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Monday, January 31, 2011

The meeting was attended by 4 co-chairs of the Pain Consortium and program staff from across the participating ICs.

Nora Volkow (Director, NIDA) reported on the potential of resting functional connectivity (RFC) imaging as a biomarker for chronic pain. Studies have shown that chronic pain patients exhibit disrupted connectivity in their pain-mediating brain matrices. The potential of this tool is enhanced by data generated through the Brain Connectome project. The means to apply RFC to chronic pain would require data from a large sample of patients with standards for data collection and scanning, phenotyping of patients, selection of a homogeneous chronic pain population, and establishment of a data base repository. The scope and infrastructure needed for such research were outlined. The ensuing discussion focused on identifying relevant efforts at NIH currently underway and leveraging existing infrastructure such as the Clinical and Translational Science Award (CTSA) centers to support this research. A small working group led by Linda Porter (NINDS) and Andrea Sawczuk (NCRR) will address these questions in a detailed analysis of needs and opportunities.

Dave Thomas (NIDA) presented a model for NIH Pain Consortium Centers of Excellence (COE) focusing on Pain Education in Medical, Nursing and Dental Schools. The model would be able to leverage existing expertise in institutions with excellent course material and academic reputations, but with resources too limited to coordinate a wide pain education initiative. Consortium members discussed options for implementation and potential specialties for centers of the COE. Dr. Thomas also presented the major conclusions from the September 24, 2010 NIDA Prescription Opiods and Pain Workshop as part of the Pain Education Initiative – (1) Pain education is currently inadequate in medical, dental and nursing schools; (2) The ‘Pain Champion’ model, where an individual with specific interest in pain education takes responsibility at an institution, has successfully led to pain curricula being adopted by institutions. (3) Accreditation for medical schools may be a useful target for system-wide changes.

Amy Adams (NIDCR) provided an update on the Institute of medicine (IOM) Conference on Pain organized by the committee on Pain Research, Care, and Education. The committee has held 3 out of 5 planned meetings. The 1st meeting which was open to the public was held in November, 2010 and Dr. Lawrence Tabak, Deputy Director of NIH, presented the charge to the committee. The 2nd meeting was held on January 4th, 2011 and covered topics on coordination of pain data collection among the Departments of Defense (DoD), Veterans’ Affairs (VA), and Health and Human Services (HHS) as well as opportunities for public-private partnerships. The 3rd meeting held on February 3rd, 2011 was open to the public and addressed barriers to pain care and basic science underlying pain. Dr. Adams informed the consortium that information on the following topics was needed from NIH for the subsequent meetings: (1) Pain researchers funded by NIH (2) Current and future initiatives on pain (3) NIH efforts to enhance pain education among medical and dental students. Dr. Adams also informed the Pain Consortium that efforts were currently underway to nominate members to the Interagency Pain Research Coordinating Committee from among the public, academia, and government.

Members were reminded that the Pain Consortium and the Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI) were required to submit a Common Fund-supported research proposal on appropriate pain research initiatives to the NIH Director by April 2011.

Michael Steinmetz (NEI) reported on the NEI Workshop on Ocular Pain and Sensitivity, held from September 30th – October 1st as part of NEI’s Strategic Planning process and was one of a series of workshops recommended by the National Eye Council. The workshop highlighted the need for focus on ocular pain and sensitivity due to a number of reasons including current lack of understanding of eye pain mechanisms, lack of diagnostic nomenclature as well as a shortage of basic science research.

Linda Porter (NINDS) informed members that the 6th Annual Pain Consortium Symposium will be held on April 14th, 2011 and a draft agenda focusing on overlapping chronic pain conditions will be shared with consortium members. The American Pain Society Annual Meeting will be held from May 19th – 21st, 2011 in Austin, Texas where Dr. Patricia Grady (Director, NINR) will deliver a plenary lecture on the promise of pain research. A satellite workshop at the meeting will address partnering with CTSA centers to support pain genetics and phenotyping, interdisciplinary pain management, and motivating chronic pain patients. Dr. Porter notified members that a report from the NIH Headache Planning Meeting held on May 16th-17th, 2010 will be available soon and following recommendations from the meeting a research workshop is planned for June 2011 and a grantsmanship workshop will be conducted during the American Headache Society annual meeting, also in June 2011. The FDA contract for the Analgesic Clinical Trial Innovations, Opportunities, and Networks (ACTION) initiative was awarded to the University of Rochester Medical Center and Dr. Robert Dworkin was appointed as Director of the initiative. ACTION is aimed at streamlining the discovery and development process for new analgesic medications and to accelerate the development of pain treatments with improved efficacy and safety.

Andrea Sawczuk (NCRR) provided an update on the CTSA Pain Researchers Interest Group (CPRIG) which was established in July 2010 to promote use of the CTSAs in Pain Research. With conferencing and media tools, the CPRIG has been actively promoting research collaborations among its 14 thematic workgroups, conducting online presentations, and establishing online information repositories. CPRIG and NCRR will host a 1.5 day conference titled “The Perplexing Pain Within: Collaborating with the CTSAs to Address Research Needs” on April 15th, 2011.

Wen Chen (NIA) reported findings from the Pharmacological Management of Chronic Pain in Older Adults Expert Panel Discussion held on September 14th – 15th, 2010. The participating experts identified the following knowledge gaps - Lack of knowledge about older patients; lack of knowledge among care providers about pain assessment and management, and lack of knowledge among health care institutions, insurance companies, and regulatory bodies on management of chronic pain in older adults. Experts felt that safety of chronic pain drugs for older adults should be tested with additional pharmaco-epidemiological studies using secondary analysis of existing health care data and well-designed clinical studies to test drug efficacy. As a follow up to the discussion, the experts are preparing a manuscript reporting the outcome of the meeting for publication in the near future. Additional programmatic activities are also underway to further support the research that would leverage existing data or studies to evaluate safety and effectiveness of pharmacological management of chronic pain in older adults.