Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing (PRISM)
The Research Need
Recent decades have seen an overreliance on the prescription of opioids for chronic pain, which has contributed to an epidemic of opioid overdose deaths and addiction. Research has shown that non-opioid pain management interventions can be effective for treating acute and chronic pain.
More support is needed to assess the impact of evidence-based health care strategies and clinical practices and procedures when they are included in health care systems. Pragmatic and implementation trials could identify strategies to most effectively implement evidence-based interventions and pain management guidelines.
About the Program
The Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing (PRISM) project will support multiple pragmatic trials to conduct research embedded in health care systems. These trials will determine the effectiveness of multiple non-opioid interventions for treating pain and assess the impact of implementing interventions or guidelines to improve pain management and reduce reliance on opioids.
Through the Helping to End Addiction Long-termSM Initiative, or NIH HEAL InitiativeSM, NIH has awarded four grants to fund research aimed at managing pain and reducing opioid prescribing. These awards total approximately $35.7 million. Each awardee will conduct a pragmatic clinical trial aimed at improving the availability of, effectiveness of, and adherence to evidence-based, non-drug pain management.
This funding will also be used to establish the PRISM Resource Coordinating Center at Duke University. The center will provide technical support and pragmatic trial expertise for the research that this program funds.
Research institutions will undertake the following types of studies to determine the effectiveness of interventions for pain and assess the impact of implementing interventions to improve pain management within health care systems:
- Testing the use of decision support tools embedded in electronic health records to help patients and clinicians choose nondrug pain care after surgery and to improve patients’ role in managing their chronic pain
- Determining whether physical therapy (PT) plus transcutaneous electrical nerve stimulation in women with fibromyalgia is more effective than PT alone at community PT clinics
- Evaluating the effectiveness of incorporating a sustainable and billable mindfulness-based stress-reduction program into a primary care treatment for chronic low back pain
- Employing primary spine practitioners, such as chiropractors and physical therapists, as first-line providers of nondrug care for low back pain
- Conducting a clinical trial in older adults (aged 65 years or older) with chronic low back pain to evaluate whether acupuncture is effective in this patient population
Lead Trial Research Institutions
- Boston Medical Center – Massachusetts
- Kaiser Foundation Research Institute – California
- Mayo Clinic – Minnesota
- University of Iowa – Iowa
Resource Coordinating Center
- Duke University – North Carolina
Participating NIH Institutes, Centers, and Offices
- National Center for Complementary and Integrative Health (NCCIH)
- National Institute on Aging (NIA)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- National Institute on Drug Abuse (NIDA)
- National Institute of Nursing Research (NINR)
- Office of Behavioral and Social Sciences Research (OBSSR)