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Wednesday, February 7, 2018

NIH Pain Consortium Quarterly Meeting Minutes

Summary:   NIH Director, Dr. Francis Collins and NIH Deputy Director, Dr. Larry Tabak presented ‘A Trans-NIH Response to the Opioid Crisis, followed by questions and discussion.  Updates were presented on:  The Public Private Partnership to Address the Opioid Crisis; Common Fund Proposal on the Transition from Acute to Chronic Pain; NCCIH IRP Pain Research Consortium; NIH Pain Consortium-IASP Exhibitor Booth; Update on the 2018 Pain Consortium Symposium; and the IASP Satellite Meeting: The Science of Complementary and Integrative Health Approaches.

A Trans-NIH Response to the Opioid Crisis – Dr. Francis Collins & Dr. Larry Tabak

Dr. Collins gave an overview of the work being done by NIH to address the opioid epidemic through overdose prevention and pain and addiction treatment.  He stated the need for more effective treatments for opioid use disorder and overdose (eg. MAT, Narcan) and expressed the urgency of more potent and longer acting overdose treatments due to the increased supply of fentanyl and carfentanil. 

A public-private partnership is being developed to address this issue and through a series of meetings and conference calls in 2017.  Whereas the PPP is focused primarily on combating the opioid epidemic through better therapeutics, there are other areas that NIH is well-positioned to tackle.  Examples include: advancing our basic understanding of addiction; distinguishing mechanisms of opioid dependence from opioid addiction; novel methods of preventing addiction (eg., vaccines); reducing prescription opioid use through better pain management (eg., pharmacological and non-pharmacological treatments); and developing non-addictive, potent analgesics as alternatives to opioids.

 Dr. Collins asked each IC to prepare research proposals to address the opioid epidemic. He provided an example of a large demonstration project that could involve healthcare systems, treatment programs and the criminal justice system. 

Dr. Volkow gave an example of a large program in Rhode Island where treatments for opioid use disorder were provided through the criminal justice system.  The program demonstrated a 12.5% decrease in mortality. 

At this stage, proposal development is a planning exercise. Dr. Tabak noted the proposals should not only expand on existing programs, but should transform them.  The intramural division was invited to submit a proposal as well.   In addition, coordinated proposals through the NIH Pain Consortium were encouraged.

Members discussed potential pain initiative proposals covering broad topics such as biomarkers, genetic analyses, non-addictive pharmacological and non-pharmacological treatments, pain therapeutics screening, appropriate prescribing for specific pain conditions, basic research on inflammatory processes in pain, and leveraging existing NIH programs to advance pain research.

 

Further Discussion on the Public Private Partnership to Address the Opioid Crisis – Dr. Walter Koroshetz (NINDS)

Dr. Koroshetz briefly discussed action items recommended through the PPP. The major topics include data and asset sharing, clinical endpoints and biomarkers, and clinical trial networks to accelerate phase 2 trials.

Update on the Common Fund Proposal-Transition from Acute to Chronic Pain – Dr. Linda Porter (NINDS)

Dr. Porter briefly provided an update on the revised version of the common fund proposal.  She introduced Tammy Massie, a statistician that assisted the CF team with developing a power analysis for the study.  The revision included updates on biomarker testing and feasibility studies.  The CF group met with NCATS to determine the potential utility of CTSAs and most recently met with the Office of Strategic Planning to discuss potential funding mechanisms. Dr. Porter thanked the PC members who were involved and Drs. Volkow and Koroshetz for their support and leadership.

NCCIH IRP Pain Research Consortium – Dr. David Shurtleff (NCCIH)

Dr. Shurtleff introduced a concept for the Intramural Research Program to integrate its research efforts on pain.  Drs. Alex Chesler and Catherine Bushnell developed a 4-page inventory summarizing IRP pain research across 10 different ICs.  A subgroup has been initiated to work on the proposal. Dr. Bushnell agreed to send a notice out to the NIH Pain Consortium listserv requesting members to serve on the subgroup.  Dr. Volkow stated that it would be important to identify unique resources in the IRP, for example, NIMH’s neuroimaging program.

NIH IASP exhibitor Booth and PC participation – Dr. David Shurtleff (NCCIH)

Dr. Shurtleff asked members to consider contributing to the IASP exhibitor space (International Association for the Study of Pain meeting in Boston, MA – Sep. 12-16).  To date, approximately 5 ICs are interested, and if more are added, the price per IC will be reduced significantly. Dr. Shurtleff agreed to send a reminder notice to the PC listserv so that other ICs could indicate their interest.

Update on the 2018 Pain Consortium Symposium - Dr. Cheryse Sankar (NINDS) and Dr. Yolanda Vallejo (NIDCR)

Drs. Sankar and Vallejo discussed the upcoming NIH Pain Consortium Symposium to be held at Masur Auditorium on May 31 – June 1, 2018.  The theme is: At the Intersection of Pain Management and the Opioid Crisis and will feature Dr. Judith Paice (Northwestern University) and the following panel session topics: At the intersection of pain, reward and tolerance; disparities in clinical pain management; and The BRAIN Initiative: Harnessing technology for pain research.  The Surgeon General has been invited to give a keynote address.  Details of the symposium will be posted on the NIH Pain Consortium website.

 IASP Satellite Meeting: The Science of Complementary and Integrative Health Approaches - Dr. Wen Chen (NCCIH)

Dr. Chen discussed an upcoming ISP satellite symposium on integrative health approaches to pain management.  Dr. Shurtleff will open the meeting.  Dr. Chen briefly discussed an upcoming workshop for natural products looking across different pain domains. The workshop has not yet been cleared internally.

Other Discussion:

Dr. Shurtleff suggested the NIH Pain Consortium would benefit from a coordinating committee similar to Blueprint/BRAIN initiative.  Dr. Volkow stated that she would support such an idea, only if more money became available.

Dr. Michael Oshinsky described an upcoming workshop on evaluation of animal models for pain. The purpose of this meeting is to convene experts in the field of animal models for pain and experts in translational development of pain therapeutics from industry to discuss screening programs in the preclinical process for determining if a compound should be developed to treat pain. The primary goal of this meeting is to have a discussion of the benefits and shortcomings of the current pain models and produce recommendations for using these models for screening compounds for a wide range of pain disorders, such as inflammatory pain, neuropathic pain conditions such as complex regional pain syndromes trigeminal neuralgia, and migraine, and cancer pain. 

 

NIH Pain Consortium Quarterly Meeting Minutes

February 7, 2018

A Trans-NIH Response to the Opioid Crisis – Dr. Francis Collins & Dr. Larry Tabak

Dr. Collins gave an overview of the work being done by NIH to address the opioid epidemic through overdose prevention and pain and addiction treatment.  He stated the need for more effective treatments for opioid use disorder and overdose (eg. MAT, Narcan) and expressed the urgency of more potent and longer acting overdose treatments due to the increased supply of fentanyl and carfentanil. 

A public-private partnership is being developed to address this issue and through a series of meetings and conference calls in 2017.  Whereas the PPP is focused primarily on combating the opioid epidemic through better therapeutics, there are other areas that NIH is well-positioned to tackle.  Examples include: advancing our basic understanding of addiction; distinguishing mechanisms of opioid dependence from opioid addiction; novel methods of preventing addiction (eg., vaccines); reducing prescription opioid use through better pain management (eg., pharmacological and non-pharmacological treatments); and developing non-addictive, potent analgesics as alternatives to opioids.

 Dr. Collins asked each IC to prepare research proposals to address the opioid epidemic. He provided an example of a large demonstration project that could involve healthcare systems, treatment programs and the criminal justice system. 

Dr. Volkow gave an example of a large program in Rhode Island where treatments for opioid use disorder were provided through the criminal justice system.  The program demonstrated a 12.5% decrease in mortality. 

At this stage, proposal development is a planning exercise. Dr. Tabak noted the proposals should not only expand on existing programs, but should transform them.  The intramural division was invited to submit a proposal as well.   In addition, coordinated proposals through the NIH Pain Consortium were encouraged.

Members discussed potential pain initiative proposals covering broad topics such as biomarkers, genetic analyses, non-addictive pharmacological and non-pharmacological treatments, pain therapeutics screening, appropriate prescribing for specific pain conditions, basic research on inflammatory processes in pain, and leveraging existing NIH programs to advance pain research.

 

Further Discussion on the Public Private Partnership to Address the Opioid Crisis – Dr. Walter Koroshetz (NINDS)

Dr. Koroshetz briefly discussed action items recommended through the PPP. The major topics include data and asset sharing, clinical endpoints and biomarkers, and clinical trial networks to accelerate phase 2 trials.

Update on the Common Fund Proposal-Transition from Acute to Chronic Pain – Dr. Linda Porter (NINDS)

Dr. Porter briefly provided an update on the revised version of the common fund proposal.  She introduced Tammy Massie, a statistician that assisted the CF team with developing a power analysis for the study.  The revision included updates on biomarker testing and feasibility studies.  The CF group met with NCATS to determine the potential utility of CTSAs and most recently met with the Office of Strategic Planning to discuss potential funding mechanisms. Dr. Porter thanked the PC members who were involved and Drs. Volkow and Koroshetz for their support and leadership.

NCCIH IRP Pain Research Consortium – Dr. David Shurtleff (NCCIH)

Dr. Shurtleff introduced a concept for the Intramural Research Program to integrate its research efforts on pain.  Drs. Alex Chesler and Catherine Bushnell developed a 4-page inventory summarizing IRP pain research across 10 different ICs.  A subgroup has been initiated to work on the proposal. Dr. Bushnell agreed to send a notice out to the NIH Pain Consortium listserv requesting members to serve on the subgroup.  Dr. Volkow stated that it would be important to identify unique resources in the IRP, for example, NIMH’s neuroimaging program.

NIH IASP exhibitor Booth and PC participation – Dr. David Shurtleff (NCCIH)

Dr. Shurtleff asked members to consider contributing to the IASP exhibitor space (International Association for the Study of Pain meeting in Boston, MA – Sep. 12-16).  To date, approximately 5 ICs are interested, and if more are added, the price per IC will be reduced significantly. Dr. Shurtleff agreed to send a reminder notice to the PC listserv so that other ICs could indicate their interest.

Update on the 2018 Pain Consortium Symposium - Dr. Cheryse Sankar (NINDS) and Dr. Yolanda Vallejo (NIDCR)

Drs. Sankar and Vallejo discussed the upcoming NIH Pain Consortium Symposium to be held at Masur Auditorium on May 31 – June 1, 2018.  The theme is: At the Intersection of Pain Management and the Opioid Crisis and will feature Dr. Judith Paice (Northwestern University) and the following panel session topics: At the intersection of pain, reward and tolerance; disparities in clinical pain management; and The BRAIN Initiative: Harnessing technology for pain research.  The Surgeon General has been invited to give a keynote address.  Details of the symposium will be posted on the NIH Pain Consortium website.

 IASP Satellite Meeting: The Science of Complementary and Integrative Health Approaches - Dr. Wen Chen (NCCIH)

Dr. Chen discussed an upcoming ISP satellite symposium on integrative health approaches to pain management.  Dr. Shurtleff will open the meeting.  Dr. Chen briefly discussed an upcoming workshop for natural products looking across different pain domains. The workshop has not yet been cleared internally.

Other Discussion:

Dr. Shurtleff suggested the NIH Pain Consortium would benefit from a coordinating committee similar to Blueprint/BRAIN initiative.  Dr. Volkow stated that she would support such an idea, only if more money became available.

Dr. Michael Oshinsky described an upcoming workshop on evaluation of animal models for pain. The purpose of this meeting is to convene experts in the field of animal models for pain and experts in translational development of pain therapeutics from industry to discuss screening programs in the preclinical process for determining if a compound should be developed to treat pain. The primary goal of this meeting is to have a discussion of the benefits and shortcomings of the current pain models and produce recommendations for using these models for screening compounds for a wide range of pain disorders, such as inflammatory pain, neuropathic pain conditions such as complex regional pain syndromes trigeminal neuralgia, and migraine, and cancer pain.