Funded Projects

Decreasing opioid dosing faster than advised by clinical recommendations often leaves chronic pain unaddressed and may increase the risk of overdose and suicide compared to continuing long-term opioid treatment. Clinical and research communities are uncertain about how to assess and manage long-term opioid therapy, despite having diagnostic and treatment frameworks for chronic pain and opioid use disorder. Because of this undefined space, health policy, institutions, and practitioners lack clear advice on long-term opioid prescribing in chronic pain. The goal of the MRC is to provide infrastructure support for the network; create a risk-benefit decision tool to assist providers in determining when opioids should be continued as prescribed, tapered, or tapered/discontinued; and develop and validate a clinical definition for this population (name, identifying associated symptoms/behaviors, and generating a screening tool). This project will leverage big data analytics in administrative datasets, natural language processing approaches in electronic health records, and cohort modeling techniques to accomplish these key responsibilities. These efforts will complement the qualitative data collection approaches in the Becker Resource Center. 

Decreasing opioid dosing faster than advised by clinical recommendations often leaves chronic pain unaddressed and may increase the risk of overdose and suicide compared to continuing long-term opioid treatment. The MIRHIQL Resource Center will provide infrastructure support for the network as well as create a risk-benefit decision tool to help providers determine when opioids should be continued as prescribed, tapered, or tapered/discontinued. The center will first develop and validate a clinical definition for individuals who take long-term opioids, then study long-term outcomes in participants who receive treatment in primary care settings. This research will partner with many groups including individuals with lived experience, community health care providers who treat such individuals, research scientists, bioethicists, and professional societies

Decreasing opioid dosing faster than advised by clinical recommendations often leaves chronic pain unaddressed and may increase the risk of overdose and suicide compared to continuing long-term opioid treatment. This project will compare a patient-centered tapering protocol with or without MORE in primary care offices in New Jersey and Utah. The MORE approach integrates training in mindfulness, reappraisal, and savoring to alter behavior away from valuation of drug rewards and toward natural rewards. This research will also identify practices to use MORE in primary care settings.

Decreasing opioid dosing faster than advised by clinical recommendations often leaves chronic pain unaddressed and may increase the risk of overdose and suicide compared to continuing long-term opioid treatment. Continued, long-term use of opioids after surgery by individuals who use opioids increases the risk of postoperative complications, opioid use disorder, and death. Surgery is a critical point-of-care moment for health care providers to interact with patients who use opioids about continued opioid use when harms outweigh benefits. This project will test of the Motivational Interviewing and guided Opioid Tapering support (MI-Opioid Taper) strategy, with or without a medication that reduces anxiety and relieves pain, at four geographically diverse hospitals across the nation.

There is little evidence available to guide clinical care for patients on long-term opioid therapy for whom risks exceed benefits. Given valid fears about both pain and withdrawal during decreased dosing (tapering), these individuals face challenges, including concerns about being abandoned by providers and uncertainty about the need to discontinue opioids. As such, these patients are hesitant to enroll voluntarily in opioid discontinuation research, further deepening the clinical evidence gap. This project will evaluate three effective and scalable interventions for individuals on long-term opioid therapy: (1) low-dose transdermal buprenorphine (without) of opioid withdrawal, (2) a brief cognitive behavioral intervention for pain, and (3) noninvasive brain stimulation.

This project supports a post-doctoral trainee to develop the skills and knowledge needed to pursue a career in clinical pain research. The research will involve optimizing a GetActive mind-body activity program to overcome barriers that prevent disadvantaged older adult populations in community health clinics from access to non-pharmacological pain management strategies. The research will include qualitative analysis of secondary data, a literature review to evaluate methods, and feasibility for establishing a community advisory board for the GetActive project.

People who live in rural areas have high rates of chronic pain and poor health outcomes and are less likely to receive evidence-based complementary and integrative treatments for chronic pain. This project will adapt a nurse care management model for use in health systems serving rural patients with chronic pain. The research aims to coordinate care, provide cognitive behavioral therapy, and refer patients to a remotely delivered exercise program.

Physical therapy is the recommended treatment for patients with low back pain and is a cost-effective method for improving pain and reducing disability. However, only 7-13% of patients receive physical therapy services. Access is particularly limited in rural communities due to lack of provider availability, transportation, and missed work time. These factors have contributed to more low back pain-related disability and opioid use among rural populations. Physical therapy delivered through telemedicine may improve access by reducing patient-reported barriers. This randomized clinical trial will compare an innovative, patient-centered telemedicine version of physical therapy to a currently used psychologically based educational approach for rural patients with chronic low back pain. The research will match individual patients to a treatment approach based on their psychosocial risk of poor outcomes.

Cataract surgery is commonly performed in older adults; however, some patients subsequently experience chronic eye pain that is difficult to treat. One promising approach that is effective in some, but not all, patients uses the patient's own serum (a component of blood) as eye drops. This project seeks to identify markers that can help predict which patients will respond to serum treatment and monitor their progress. Using advanced technology and data analysis to evaluate patient histories, questionnaires, and different genetic and other molecular characteristics in the eyes and serum it aims to identify potential markers that can then be tested in a clinical study.

Chronic pancreatitis is a painful condition often caused by long-term alcohol use, and patients often require treatment with strong pain medications, including opioids. Therefore, alternative treatments for chronic pancreatitis are needed. This project will use machine learning approaches to create a prediction tool based on electroencephalography analyses, sensory tests, and psychological questionnaires that can help determine which patients with chronic pancreatitis will benefit most from a specific type of treatment called endoscopic therapy.

Clinician bias causes inequities in healthcare, and interventions are needed to mitigate and eradicate this bias. This project aims to develop and test the impact of two interventions on overcoming clinician implicit bias in the management of pain for children from ethnic minorities treated in the emergency department. The study will include pediatric patients from under-represented minority groups with pain from long-bone fractures or acute appendicitis who are cared for by racially and ethnically diverse caregivers. Researchers will use stakeholder-informed approaches to establish quality of care metrics and then use clinician audit and feedback as well as data from electronic health records to quantify evidence of bias.      

There is a need to improve access to treatments and address the stigma, bias, and mistrust that harm and isolate people with chronic pain, especially those from ethnic and racial minority populations. The Integrating Nonpharmacologic Strategies for Pain with Inclusion, Respect, and Equity (INSPIRE) Chronic Pain (CP) intervention blends cognitive-behavioral therapy, physical therapy, mindfulness, and pain education, and is delivered by a trilingual mobile app and supported by a telehealth pain coach who coordinates with doctors. The coach will collect and summarize patient reports on pain, depression, anxiety, substance use, and social factors, and share them with healthcare providers. In this project, researchers will create the digital tool and coaching protocol, develop educational and implementation strategies for healthcare providers, and conduct a pilot test. They will then perform a randomized clinical trial to compare INSPIRE to current treatment, analyze its effects, and evaluate outcomes.

Pain in muscles and surrounding connective tissue (myofascial pain) is a significant health concern affecting hundreds of millions of Americans. There is no objective way to identify and measure myofascial pain. This project will address this unmet challenge by developing a robust approach to identify imaging biomarker(s) that can distinguish different states of myofascial pain. The research will then examine the ability of identified biomarker(s) to predict patient responses to a myofascial pain treatment in a randomized controlled clinical trial.