One HEAL Community Seeking Solutions for Pain and Addiction

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Dear HEAL community,

First, I’d like to thank all of you who shared your questions about the Helping to End Addiction Long-term^® Initiative, or NIH HEAL Initiative, for the fireside chat between Dr. Francis Collins, director of NIH, and Dr. Nora Volkow, director of National Institute on Drug Abuse. We were able to answer several of your questions and you can now watch the conversation.  

One theme of the discussion was how the COVID-19 pandemic is colliding with the public health crisis of opioid misuse, addiction, and overdose. This pandemic affects not only our initiative’s research, but also the millions of people suffering from chronic pain, those with substance use disorders, and our partners in healthcare, the criminal justice system, and communities across the country. Much of our current work aims to understand the effects of COVID-19 on our stakeholders and organize the path forward through engagement with HEAL networks and their deep connections in communities nationwide.

Today, I’d like to share some thoughts about another recurring theme of your questions, and one that is at the core of HEAL – the intersection of pain and addiction.

Understanding pain and addiction together

The NIH HEAL Initiative was developed to address the opioid crisis via two overarching goals – to enhance pain management, and to improve prevention and treatment strategies for opioid misuse and addiction.

These goals are interdependent. The overreliance on opioids to treat pain was a primary contributor to the current opioid crisis. Yet, in our efforts to reduce opioid misuse, we cannot neglect the needs of the 25 to 30 million people suffering daily from chronic pain. We need better, non-addictive treatments for their pain conditions. Opioids can be effective, even essential medications for many patients. But the risks of opioid drugs are significant, and over time opioids often require progressively higher doses to achieve the same pain relief, increasing those risks to the patient. Not least, people in recovery, and those receiving treatment for opioid use disorder, have unique needs for options to safely and effectively treat pain without opioids.

The NIH HEAL Initiative is taking on this challenge through research programs that foster collaboration across the pain and addiction fields.

Pain and reward pathways associated with addiction are linked in molecular signaling pathways and common neural circuits in the brain. Opioids target these shared pathways and relieve pain but also can lead to addiction.

To uncover novel treatment approaches at the molecular level, researchers are validating potential new analgesic non-opioid targets that reduce pain but, unlike opioids, don’t stimulate reward pathways, which lowers their risk for addiction. HEAL is also developing novel medications that act as analgesics and prevent opioid use disorder and overdose.

A therapeutic, non-opioid based intervention for postoperative pain is being tested for its effects on reducing both pain and opioid usage following mastectomy. One HEAL funded therapeutic to relieve pain was recently granted Fast Track designation by the Food and Drug Administration for treatment of neuropathic pain.

In the clinical research area, HEAL supports efforts to understand the interplay of treatments for pain and for opioid use disorder (OUD). One of the projects in the Pain Management Effectiveness Research Network is testing an integrated treatment for veterans with chronic pain and OUD. And a study from the Back Pain Consortium Research Program is comparing the effectiveness of treatments to  relieve pain and improve function and to prevent or reduce opioid misuse.

Several studies in the translation of research to practice address the care of people with both pain and OUD. As one example, the Behavioral Research to Improve Medication-Based Treatment program focuses on pain and addiction, including combining mindfulness and Methadone treatment for opioid use and chronic pain management, psychosocial pain management to improve outcomes in the treatment of opioid use disorder, and enhancing the impact of behavioral pain management on MAT outcomes.  

Future opportunities and connections 

Beyond the investments made to date, we are working to build a future of increased trans-NIH and interdisciplinary research in the fields of pain and opioid addiction. Several cross-cutting funding opportunities seek to address pain management in the context of opioid misuse, and more are in the pipeline. I’d like to bring your attention to one new funding opportunity that seeks to address stigma in both pain and addiction focused research studies.

As always, please continue to share your thoughts, concerns and ideas with the HEAL Initiative by writing to us at [email protected].