Guest Editorial

By Dr. David A. Thomas, NIH/NIDA

Dear Reader,

The National Institutes of Health (NIH), a component of the United States Department of Health & Human Services, with an annual budget exceeding 30 billion dollars, is the world’s largest funder of biomedical research. The NIH funds both basic and applied research on nearly all aspects of disease and health.

The National Institute on Drug Abuse (NIDA), part of the NIH, is among the leading funders of pain research at the NIH. In addition to programs in basic pain research and research on the connections between pain and drug abuse, NIDA has a strong translational pain research program. The focus of this program includes research on reducing the abuse liability of some commonly used analgesics and developing novel pain medications with little abuse liability. Further, NIDA has a long history of funding the development of non-pharmacological technologies to treat pain, including the application of “cyber” technologies (e.g. virtual reality and emedicine).

NIDA does not stand alone at the NIH in its support and development of various technologies to treat pain, including cyber technologies. NIDA and many other NIH Institutes are members of the NIH Pain Consortium, which was established in 1996 by an act of The United States Congress to “…enhance pain research and promote collaboration among researchers across the many NIH Institutes and Centers that have programs and activities addressing pain.”

By law, the NIH must issue announcements of areas of research interest. One major series of pain research funding announcements, issued by nine Institutes and developed in cooperation with the NIH Pain Consortium, is titled Mechanisms, Models, Measurement, & Management in Pain Research. In these announcements, many examples of interests in technologies to either measure or treat pain are given. In fact, one bullet specifically mentions “virtual reality.”

Why such an interest at NIDA, and across the NIH, in technologies to treat pain? Approximately 50 million people in The United States alone suffer from chronic pain, and each case is somewhat different. There exists no single pain treatment that is good for everyone, or even the majority of people. Research findings are making it abundantly clear that pain has many causes and courses, and can impact individuals in a multitude of ways including on the behavioral, physiological, cognitive, emotional, psychological, social and spiritual levels. It can impact a person’s productivity at work, and the lives of their friends and family. Further, pain and analgesic efficacy varies with individual factors such as age, ethnicity, sex, and genetics. Additionally, personal history differences, such as a history of chronic pain or drug abuse, can also have an impact on how pain is felt, how it impacts ones’ life and how well analgesics work.

Just as pain varies in many ways, pain treatments need to vary and be individualized. Research is showing that cyber technologies offer one viable option. These technologies are showing promise in reducing pain, either alone or as adjunctive therapies.

The challenges will be to discover how to better harness the power of these therapies to treat pain, to identify those patients who will benefit, and to facilitate the adoption of these technologies into clinical practice.

The NIH is committed to supporting research on understanding and reducing pain and suffering, and this includes research on cyber technologies. Although the field of “cybertherapy” is in its infancy, researchers in this field have great passion and vision, and findings thus far are more than encouraging for an array of applications, including pain treatment. With continued commitment by the NIH and the cybertherapy research community, these technologies will likely be developed to the point where wide clinical application is not only feasible, but essential.

David A. Thomas, Ph.D.                                                                                           Program Officer Division of Basic Neuroscience and Behavioral Research National Institute on Drug Abuse                                                                               National Institutes of Health