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Tuesday, October 23, 2012

Update on the NIH Consensus Workshop on Opioids and Chronic Pain: Dr. Nora Volkow, Director NIDA, presented plans for this workshop. She noted the increasing use of prescription opioids for acute and chronic pain, which is paralleled by rising death rates from opioid overdoses.  The workshop will consider several issues related to the appropriate use of opioids in the treatment of chronic pain.  An NIH working group has been developing questions to be addressed by this workshop, including those related to the pain conditions for which opioids are effective,  management of opioid-induced hyperalgesia, treatment options for pain flare ups,  minimizing adverse effects,  best practices to discontinue opioids,  managing tolerance and addiction,  optimizing individual treatment strategies,  combination therapies to optimize efficacy and reduce adverse effects, and treatment approaches targeting special populations, gender  differences and ethnic and racial minorities.  These questions will be handed off to an external group to define the aims of the workshop and to recommend future research directions. Pain Consortium members were encouraged to submit names of potential members for this group.  A twelve to eighteen month timeline is proposed for the workshop and report.

Update on the Interagency Pain Research Coordinating Committee Meeting: Dr. Linda Porter summarized the proceedings of the Oct 22nd, 2012 IPRCC meeting.

  • Dr. Howard Koh, Assistant Secretary for Health and Human Services attended the meeting to charge the Committee with developing  “a comprehensive population health-level strategy for pain prevention, treatment, management, and research.”   Development of this strategy was a core recommendation of the 2011 IOM report: Relieving pain in America.  The charge expanded the mandate of the IPRCC and a working group of the committee will be formed as a first step towards addressing the task. The comprehensive plan should include specifics on how stakeholders can work together to address disparities, heighten awareness of pain, improve pain assessment and management and develop strategies to help patients self-manage their pain.

  • An overview of the federal pain research portfolio analysis, which was conducted by Federal members of the IPRCC, was presented at the meeting.  Federal members were asked to identify the projects in their agencies’ pain portfolios as basic, translational, or clinical research, and to categorize the projects according to a set of more specific secondary categories, as well to identify the pain condition that was most relevant to the project. A number of trends were evident from this first level analysis, and more detailed analyses are being done.   A subset of the IPRCC completed an analysis of one of the largest basic research secondary categories defined as “Neurobiological and Glial Mechanisms of pain”, breaking this category down further based on themes used by the Society for Neuroscience in assigning  pain abstracts for their annual meeting.  The IPRCC asked to see more of this type of specific analysis, for both disease conditions as well as for categories that are not disease specific.  It is hoped that this type of analysis will help identify areas of overlap, shared interests among agencies, and areas of research that might benefit from collaborations/cross-fertilization across different agencies.   A longer term goal is to produce a report based on these analyses, as a way to summarize research across the agencies as well as to identify gaps and opportunities.  Dr. Porter will provide some of the analyses that have been completed to the Pain Consortium members for their information.

  • The IPRCC meeting also included a discussion of their selection of recent science advances.  A total of 131 advances were submitted by IPRCC members for prioritization and posting on the IPRCC website.  A subset of 20 advances were selected by IPRCC members to highlight.  Summaries of these advances will be written up in lay terms for the IPRCC website.  There will be a process in place to add new advances to this list on an annual basis.  The IPRCC also agreed to identify historically significant pain advances and to post them on the website.  Dr. Landis suggested that this step be taken after developing and posting summaries of the current advances.

  • Other items on the agenda for the IPRCC meeting included an update on the Consensus Workshop on Opioids and Chronic Pain (referred to  above) and an update on the Centers of Excellence for Pain Education (referred to below).

Update on the Pain Consortium-funded Stanford Pain Registry: Dr. Richard Denisco (NIDA) presented an update on the Pain Consortium-funded Stanford Pain Registry.  This will be an open source centralized registry for tracking self-reported outcomes of chronic pain sufferers over time.  The registry data will be free and accessible to investigators for outcomes research, comparative effectiveness research, and point-of-care decision making.  The start date for the project was 8/14/2012, and full rollout of the registry is targeted to take 24 months.  The Registry is working with the NIH-funded Patient Reported Outcomes Measurement Information System (PROMIS) to help develop data definitions and standards.  An executive committee of the Stanford registry will help make decisions about data definitions and data sharing policies.   Dr. Denisco will follow-up on questions raised about the process for informed consent of participants in longitudinal studies generated by the registry. 

Update on Centers of Excellence for Pain Education: Dr. Dave Thomas (NIDA) presented an update on the Centers of Excellence for Pain Education (CoEPEs).  There are 12 CoEPEs, which include over 100 schools and over 250 total participants.  Other institutions, which were not designated official CoEPEs are also interested in participating in the program in some way and benefiting from the educational materials, and NIH is looking into ways to do this.  There have been presentations about the CoEPEs at a number of recent meetings, including the Society for Neuroscience and the recent IPRCC, and NIH will continue publicizing these centers at upcoming meetings.  Topics for the case studies that will be used in the Centers’ educational materials are being discussed; NIH, working with the CoEPEs contractor, now has access to an easy-to-use tool to help with the technical aspects of developing these case studies into a web-based format.  The Pain Consortium members will have an opportunity to provide input on the case format as well as a final review of the case presentations.

Action items: 2013 Common Fund Proposals: The final topic discussed was  a Common Fund Proposal from the Pain Consortium  for 2013.  Dr. Landis suggested forming a working group of the Pain Consortium to review proposals that have been successful under Dr. Collins’ leadership to guide the Consortium as they think of topics to submit.  Dr. Collins has stressed that common fund themes should be those that affect research globally rather than being focused on specific disease(s).