October 31, 2019
A portrait of Dr Robert Carter.
Robert H. Carter, M.D.

Dear Colleagues,

I’d like to take this opportunity to focus on what the National Institutes of Health (NIH) and the NIAMS are doing to help curb the opioid crisis that has impacted so many families across the nation. Many parts of the NIH have come together to enable the biomedical research community to uncover new solutions to this national problem. At NIAMS, we are contributing by working to find ways to reduce opioid misuse through research to improve treatments for musculoskeletal pain, particularly lower back pain. We hope this effort will ease the ongoing crisis while opening doors to create better, more sustainable treatments for pain.

NIH launched the Helping to End Addiction Long-termSM, or the NIH HEAL InitiativeSM, in April 2018. The initiative is an aggressive trans-agency effort focused on improving strategies for reducing opioid misuse and addiction, including enhanced management of pain to decrease overall opioid use.

To reverse the opioid crisis that continues to grip the nation, the NIH has awarded $945 million in total fiscal year 2019 funding for grants, contracts and cooperative agreements across 41 states through this initiative. The initiative aims to improve treatments for chronic pain, curb the rates of opioid use disorder (OUD) and overdose and achieve long-term recovery from opioid addiction.

NIAMS is leading a major component of the NIH HEAL Initiative, the Back Pain Consortium (BACPAC) Research Program. Back pain is among the most common forms of chronic pain in adults worldwide and is a major contributor to opioid use in the United States.

The BACPAC Research Program will:

  • Take an integrative approach to better understand the nature of chronic low back pain. Studies have traditionally looked at tissues and systems that contribute to low back pain – such as fascia, ligaments, bones, the vertebral column and the nervous system – in isolation. BACPAC will use an integrated model to look at how all the various components interact to contribute to chronic low back pain. For example, a 3-D kinematic model that encompasses all these tissues could show how abnormalities in one tissue alter the mechanics of others. When integrated with changes in both spinal pathways and secondary changes in the brain, this model will provide a more fundamental understanding of what drives pain. The precise abnormalities are likely to differ among individuals. Correlation of different abnormalities in the components of the back and the nervous system with different symptoms will help define individualized treatment strategies for different subsets of patients.
  • Develop new approaches to treat chronic low back pain. Several therapies have yielded some benefit in some people with chronic low back pain. BACPAC will examine therapeutic strategies that involve multiple interventions – together or in sequence – that treat the mind and the body. In addition, using the linkages between symptoms and types of abnormalities, this multimodal approach will include developing algorithms to predict which therapies will work best for which patients. These personalized treatment plans will be followed by efficacy studies.
  • Create new technical approaches to understanding the mechanisms and treatments of the condition. BACPAC will conduct clinical trials of interventions that are ready to treat patients now. In addition, the program will promote the development of new technologies for back pain diagnosis and treatment. The improved models of the drivers of back pain are also intended to lead to new treatment interventions. BACPAC provides hope for improved interventions, including those targeted to specific causes of pain in different people.

The NIH HEAL Initiative provides a unique opportunity to address chronic low back pain through a collaboration of mechanistic research centers, technology sites and networks. The effort will help us better understand the condition and identify individually-tailored treatments.

To learn more about the program, including a list of funded projects, visit the Back Pain Consortium Research Program. More information on the initiative can be found on the NIH HEAL Initiative website.

Robert H. Carter, M.D.
Acting Director
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health