies that have promise for relieving pain, as well as new programs to turn these more quickly into safe and effective treatments and test them in people with specific pain conditions.

First, working with stakeholders from the industry, academic, and nonprofit communities, NIH identified the need for a sophisticated clinical trial network to design and execute innovative early phase trials of promising non-addictive pain therapies.  NIH’s network sites are in a good position to identify well characterized patient cohorts with specific pain conditions, with an emphasis on conditions of unmet need, who may participate in testing of therapeutics and devices (“assets”) for pain. The Early-Phase Pain Investigation Clinical Network (EPPIC-Net), led by NINDS, will soon be up and running and we are currently soliciting applications on assets to be tested in these patient cohorts. These applications are simpler and more streamlined than a typical NIH grant application and are open to all in industry, academia, and nonprofits. Second, NINDS is developing a Preclinical Screening Platform for Pain (PSPP) to facilitate the identification of potential non-addictive treatments for acute and chronic pain conditions in well-validated animal models. This program also is accepting applications for researchers from industry and academia now.

NINDS is working closely with many other NIH Institutes and Centers whose mission includes improving the treatment of a variety of pain conditions. Major research projects will focus on specific pain conditions, such as back pain projects led by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the transition from acute to chronic pain after injury or surgery, pain during hemodialysis, and non-pharmacologic pain treatments led by the National Center for Complementary and Integrative Health (NCCIH). The NIH HEAL Initiative will also fund discovery and validation of pain therapeutic targets, as well as pain biomarker studies. These are just some of the many efforts within the initiative, and I have been excited to see our NIH staff truly answer the call to address this urgent and pressing public health need. In my many years as a physician, and in the decade I have served in the federal government, the opioid epidemic is one of the most troubling problems I have ever witnessed. In Fiscal Year 2019, NIH is investing an unprecedented $945 million across 41 states through approximately 375 awards to accelerate permanent solutions.

Beyond the NIH HEAL Initiative, the NIH – in partnership with other federal agencies – supports and promotes a wide range of research to improve outcomes for people living with pain. Pain is a significant factor in health conditions ranging from arthritis to sickle cell disease to childbirth. Because of this breadth, 25 of the 27 Institutes and Centers at the NIH include pain in their research portfolios. The NIH Pain Consortium, led by NINDS, was established to enhance pain research and promote collaboration across these many NIH Institutes and Centers.

The broader Interagency Pain Research Coordinating Committee was established after a report from the Institute of Medicine (pdf, 744 kb) called for improved pain care and a change in the culture of pain management. The IPRCC is a Federal Advisory Committee tasked with working to improve pain research and collaboration across the federal government. It includes representatives from the NIH, the Department of Defense (DoD), Veterans Affairs (VA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Agency for Healthcare Research and Quality (AHRQ), as well as members of the public from the scientific and patient advocacy communities. In 2017, the IPRCC released the Federal Pain Research Strategy (FPRS) (pdf, 959 kb), a series of recommendations intended to guide the development of a long-term strategic plan for federal agencies and departments that support pain research. Indeed, top priorities from the FPRS informed the NIH HEAL Initiative research plan. In addition, the IPRCC continues to conduct a regular, comprehensive analysis of the federal pain research portfolio to identify critical gaps in basic and clinical research on the symptoms and causes of pain, and to make recommendations that ensure the activities of the NIH, including investments through the  initiative, are free of unnecessary duplication of effort.

Planning for the NIH HEAL Initiative was a gargantuan task for NIH staff, and I’d like to thank everyone who worked tirelessly to ensure the quick launch of many new programs and awards. There is so much promise in this work: recent advances have identified potassium channels as potential targets for migraine treatment research, revealed the structure of a cold-sensing protein that could pave the way toward chronic pain treatment, and highlighted the neural circuitry that encodes the negative affective valence of pain.  To learn more about all NIH HEAL Initiative projects and programs, visit I am eager to follow the progress of these programs and share updates with you as we keep working to improve pain management and outcomes through research.

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