Each September, Pain Awareness month gives us an opportunity to reflect on the needs of the millions of people with chronic pain, as well as the research that we hope will better prevent and treat it.
Chronic pain is highly persistent, with almost two-thirds (61.4%) of those who reported chronic pain in 2019 still reporting chronic pain a year later. There are more new cases of chronic pain in the United States per year than new cases of hypertension, depression or diabetes, according to research from the National Center for Complementary and Integrative Health (NCCIH).
NIH supports a highly integrated, comprehensive research portfolio to address this pressing need. NINDS is one of many NIH Institutes, Centers, and Offices (ICOs) committed to understanding, preventing and treating pain. Because pain is a cross-cutting health problem, the ICOs work together to find solutions, including through the NIH Pain Consortium and the NIH Helping to End Addiction Long-term ® Initiative, or NIH HEAL Initiative®. Together, we strive to bridge the gaps between basic research, clinical trials, and implementation science towards meeting the needs of people living with chronic pain and co-occurring conditions.
Importantly, NIH’s pain research efforts are guided by the wisdom and experience of those living with pain. A key priority of our current NINDS Strategic Plan(pdf, 1391 KB) is to increase patient engagement throughout the research process. None of this work would be possible without from the expertise of those who live with pain, including the HEAL Community Partner Committee (HCPC) and others who advise individual studies, as well as the people who volunteer to participate in studies and clinical trials. The NIH HEAL Initiative® recently launched a web page to promote patient and community engagement efforts and provide resources for researchers to help them involve “experience experts” as advisors and partners to their studies. During Pain Awareness month, NIH is partnering with the U.S. Pain Foundation on a webinar series connecting researchers with those living with pain.
While pain is both a broad public health issue that we must work as a nation to address, it is also a series of individual circumstances that necessitate an individualized and whole-person approach to pain management. Each year, the NIH Pain Consortium hosts a symposium to highlight NIH-funded research related to pain. This year, we focused on Resilience and Pathways to Recovery, and on how whole-person health and a person’s environment affect pain. Members of the pain community shared their research showing how experiences with pain are unique and influenced by their social and physical environment, as well as the condition causing the pain, their genetic makeup, and their lived experience.
Research underway
Research from across the ICOs is improving our understanding of the biology underlying different pain conditions, identifying potential pain targets, and elucidating mechanisms that cause pain or deliver relief, and testing new treatment approaches:
- Researchers funded by NINDS and our partnering ICOs are uncovering potential new cellular targets that influence pain, identifying new molecules that could provide alternatives to opioids, and adapting known therapeutics in a way that might make them more effective against pain receptors.
- These new discoveries include identifying pathways in mouse models that can modulate pain-related behavior, and the brain circuitry that underlies how sound provides pain relief. Other research has found promising new targets that could ease chronic visceral pain. And researchers are finding promising new molecules that could lead to nonopioid pain therapies, and improving existing drugs in a way that could help better treat pain.
- Further along the research spectrum, clinical trials are building on advances made in preclinical research and are using novel technologies to reveal more about the pain experience and pain treatments. For example, a randomized clinical trial used imaging to show what parts of the brain played a role in providing the pain relief when engaging in mindfulness meditation. And in a small, early-stage study, a team of multidisciplinary researchers were able to identify signals in the brain that predicted chronic pain severity. Their findings suggest that a region of the brain called the orbitofrontal cortex might be an important mechanism in the perception of chronic pain.
This last research finding is a great example of cross-NIH ICO collaboration at work – the tools for measuring brain activity were developed by the NIH BRAIN Initiative, and the study was additionally supported by NIH HEAL Initiative® funding to develop innovative devices for pain treatment. Neuroimaging research can supplement a person’s self-report of pain to find brain-specific causes of pain and to provide new research directions.
This September, amid our search for safe and effective pain management approaches, we must also acknowledge the opioid crisis that continues to evolve in dangerous ways. Just a few weeks ago, we recognized the last day of August as Overdose Awareness Day, and September is also National Recovery Month. Overdoses and rates of substance use disorder have increased dramatically, further highlighting the need for alternatives to opioid analgesics. Research funded by our federal partners both at NIH and at other agencies show promising trends, but more must be done. The use of non-pharmacological treatments for those with chronic pain has been increasing, and more research is needed to maximize their efficacy. Broadening the availability of non-opioid treatments will empower people living with chronic pain to work with their providers in choosing the most effective and safest approaches to manage their pain.
People make research possible
To keep up the pace of discovery, we need to grow and support the pain research workforce and continue a commitment to the inclusion of unique perspectives in the research community. NINDS and the NIH HEAL Initiative® have developed several programs to help pain researchers gain more experience and connect with potential mentors and other scientists across the research spectrum. The PURPOSE Network (Positively Uniting Researchers of Pain to Opine, Synthesize & Engage) is a career development network that organizes an annual meeting and provides a collaborative online space for pain researchers to learn about new pain funding opportunities, career opportunities, peer networking, and ongoing education and training.
To further foster education and training opportunities, the HEAL National K12 Clinical Pain Career Development Award provides protected research time for clinicians and scientists who come from institutions that may not be able to support the scholar’s research ambitions. Scholars will receive funding for their research and training, and they will be matched with mentors. The program will hold an information webinar on September 15, 2023, with full applications due February 5, 2024.
The pain research community is more aligned than ever, but we still have a long way to go. NINDS and the other Institutes, Centers, and Offices across NIH are committed to listening to patients, communities, and scientists – towards ensuring that we support research that will improve our understanding of and deliver effective new treatments for pain.