The purpose of this FOA is to solicit UG3/UH3 phased cooperative agreement research applications to conduct efficient, large-scale pragmatic clinical trial and/or implementation science Demonstration Projects within the infrastructure of the NIH-DOD-VA Pain Management Collaboratory (PMC) on nonpharmacologic approaches to pain management and other comorbid conditions in U.S. military personnel, veterans and their families. The PMC established a Coordinating Center that provides national leadership and technical expertise for all aspects of health care system (HCS)-focused research including assistance to UG3/UH3 grant awardees.
Since 2001, more than 2.77 million U.S. troops have been deployed for Operation New Dawn, Operations Enduring Freedom (OEF) in Afghanistan and Iraqi Freedom (OIF) in Iraq. The all-volunteer military experienced multiple redeployments to the war zone, extensive use of the reserve components of the military and National Guard, that also involved the deployment of women and parents of young children. Many of these deployed service members sustained severe injuries that in previous wars would have resulted in death. Significant and continuing improvements in outer tactical vests (body armor) and helmets have saved lives. However, despite these improvements, many service members returning from these operations, and from other military operations, experienced pain, traumatic brain injuries (TBIs), symptoms of post-traumatic stress disorder (PTSD), suicidal thoughts or behaviors, substance abuse, and/or related comorbidities. Studies report nearly 45% of active-duty service members and 50% of veterans experience pain on a regular basis and there is significant overlap between chronic pain, PTSD, and persistent post-concussive symptoms. There is an ongoing challenge with pain among military and veteran populations and an incomplete evidence base for effective pain management. Opioid medications are often prescribed for the treatment of chronic pain, despite the association of chronic opioid use with the potential for misuse and they often fail to adequately control pain. As a result, there continues to be a need for additional nonpharmacologic approaches to complement or replace pharmacological strategies for pain management and to reduce the needs and risks associated with excessive reliance on opioids.
In June 2011, the Institute of Medicine (IOM) released a Consensus Report on “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research” (http://iom.edu/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research.aspx). The report notes that chronic pain affects an estimated 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity. The report notes that ideally, most patients with severe persistent pain would obtain pain care from an interdisciplinary team using an integrated approach that would target multiple dimensions of the chronic pain experience including disease management, reduction in pain severity, and improved functioning, emotional well-being, and health-related quality of life.
The NIH, DOD, and VA have been working individually and collaboratively to develop and improve pain management approaches for military personnel, veterans, and their families. In 2014, NCCIH partnered with the National Institute on Drug Abuse (NIDA) and U.S. Department of Veterans Affairs (VA) to fund 13 grants to research military and veteran health with a focus on nonpharmacologic approaches to pain and related conditions. This important partnership was expanded in 2017 to include the Department of Defense (DOD) and additional NIH agencies (NINDS, NIAAA, NICHD, ORWH, OBSSR, and NINR) to initiate the NIH-DOD-VA Pain Management Collaboratory (PMC). The first wave of the Pain Management Collaboratory resulted in the support of 11 research projects focused on the development and testing of nonpharmacologic approaches to pain management as well as a Coordinating Center.
Military and veteran health care systems (HCS) and other HCS that provide services to military personnel, veterans and their families are the targeted organizations for this program. Research conducted in partnership with eligible VA and DOD health care providers is essential for obtaining meaningful and relevant research results in ‘real world’ health care delivery systems serving veterans and service members.
Team-based care is increasingly recognized as fundamental to effective health care systems. Defined as the interprofessional, multidisciplinary team approach to patient-centered care coordinated across a variety of systems, the National Academy of Medicine (formerly known as the Institute of Medicine) predicts team-based care models willcut down significantly on health care costs, estimating savings of $240 billion annually in national health care expenditures.
Despite the recognized and compelling need for research to identify and implement effective complementary nonpharmacologic approaches for pain management and comorbid conditions in military and veteran populations, many challenges exist. Ethical and regulatory issues must be addressed to perform research in health care delivery settings. Health care providers focus on providing the best treatment, based on current knowledge, whereas research typically focuses on studying which treatments work best in a precisely defined population. Further, research studies have frequently used endpoints that are not part of routine patient assessments of care and may support adoption of interventions that are challenging to implement in many health care delivery settings. Multiple challenges remain in identifying the best strategies to successfully integrate evidence-based interventions within specific health care settings. Bridging the gap between research and practice is an important step in the direction of providing increased effective treatment options to patients.
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Filed Under: Funding Opportunities