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Wednesday, July 16, 2014

Story Landis, NINDS - Pain Consortium Coordinating Committee

Dr. Landis proposed the creation of a standing coordinating committee for the Pain Consortium in order to facilitate and maintain the collaborative nature of the consortium.  The coordinating committee would take on a variety of responsibilities including developing the agenda for the annual PC symposium; updating pain information brochure on the PC website; developing referral guidelines specific to the PC; and contributing ideas and strategies for Pain awareness month.

Other PC Executive Committee members were supportive of this idea.  It was proposed that the coordinating committee would meet every other month and the PC Quarterly meeting would then only need to take place twice a year.  Another topic that was raised was the potential for a central pool of PC funds to support multi-IC initiatives.  It was determined that this topic might be revisited after the coordinating committee is developed and a list of initiatives are developed that warrant such funding.  Dr. Landis stated that one person from each institute should serve as a representative on the coordinating committee. Further correspondence will come from the Office of Pain Policy (OPP).

Linda Porter, NINDS - Update:  Receipt and Referral Guidelines

The Pain Consortium held a meeting of program staff to discuss revision of pain-relevant referral guidelines.

The primary objective of the meeting was to facilitate interaction among or between ICs in areas where their interests overlap so that during the guideline revision process, assignments for these shared areas are appropriately reflected in the referral guidelines.  The meeting was well attended and examples of areas of shared interest between ICs were discussed in detail. Following the meeting, OPP provided a summary of the call and a list containing ICs paired together for follow-up discussion on a shared topic of interest.   The ICs are asked to contact one another and consider revising their pain-related guidelines based on their discussions.  The NIH is considering the potential for general referral guidelines to be made public.  Should this happen, the PC group will consider including general pain-specific guidelines on the website to assist investigators with knowledge of grant placement.

Linda Porter, NINDS - Pain Awareness Month

The American Chronic Pain Association established September as Pain Awareness Month. The Office of Pain Policy has coordinated various activities to occur to promote pain awareness.  These include twitter chats by several ICs; NIDA-hosted video chats with the Pain Consortium Executive Committee; Infographics on specific pain topics; NINDS-hosted radio media tour on low back pain.  The goal is to engage other ICs to do activities and promote pain awareness month.  It is anticipated that the NIH home page will have a pain awareness rotator and other ICs may include the pain awareness banner in their rotators as well.  Some relevant topics for pain awareness that came up during the meeting included: Sickle cell pain; sleep & pain; depression/suicide and chronic pain; obesity and pain, and women’s health.  Another suggestion was to include an ‘ask the experts’ video where the public is able to ask direct questions.  It is anticipated that some of these activities would be held until next year to continue pain awareness momentum.

Linda Porter, NINDS - Update: National Pain Strategy

Development of a National Pain Strategy (NPS) was delegated to the Interagency Pain Research Coordinating Committee (IPRCC) by HHS.  To address this effort, an Oversight Panel and 6 Thematic working groups (Professional Education & Training; Public Education & Communication; PH: Disparities; PH: Care & Prevention; PH: Service Delivery & Reimbursement and Population Research) were created. The NPS report is now in its final stages.  Dr. Koh, HHS Assistant Secretary of Health, gave a specific set of guidelines for the development including a particular timeframe and deliverables.  The report will be finalized and sent to the IPRCC and then to HHS.  The Pain Consortium will have an opportunity to view the report in a near-final stage. HHS will be responsible for targeting the appropriate agencies for implementation of the recommendations.

Nora Volkow, NIDA - FOA concept proposal,  Medicinal Marijuana & Chronic Pain

Dr. Volkow opened by stating that marijuana is currently being used for the treatment of pain despite limited research-based evidence to support this treatment.  Research needs to be done to examine the safety for the use of marijuana, particularly in populations that may be vulnerable such as the elderly, or chronic disease patients. In addition, persons with certain pain disorders or heightened pain sensitivity may exhibit different physiological responses to marijuana use.  Given the legal issues of marijuana, the topic may be best addressed at the level of the cannabinoid receptor – i.e., what is the role of cannabinoid receptors in chronic pain?   Discussion included utilizing existing longitudinal studies (i.e., The Framingham Study, The Baltimore Study) to gather population research data on marijuana use and pain.  Measures of cannabinoid exposure may be incorporated into these existing studies.  Dr. Josie Briggs (NCCAM) noted that studying a characterized preparation, such as Sativex or Marinol would allow for a more controlled study since the dosing of street marijuana is highly variable.  The FOA could potentially have different research components (i.e., inhaled marijuana v. medical preparations). The topic of marijuana and chronic pain is of interest across multiple ICs.  For example, NCI is interested in cannabinoids and cancer pain, NINDS is interested in marijuana as a potential treatment for severe epilepsy.  Marijuana is also a potential treatment of interest for diseases such as MS, Alzheimer’s and HIV. The group noted that involvement with PCORNet would be beneficial.  It was determined that a working group on cannabinoids may be established.  Dr. Joni Rutter (NIDA) is currently leading a multi-IC initiative that focuses on marijuana as a potential treatment for a variety of diseases.

David Thomas, NIDA - FOA concept proposal – Chronic Pain & Central Sensitization

Dr. Thomas opened by stating that chronic pain is a huge issue in the military.  According to a research letter published in JAMA, a little less than half of active duty soldiers suffer from chronic pain.  Of those suffering from chronic pain, the majority are taking OTC, non-opioid or opioid medications.  Dr. Thomas attended a meeting between NIDA and DoD regarding this issue and high-level officials at DoD attended and were very interested.    Soldiers face stress, sleep deprivation, and PTSD among other issues; and these physiological stressors may exacerbate chronic pain.   These stressors may be cumulative over time and lead to widespread chronic pain.  Dr. Thomas discussed the potential for a future FOA that may include studies that explore mechanisms of central sensitization and its role in chronic pain and whether opioid medications help or hurt this population.  The upcoming Pathways to Prevention Workshop on The Role of Opioids in Chronic Pain should help inform this effort. 

Partap Khalsa, NCCAM - Update: Low Back Pain Task Force

The Chronic Low Back Pain Task Force report on research standards is now available on the Pain Consortium website (painconsortium.nih.gov).  The report was presented at this year’s American Pain Society annual meeting. The manuscript has been published in multiple journals including the Journal of Pain, Spine, The Spine Journal and the Clinical Journal of Pain.  Next steps include a push for ICs to strongly encourage investigators to use the research standards (i.e., minimum dataset) in NIH-funded studies of cLBP.  In order to advance the research agenda on cLBP, there is a need to further refine & validate the minimum dataset.  One consideration is a Pain Consortium/multi-IC FOA that would solicit applications proposing validation studies.  It was determined that this topic would be ideal for discussion by the Pain Consortium coordinating committee which will soon be developed.

Cheryse Sankar, NINDS - Website update

The NIH Pain Consortium website (painconsortium.nih.gov) is new & improved. It features a rotating carousel and search engine on the home page, and multiple resources (such as the pain information brochure) have been updated.