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NIH Record

NIH Pain Symposium Reinvigorates Field

By Stephanie E. Clipper

On the Front Page...

"It has no future but itself," wrote the poet Emily Dickinson about pain. Fortunately, the future is much brighter following a recent symposium called, "New Directions in Pain Research," held at the Natcher Conference Center.


The symposium, the first in a series of meetings on pain to be convened annually, served as the inaugural event of the recently established NIH Pain Research Consortium, which includes the participation of 21 NIH components. The meeting was also the first of its kind to bring together experts from the field of pain research with investigators from other scientific disciplines, including neurobiology.

The consortium got its start in 1996 and draws its membership from the directors of NIH institutes, offices and centers and their staffs. It is designed to promote pain research and to increase awareness in the various NIH ICs in order to stimulate collaborative research initiatives, to coordinate both intramural and extramural research programs, and to foster and maintain contact with research and patient communities.

"For the first time, scientists within the mainstream of pain research were exposed to the work of investigators who do not normally focus on this area," said NINDS health scientist administrator Dr. Cheryl Kitt, one of the organizers of the meeting. "In this way, we were able to bring new ideas, methodologies and techniques to pain researchers, where novel approaches to understanding and treating pain are greatly needed."

Dr. Kathleen M. Foley

Noted cancer pain specialist Dr. Kathleen M. Foley of Memorial Sloan-Kettering Cancer Center in New York presented a clinical overview of pain. "We at the bedside bring to you an enormous challenge," she said. "The message to the public is often, 'we can't treat pain.'"

Foley called the under-treatment of pain "a very serious public health issue," and made reference to "a national tragedy that is evolving." The statistics are staggering, she said. Pain costs the country $65 billion lost in work productivity per year and 4 billion work days lost -- 515 million of them by full-time employees -- with 40 million visits per year to physicians for "new" pain and $3 billion in sales each year of over-the-counter analgesics.

"Pain is often considered a subjective experience but it involves very, very specialized systems that have their own signature," said Dr. Ronald Dubner, formerly with the National Institute of Dental Research and now on the faculty of the University of Maryland's Dental School.

NIDR director Dr. Harold Slavkin chairs a panel on systems and imaging.

"The field of pain research is poised to benefit enormously from the revolution in modern biology that has occurred over the last few years," said former NINDS director Dr. Zach Hall, who cochaired the symposium with NIDR director Dr. Harold Slavkin. "We can expect to transform and reinvigorate the field."

"Bedside to bench may be just as important as bench to bedside," said NIDR intramural pain investigator Dr. Mitchell Max, who offered the participants a probing roundup of clinical opportunities in the field of pain research. "Well-designed human experiments are crucial to prioritize the large number of appealing hypotheses developed in animal experiments."

Max pointed out that because the field of pain research was largely founded by anesthesiologists, oncologists, neurologists and dentists, most clinical research in pain is focused in a few specialty areas, including postoperative pain, cancer pain, headache, nerve injury and facial pain.

"Although surgery can now be painless and cancer patients can be made remarkably comfortable, many chronic pain conditions remain resistant to treatment," he added, indicating a role for NIH in demonstrating feasibility studies and in designing methodology to further research.

"Conditions such as gastrointestinal, urological, gynecological and cardiac pain affect tens of millions of Americans, but as yet receive relatively little study in the clinic," Max said. "Recent discoveries at the bench about the basis of visceral pain offer great opportunities if we can attract specialists in these areas to explore the mechanisms and treatment of these disorders."

Dr. Ronald Dubner of the University of Maryland, formerly of NIDR.

The consortium has already given rise on campus to the formation of a Pain Interest Group and an NIH extramural staff work group on pain. The consortium is also expected to launch a Web page and a series of program announcements or RFAs. Summary reports from the meeting are scheduled to appear in the journals Neuron and Science.

"The time was right to have a meeting like this," said Dubner, who added that the meeting would serve as "the framework upon which the future of all pain management will be based."

In the next issue of the Record: "Glimpses into the Future of Pain Relief."

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