RENEW OR SUBSCRIBE TO PPM
Subscription is FREE for qualified healthcare professionals in the US.
14 Articles in Volume 18, Issue #7
A 2018 Update: The Federal Pain Research Strategy
A Commentary on Medical Cannabis
Are Abuse-Deterrent Opioids Appropriate for Your Pain Patient?
Behind the AHRQ Report
Challenges Facing Abuse-Deterrent Formulations
Demystifying Opioid Abuse-Deterrent Technologies
Editorial: Our Clinical Pain Neighborhood
Independent Pain Practice: A Case Example
Inside Performing Arts Medicine
Letters to the Editor: ACT Therapy; Compounded Topicals
Nerve Growth Factor and Targeting Chronic Pain
Pain Control for Athletes: What Works?
Quality Training: One Center’s Experience with Pain Assessment
The Importance of Developing Professional Relationships in Pain Practice

A 2018 Update: The Federal Pain Research Strategy

Inside the Interagency Working Group on the Prevention of Acute and Chronic Pain, with Robert J. Gatchel, PhD, ABPP

The US Department of Health and Human Services established the Interagency Pain Research Coordinating Committee as part of the Patient Protection and Affordable Healthcare Act (Public Law 111-148) to coordinate all pain research efforts within HHS and across other federal agencies. A major outcome of this committee was the publication of the Federal Pain Research Strategy, which included a report published in late 2017 and the creation of five Working Groups across the continuum of pain. PPM Editorial Board Advisor Robert J. Gatchel, PhD, ABPP, co-chaired, along with David B. Reuben, MD, of the University of California Los Angeles, the Working Group on the Prevention of Acute and Chronic Pain. In mid-2018, he shared some insights on their findings.*

Dr. Gatchel also serves as the Nancy P. & John G. Penson Endowed Professor of Clinical Health Psychology and Distinguished Professor of Psychology, and Director of the Center of Excellence for the Study of Health & Chronic Illnesses, at the University of Texas at Arlington.

On Research Priorities

After reviewing the expert literature, the Working Group identified seven specific clinical research gaps in need of research and strategic action:

  • Public health strategies that educate patients on managing pain 

  • The association between patient intervention factors and psychosocial interventions 

  • The epidemiology of acute pain from healthcare procedures 

  • The epidemiology of acute pain from work-related injuries 

  • The safety and effectiveness of the management of pain associated with healthcare procedures 

  • Optimized approaches for the treatment of acute post-surgical pain 

  • Safety and effectiveness of early interventions for the tertiary prevention of pain. 


As a result of the group’s efforts, said Dr. Gatchel, new federally sponsored research programs at participating agencies (in addition to programs led by stakeholders

and policymakers) are being implemented to bring these recommendations to fruition. “We certainly now have the research technology and methodology to make this work happen,” he said. For example, the NIH released a research plan known as HEAL to help end addiction long- term. This initiative focuses on improving treatments for opioid misuse and addiction, and enhancing strategies for pain management, with an initial investment of $500 million appropriated by Congress in FY 2018.

On Care Models

As new research gets underway, Dr. Gatchel noted that the biopsychosocial model of pain has, unfortunately, been neglected in the past, even though it offers “the most heuristic approach to the etiology, assessment, and treatment of pain. A major reason for this gap has been the long-term adherence to an overly- simplistic and outdated biomedical model, which is still emphasized in many medical schools today, as well as to practitioners,” he explained.

Fortunately, he added, there is now increasing recognition of the clinical utility of the biopsychosocial approach and its emphasis on integrated/collaborative care. “Indeed, interdisciplinary pain management programs, based on the biopsychosocial model, have been shown to be very effective in this country, as well as in other countries, such as Canada, Sweden, France, Germany, and Japan, which all have different socioeconomic and workers’ compensation systems.”

On Opioid Alternatives

The Federal Pain Research Strategy report noted that “novel pharmacologic treatments for pain have not emerged for some time.” Although developed primarily for severe acute pain, opioids became increasingly prescribed for chronic pain in the United States, explained Dr. Gatchel, putting the development of newer alternatives “on the back burner.” Other working groups within the interagency committee are working to move this development to the “front burner,” with the use of newer neuroscience research. “Along with the evaluation of biomarkers and genetic testing, such new specialty drugs will provide guidance in their use,” said Dr. Gatchel.

Also, he said, “The genetic pro ling eld to identify patients who are either ‘over-metabolizers’ or ‘under-metabolizers’ of certain opioids is making rapid advances. Indeed, with the emergence of ‘precision medicine,’ the new philosophy is to: ‘prescribe the right drug, at the right dosage, for the right person.’”

On Big Data

The Federal Pain Research Strategy addressed the need for shared datasets and research networks, suggesting, at some levels, that pain management may behind other medical fields in this area. “This is not so anymore,” said Dr. Gatchel. “Many medical fields, including the neurosciences, now recognize the great need for shared datasets and research networks in order to pool resources for the large sample sizes needed for accurate statistical analyses of large datasets. ‘Big Data’ is now an important emerging eld dedicated to making such analyses possible.”

On Moving Forward

Dr. Gatchel shared a few overall takeaways from his work with the committee:

There is now a major commitment by federal agencies 
to fund more clinical research projects in the area of pain because it is such an immense problem in this country (eg, 80% of patients who seek primary care report that pain is a major symptom). 


The current opioid crisis will help further stimulate this commitment. 


The pain management community has a real “brain trust” of dedicated pain researchers who will make even greater strides and progress if sufficient research funding is made available to them. This message needs to be urgently communicated to all the major stakeholders involved: patients, insurance payers, health- care providers, as well as state and federal agencies who can fund this essential clinical research. 


The full interagency committee meets a few times a year and was recently involved in hosting the NIH Pain Consortium Symposium, themed “From Science to Society” with NIH Director Francis S. Collins, MD, and US Surgeon General VADM Jerome M. Adams, MD, MPH.

 

*The Working Group’s final report was published in the Journal of Pain in August 2018.

 

 

Last updated on: January 3, 2019
close X
SHOW MAIN MENU
SHOW SUB MENU