Funded Projects

Managing the risks and benefits of opioid medications can be difficult. Although prescription opioids alleviate pain for some patients, serious adverse effects include opioid use disorder. There is a critical, unmet need for new technologies that significantly minimize the opioid doses needed for effective relief from moderate to severe pain. This project will develop a novel combination treatment containing a small amount of morphine along with pramipexole, a drug approved by the U.S. Food and Drug Administration for Parkinson’s disease and restless legs syndrome that reduces the reward-seeking behavior associated with opioids. The research will conduct safety studies to enable testing in human research participants.

Chronic pain is a debilitating medical condition that affects roughly 50 million people in the United States. Current diagnostics and treatments rely primarily on subjective metrics and do not target the unique biological, psychological, and social factors that contribute to an individual’s pain. This project is part of the NIH Back Pain Consortium (BACPAC) program, a patient-centered effort to address the need for effective and personalized therapies for chronic low back pain. This research will enhance patient diversity within the BACPAC research participant population.

Myofascial pain syndrome is a prevalent and debilitating condition and can aggravate other conditions such as sickle cell disease. This project will use total body imaging using positron emission tomography/computed tomography (TB-PET/CT) to identify and monitor this pain syndrome and potential treatments over time. The research will use TB-PET/CT to assess myofascial tissue effects of chronic low back pain and sickle cell disease pain. The first phase of the project will assess health changes observed by TB-PET/CT imaging in painful and non-painful myofascial tissues compared to healthy myofascial tissue. The second phase of the research will be a randomized, controlled longitudinal interventional study to evaluate the effectiveness of acupuncture on myofascial pain syndrome, using TB-PET/CT imaging to assess changes.

Pain is common, complex, and debilitating in many cancer patients. Although adequate pain management can significantly improve health-related quality of life for these individuals, substantial disparities limit care access, especially among underserved populations. After the 2014 Drug Enforcement Agency policy that raised the risk potential of the opioid hydrocodone (from Schedule III to Schedule II), few studies examined the impact of this policy on pain management strategies and outcomes among cancer patients. This project will use national cancer registry data linked with Medicare claims to assess the change in opioid and non-opioid medication use among older lung cancer patients before and after this policy change. By focusing on older racial/ethnic minority groups dually eligible for both Medicare and Medicaid, the research will also examine disparities in the use of medications for pain management and service use consistent with inadequate pain management.

Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, tenderness, stiffness, fatigue, and sleep disturbance. The FAST trial (Fibromyalgia Activity Study with transcutaneous electrical nerve stimulation [TENS]) was the first study to conclusively demonstrate the clinical value of TENS for treating musculoskeletal pain. While physical therapists are trained in the use of TENS, it is underused in clinical practice. This project will test TENS in fibromyalgia patients receiving physical therapy in a real-world physical therapy practice setting. This research will determine if adding TENS to physical therapy reduces pain, increases adherence to physical therapy and allows fibromyalgia patients to reach their self-defined functional goals with less use of medication.

Chronic pain is a persistent source of disability and reduced quality of life for aging adults. Chronic pain-related outcomes are disproportionately worse for aging African Americans, who report greater pain severity and worse pain-related disability compared to White peers. A significant pain risk factor for African Americans is chronic stress (including family-related stress), which is worsened by structural inequities that affect this population. Although many African Americans identify family support as critical for pain self-management, this influence has not been studied thoroughly. This project will study how pain conditions develop and persist for aging African Americans by analyzing existing data from African American participants in two large aging studies: Midlife in the U.S. (721 participants) and the Health and Retirement Study (2,698 participants). The research aims to determine how family emotional climate affects pain risk, taking into account structural factors like discrimination, socioeconomic disparity, and the influence of various neighborhood settings.

Maternal opioid use disorder is the leading cause of death for women who die within a year of giving birth. Many pregnant women do not have access to prenatal care and medications known to be standard of care for opioid use disorder. This project will create, measure, and evaluate costs for an interactive dashboard that collects and analyzes data about maternal, newborn, and infant outcomes for pregnancies affected by opioid use disorder. This research will also monitor mothers’ use of medications for opioid use disorder and the number of infants born with neonatal withdrawal syndrome that require medication treatment.

Despite substantial increases in overdose deaths among people who use methamphetamine, little is known about how to effectively provide harm reduction services to these individuals. This project will combine and test two harm reduction interventions for people who use methamphetamine. First, peer recovery support specialists will help identify personal harm reduction goals. The project will also test the value of incentives toward achieving these goals (a strategy known as contingency management).

This project creates the HEAL Data2Action Modeling and Economic Resource Center that will conduct research as well as support the HEAL Data2Action Innovation Projects with expertise and consultation about simulation modeling and economic evaluation methods. The consultation service will advise on how to select and use various research methods, including economic evaluation, simulation modeling, advanced statistical analysis, behavioral economics, treatment program organization research, and cost analysis. The center will use a dynamic simulation model of opioid use disorder to enhance data-driven decision making. The center will also provide online training resources, tools, and other resources to assess a variety of economic aspects related to the HEAL Data2Action Innovation Projects.

This project will evaluate a previously developed harm reduction intervention that addresses the needs of women who use drugs in an urban environment. The approach uses a mobile van to offer naloxone, fentanyl test strips, and other harm reduction supplies – along with necessities such as food and clothing, brief trauma-informed counseling, and referrals to drug treatment, medical care, and social services. This research aims to test the impact of an intervention that may increase access to harm reduction services for women, as well as assess how to put it into place.

Harm reduction supplies include fentanyl test strips that allow people who use drugs to identify whether the substance(s) they plan to take contain fentanyl and sterile syringes that help to prevent the spread of infectious diseases among people who inject drugs. One potential way to increase access to harm reduction supplies is mail delivery. This project will describe state-level policies that deter the use of mail-based delivery of harm reduction services, examine characteristics of people who use mail-based harm reduction services, and assess individual preferences related to mail-based harm reduction services.

This project will use a data-to-action framework to guide implementation of opioid use disorder treatment and harm reduction interventions based on rapid data analysis. It will leverage existing data systems such as Emergency Medical Services (EMS) reports, mobile integrated health case management data, and medical examiner data for near real-time data analyses, visualization, and action planning. This research will collect a range of data (opioid treatment, use of acute care services, morbidity, mortality, incarceration, housing support, and cost benefits) from a sub-acute stabilization center for people at high risk for opioid overdose, including those who have recently overdosed and are referred and transported by EMS teams.

Numerous harm reduction strategies are available to reduce the harmful consequences of drug use. Examples include syringe services programs that provide sterile syringes, easy access to naloxone, and fentanyl test strips that may help people identify whether the substance(s) they plan to take contain fentanyl. This project aims to evaluate the use and effectiveness of several strategies in an urban environment as well as determine the openness and commitment of providers to offering them.