Appropriations Watch FY2022
Attn: Those Interested in NIH HEAL Initiative Funding
s we reported last month, we are still awaiting passage of the appropriations bill that will finalize the NIH budget for the 2022 Fiscal Year. On February 17, the Senate passed a third FY2022 continuing resolution, this time extending the Congressional deadline to March 11, 2022.
A number of important pain-related research concepts have been cleared for funding, pending appropriation. As we are awaiting passage of the appropriations bill that will finalize the NIH budget, it is important to know that new Request for Applications (RFAs) are likely coming soon and will require swift action when they do. This year’s anticipated appropriation includes a sizable $270M increase in HEAL Initiative funding. To ensure potential applicants aren’t caught off guard with quick turnaround for submission (a timeline caused due to the stalled legislation), NIH is working to apprise interested parties that new proposals may be released soon. If this extra funding is approved, it will have to be spent by the end of the 2022 fiscal year.
Numerous important research concepts have been cleared for funding, pending appropriation, at a recent NIH HEAL Initiative meeting. Likely-to-be-funded concepts can be found here. RFAs for these concepts are not expected to be released before late February.
CDC Releases Opioid Guideline for Public Comment
The CDC has officially released the draft CDC Clinical Practice Guideline for Prescribing Opioids—United States, 2022. The docket is now open for public comment, and it will remain open until April 11, 2022.
In order to discuss the guideline and possibility of a collective response, AACIPM facilitated a multi-stakeholder Zoom meeting on February 18th with 45 leaders representing over 30 national organizations. The perspectives included a wide range of multidisciplinary health care providers, payers, purchasers, academia, policymakers, people living with pain, and more. Many of the guideline’s proposed updates were discussed, including its:
- Promotion of integrative pain management, including both non-pharmacological therapies and team-based care.
- Application of the guideline to additional clinician types.
- Call to health systems and payers to ensure that multimodal pain treatments are available, accessible, and reimbursed.
- Emphasis on the clinician and patient jointly determining treatment goals.
- Removal of arbitrary dosage ceilings.
If you would like to learn more about the proposed changes, the National Pain Advocacy Center has developed a spreadsheet that directly compares the twelve recommendations from the 2016 guideline and the 2022 update.
A writing group has been established to prepare a collective response to the proposed updates on behalf of the AACIPM community of stakeholders. If you are a leader of an organization or policy group interested in learning more about this effort, contact Amy Goldstein, Director, AACIPM.
NASEM Releases ‘Traumatic Brain Injury: A Roadmap for Accelerating Progress’
Important Opportunity to Connect More Dots
NASEM has released a new report on traumatic brain injury (TBI) that calls for a transformation of attitudes, understanding, investments, and care systems for TBI. Traumatic Brain Injury: A Roadmap for Accelerating Progress examines the current landscape of basic, translational, and clinical TBI research and identifies gaps and opportunities to accelerate research progress and improve care with a focus on the biological, psychological, sociological, and ecological impacts.
“Because of the co-morbidity associated with TBI and with chronic pain – and the very substantial overlap between these two, especially related to motor vehicle accidents, violent crimes, natural disasters, severe sports injuries, combat wounds and others, I believe AACIPM can help in moving the translation of science and best practices forward,” said Eric Schoomaker, MD, PhD, FACP, Lt. General, US Army (RET), AACIPM Advisory Committee member and member of the NASEM task force responsible for this TBI project.
AACIPM invites groups interested in this intersection to reach out to Amy Goldstein, Director, AACIPM.
FDA Issues Draft Guidance on Developing Non-Opioid Analgesics for Acute Pain
The FDA has published draft guidance for industry entitled Development of Non-Opioid Analgesics for Acute Pain. The guidance provides recommendations about three specific topics: development of non-opioid analgesic products for acute pain, labeling claims, and expedited programs as they pertain to this purpose. Further, it stresses the FDA’s commitment to providing non-addictive alternatives to opioids and decreasing exposure to opioids.
The FDA will accept public comments on the draft guidance until April 11, 2022.
AMA Releases State Toolkit to Reduce Overdoses and Remove Barriers to Evidence-Based Care
The American Medical Association (AMA), in partnership with Manatt Health, has released their State Toolkit to End the Nation’s Drug Overdose Epidemic: Leading-Edge Actions and Strategies to Remove Barriers to Evidence-Based Patient Care. In addition to its focus upon increasing access to evidence-based substance use disorder treatment and ensuring access to addiction medicine and other trained physicians, the toolkit dedicates substantial effort toward encouraging the enforcement of parity laws and improving access to multidisciplinary, multimodal care for patients with pain.
The toolkit contains resources for policymakers regarding:
- Promoting access to evidence-based interdisciplinary pain management delivery models;
- Advancing medical education curriculum focused on evidence-based, compassionate care for patients with pain; and,
- Protecting provider discretion to develop individualized treatment plans.
SCOTUS to Consider Landmark Opioid Prescribing Cases
Next month, the U.S. Supreme Court will consider U.S. v. Ruan and U.S. v. Kahn, two cases that will have significant implications for health care providers and people living with pain. The cases will determine under what circumstances lawful prescribing crosses the line into unlawful drug distribution. The cases reflect many that we have heard in recent years: the doctors have argued they were acting in good faith trying to provide care for their patients, while the government has accused them of “acting as drug dealers, lining their own pockets by dispensing addictive, dangerous, and lethal drugs, aware all the while that their profit-seeking came at the expense of their patients’ health.”
A number of pain advocates have filed amicus curiae, or “friend of the court,” briefs, arguing that current interpretations of the Controlled Substances Act have had a chilling effect on pain care, causing medical providers to be less willing to treat people with people pain or to prescribe opioids or other regulated medications—even when they believe these medications are necessary—because they fear criminal prosecution.
NIH and NIDA Continue to Fund Various Pain-related Projects
Funding opportunities related to pain management, integrative care, and other related topics continue to abound.
The NIH HEAL Initiative currently has open funding opportunities related to:
- Secondary Analysis and Integration of Existing Data Related to Acute and Chronic Pain Development or Management (LOI Due 3/01)
- Restoring Joint Health and Function to Reduce Pain Consortium (LOI Due 3/11)
- Discovery and Functional Evaluation of Human Pain-Associated Genes and Cells (LOI Due 6/07)
- Discovery and Validation of Novel Targets for Safe and Effective Pain Treatment (LOI Due 5/02)
NIDA is currently aiming to fund:
- Public Health Research on Cannabis, including impact of polysubstance use on health outcomes, including interactions (substitution/complementation) of cannabis product use with alcohol, tobacco, and prescription and nonprescription opioids. (Begins accepting applications June 5, 2022)
Message from the Director
There is a great deal happening on the national scene that impacts access to whole person, integrative pain management. AACIPM strives to build unique and meaningful collaboration across stakeholders that can leverage the collective strength and lead to practical action that will change the paradigm.
I encourage you to look at NASEM’s report on Traumatic Brain Injury and consider Lt. General Schoomaker’s comment about ways that we can synthesize efforts (see blurb above). AACIPM welcomes any thoughts from you that can connect more dots across our efforts.
We have a number of resources in development and are excited to share them with you in the coming weeks and months.
Onward and Upward!
Using Mindfulness and Compassion for Long COVID, Psychology Today, February 26
Scientific Knowledge Graph and Trend Analysis of Central Sensitization: A Bibliometric Analysis, Dovepress, February 24
Pregnant People Who Use Opioids Face Significant Barriers to Treatment, Everyday Health, February 22
Managing Chronic Pain in Adults: The Latest Evidence on Psychological Therapies, The Good Men Project, February 19
Revised CDC Opioid Guideline a ‘Band Aid for a Stab Wound’, Pain News Network, February 18
Exploring the Present and Future of Pain Management, Columbia News, February 18
The CDC should rescind, not ‘update,’ its 2016 opioid guideline, The Hill, February 18
Art as a Tool to Manage Pain—Swapping the heating pad for pastels and colored pencils, MedPage Today, February 15
Long COVID’s Pain, Neurologic Effects Understudied, Pain Medicine News, February 14
To Lose My Chronic Pain, I Had to Find My Rage, MS Magazine, February 12
New clues in the brain linking pain and food, ScienceDaily, February 11
CDC proposes new prescription opioid guidelines for caregivers, Washington Post, February 10
Chronic pain precedes disrupted eating behavior in low-back pain patients, PLOS One, February 10
Muscle pain, fatigue, brain fog: Doctors grapple for answers about long COVID in kids, NorthJersey.com, February 10
How Mindfulness Helps Me Cope With RA, HealthCentral, February 9
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Chronic Pain Gets Its Own Condition Under ICD-11, February 7
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Telemedicine: Changing the Management of Chronic Pain, Clinical Pain Advisor, February 4
Can acupuncture treat irritable bowel syndrome?, Medical News Today, January 28
Effects of Music Therapy on Quality of Life in Adults with Sickle Cell Disease (MUSIQOLS): A Mixed Methods Feasibility Study, Journal of Pain Research, January 2021