Dr. Josephine Briggs, director of the National Center for Complementary and Integrative Health (NCCIH), spoke with NIH MedlinePlus magazine about research and complementary approaches to pain management.
What can you tell us about NCCIH's work and what you've learned about pain?
We see all sorts of clinical problems with conventional treatments for pain; both problems with opioids, and treatments that do not adequately address pain for some patients. Those problems have become a big driver of our work around pain management.
An interesting thing about pain is the impact emotions have on our perception of pain. Everyone is somewhat aware of the emotion and fear of pain from their own personal experience. It is clear that as one becomes more fearful, it can make the pain worse.
Like many of your readers, I do a bit of yoga. Sometimes in a yoga posture, something might hurt a bit, and it's uncomfortable. The teacher is saying "concentrate on your breathing," and that distracts me. There are ways in which your mental state can turn a little discomfort into lots of pain or the other way around. Pain is very susceptible to that.
What kinds of research is NCCIH currently doing on pain?
The Division of Intramural Research at NCCIH conducts basic, clinical, and translational research focusing on the role of the brain in perceiving, modifying, and managing pain. Our scientists are looking at the role of the brain in pain processing and control, and how factors such as emotion, attention, environment, and genetics affect pain perception.
For instance, evidence from a recent NCCIH-funded study suggests that regular and long-term practice of yoga may improve pain. This type of research is going very well.
There is also some evidence about the relationships between sleep disturbance and pain, and depressive disorders and pain, but the nature of these relationships is not well understood. Ongoing research is examining them further.
In 2014, NIH and the Department of Veterans Affairs (VA) funded 13 5-year studies to address pain and related conditions using non-drug approaches in U.S. military personnel, veterans, and their families. We are now getting ready to move forward with new plans to work with the VA and the Department of Defense (DoD) to do more research on pain management. We expect to launch these efforts very soon. Both the VA and the DoD are very eager to continue working with us on pain trials.
We're also very involved with various consortiums within NIH to develop a national strategy for pain. NCCIH led in the development of standards for back pain research. For instance, recently, a panel of experts on back pain determined what data need to be collected in clinical trials around back pain. These are usable across multiple studies.
How might the medical community change in the future as a result of some of this research on pain?
I think we all recognize as physicians that we haven't learned to use opioids in a way that helps people develop personal strategies for pain. I'm hoping that five or 10 years from now, we'll have the evidence that will contribute to more effective approaches.
Americans do turn to complementary practices for pain management. We know from data that many people living with pain try these various approaches for pain and many use them quite extensively. That includes relaxation techniques like breathing and meditation. It includes chiropractic, massage, and acupuncture. While we recognize that they are helpful to people, we really do not see them as integrated into conventional care yet to improve pain management. The evidence makes it promising, but we aren't quite there yet.