Two weeks ago was the occasion of the NIH Pain Consortium 7th Annual Symposium on Advances in Pain Research. It was a great meeting, and we heard some terrific science presented. Modern neuroscience is clearly opening up our understanding of how the brain processes painful stimuli, and is yielding insights about how emotional states (or even placebo pills) modify the processing of pain in the brain. We heard about intriguing work on novel therapeutic targets, such as the adenosine pathway, a long-time scientific interest of mine, and learned about a number of highly innovative approaches to the development of new analgesic drugs. I also really enjoyed hearing about rigorous studies testing nonpharmacological approaches, such as massage, behavioral therapies, and mindfulness meditation.
Nevertheless, all is not well. My delight with the good science was tempered by my awareness, that despite progress, we do not have satisfactory answers for many, perhaps most, patients with chronic pain. As one colleague at the meeting commented, the great strides we are making in basic research are just not automatically connecting to clinical results. The recent IOM Pain report is a powerful summary of how much remains to be done. Dr. Volkow, in her introductory comments, also reminded us of the enormous burden on our communities caused by the abuse of prescription pain medications. Clearly, there is a big gap between what patients and clinicians need and what we are achieving in pain management. A holy grail of analgesia research is the development of a drug that would retain the impressive impact of opioid receptors to reduce pain, but eliminate other opioid effects, such as depression, cognitive impairment, risk of falling, and potential for abuse. It is not clear whether this is possible, but certainly it is a desirable goal.
Clearly, drugs are, and will remain, critically important in managing pain, but drugs alone are not enough. There is another important piece to pain management—patients also need strategies for self-care and ways to harness the huge impact that context, attention, emotional state, and reassurance can have on pain. NCCAM is bringing a special contribution to pain research by pursuing promising, nonpharmacological approaches to pain management; about 30 percent of our total research budget is focused on pain. Our research is built on evidence, still incomplete, that various mind and body approaches, such as meditation, guided imagery, yoga, tai chi, massage, and spinal manipulation, may have value as adjuncts in pain management. Some of these techniques are being integrated into pain management in health care facilities around the country. And, while there is a growing evidence base for their value, and a number of “real world” testimonials, there are still many areas of uncertainty. It’s my belief that NCCAM, by funding the kind of research that builds a critical, rigorous evidence base, can truly have an impact on pain management.
But, there are so many unanswered scientific questions in this field. Thus, part of our task is continuing to work to define the most important questions that are amenable to rigorous study and will help meet the enormous needs. We want to hear from you: Where can science have the most impact on pain management? What do you see as the key research questions? What do you suggest as important priorities in this often equally perplexing and rewarding field?