119 Search Results for "pain"
A Whole Person Approach to Lifting the Burden of Chronic Pain Among Service Members and Veterans
Posted on by Helene M. Langevin, M.D., National Center for Complementary and Integrative Health
Chronic pain and its companion crisis of opioid misuse have taken a terrible toll on Americans. But the impact has been even greater on U.S. service members and veterans, who often deal with the compounded factors of service-related injuries and traumatic stress.
For example, among soldiers in a leading U.S. Army unit, 44 percent had chronic pain and 15 percent used opioids after a combat deployment. That compares to 26 percent and 4 percent, respectively, in the general population [1,2].
This disproportionate burden of chronic pain among veterans [3] and service members led NIH’s National Center for Complementary and Integrative Health (NCCIH) to act. We forged a collaboration in 2017 across NIH, U.S. Department of Defense (DOD), and U.S. Department of Veteran’s Affairs (VA) to establish the Pain Management Collaboratory (PMC).
The PMC’s research focusing on the implementation and evaluation of nondrug approaches for the management of pain is urgently needed in the military and across our entire country. Nondrug approaches require a shift in thinking. Rather than focusing solely on blocking pain temporarily using analgesics, nondrug approaches work with the mind and body to promote the resolution of chronic pain and the long-term restoration of health through techniques and practices such as manual therapy, yoga, and mindfulness-based interventions.
Addressing chronic pain in ways that don’t only rely on drugs means addressing underlying issues, such as joints and connective tissue that lack adequate movement or training our brains to “turn down the volume” on pain signals. Using mind and body practices to reduce pain can help promote health in other ways. Possible “fringe benefits” include better sleep, more energy for physical activity, a better mindset for making good nutritional choices, and/or improved mood.
Indeed, there is a growing body of research on the benefits of nondrug approaches to address chronic pain. What is so powerful about PMC is it puts this knowledge to work by embedding research within military health care settings.
The PMC supports a shared resource center and 11 large-scale pragmatic clinical trials. Within this real-world health care setting, the clinical trials have enrolled more than 8,200 participants across 42 veteran and military health systems. These studies offer both strength in numbers and insights into what happens when learnings from controlled clinical trials collide with the realities of health care delivery and the complexities of daily life. [4]
Central to the PMC partnership is whole person health. Too often, we see health through the prism of separate parts—for example, a person’s cardiovascular, digestive, and mental health problems are viewed as co-occurring rather than as interrelated conditions. A whole person framework—a central focus of NCCIH’s current Strategic Plan—brings the parts back together and recognizes that health exists across multiple interconnected body systems and domains: biological, behavioral, social, and environmental.
The VA’s implementation of a whole health model [5] and their unique closed-loop health care system offers an opportunity to deliver care, conduct research, and illustrate what happens when people receive coordinated care that treats the whole person. In fact, VA’s leadership in this area was the impetus for a recent report by the National Academies of Sciences, Engineering, and Medicine. The report underscored the importance of implementing whole person health care in all settings and for every American.
There are many opportunities ahead for this interagency collaboration. It will help to achieve an important shift, from treating problems one at a time to promoting overall military readiness, resilience, and well-being for U.S. service members and veterans.
Congress appropriated $5 million to NCCIH in fiscal year 2023 to enhance pain research with a special emphasis on military populations. These additional resources will allow NCCIH to support more complex studies in understanding how multiple therapeutic approaches that impact multiple body systems can impact chronic pain.
Meanwhile, programs like the DOD’s Consortium for Health and Military Performance (CHAMP) will continue to translate these lessons learned into accessible pain management information that service members can use in promoting and maintaining their health.
While the PMC’s research program specifically targets the military community, this growing body of knowledge will benefit us all. Understanding how to better manage chronic pain and offering more treatment options for those who want to avoid the risks of opioids will help us all build resilience and restore health of the whole person.
References:
[1] Chronic pain and opioid use in US soldiers after combat deployment. Toblin RL, Quartana PJ, Riviere LA, Walper KC, Hoge CW. JAMA Intern. Med. 2014 Aug;174(8):1400-1401.
[2] Pain and opioids in the military: We must do better. Jonas WB, Schoomaker EB. JAMA Intern. Med. 2014 Aug;174(8):1402-1403
[3] Severe pain in veterans: The effect of age and sex, and comparisons with the general population. Nahin RL. J Pain. 2017 Mar; 18(3):247-254.
[4] Justice and equity in pragmatic clinical trials: Considerations for pain research within integrated health systems. Ali J, Davis AF, Burgess DJ, Rhon DI, Vining R, Young-McCaughan S, Green S, Kerns RD. Learn Health Sys. 2021 Oct 19;6(2): e10291
[5] The APPROACH trial: Assessing pain, patient-reported outcomes, and complementary and integrative health. Zeliadt S, Coggeshall S, Thomas E, Gelman H, Taylor S. Clin. Trials. 2020 Aug;17(4):351-359.
Links:
National Center for Complementary and Integrative Health (NIH)
NCCIH Strategic Plan FY 2021-2025: Mapping a Pathway to Research on Whole Person Health (NIH)
Pain Management Collaboratory (Yale University, New Haven, CT)
Whole Health (U.S Department of Veteran’s Affairs, Washington, D.C.)
Consortium for Health and Military Performance (Department of Defense, Bethesda, MD)
Achieving Whole Health: A New Approach for Veterans and the Nation. (National Academies of Sciences, Engineering, and Medicine, Washington, D.C.)
Note: Dr. Lawrence Tabak, who performs the duties of the NIH Director, has asked the heads of NIH’s Institutes, Centers, and Offices to contribute occasional guest posts to the blog to highlight some of the interesting science that they support and conduct. This is the 26th in the series of NIH guest posts that will run until a new permanent NIH director is in place.
Could CRISPR Gene-Editing Technology Be an Answer to Chronic Pain?
Posted on by Dr. Francis Collins
Gene editing has shown great promise as a non-heritable way to treat a wide range of conditions, including many genetic diseases and more recently, even COVID-19. But could a version of the CRISPR gene-editing tool also help deliver long-lasting pain relief without the risk of addiction associated with prescription opioid drugs?
In work recently published in the journal Science Translational Medicine, researchers demonstrated in mice that a modified version of the CRISPR system can be used to “turn off” a gene in critical neurons to block the transmission of pain signals [1]. While much more study is needed and the approach is still far from being tested in people, the findings suggest that this new CRISPR-based strategy could form the basis for a whole new way to manage chronic pain.
This novel approach to treating chronic pain occurred to Ana Moreno, the study’s first author, when she was a Ph.D. student in the NIH-supported lab of Prashant Mali, University of California, San Diego. Mali had been studying a wide range of novel gene- and cell-based therapeutics. While reading up on both, Moreno landed on a paper about a mutation in a gene that encodes a pain-enhancing protein in spinal neurons called NaV1.7.
Moreno read that kids born with a loss-of-function mutation in this gene have a rare condition known as congenital insensitivity to pain (CIP). They literally don’t sense and respond to pain. Although these children often fail to recognize serious injuries because of the absence of pain to alert them, they have no other noticeable physical effects of the condition.
For Moreno, something clicked. What if it were possible to engineer a new kind of treatment—one designed to turn this gene down or fully off and stop people from feeling chronic pain?
Moreno also had an idea about how to do it. She’d been working on repressing or “turning off” genes using a version of CRISPR known as “dead” Cas9 [2]. In CRISPR systems designed to edit DNA, the Cas9 enzyme is often likened to a pair of scissors. Its job is to cut DNA in just the right spot with the help of an RNA guide. However, CRISPR-dead Cas9 no longer has any ability to cut DNA. It simply sticks to its gene target and blocks its expression. Another advantage is that the system won’t lead to any permanent DNA changes, since any treatment based on CRISPR-dead Cas9 might be safely reversed.
After establishing that the technique worked in cells, Moreno and colleagues moved to studies of laboratory mice. They injected viral vectors carrying the CRISPR treatment into mice with different types of chronic pain, including inflammatory and chemotherapy-induced pain.
Moreno and colleagues determined that all the mice showed evidence of durable pain relief. Remarkably, the treatment also lasted for three months or more and, importantly, without any signs of side effects. The researchers are also exploring another approach to do the same thing using a different set of editing tools called zinc finger nucleases (ZFNs).
The researchers say that one of these approaches might one day work for people with a large number of chronic pain conditions that involve transmission of the pain signal through NaV1.7. That includes diabetic polyneuropathy, sciatica, and osteoarthritis. It also could provide relief for patients undergoing chemotherapy, along with those suffering from many other conditions. Moreno and Mali have co-founded the spinoff company Navega Therapeutics, San Diego, CA, to work on the preclinical steps necessary to help move their approach closer to the clinic.
Chronic pain is a devastating public health problem. While opioids are effective for acute pain, they can do more harm than good for many chronic pain conditions, and they are responsible for a nationwide crisis of addiction and drug overdose deaths [3]. We cannot solve any of these problems without finding new ways to treat chronic pain. As we look to the future, it’s hopeful that innovative new therapeutics such as this gene-editing system could one day help to bring much needed relief.
References:
[1] Long-lasting analgesia via targeted in situ repression of NaV1.7 in mice. Moreno AM, Alemán F, Catroli GF, Hunt M, Hu M, Dailamy A, Pla A, Woller SA, Palmer N, Parekh U, McDonald D, Roberts AJ, Goodwill V, Dryden I, Hevner RF, Delay L, Gonçalves Dos Santos G, Yaksh TL, Mali P. Sci Transl Med. 2021 Mar 10;13(584):eaay9056.
[2] Nuclease dead Cas9 is a programmable roadblock for DNA replication. Whinn KS, Kaur G, Lewis JS, Schauer GD, Mueller SH, Jergic S, Maynard H, Gan ZY, Naganbabu M, Bruchez MP, O’Donnell ME, Dixon NE, van Oijen AM, Ghodke H. Sci Rep. 2019 Sep 16;9(1):13292.
[3] Drug Overdose Deaths. Centers for Disease Control and Prevention.
Links:
Congenital insensitivity to pain (National Center for Advancing Translational Sciences/NIH)
Opioids (National Institute on Drug Abuse/NIH)
Mali Lab (University of California, San Diego)
Navega Therapeutics (San Diego, CA)
NIH Support: National Human Genome Research Institute; National Cancer Institute; National Institute of General Medical Sciences; National Institute of Neurological Disorders and Stroke
#PainMonth18 Twitter Chat
Posted on by Dr. Francis Collins
A look behind the scenes at the #PainMonth18 Twitter Chat. I’m sitting with Alex Azar, secretary of Health and Human Services (HHS), and we’re watching a brief video. The twitter chat took place on September 18 in Washington, D.C. in recognition of Pain Awareness Month. Credit: HHS
Researchers Elucidate Role of Stress Gene in Chronic Pain
Posted on by Dr. Francis Collins
Credit: Getty Images/simonkr
For most people, pain eventually fades away as an injury heals. But for others, the pain persists beyond the initial healing and becomes chronic, hanging on for weeks, months, or even years. Now, we may have uncovered an answer to help explain why: subtle differences in a gene that controls how the body responds to stress.
In a recent study of more than 1,600 people injured in traffic accidents, researchers discovered that individuals with a certain variant in a stress-controlling gene, called FKBP5, were more likely to develop chronic pain than those with other variants [1]. These findings may point to new non-addictive strategies for preventing or controlling chronic pain, and underscore the importance of NIH-funded research for tackling our nation’s opioid overuse crisis.
Managing Chronic Pain: Opioids Are Often Not the Answer
Posted on by Dr. Francis Collins
The term “silent epidemic” sometimes gets overused in medicine. But, for prescription opioid drugs, the term fits disturbingly well. In 2012, more than 259 million prescriptions were written in the United States for Vicodin, OxyContin, and other opioid painkillers. That equals one bottle of pain pills for every U.S. adult. And here’s an even more distressing statistic: in 2011, overdoses of prescription painkillers, most unintentional, claimed the lives about 17,000 Americans—46 people a day [1].
The issue isn’t whether opioid painkillers have a role in managing chronic pain, such as that caused by cancer or severe injuries. They do. What’s been lacking is an unbiased review of the scientific literature to examine evidence on the safety of long-term prescription opioid use and the impact of such use on patients’ pain, function, and quality of life. The NIH Office of Disease Prevention (ODP) recently convened an independent panel to conduct such a review, and what it found is eye-opening. People with chronic pain have often been lumped into a single category and treated with generalized approaches, even though very little scientific evidence exists to support this practice.
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