The National Institutes of Health has launched the Acute to Chronic Pain Signatures (A2CPS) program to investigate the biological characteristics underlying the transition from acute to chronic pain. The effort will also seek to determine the mechanisms that make some people susceptible and others resilient to the development of chronic pain. A2CPS is part of the NIH-wide HEAL (Helping to End Addiction Long-term) Initiative, an aggressive, trans-NIH effort to speed scientific solutions to stem the national opioid public health crisis. The high prevalence of chronic pain in the United States, and the reliance on opioids for its management, has created an urgent need for safer, more effective pain control. Though A2CPS is part of the HEAL Initiative, its anticipated $40.4 million four-year budget is supplied by the NIH Common Fund, and is an additional investment to enhance research on pain and opioid addiction beyond funds already allocated to HEAL.
A major challenge in pain care is to prevent chronic pain from developing after an initial painful event. For most people, pain goes away as an injury heals. For many others, the pain persists beyond healing of the initial event, and can last for years or even a lifetime. Changes that occur in the body and brain during the development of chronic pain are poorly understood.
“Our lack of understanding of how acute pain becomes chronic pain has limited our ability to target effective preventive and treatment strategies to patients,” said NIH Director Francis S. Collins, M.D. Ph.D. “The ability to identify those at risk will increase our understanding of pain, accelerate therapy development, and ultimately may guide chronic pain prevention strategies tailored for those at risk for chronic pain.”
The A2CPS program will collect data from patients with acute pain associated with a surgical procedure, and patients with acute pain from a musculoskeletal trauma such as a broken bone. Neuroimaging, high-throughput biomedical measurements, sensory testing, and psychosocial assessments collected periodically after the acute pain event will form a comprehensive data set to help predict which patients will develop chronic pain.
The goal of these studies is to identify individual patient features that together will provide clinically meaningful, predictive “signatures” of transition or resilience to chronic pain. If these large-scale longitudinal studies successfully identify predictive signatures, then additional studies that include patients with other acute pain events will be considered. The data gathered from this NIH Common Fund project and any later studies will enable the research community to explore additional signatures predictive of transition or resilience to chronic pain. Using biological signatures to predict who might be at risk for developing chronic pain would be valuable in guiding precision medicine approaches to prevent chronic pain, and by doing so, reduce reliance on opioids.
Funding Opportunity Announcements for researchers to apply to participate in the A2CPS program are now available. NIH is seeking applications for multisite clinical centers for the surgical and musculoskeletal pain studies, a clinical coordination center, omics data generation centers, and a data integration and resource center. Applications are due October 24, 2018. Once the program’s researchers are selected, they will enter a planning year to prepare for study launch and patient recruitment. Recruitment for approximately 1,800 participants per study could begin as soon as 2019.
The A2CPS program is supported by the NIH Common Fund and is managed by a trans‐NIH working group representing multiple NIH Institutes and Centers, led by the Office of the Director, the National Institute on Drug Abuse, and the National Institute of Neurological Disorders and Stroke.