These are unprecedented times calling for targeted research by the National Center for Complementary and Integrative Health (NCCIH) and the wider National Institutes of Health (NIH) community. Plans and actions focus on the opioid epidemic and the problems with which it is often associated: most prominently, pain, especially chronic pain; substance misuse and addiction; and mental health problems.
In April, NIH launched the HEAL (Helping to End Addiction Long-term) initiative, a large interagency effort to accelerate scientific solutions to stem our national public-health crisis related to opioids. HEAL is designed to speed NIH research to enhance pain management and improve treatments for opioid addiction (more information is available on the HEAL website).
Since then, NCCIH and other agencies have been identifying and developing areas they think would benefit from focused efforts, on their own or in partnerships. The study of nonpharmacologic treatments and integrated approaches to manage pain are among HEAL’s major elements and have been longstanding commitments at NCCIH.
The initial research plan for HEAL was outlined in a JAMA Viewpoint on June 12 by Dr. Francis Collins, NIH Director; Dr. Walter Koroshetz, Director of the National Institute of Neurological Disorders and Stroke (NINDS); and Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA).
To offer my perspective: The plans for HEAL include short-term and long-term goals. The Viewpoint details several activities/themes pertinent to NCCIH: (1) identifying new treatment options for addiction and optimizing effective existing therapies; and (2) enhancing pain management, via improved understanding of chronic pain and developing new, nonaddictive pain treatments. These areas have been priorities in NCCIH’s Division of Intramural Research (DIR) and extramural portfolio in recent years.
In DIR, for example, I’m excited about plans to develop a pain center as a “core facility” of the NIH Clinical Center. We envision investigators coming together from across NIH to study biological mechanisms of pain and novel therapeutic approaches at the Clinical Center. Studying mechanisms as well as other factors in chronic pain (e.g., cognitive, emotional, and psychosocial ones) may yield insights on this complex and often debilitating condition.
Drs. Collins, Koroshetz, and Volkow also noted that further resources will be directed to “gaps in current plans,” including “precision medicine for pain and addiction, and nonpharmacological and integrative models of pain management…[and as part of HEAL’s ambitious vision] nonaddictive management strategies for chronic pain, whether pharmacological, device-based, behavioral, or integrative interventions, will be made available to individuals based on objective knowledge of what is likely to work best for them.”
Part 2 of Dr. Shurtleff’s update on this topic will appear on July 26, 2018.