PCORI-Funded Research Addresses Pain and Opioid Use

As the nation’s growing opioid crisis continues to make headlines, the underlying problem of managing chronic pain gets less public attention. Around 100 million US adults experience chronic pain, according to the National Academy of Medicine, costing the nation up to $635 billion each year in medical treatment and lost productivity.

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We’ve heard from patients, clinicians, purchasers, payers, and other stakeholders that people dealing with pain need a range of safe, effective treatment options, and they also need information about how to use opioids appropriately and safely. In observance of Pain Awareness Month, we are sharing highlights of our research portfolio of 56 comparative clinical effectiveness research studies comparing which care approaches work better for managing pain unrelated to cancer and reducing opioid use, considering outcomes important to patients.

This week, PCORI is jointly hosting with Anthem a briefing in Washington, DC, on the need for evidence-based strategies to address America’s opioid epidemic. Among the speakers are our executive director, Joe Selby, MD, MPH, and Senator Shelley Moore Capito, of West Virginia.

Answering Questions Our Stakeholders Identified

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We recently issued a funding announcement and made several new awards to fill gaps in our understanding of treating pain and prescribing opioids safely. In August, we awarded just under $10 million to support two studies comparing the effectiveness of strategies designed to reduce unsafe opioid prescribing by improving pain management. And this month, we awarded $8.8 million to fund a study testing whether cognitive behavioral therapy or pain self-management therapy is more effective at alleviating pain and reducing opioid use.

We are expecting applications in October for research funding on treatment for pregnant women who have an opioid use disorder. Opioid misuse in pregnant women has increased dramatically in recent years. It can cause pregnancy complications for mothers and neonatal abstinence syndrome for babies. Medication-assisted treatment is an effective strategy for patients with an opioid use disorder. The treatment involves using methadone or buprenorphine, along with psychological services. But many providers don’t offer this treatment, and some pregnant women are reluctant to take the medications. So, PCORI has offered up to $16 million to fund research on ways to deliver medication-assisted treatment to pregnant women with an opioid use disorder.

Research Covering a Broad Array of Topics

Some of PCORI's existing studies assess what’s most effective in managing acute and chronic pain, comparing different therapies. Others evaluate what works best for preventing or reducing opioid reliance among people already using these drugs, and preventing and treating opioid use disorders.

And some of our earliest funded projects already have produced promising results. For instance, a study in Washington State compared clinics that did and did not implement an initiative prompting physicians to be more cautious in prescribing opioids. Physicians following the initiative prescribed fewer high opioid doses, and their patients reported no worse pain control.

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Many of our funded studies promise to have a major impact once the results are released. One study compares mindfulness meditation to cognitive behavioral therapy for people with chronic low back pain who already use opioids. These nondrug treatments could help people lower their opioid doses while easing pain. Another study is comparing group sessions of cognitive behavioral therapy with education about pain to help economically disadvantaged people deal with chronic pain. Compared with the general population, such people have not only a higher incidence of chronic pain but also less access to pain treatment. Preliminary results suggest that both interventions may be effective.

Improving care for chronic pain is a priority at PCORI. We clearly need more evidence-based information about how to better manage pain while reducing risk to patients. We look forward to working with patients, clinicians, and other stakeholders at every step as we attempt to make a dent in the many evidence gaps that still exist, and thereby help people make better-informed decisions about pain.