THANK YOU, EVERYONE, FOR JOINING
US.
FOR THOSE OF YOU WHO DON'T KNOW
ME BY FACE, ONLY BY EMAIL, I'M
LEAH POGORZALA.
I AM A POLICY DIRECTOR IN THE
OFFICE OF PAIN POLICY AND
PLANNING, AND I HAVE TAKEN OVER
THE ROLE AS THE DESIGNATED
FEDERAL OFFICIAL FOR THE IRPCC.
LINDA IS OUT OF THE OFFICE
TODAY, SO SHE WILL NOT BE ABLE
TO JOIN THIS MEETING.
SO IT IS MY DUTY AND PLEASURE TO
WELCOME YOU ALL TO THIS MEETING.
IT IS ALSO MY RESPONSIBILITY TO
TAKE CARE OF ALL THE COMMITTEE
BUSINESS.
SO I'M GOING TO GO THROUGH VERY
QUICKLY A COUPLE OF INTRODUCTORY
THINGS TO SAY AND THEN WE HAVE A
FEW THINGS WE NEED TO VOTE ON.
SO AS I SAID THANK YOU ALL FOR
JOINING THIS IRPCC MEETING.
WE HAVE A PRETTY FULL AGENDA.
WE'RE GOING TO HAVE SOME OPENING
REMARKS FROM DR. LANGEVIN, THEN
WE ARE GOING TO HAVE A
SCIENTIFIC PRESENTATION FROM DRE
GOING TO GET SOME PRETTY
SIGNIFICANT UPDATES FROM OUR
FEDERAL PARTNERS.
THE IRPCC IS UNDERGOING -- WE'RE
TRYING TO DO A LITTLE BIT OF A
REFRESH OF THE COMMITTEE AND SO
WE ARE HAVING OUR PARTNERS GIVE
AN OVERVIEW OF THEIR ACTIVITIES.
AND WE'RE GOING TO HEAR FROM
SOME WORKING GROUPS THAT WE HAVE
STARTED.
AND WITH THAT, LET'S GET INTO
IT.
SO EARLIER -- LAST WEEK AND THEN
I BELIEVE TODAY -- OH, I
APOLOGIZE.
I JUST GOT AN ECHT M EMAIL FROM
SOMEBODY.
JEFF, I GOT AN EMAIL SAYING THAT
THE VIDEOCAST LINK IS NOT ON THE
VIDEOCAST WEBSITE.
SO I JUST WANTED TO LET YOU KNOW
THAT I GOT THAT EMAIL.
SORRY.
SO LET ME GO AHEAD AND GET
STARTED.
SO EARLIER, A COUPLE OF WEEKS
AGO I THINK WHEN I SENT YOU THE
AGENDA, I SENT THE MINUTES FOR
THE LAST MEETING.
HOPEFULLY YOU'VE HAD A CHANCE TO
LOOK AT THEM.
IF YOU HAVEN'T, IF YOU HAVE
THEM, YOU COULD LOOK AT THEM
NOW.
WE NEED TO APPROVE THOSE
MINUTES.
THAT IS ONE OF THOSE THINGS THAT
WE NEED TO VOTE ON.
SO I'M GOING TO GIVE YOU A
COUPLE OF MINUTES.
TO LOOK AT THOSE IF YOU HAVEN'T
HAD A CHANCE, AND THEN I'LL NEED
A MOTION TO APPROVE IF SOMEONE
COULD JUST PUT IT -- YOU COULD
JUST PUT IT IN THE CHAT OR YOU
CAN SPEAK UP.
>> MOTION TO APPROVE.
>> THANK YOU, BETH.
>> SECOND.
CHRISTINE.
I SECONDED.
>> OKAY.
THANK YOU.
SO IF YOU COULD JUST PUT APPROVE
OR DISAPPROVE IN THE CHAT,
REALLY IF YOU HAVE ANY COMMENTS
OR IF YOU GO THROUGH THEM MORE
CAREFULLY LATER AND NOTICE
ANYTHING, FEEL FREE TO REACH OUT
TO ME AND I CAN MAKE ANY
CHANGES, BUT WITH THAT, THE
MINUTES HAVE BEEN APPROVED, AND
I NEED TO MOVE ON TO THE SECOND
PIECE OF BUSINESS THAT WE HAVE
TO VOTE ON.
SO EVERY -- WELL, ACTUALLY
WHENEVER CHELSEA FROM THE FACA
OFFICE TELLS ME WE NEED TO VOTE
ON THE CHAIR FOR THE COMMITTEE.
SO IT IS TIME TO VOTE.
DR. LANGEVIN HAS AGREED TO
CONTINUE ON AS THE CHAIR, IF WE
WOULD LIKE TO KEEP HER ON.
I WOULD NEED A MOTION TO
NOMINATE, IF ANYONE HAS ANYTHING
ELSE THEY'D LIKE TO SAY, NOW
WOULD BE THE TIME.
>> I MOVE TO NOMINATE
DR. LANGEVIN.
>> I SECOND.
>> OKAY.
SO DO WE HAVE ANY DISSENTS?
IF NOT, IF YOU COULD VOTE TO
APPROVE, I THINK I'M SEEING
APPROVALS.
WONDERFUL.
THANK YOU.
AND THANK YOU TO DR. LANGEVIN
FOR AGREEING TO CONTINUE ON AS
THE CHAIR.
AND SO WITH THAT, I WOULD LIKE
TO TURN IT OVER TO DR. LANGEVIN
FOR HER OPENING REMARKS.
THANK YOU ALL AGAIN FOR JOINING.
>> THANK YOU SO MUCH, LEAH, AND
THANK YOU ALL FOR TRUSTING ME
WITH CONTINUING IN THIS ROLE.
ARE WE ALL OKAY WITH THE
VIDEOCAST NOW?
I DON'T KNOW, I GUESS WE'LL KEEP
GOING ANYWAY.
SO I'M REALLY EXCITED ABOUT THIS
PROGRAM WE HAVE TODAY,
INCLUDING, AS LEAH MENTIONED, A
PRESENTATION BY DR. DIANA
BURGESS, AND WE'RE SO EXCITED
ABOUT THIS BECAUSE THIS IS BASED
ON THE RESULTS OF THE FIRST
TRIAL FROM THE NIH DOD VA PAIN
MANAGEMENT COLLABORATORY THAT
HAS BEEN COMPLETED AND ITS MAIN
RESULTS PUBLISHED IN JAMA
INTERNAL MEDICINE EARLIER THIS
YEAR.
SO THIS IS REALLY QUITE A
MILESTONE.
AND I ALSO WANT TO THANK ALL THE
IRPCC MEMBERS WHO HAVE JOINED
THE THREE WORKING GROUPS AND
HAVE SHARED THEIR TIME AND
EXPERTISE.
THE WORKING GROUPS HAVE MET NOW
A FEW TIMES SINCE THE LAST IRPCC
MEETING, SO THE RESILIENCE AND
PREVENTION IN CHRONIC PAIN --
PREVENTION OF CHRONIC PAIN
WORKING GROUP, THE WORKFORCE AND
PROVIDER TRAINING WORKING GROUP
AND THE IMPLEMENTATION SCIENCE
WORKING GROUP.
AND WE'RE GOING TO HEAR UPDATES
FROM THEM LATER, FROM EACH OF
THESE GROUPS.
AND TODAY, I'M ALSO VERY HAPPY
THAT WE ARE GOING TO HAVE A
SPECIAL PRESENTATION ON
RESILIENCE AND WELLNESS BY
DR. CHRISTINE SPELL MAN, THE
EXECUTIVE DIRECTOR OF THE MAY
DAY FUND TOGETHER WITH DR. SCOTT
FISHMAN, AND WE ALSO ARE
DELIGHTED THAT DR. LAVERNE BROWN
WAS ABLE TO JOIN US TODAY.
DR. BROWN IS THE CHAIR OF THE
TRANS-NIH RESILIENCE WORKING
GROUP THAT WAS ESTABLISHED TO
FACILITATE THE COORDINATION AND
HARMONIZATION OF A RESILIENCE
RESEARCH AGENDA ACROSS ALL OF
NIH.
SO BEFORE INTRODUCING
DR. BURGESS AS OUR FIRST SPEAKER
I WOULD LIKE TO TAKE A FEW
MINUTES TO GIVE THE CONTEXT OF
THIS IMPORTANT TRIAL THAT
DR. BURGESS IS GOING TO TELL US
ABOUT CALLED THE LAMP TRIAL.
I'M GOING TO SHARE A COUPLE OF
SLIDES HERE.
NOW THIS TRIAL IS INTERESTING,
AS FOR MANY REASONS, AND ONE OF
THEM IS IT KIND OF STANDS AT THE
INTERSECTION OF THREE REALLY
IMPORTANT PROGRAMS.
THE PAIN MANAGEMENT
COLLABORATORY, THE NIH PRAGMATIC
TRIAL COLLABORATORY, AND THE
HEAL INITIATIVE.
AND I'M GOING TO TELL YOU A
LITTLE BIT OF A TIMELINE STORY
AS TO THE CONTEXT SO THAT YOU
CAN REALLY SEE HOW REALLY
CRITICAL THIS WHOLE PUZZLE THAT
WE'RE PUTTING TOGETHER IS IN
ADVANCING PAIN RESEARCH.
SO FIRST LET'S TALK ABOUT THE
PAIN MANAGEMENT COLLABORATORY.
SO THIS WAS A PROGRAM THAT WAS
STARTED BACK IN 2017.
AND IT'S A COLLABORATION BETWEEN
THE NIH, THE DEPARTMENT OF
DEFENSE, AND THE VETERANS'
ADMINISTRATION, AND THIS IS IN
RECOGNITION OF THE VERY EXTREME
BURDEN, REALLY, OF PAIN IN
MILITARY POPULATIONS, BOTH
ACTIVE DUTY AND VETERANS, THAT
THEY SUFFER FROM PAIN, CHRONIC
PAIN, ESPECIALLY
DISPROPORTIONATELY TO THE REST
OF THE POPULATION.
A LOT OF THIS PAIN STEMS FROM
INJURIES THAT ARE SUSTAINED
WHILE IN COMBAT AND THEN THAT
RESULTS IN CHRONIC PAIN THAT CAN
BE VERY DISABLING FOR THE REST
OF THE LIFE OF THE INDIVIDUAL.
SO THIS EFFORT WAS PUT UNDERWAY
TO REALLY MAXIMIZE OUR EFFORTS
IN RESEARCH IN THIS VERY
IMPORTANT POPULATION, AND REALLY
GEARED TOWARDS
NON-PHARMACOLOGICAL AND ALSO
INTEGRATED PHARMACOLOGICAL AND
NON-PHARMACOLOGICAL TREATMENTS
OF PAIN.
SO THE LAMP TRIAL WAS ONE OF THE
VERY FIRST TRIALS THAT WERE
FUNDED.
YOU SEE BACK HERE IN 2017, IT'S
CALLED LEARNING TO APPLY
MINDFULNESS TO PAIN.
YOU CAN SEE HERE THAT IN THIS
FIRST TRANCHE, WE HAD SIX
FUNDED -- NIH FUNDED TRIALS AND
THE VA FUNDED ONE, AND THIS LAMP
TRIAL WAS ONE OF THE ONES FUNDED
BY THE DEPARTMENT OF DEFENSE.
YOU CAN SEE HERE THAT OVER TIME,
AS TIME WENT, WE WERE ABLE TO
ADD SOME TRIALS.
WE ADDED TWO TRIALS IN FY 22 AND
23, AND THEN WE ADDED RECENTLY
SEVERAL MORE, ONE FROM NIH, ONE
FROM DOD AND ONE FROM VA IN '24,
AND WE'RE VERY EXCITED THAT
STARTING IN FY '25, THE HEAL
INITIATIVE IS NOW COFUNDING THE
COWACOORDINATING CENTER FOR THE,
AND WE THINK THAT THIS
PARTNERSHIP BETWEEN THE HEAL
INITIATIVE AND THE PAIN
MANAGEMENT COLLABORATORY IS VERY
EXCITING, I THINK IT RECOGNIZES
THE IMPORTANCE OF ADVANCING --
AND THE VERY -- ADVANCING
RESEARCH OF PAIN IN THE MILITARY
BUT ALSO RECOGNIZING THE VERY
SPECIFIC EXPERTISE THAT THIS
PAIN MANAGEMENT COLLABORATORY
COORDINATING CENTER HAS IN
CONDUCTING THIS RESEARCH IN THIS
VERY SPECIAL SETTING, INCLUDING
ACCESS TO THE PATIENTS BUT ALSO
THE HEALTH RECORDS AND THE VERY
SPECIAL ABILITY OF HAVING A
PATIENT POPULATION THAT WE CAN
STUDY ESSENTIALLY FOR THE LONG
TERM.
SO NOW I'M GOING TO BE TELLING
YOU A LITTLE BIT ABOUT A
DIFFERENT COLLABORATORY.
SOMETIMES PEOPLE CONFUSE THESE
TWO.
THIS ONE WAS CALLED THE
HEALTHCARE SYSTEMS RESEARCH
COLLABORATORY.
AND THIS GOES BACK IN TIME EVEN
A LITTLE BIT FURTHER, BACK IN
2012.
THIS WAS AN NIH COMMON FUND
PROGRAM THAT WAS STARTED OUT OF
THE OFFICE OF THE NIH DIRECTOR,
SO AGAIN, IN 2012, AND THE
MISSION OF THIS COLLABORATORY
WAS TO STRENGTHEN THE NATIONAL
CAPACITY TO IMPLEMENT
COST-EFFECTIVE LARGE SCALE
RESEARCH STUDIES THAT ENGAGE,
VERY IMPORTANTLY, HEALTHCARE
DELIVERY ORGANIZATIONS AS
RESEARCH PARTNERS.
THIS WAS REALLY KEY, IS TO START
BY DOING RESEARCH IN AND EMBED
THIS RESEARCH WHERE THE CARE IS
ACTUALLY DELIVERED, TO ANSWER
QUESTIONS THAT THE HEALTHCARE
SYSTEMS AND THE HEALTHCARE
PROVIDERS CARE ABOUT, AND THAT
WILL BE THE DIFFERENCE, AND THE
THOUGHT IS IF WE DO IT
CORRECTLY, THEN THE RESULT OF
THIS RESEARCH WILL BE
IMPLEMENTED AS THE RESULTS COME
OUT, THAT THIS WILL ESSENTIALLY
CREATE A LEARNING HEALTHCARE
SYSTEM WHERE CLINICAL QUESTIONS
ARE GENERATED BY THE HEALTHCARE
SYSTEM IN PARTNERSHIPS WITH THE
HEALTHCARE SYSTEM AND THE
RESEARCHERS, WHERE THE RESEARCH
IS EMBEDDED IN THE CARE AND THE
EVIDENCE IS THEN USED TO BOTH
DISSEMINATE AND IMPLEMENT THE
RESULTS AND ALSO GENERATE MORE
DIFFERENT TYPES OF RESEARCH
QUESTIONS.
SO THIS WAS VERY MUCH THE
MISSION OF THE CLINICAL TRIAL
AND NOW THIS PRAGMATIC TRIAL HAS
BEEN RENAMED THE PRAGMATIC
TRIALS COLLABORATORY BECAUSE
SOMETHING VERY EXCITING HAS
HAPPENED, IS THAT THIS COMMON
FUND PROGRAM THAT WAS INITIALLY
OUT OF THE OFFICE OF DIRECTOR
HAS BEEN SO SUCCESSFUL THAT IT
HAS MIGRATED AND CONTINUED ON,
SUPPORTED BY THE NIH INSTITUTES
AND CENTERS AND NOW BY THE NIH
HEAL INITIATIVE.
SO YOU CAN SEE THIS IS REALLY
WHAT EXACTLY THESE COMMON FUND
PROGRAMS ARE SUPPOSED TO DO.
THEY'RE SUPPOSED TO JUMPSTART A
NEW PROCESS THAT CAN THEN LIVE
ON AND SO YOU CAN SEE HERE THE
CURRENT STRUCTURE OF THE
PRAGMATIC TRIALS COLLABORATORY,
WHICH WAS RENAMED THE HEALTHCARE
SYSTEMS COLLABORATORY TO THE
PRAGMATIC TRIALS COLLABORATORY
TO REALLY EMPHASIZE THAT THE
NATURE OF THESE TRIALS ARE
TRIALS THAT ARE PERFORMED USING
THE HEALTHCARE SYSTEM, USING THE
ELECTRONIC HEALTH RECORDS,
REALLY LIVING WITH THE REALITY
OF THE ETHICS AND REGULATORY
ISSUES THAT COME UP WITH DOING
RESEARCH EMBEDDED IN HEALTHCARE
SYSTEMS, INTERACTING WITH THESE
HEALTHCARE SYSTEMS AND UTILIZING
THE HEALTHCARE -- THE ELECTRONIC
HEALTH RECORD TO GENERATE
PATIENT-CENTERED OUTCOMES AND
THEN UTILIZING SOPHISTICATED
STATISTICS AND STUDY DESIGN TO
DO THIS RESEARCH IN THE MOST
RIGOROUS MANNER.
AND I HAVE TO SAY THAT THE
COLLABORATORY HAS BEEN SO
EXCELLENT IN REALLY PROVING THAT
THIS KIND OF RESEARCH CAN BE
DONE REALLY, REALLY WELL AND BE
VERY IMPACTFUL.
SO THIS IS THE TIMELINE OF THE
PRAGMATIC TRIALS COLLABORATORY.
YOU CAN SEE THAT FROM THE
BEGINNING, THE HEAL INITIATIVE
WAS ABLE TO SUPPORT A PROGRAM
CALLED PRISM THAT UTILIZED THE
NIH PRAGMATIC TRIAL
COLLABORATORY INFRASTRUCTURE,
INCLUDING THE COORDINATING
CENTER OF THE PRAGMATIC TRIALS
COLLABORATORY.
YOU CAN SEE THAT PRI SM IS A
PROGRAM THAT WAS FUNDED BY THE
HEAL INITIATIVE TO STUDY
NON-PHARMACOLOGICAL
INTERVENTIONS FOR PAIN, AND FOUR
TRIALS WERE FUNDED IN 2019, TWO
TRIALS IN 2020, AND THEN WE
ADDED ANOTHER PROGRAM THAT WAS
ALSO PART OF THE HEAL INITIATIVE
WHICH IS RURAL PAIN MANAGEMENT,
THREE TRIALS FUNDED IN '23 AND
ONE IN '24, AND IMPORTANTLY, ONE
OF THE TRIALS OF THIS THAT WAS
FUNDED IN '23 IS THE RAMP TRIAL
ALSO BY P.I. DR. BURGESS THAT IS
KIND OF A FOLLOW-UP FROM THE
LAMP TRIAL CALLED REACHING RURAL
VETERANS, APPLYING MIND-BODY
SKILLS FOR PAIN USING A WHOLE
HEALTH TELEHEALTH INTERVENTION.
SO EVEN THOUGH WHAT DR. BURGESS
IS GOING TO TELL US TODAY, I
THINK, IS MOSTLY ABOUT THE LAMP
TRIAL, I THINK IT'S IMPORTANT
FOR EVERYBODY TO REALIZE HOW
IMPACTFUL THIS IS GOING FORWARD,
AND ALSO IN FY '25, WE HAVE
ADDED TO THE STRUCTURE THREE OR
FOUR TRIALS THAT ARE ANTICIPATED
IN FY '25 ON COORDINATED PAIN
CARE WHICH IS A VERY IMPORTANT
APPROACH THAT REALLY UTILIZES A
WHOLE PERSON APPROACH TO PAIN
CARE THAT COORDINATES ACROSS
MANY DIFFERENT SOURCES OF CARE
TO REALLY ADDRESS PAIN IN AN
INTEGRATED WAY.
AND GOING FORWARD, WE'RE HOPING
THAT THE STRUCTURE CAN SUPPORT
ADDITIONAL HEAL PRIORITIES AND
GAPS.
SO JUST TO SHOW YOU KIND OF IN A
SYNOPSIS HOW THE LAMP TRIAL AND
THE RAMP TRIAL ARE REALLY AT THE
INTERSECTION OF THESE THREE
ORGANIZATIONS, THE PMC,
OBVIOUSLY THE U.S. DEPARTMENT OF
DEFENSE, WHICH FUNDED THE LAMP
TRIAL, AND THEN THE NIH
PRAGMATIC TRIAL COLLABORATORY
AND THE HEAL INITIATIVE.
SO I HOPE THIS CONTEXT IS
HELPFUL IN SITUATING WHAT WE'RE
GOING TO BE HEARING NEXT.
SO IT MY GREAT PLEASURE TO
INTRODUCE OUR SPEAKER, DR. DIANA
BURGESS.
DR. BURGESS IS A CORE
INVESTIGATOR AND DIRECTOR OF THE
VA ADVANCED FELLOWSHIP PROGRAM
IN HEALTH SERVICES RESEARCH AT
THE CENTER FOR CARE DELIVERY AND
OUTCOMES RESEARCH, OR CCDOR AT
THE MINNEAPOLIS VETERANS AFFAIR
HEALTHCARE SYSTEMS, AS WELL AS
DIRECTOR OF THE VA QUERY
COMPLEMENTARY HEALTH AND
INTEGRATIVE HEALTH EVALUATION
CENTER AND PROFESSOR OF MEDICINE
AT THE UNIVERSITY OF MINNESOTA.
AS A SOCIAL PSYCHOLOGIST WITH
ADDITIONAL TRAINING IN
ORGANIZATIONAL BEHAVIOR AND
HEALTH SERVICES RESEARCH,
DR. BURGESS HAS OVER 20 YEARS OF
EXPERIENCE CONDUCTING RESEARCH
IN HEALTH EQUITY AND CHRONIC
PAIN.
HER CURRENT RESEARCH FOCUSES ON
INNOVATIVE APPROACHES TO
DELIVERING COMPLEMENTARY AND
INTEGRATIVE APPROACHES FOR
CHRONIC PAIN CONDITIONS WITH AN
EMPHASIS ON IMPROVING ACCESS,
QUALITY AND EQUITY.
SO I'M REALLY LOOKING FORWARD TO
HEARING DR. BURGESS DISCUSS
SCALABLE MINDFULNESS-BASED
INTERVENTIONS FOR CHRONIC PAIN,
RESULTS FROM THE LEARNING TO
APPLY MINDFULNESS TO PAIN OR
LAMP TRIAL.
SO, TAKE IT AWAY.
>> THANK YOU SO MUCH, AND I AM
SO HONORED TO BE HERE.
OH, SO SHARING MY SCREEN, AM I
ABLE TO DO THAT?
OTHERWISE I JUST FORWARDED MY
TALK ALONG SO WE CAN DO IT THAT
WAY.
OH, HERE IT IS.
OKAY.
THAT WORKS.
GREAT.
OKAY, SHARE.
OKAY.
I'M GOING TO PUT THIS IN SLIDE
SHOW MODE.
THANKS SO MUCH.
I FIRST WANT TO ACKNOWLEDGE ALL
THE CONTRIBUTORS TO THIS
PROJECT, INCLUDING ALL THE
VETERANS WHO CONTRIBUTED WHOSE
NAMES ARE HIGHLIGHTED IN BLUE,
AND OF COURSE OUR FUNDERS, THE
DEPARTMENT OF HEALTH, THE
NATIONAL CENTER FOR
COMPLEMENTARY AND INTEGRATIVE
HEALTH, AND ALL THE RESOURCES
PROVIDED TO US BY THE VA AND THE
PAIN MANAGEMENT COLLABORATORY.
AND WE WERE VERY GRATEFUL TO
HAVE THIS PUBLISHED IN JAMA
INTERNAL MEDICINE WITH THAT
GREAT COM COMMENTARY BY DR. DAN
SHERKIN ON OVERCOMING CHALLENGES
TO IMPLEMENTING MINDFULNESS
BASED PAIN INTERVENTIONS WHO
TALKS A LOT ABOUT OUR CONTEXT IN
THE V.A. AND HOW WE WERE ABLE TO
ACCOMPLISH THIS.
SO JUST TO BEGIN, VETERANS NEED
AND WANT BETTER WAYS TO MANAGE
THEIR PAIN.
SO AS MANY OF YOU PROBABLY KNOW,
VETERANS ARE DISPROPORTIONATELY
AFFECTED BY CHRONIC PAIN AND
CO-OCCURRING CONDITIONS SUCH AS
PTSD, SUBSTANCE USE, DEPRESSION,
ALSO SLEEP DISORDERS, AND OPIOID
HARMS SUCH AS OWED Y OPIOID USE
DISORDER AND OPEN YOAD OVERDOSE.
OPIOID OVERDOSE.
EVIDENCE-BASED
NON-PHARMACOLOGICAL TREATMENTS
FOR PAIN ARE RECOMMENDED YET
UNDERUTILIZED DUE TO PATIENT
PROVIDER AND SYSTEM LEVEL
BARRIERS INCLUDING THE V.A.,
ALTHOUGH THE V.A. IS A LADIER IN
OFFERING CIH THERAPIES AND
MULTIMODAL PAIN MANAGEMENT.
AND I WANTED TO READ A COUPLE OF
QUOTES FROM FOCUS GROUPS WE
CONDUCTED WITH BLACK VETERANS
WITH CHRONIC PAIN.
>> DIANA, I THINK WE'RE JUST
SEEING THE FIRST SLIDE.
>> OH!
>> IT ALSO NOT IN SLIDE SHOW
MODE.
MAYBE THAT'S WHY.
>> OH.
OKAY.
SO HOLD ON.
IS THIS WORKING?
>> NOT YET, NO.
>> OH.
>> NOW YOU'RE NOT SHARING
ANYMORE.
>> OKAY.
LET ME SHARE.
SORRY ABOUT THAT.
>> DIANA, IF YOU'RE HAVING ANY
ISSUES, I HAVE YOUR SLIDES NOW
SO HAPPY TO SHARE THEM.
>> YEAH, WHY DON'T WE DO IT THAT
WAY.
>> THAT SOUNDS GOOD.
IF YOU WANT TO STOP SHARING, I
CAN SHARE FOR YOU.
ARE WE SEEING THE SLIDES?
>> YES.
I CAN SEE IT.
OKAY.
SO NEXT SLIDE.
OKAY.
SO GREAT.
SO JUST ACKNOWLEDGING EVERYBODY,
WE HAD MAYBE THE PRIOR SLIDE
REALLY QUICK?
OKAY, SO LOTS AND LOTS OF
VETERANS PARTICIPATED IN THIS.
WE GOT GREAT FEEDBACK FROM
ENGAGEMENT PANEL, VETERAN
STAKEHOLDERS AND THE PAIN
MANAGEMENT COLLABORATORY
RESOURCE GROUP OF VETERANS.
OKAY.
I MENTIONED THE GREAT COMMENTARY
WHICH DR. SHERKIN.
SO I'M JES JUST GOING TO READ A
COUPLE OF QUOTES WE GOT FROM
SOME FOCUS GROUPS, BLACK
VETERANS WITH CHRONIC PAIN.
I THINK ABOUT THE TIME THAT WE
GOT INTO THE MILITARY.
IT WAS GREAT, EVERYTHING WAS
FINE.
OUR HEALTH WAS GOOD.
AND WE WOULD LIKE TO CONTINUE
WITH THE SAME THING ONCE WE
GOTTEN OUT OR FINISHED BUT WE
CAN'T BECAUSE IT SEEMS LIKE IT
GAVE US MORE PAIN.
IT HURT US MORE.
WE'RE OUT THERE HELPING THE
PEOPLE BUT IT HURT US MORE.
OUR BODIES.
THEN WHEN WE ASK FOR THE HELP WE
CAN'T GET THE HELP AND IT'S
GETTING PROGRESSIVELY WORSE AND
THEN THEY GIVE US DRUGS, YEAH,
THERE YOU GO, PERCOCET,
TRAMADOL, VICODIN.
I SAID I DON'T WANT ANY MORE
DRUGS SO I'M JUST I'M DEALING
WITH PAIN WITHOUT DRUGS.
SO THIS WAS A NUMBER OF YEARS
AGO, BUT THERE WAS A SENSE THAT
VETERANS REALLY WANTED DRUGS FOR
PAIN BUT MORE AND MORE WE'RE
HEARING THAT VETERANS WANT OTHER
AND BETTER WAYS TO MANAGE THEIR
PAIN.
SO THE LONG TERM GOAL OF LAMP IS
TO MAKE IT EASIER FOR MORE
VETERANS IN V.A. TO RECEIVE
EFFECTIVE NON-DRUG TREATMENTS
FOR CHRONIC PAIN.
SO LAMP TESTS TWO MINDFULNESS
BASED INTERVENTIONS DESIGNED TO
BE SCALABLE, ACCESSIBLE AND
VETERAN CENTERS BECAUSE AS YOU
MIGHT KNOW, THE V.A. TREATS
9 MILLION VETERANS AND DEPENDING
ON THE ESTIMATE, OVER HALF AND
UP TO LIKE THREE QUARTERS HAVE
CHRONIC PAIN.
AND IT'S HIGHER AMONGST CERTAIN
GROUPS SUCH AS WOMEN.
MINDFULNESS BASED INTERVENTIONS
ARE EFFECTIVE, NON-DRUG
TREATMENTS FOR CHRONIC PAIN AS
WELL AS CO-OCCURRING CONDITIONS
THAT AFFECT MANY VETERANS.
SO AS I MENTIONED DEPRESSION,
ANXIETY, PTSD, SLEEP DISORDERS.
AND MINDFULNESS IS PAYING
ATTENTION NON-JUDGE MENTALLY IN
THE PRESENT MOMENTS WITH
OPENNESS AND CURIOSITY.
AND MBIs OR MINDFULNESS BASED
INTERVENTIONS TEACH MINDFULNESS
SKILLS AND CONCEPTS THROUGH
PRACTICES LIKE MEDITATION AND
MINDFUL MOVEMENT, DESIGNED TO
FOSTER AWARENESS AND ACCEPTANCE,
OFTEN IN A GROUP SETTING.
AND ONE OF THE MECHANISMS IS BY
DECOUPLING THE SENSATIONS FROM
KIND OF THE COGNITIONS, THE
STORIES AND THE EMOTIONS
SURROUNDING THE EXPERIENCE OF
CHRONIC PAIN.
SO LAMP IS DESIGNED TO TEST
SCALABLE VETERAN-CENTRIC MBIs.
SO MANY MBIs SUCH AS THE MOST
COMMONLY TESTED AND KIND OF
PREVALENT MBI, MIND FULLNESS
BASED STRESS REDUCTION, ARE
DIFFICULT TO IMPLEMENT AT SCALE
IN HEALTHCARE SYSTEMS, AND POSE
ACCESS BARRIERS FOR PATIENTS.
SO IT REQUIRES TRAINED
MINDFULNESS INSTRUCTORS,
DEDICATED SPAI THERE'S A LOT OF
TRAINING TO BECOME AN MDSR
INSTRUCTOR.
IT'S EIGHT WEEKS OF IN-PERSON
SECTIONS WITH A HIGH TIME
COMMITMENT, SO EIGHT TWO AND A
HALF-HOUR GROUP SESSION, AN
OPTIONAL DAY-LONG RETREAT, 45
MINUTES OF RECOMMENDED HOME
PRACTICE.
AND THERE'S BEEN SOME RESEARCH
CONDUCTED IN V.A. ON HOW SOME
VETERANS, ESPECIALLY WOMEN
WHO'VE EXPERIENCED MILITARY
SEXUAL TRAUMA AT HIGH RATES,
FIND THE GROUP FORMAT
UNCOMFORTABLE, ESPECIALLY BEING
IN PERSON WITH YOUR EYES CLOSED
WITH MALE VETERANS.
AND OFTEN THEY FIND BARRIERS TO
THE IN-PERSON FORMAT, SO
TRANSPORTATION, DISTANCE FROM
MAIN FACILITIES AND WOMEN HAVE
EXPERIENCED SEXUAL HARASSMENT IN
THE V.A.
SO THE LAMP MBIs WERE DESIGNED
TO BE SCALABLE, ACCESSIBLE AND
VETERAN-CENTERED AND TO ADDRESS
THE NEEDS OF WOMEN VETERANS WHO
ARE DISPROPORTIONATELY IMPACTED
BY CHRONIC PAIN AND CO-OCCURRING
CONDITIONS AND REALLY SOME OF
THE CONTRIBUTORS TO CHRONIC
PAIN.
THE LAMP STUDY OVERSAMPLES WOMEN
WHO ARE UNDERREPRESENTED IN
STUDIES OF VETERANS BECAUSE THEY
ONLY REPRESENT ABOUT 10% OF THE
V.A. POPULATION BUT THE NUMBERS
ARE GROWING.
SO AS YOU ALL KNOW CHRONIC PAIN
IS A COMPLEX BIOPSYCHOSOCIAL
PHENOMENON THAT INVOLVES THE
WHOLE PERSON, AND VETERANS AND
VA PATIENTS DISPROPORTIONATELY
EXPERIENCE BIOPSYCHOSOCIAL
FACTORS THAT CONTRIBUTE TO AND
ARE EXACERBATED BY PAIN.
SO HIGHER RATES OF MENTAL HEALTH
COMORBIDITIES LIKE DEPRESSION,
ANXIETY, PTSD, TRAUMA WITHIN AND
OUTSIDE OF THE MILITARY, THEY
OFTEN LACK SOCIAL SUPPORT.
IN THE V.A., WHICH IS A SYSTEM
WHICH IS A SAFETY NET SYSTEM,
PEOPLE OFTEN HAVE LOWER LEVELS
OF INCOME AND EDUCATION.
SO LAMP IS GROUNDED IN A
BIOPSYCHOSOCIAL MODEL AIMED AT
IMPROVING PHYSICAL,
PSYCHOLOGICAL AND SOCIAL
OUTCOMES.
THERE'S A GREAT QUOTE BY DAN
SHERKIN IN THE COMMENTARY WHICH
SAYS MBIs DO NOT DIRECTLY
TARGET THE PATIENT'S CONDITION,
RATHER THEY TARGET THE
COUNTERPRODUCTIVE WAYS IN WHICH
PATIENTS THINK ABOUT AND REACT
TO THE PROBLEMS.
THEY PROVIDE PATIENTS WITH
STRATEGIES AND TOOLS TO HELP
THEM CREATE THE TIME AND SPACE
TO BECOME MORE FULLY AWARE OF
WHAT IS GOING ON IN THEIR MINDS
AND HEARTS THAT IS NEGATIVELY
IMPACTING THEIR LIVES.
SO THE GOAL OF LAMP WAS TO TEST
THE EFFECTIVENESS OF TWO MBIs
DESIGNED TO BE SCALABLE AND SINL
AT IMPROVING VETERANS' CHRONIC
PAIN AND BIOPSYCHOSOCIAL
OUTCOMES.
SO THE INTERVENTIONS BASICALLY
TOOK THE CORE ELEMENTS OF
MINDFULNESS BASED STRESS
REDUCTION, BUT THEY WERE ALSO
GROUNDED IN BEHAVIORAL CHANGE
STRATEGIES USING THE BEHAVIORAL
CHANGE WHEEL MODEL.
IT REPRESENTS A SYNTHESIS OF
ABOUT 20 BEHAVIORAL MODELS AND
HAS BEEN DESIGNED TO INTEGRATE
AND USE BEHAVIORAL HEALTH
TECHNIQUES TO CREATE BEHAVIOR
CHANGE.
SO THE GROUP MBI WAS COMPRISED
OF EIGHT 90-MINUTE STRUCTURED
GROUP SESSIONS AND AN
ORIENTATION CENTERED SESSION.
IT WAS DELIVERED VIA VIDEO
CONFERENCING WHICH WAS NOT WHAT
WE INTENDED BUT BECAUSE OF THE
PANDEMIC, WE SWITCHED, AND A BIG
SCALABLE FEATURE WAS THAT WE
USED PRERECORDED MINDFULNESS
EDUCATION AND SKILL TRAINING
VIDEOS BY EXPERIENCED
MINDFULNESS INSTRUCTOR WITH
FACILITATED DISCUSSIONS BY V.A.
STAFF.
SO IT WAS SCALABLE BECAUSE YOU
DIDN'T NEED TO HAVE TRAINED
MINDFULNESS INSTRUCTORS.
THE SELF-PACED MBI WAS EVEN MORE
STRIPPED DOWN.
IT HAD THE SAME EIGHT WEEKLY
MODULES, MINDFULNESS EDUCATION
AND SKILL TRAINING, BUT THESE
WERE COMPLETED ON ONE'S OWN, NOT
IN A GROUP SETTING, AND IT WAS
SUPPLEMENTED BY THREE CALLS BY
V.A. STAFF TO BASICALLY CHECK IN
WITH PEOPLE AND ORIENT THEM.
ALL PARTICIPANTS WERE ENCOURAGED
TO PRACTICE ON THEIR OWN BETWEEN
SESSIONS USING A WORKBOOK, THE
MOBILE APP AND THE STUDY KEP STE
AND THIS WAS LED BY CO-I
DR. RONI EVANS BASED ON AN NCCIH
FUNDED GRANT THAT USED A SIMILAR
TECHNIQUE OF PRERECORDED
MINDFULNESS EDUCATION AND SKILL
TRAINING VIDEOS.
SO JUST QUICKLY, IT WAS SIMILAR
TO MBI AND OTHER PROGRAMS IN THE
PRINCIPLES AND CONCEPTS AND THE
FACT THAT CONTENT WAS PROTECTED
BY EXPERTS BUT IT'S SHORTER, IT
INTEGRATES SPECIFIC BEHAVIOR
CHANGE TECHNIQUES, LESS JARGON.
AGAIN, THE PRERECORDED SESSIONS.
THE SESSIONS WERE VERY
STRUCTURED BECAUSE IT WAS SHORT,
AND THAT WAS ALSO IMPORTANT
BECAUSE WE WANTED THAT
DISCUSSION TO STAY ON POINT.
IT WAS SPECIFIC TO PAIN, WHEREAS
MBSR TYPICALLY IS NOT
PAIN-SPECIFIC, IT WAS CUSTOMIZED
FOR WOMEN AND FOR VETERANS
INCLUDING THE NEED OF WOMEN
VETERANS, TRAUMA-INFORMED IN
THAT PEOPLE DIDN'T NEED TO DO
THINGS IF THEY WEREN'T
COMFORTABLE.
WE HAD GROUNDING EXERCISE, WE
HAD A SELF-PACED VERSION WITHOUT
THE GROUP COMPONENT, AND
DELIVERED VIA TELEHEALTH, WHICH
AT THE TIME WAS MUCH MORE NOVEL.
SO WE WERE LUCKY ENOUGH TO HAVE
A TWO-YEAR UG3 PERIOD WHERE WE
WERE ABLE TO DEVELOP THE
PACKAGE, SO OPTIMIZE THE MOBILE
APP, VIDEOS, WORKBOOK, THE
FACILITATOR TRAINING MANUAL
THROUGH FEEDBACK FROM VETERANS,
STAKEHOLDERS AND EXPERTS.
WE HAD OUR VETERAN ENGAGEMENT
PANEL, OUR STAKEHOLDER ADVISORY
PANEL WHICH INCLUDED VETERAN
EXPERTS AND THEN A LOT OF
EXPERTS IN MINDFULNESS,
TECHNOLOGY, VETERAN END USERS,
AND WE DID A PILOT.
AND WE WERE USING THE COMBI
MODEL WHICH I WILL BRIEFLY TOUCH
ON, ON THE NEXT SLIDE.
OKAY.
SO THE COM-B MODEL, AND THE
BEHAVIORAL CHANGE WHEEL GUIDED
THE INTERVENTION DESIGN,
OPTIMIZATION AND EVALUATION.
SO BASICALLY THE PREMISE OF THIS
MODEL IS THAT FOR BEHAVIOR TO
OCCUR, ONE NEEDS TO HAVE THE
CAPABILITY, THE KNOWLEDGE AND
THE SKILLS, THE MOTIVATION,
CONSCIOUS AND UNCONSCIOUS, AND
OPPORTUNITIES AND RESOURCES.
AND THE BEHAVIOR, MINDFULNESS
BEHAVIORS, WE COMPRISE THEM --
WE ENCANS LATE THEM AS
MINDFULNESS SKILLS, ATTENTION
REGULATION, BODY AWARENESS,
EMOTIONAL REGULATION, SHIFTS IN
SELF-TALK, AND THEN WE USE THE
COM-B THROUGHOUT THE STUDY.
SO SOME OF THE THINGS VETERANS
WANTED AND NEEDED WAS SHORT
SEGMENTS, MORE CLARITY.
WE LED THEM THROUGH, YOU KNOW, A
SAMPLE SESSION, AND THEY REALLY
WANTED MORE CONTEXT OF HOW CAN
MINDFULNESS HELP ME WITH MY
PAIN?
SO WE SPENT MORE TIME TALKING
ABOUT THE MIND-BODY CONNECTION
AND BEING MORE EXPLICIT.
THEY WANTED -- HAD A LOT OF
OPPORTUNITY AND RESOURCE-RELATED
NEEDS SUCH AS, YOU KNOW, WE DID
USABILITY TESTS, THEY WANTED
CUES, WRITTEN MATERIALS WHICH WE
GAVE THEM, SHORTER SESSION
LENGTHS AND THE OPPORTUNITY TO
MAKE UP FOR MISSED SESSIONS.
THEN THERE WAS
MOTIVATION-RELATED NEEDS.
SO LESS JARGON, MORE SECULAR.
THEY REALLY CARED ABOUT SUPPORT
FROM OTHER VETERANS, SO WE MADE
SURE THAT WE HAD THAT,
ESPECIALLY IN OUR GROUP
SESSIONS.
THEY WANTED THINGS TO BE
TRACK.
WE GAVE THEM REMINDER CALLS
ABOUT THE SESSIONS AND GUIDANCE
FOR HOME PRACTICE, AND IT WAS
INTERESTING, A LOT OF WOMEN HAD
EXPERIENCED MILITARY SEXUAL
HARASSMENT AND AS WE TESTED THE
APP, IT REALLY WASN'T ABOUT --
WE DIDN'T PLAN ON GETTING INTO
THEIR MILITARY SEXUAL TRAUMA AND
OTHER TYPES OF SEXUAL TRAUMA,
BUT THEY ALL WANTED GUIDED
MEDITATIONS IN A FEMALE VOICE,
SO WE MADE SURE WE RECORDED
EVERYTHING IN A FEMALE VOICE.
SO BRIEFLY, THIS WAS A THREE-ARM
DESIGN, HYBRID TYPE 1,
EFFECTIVENESS IMPLEMENTATION
PRAGMATIC TRIAL WITH 811
PARTICIPANTS.
WE SET THIS USING PATIENTS FROM
THE MINNEAPOLIS, DURHAM AND
GREATER L.A. HEALTHCARE SYSTEMS
BECAUSE WE WANTED TO HAVE
DIVERSE MINORITIZED VETERANS.
WE ENDED UP DOING EVERYTHING VIA
TELEHEALTH.
SO THEY NEEDED TO HAVE TWO
QUALIFYING PAIN DIAGNOSES IN THE
EHR.
IT WAS VERY BROAD.
PAIN DURATION OF GREATER OR
EQUAL TO SIX MONTHS, A PAIN
INTENSITY SCORE OF GREATER OR
EQUAL TO 4 DURING THE PAST WEEK,
ACCESS TO A SMARTPHONE AND THE
INTERNET.
THEY COULDN'T BE ENROLLED IN
ANOTHER PAIN STUDY OR MBSR, AND
WE DID HAVE SOME EXCLUSION
CRITERIA BASED ON THEIR MEDICAL
RECORD, AND THIS WAS REALLY
BECAUSE WE WANTED THEM TO BE
SAFE IN THE GROUPS AND BECAUSE
WE WERE DOING THIS VIA
TELEHEALTH.
SO OUR PRIMARY OUTCOME WAS PAIN
RELATED FUNCTION USING THE BRIEF
PAIN INVENTORY, BPI,
INTERFERENCE SCALE OVER 12
MONTHS.
THIS WAS HARMONIZED WITH THE
OTHER TRIALS IN THE PAIN
MANAGEMENT COLLABORATORY AS PART
OF ONE OF OUR WORKING GROUPS.
WE HAD A NUMBER OF SECONDARY
OUTCOMES: ASSESSING PAIN, PSYCH
PSYCHOLOGICAL SYMPTOMS, HEALTH
AND SOCIAL.
WE TRIED TO USE PROMIS MEASURES
AND WE USED THE PHQ-8 I BELIEVE
BECAUSE THERE WERE TWO THINGS
THAT COULD BE PULLED OUT THAT WE
ALL HARMONIZED ON.
SO I'LL BRIEFLY GO THROUGH THE
FLOW DIAGRAM.
SO ON THE TOP, WE SENT MATERIALS
TO A LOT OF VETERANS THROUGH THE
MEDICAL -- THROUGH THE EHR, AND
WE WERE ABLE TO DO THIS BECAUSE
MOST VETERANS AT THE TIME HAD
EMAIL ADDRESSES IN THEIR MEDICAL
RECORD, SO THAT WAS VERY EASY.
WE ACTUALLY STARTED OUT BY USING
REGULAR MATERIALS, AND THEN WE
SWITCHED AND WE FOUND OUT THAT
WE ACTUALLY WERE ABLE TO GET
HIGHER RETURN RATE AND A MORE
DIVERSE SAMPLE USING EMAIL
RECRUITMENT.
AND ULTIMATELY, IF YOU GO DOWN
TO ALLOCATION IN THE MIDDLE, WE
RANDOMIZED 811.
WE MEANT TO DO 750 BUT WE END
UP -- WE ENDED UP RANDOMIZING
MORE BECAUSE WE WANTED TO MEET
OUR GOALS OF HAVING ENOUGH WOM
WOMEN.
SO THEY WERE SPLIT BETWEEN THE
THREE ARMS, AND THE ONE THING TO
NOTE IS THAT WE HAD PRETTY HIGH
FOLLOW-UP RATES.
SO IF YOU LOOK AT THE BOTTOM, I
FOR SOME REASON CAN'T SEE THE
VERY BOTTOM, BUT IT WAS ABOVE --
THEY WERE VERY HIGH -- OH, THERE
IT IS.
GREAT.
AT 12 MONTHS.
IT WAS HIGHER IN THE USUAL CARE
GROUP, 90%, AND 83% IN BOTH OF
THE OTHER -- IN THE EXPERIMENTAL
GROUP.
SO WE DID USE PROCEDURES TO
ADDRESS NOT AT RANDOM
MISSINGNESS.
BUT WE WERE VERY HAPPY OF OUR
FOLLOW-UP RATES.
WE ACTUALLY USED A COMBINATION
OF EMAIL, TEXT, PHONE, AND THEN
MAILING TO GET THESE FOLLOW-UP
RATES.
SO JUST A SNAPSHOT.
IT WAS ALMOST HALF AND HALF MEN
AND WOMEN.
IT WAS 68% WHITE, 26% BLACK, AND
OTHERWISE PEOPLE FROM DIFFERENT
MINORITIZED GROUPS AND PEOPLE
WHO DIDN'T INDICATE.
THE MEAN AGE WAS 54.6 YEARS.
94% HAVE AT LEAST SOME COLLEGE
EDUCATION.
ALTHOUGH DESPITE THAT, ONLY 31%
DESCRIBED THEIR HOUSEHOLD
FINANCIAL SITUATION AS LIVING
COMFORTABLY.
AND THE PERCENTAGE OF COLLEGE
GRADUATES WAS LOWER.
ONLY 41% WERE EMPLOYED, AND 22%
WERE DISABLED.
63% HAD AT LEAST ONE MENTAL
ILLNESS DIAGNOSIS IN THE EHR,
WHICH IS KIND OF TYPICAL OF
TREATMENT-SEEKING SAMPLES FOR
CHRONIC PAIN, YOU KNOW, STUDIES
IN V.A.
THIS WAS HIGHER AMONG WOMEN.
THE MOST COMMON CONDITIONS WERE
DEPRESSIVE DISORDERS, ANXIETY
DISORDERS AND PTSD.
AND THE MOST PREVALENT PAIN
CONDITIONS WERE EXTREMITY PAIN
AND ARTHRITIS, BACK PAIN,
FIBROMYALGIA/WIDSPREAD MUSCLE
PAIN, NECK PAIN AND HEADACHE.
AND THE MEAN BPI INTERFERENCE
SCORE WAS 5.6 AND THE MEAN PAIN
INTENSITY SCORE WAS 5.5 AT
BASELINE.
OKAY.
SO WE DID A BASELINE GENDER
COMPARISON WHICH WAS FEATURED AS
A PUBLICATION BRIEF.
WE FOUND WOMEN HAVE A HIGHER
PREVALENCE OF PSYCHIATRIC AND
SLEEP DISORDER DIAGNOSES,
CHRONIC OVERLAPPING PAIN
CONDITIONS AND GREATER LEVELS OF
DEPRESSION, ANXIETY, PTSD,
FATIGUE, SLEEP DISTURBANCE,
STRESS, PAIN CATASTROPHIZING AND
LOWER LEVELS OF PAIN
SELF-ADVOCACY AND PARTICIPATION
IN SOCIAL ROLES AND ACTIVITIES
SO MANY OF THE BIOPSYCHOSOCIAL
CONTRIBUTORS TO PAIN ALTHOUGH
THEY WERE LESS LIKELY TO SMOKE
OR HAVE SUBSTANCE USE DISORDER
AND THEY USE A MORE
NON-PHARMACOLOGICAL PAIN
TREATMENT MODALITIES INCLUDING
COMPLEMENTARY AND INTEGRATIVE
HEALTH APPROACHES SO THOSE WERE
SOME POSITIVES.
SO WE HAD FAIRLY HIGH
ENGAGEMENT, SO THE GROUP MBI,
69% HAD AT LEAST SIX VISITS THAT
WAS CONSIDERED ADHERENT, BUT
ONLY 26% ATTENDED ALL NINE
SESSIONS.
WE HAD HIGHER ENGAGEMENT IN THE
SELF-PACED MBI WHERE 76% DID AT
LEAST TWO OF THE COACHING CALLS
AND 62%, ALL THREE CALLS.
HOWEVER WE DID GIVE PEOPLE THE
OPPORTUNITY TO PRACTICE ON THEIR
OWN AND IN BOTH GROUPS, OVER 90%
REPORTED AT LEAST SOME WEEKLY
PRACTICE AND THAT WAS THE
MINDFUL MINI PRACTICES AT 10
WEEKS.
SO THAT WAS SORT OF DOING THESE
ON THE SPOT MINDFULNESS.
OVER 80% SAID THAT THEY
ENGAGE -- OF THOSE SURVEYED
ENGAGED IN THE MINDFUL MINI
PRACTICES AT 12 MONTHS.
SO AGAIN THE PRIMARY OUT COME
WAS THE BPI INTERFERENCE SCALE,
WE MEASURED PEOPLE AT 10 WEEKS,
SIX MONTHS AND 12 MONTHS.
IT WAS AN INTENTION TO TREAT
ANALYSIS.
YOU CAN READ THIS.
THE MAIN THINGS IS THAT WE
ADJUSTED FOR DESIGN FACTORS OF
THE GENDER STRATIFIED SAMPLING
FRAME, SURVEY WEIGHED SITE,
BASELINE BPI INTERFERENCE AND
BASELINE PAIN SELF-EFFICACY,
WHICH IS THE ONLY ATTRIBUTE THAT
DIFFERED AT BASELINE.
AND THEN WE HAVE A PROCEDURE FOR
HANDLING MISSING OUTCOME DATA.
SO THE BIG FINDING WAS THAT PAIN
RELATED FUNCTION IMPROVED MORE
IN THE TWO MBIs COMPARED TO
USUAL CARE.
SO THIS WAS A GREATER REDUCTION
IN THE PAIN INTERFERENCE SCORE
OVER 12 MONTHS IN BOTH MBIs,
AND ALTHOUGH IT LOOKS LIKE THE
SELF-PACED MBI, WHICH IS ORANGE,
WAS THE BEST, BECAUSE OF
ADJUSTING FOR MULTIPLE
COMPARISONS.
THEY DIDN'T STATISTICALLY DIFFER
FROM EACH OTHER.
SO IF YOU LOOK ON THE LEFT, AND
ALL ESTIMATES WERE ADJUSTED FOR
BASELINE PAIN AND THESE BASELINE
BPI INTERFERENCE, DESIGN FACTORS
AND PAIN AND SELF-EFFICACY.
STARTING AT 5.6 THE MOST
IMPROVEMENT WAS AT 10 WEEKS, SO
PEOPLE IN THE ORANGE GROUP, THE
SELF-PACED MBI, THEIR BPI
INTERFERENCE SCORE WENT DOWN TO
4.4 AND THEN IT WENT UP A LITTLE
BIT, BUT NOT THAT MUCH, AND THIS
WAS MORE THAN A ONE-POINT
DIFFERENCE, WHICH IS CONSIDERED
CLINICALLY SIGNIFICANT.
IT WAS NOT AS DRAMATIC BUT STILL
STATISTICALLY SIGNIFICANT IN THE
GROUP MBI AND IN USUAL CARE,
PEOPLE DID IMPROVE OVER 12
MONTHS IN PAIN, BUT AGAIN, LESS
THAN IN THAT MBI CONDITION.
SO HERE IS JUST SORT OF OUR
STATISTICAL RESULTS OF OUR
ANALYSES THAT WERE -- OUR
A PRIORI ANALYSES.
SO AGAIN AVERAGED OVER THREE
TIME POINTS, BPI PAIN
INTERFERENCE SCORES WAS LOWER
FOR THOSE WHO HAD IN MY
OPINIONs VERSUS USUAL CARE AND
THE TWO IN MY OPINIONs DID NOT
SIGNIFICANTLY DIFFER FROM EACH
OTHER USING THE SIGNIFICANT
THRESHOLD OF .0167.
AND THE SECOND ROW IS JUST THE
DIFFERENCE AVERAGED OVER THE
THREE TIME POINTS.
SO THIS IS A SLIDE THAT
CLINICIANS AND OUR PARTNERS WERE
THE MOST INTERESTED IN,
ESPECIALLY DR. KLIEGLER REALLY
WANTED ME TO EMPHASIZE THIS
BECAUSE MORE VETERANS EXPERIENCE
MODERATE OR SUBSTANTIAL
IMPROVEMENT IN PAIN RELATED
FUNCTION IN THE MBIs VERSUS
USUAL CARE, SO THIS IS LOOKING
AT THE ADJUSTED PROBABILITY
ESTIMATES FOR CHANGES IN PAIN
RELATED FUNCTION.
AND AN INCREASE OF 30% OR MORE
FROM BASELINE IS CONSIDERED A
MODERATE IMPROVEMENT AND BASED
ON IMPACT GUIDELINES, AND 50% OR
MORE IS CONSIDERED SUBSTANTIAL
IMPROVEMENT.
IF YOU LOOK AT THE FIRST TWO
COLUMBUS, AT 10 WEEKS, 33.6% AND
40.3% HAVE THIS 30% OR MORE
IMPROVEMENT COMPARED TO 15.9% IN
USUAL CARE.
SO A LOT MORE PEOPLE IMPROVED,
AND AGAIN, NOT EVERYBODY MIGHT
IMPROVE BUT THOSE WHO DID REALLY
IMPROVED A LOT, AND THEN IF YOU
LOOK AT SIX MONTHS, THIS DID
PERSIST, IS FOR 30%, 34.4%
CONTINUED TO HAVE THIS
IMPROVEMENT OF 30% OR MORE FROM
BASELINE, THIS MODERATE
IMPROVEMENT, AND 38.2% IN THE
SELF-PACED MBI COMPARED TO 22.2%
USUAL CARE.
SO PEOPLE DID, YOU KNOW, GET,
YOU KNOW, A LITTLE BETTER ON
THEIR OWN, MORE PEOPLE, BUT YOU
KNOW, MANY MORE PEOPLE IN THE
TWO CONDITIONS.
AND EVEN AT -- IF YOU'RE LOOKING
AT 50% IMPROVEMENT AT SIX
MONTHS, 19.2% REPORTED HAD THIS
IMPROVEMENT COMPARED TO 10.4% IN
USUAL CARE.
AND AT 12 MONTHS, THERE IS
SUSTAINED IMPROVEMENT IN THE
SELF-PACED MBI IN BOLD, SO 42.2%
CONTINUE TO HAVE THIS 30%
IMPROVEMENT FROM BASELINE
COMPARED TO 24.1% IN USUAL CARE,
AND A SIMILAR PATTERN AT 50%.
SO WHAT WE'RE REALLY INTERESTED
NOW IN LOOKING AT IS WHO ARE THE
PEOPLE WHO REALLY IMPROVED WITH
THE MBI.
WE ALSO LOOKED AT OUR
BIOPSYCHOSOCIAL OUTCOMES, AND
WHEN I PRESENTED THIS, I HAD
SORT OF DOWNPLAYED, YOU KNOW,
THE FACT THAT THESE AREN'T BIG
DIFFERENCES BUT THEY'RE
CONSISTENT, AND THEN HELENE HAD
MENTIONED THAT IT REALLY IS
EXCITING THAT A FAIRLY MODEST
INTERVENTION PRODUCED
SIGNIFICANT IMPROVEMENT IN THESE
BIOPSYCHOSOCIAL OUTCOMES.
SO PAIN INTENSITY, PHYSICAL
FUNCTION, FATIGUE, SLEEP
DISTURBANCE, DEPRESSION, PTSD,
ANXIETY AND PARTICIPATION IN
SOCIAL ROLES AND ACTIVITIES.
SO I'M VERY HAPPY THAT WE
MEASURED THESE WHOLE PERSON
OUTCOMES IN THAT, YOU KNOW,
LOOKING AT THEM TOGETHER, YOU
COULD SEE THAT THE SUM IS MORE
THAN THEIR PARTS.
SO ANY ONE THING MIGHT NOT BE
THAT HUGE BUT TAKEN TOGETHER,
THERE'S REALLY HOLISTIC
IMPROVEMENTS.
SO WE LOOKED AT OUR QUALITATIVE
RESULTS, AND THIS REALLY
PROVIDES SOME INSIGHTS ON HOW
LAMP IMPROVED VETERANS'
CAPABILITY, MOTIVATION AND
OPPORTUNITIES TO CHANGE
BEHAVIOR.
SO HERE'S A COUPLE OF
REPRESENTATIVE QUOTES ABOUT THE
CAPABILITY.
IT HELPS BRING ATTENTION TO THE
FACT THAT SOME PAIN CAN BE
OVERCOME AND WE CAN STILL HAVE A
NORMAL LIFE WITH CHRONIC PAIN.
SO THAT'S KNOWLEDGE.
I DEFINITELY FIND MYSELF USING
THE MINDFUL PRACTICES AND
MOVEMENTS MORE TO CLEAR MY MIND
AND REPLACE NEGATIVE THOUGHT
SPIERLS.
SPIRALS.
SO KNOWLEDGE AND SKILLS.
OPPORTUNITY.
THIS IS -- THE PEOPLE IN THE
GROUP REALLY LIKED THE GROUPS.
IT WAS GREAT TO TALK TO OTHER
VETERANS, ESPECIALLY THE
FEMALES, TO KNOW I WAS NOT
ALONE.
THE GROUP INTERACTION WAS SO
BENEFICIAL TO ME.
HEARING WHAT OTHERS DO AND THE
PAIN THEY EXPERIENCE AND MANAGE
HELPED MY PERSPECTIVE.
AND IN DOING SOME OF THE
SUBGROUP ANALYSES, SO FAR IT
LOOKS LIKE WOMEN MIGHT HAVE
GOTTEN MORE TO GROUP AND PEOPLE
WHO ARE ANXIOUS LESS OF GROUP
AND LIKE THE INDIVIDUAL APPROACH
BETTER.
SO IT LOOKS LIKE GROUP MIGHT BE
USEFUL FOR PARTICULAR PEOPLE, SO
GIVING PEOPLE THE OPPORTUNITY TO
CHOOSE MAY MEAN THAT WE SEE MORE
BENEFITS IN GROUP BECAUSE IT
REALLY -- IT'S FOR PEOPLE WHO
WANT THE SOCIAL SUPPORT.
MOTIVATION.
SO WE CODED THE FIRST AS
MOTIVATION IN TERMS OF GOALS.
WHEN THE PAIN WAKES ME, I USE
THE MEDITATION AND BREATHING TO
FOCUS ON RELIEVING THE PAIN.
THIS DOES HEL HELP AND LESSENS
TIEMENT I'M AWAKE, BEFORE PAIN
IS REDUCED AND I CAN AGAIN
SLEEP.
I AM GOING TO TRY DOING THE
MEDITATION BEFORE GOING TO SLEEP
AND SEE IF THAT HELPS.
THIS PROGRAM HELPED ME TO GET
OUT OF THE MINDSET AND LEARN TO
BE KIND TO MY BODY WHEN IT WAS
TELLING ME TO STOP AS OPPOSED TO
GET ANGRY AND I WAS IN PAIN AND
UNABLE TO DO THINGS.
SO THAT'S EMOTIONS.
AND WE KNOW THAT EMOTIONS ARE A
BIG PART OF THE CYCLE OF CHRONIC
PAIN.
SO THE BOTTOM LINE IS THAT TWO
SCALABLE TELEHEALTH MBIs
IMPROVED PAIN AND MENTAL,
PHYSICAL AND SOCIAL OUTCOMES
AMONG VETERANS WITH CHRONIC
PAIN, THE EFFECTS WERE
CONSISTENT ACROSS OUTCOMES AND
SUSTAINED OVER 12 MONTHS.
THE EFFECTIVENESS OF MBIs
DIDN'T DIFFER IN COMPARISON OF
GROUP MEANS, SELF-PACED WAS
SUPERIOR IN RESPONDER ANALYSES,
AND THE OTHER THING IS THERE
WERE NO GENDER DIFFERENCES ON
THE PRIMARY OUTCOME AND REALLY
ON THE SECONDARY OUTCOMES.
SO THE NEXT STEPS, WE'RE DOING
SOME FOLLOW-UP ANALYSES TO SEE
WHY THE GROUP MBI WASN'T
SUPERIOR TO SELF-PACED MBI.
SOME OF IT SEEMS TO BE ADHERENCE
AND SOME OF IT SEEMS TO BE
CERTAIN FORMATS ARE BETTER FOR
CERTAIN PEOPLE.
WE'RE LOOKING AT WHAT TYPES OF
PEOPLE AND GROUPS BENEFITED MOST
FROM EACH INTERVENTION.
WE ARE CONDUCTING ANALYSES
LOOKING AT THE MEDIATORS OF THE
INTERVENTION'S EFFECTIVENESS ON
PAIN AND NON-PAIN OUTCOMES, AND
TWO OF THE BIG ONES SEEM TO BE
IN MEDIATION ANALYSIS, LOOKING
AT PAIN INTERFERENCE.
PAIN SELF-EFFICACY, FEELING LIKE
YOU COULD COPE WITH YOUR PAIN,
AND REDUCTION IN PAIN
CATASTROPHIZING ARE TWO NEED YEA
MEDIATORS.
WE'RE WORKING THIS WITH SOME
PEOPLE, SOME FELLOWS LOOKING AT
THE CHARACTERISTICS OF PATIENTS
WITH CHRONIC OVERLAPPING PAIN
CONDITIONS IN THE BASELINE
SAMPLE AS PART OF THEIR PROGRAM
OF RESEARCH ON COPCs.
WE'VE ALSO SUBMITTED A LETTER OF
INTENT TO THE OFFICE OF RURAL
HEALTH TO IMPLEMENT THE
SELF-PACED LAMP IN RURAL V.A.
FACILITIES USING ACADEMIC
DETAILING AND OUTREACH.
WE'RE WORKING WITH THE OFFICE OF
PATIENT-CENTERED CARE AND
CULTURAL TRANSFORMATION TO
IMPLEMENT SELF PACED LAMP IN
V.A. THROUGH OCCUPATIONAL
THERAPY, PHYSICAL THERAPY AND
THROUGH THE WHOLE HEALTH
COACHING IN PAIN TEAMS PROGRAM.
AND WE'RE TALKING ABOUT
SUBMITTING WHAT'S CALLED A
DOD/VA JOINT INCENTIVE FUND
PROJECT IN COLLABORATION WITH
BRIGADIER-GENERAL TO SPREAD THE
SELF-PACED LAMP ACROSS THE
DEFENSE HEALTH NETWORK AS WELL
AS THE V.A.
THEN OF COURSE DR. LANGEVIN
TALKED ABOUT RAMP PART OF THE
NIH PRAGMATIC COLLABORATORY.
IT'S FUNDED BY NIMR AS PART OF
THE NIH HEAL INITIATIVES WITH IN
MY OPINIONs RONI EVANS AND
KATIE HADLANDSMYTH.
SO THIS IS A PRAGMATIC CLINICAL
TRIAL TO ASSESS EFFECTIVENESS OF
RAMP PROGRAM AT IMPROVING PAIN
AND BIOPSYCHOSOCIAL OUTCOMES
AMONG RURAL VA PATIENTS.
RURAL VA PATIENTS JUST LIKE
PEOPLE IN GENERAL ARE
DISPROPORTIONATELY AFFECT BID
PAIN AND HAVE A LOT OF BARRIERS
TO ACCESSING CIH AND MULTIMODAL
PAIN CARE AND ALSO THERE'S OTHER
BARRIERS.
SO THIS IS A MULTICOMPONENT CIH
INTERVENTION THAT ALSO DEALS
WITH THINGS LIKE SLEEP, AND
EXERCISE, AND IT'S DESIGNED TO
BE IMPLEMENTED WITHIN THE V.A.
WHOLE HEALTH FOR RURAL VETERANS.
AND A BIG FEATURE IS THAT WE'RE
REALLY DOING EVEN MORE
COLLABORATION WITH PATIENTS,
COMMUNITY ADVISORS, AND V.A.
HEALTHCARE SYSTEM LEADERS TO
CODEVELOP AND EVALUATE
INTERVENTIONS USING THE TRIAL
AND TO SCALE UP WITHIN THE
HEALTHCARE SYSTEM.
BETH!
>> THANK YOU, DR. BURGESS.
I JUST LOVE YOUR WORK.
I WAS CURIOUS, YOU KNOW, I'M
REALLY STRUCK BY YOUR POINT
THAT, YOU KNOW, SOME VETERANS
MAY PREFER ONE VERSUS THE OTHER
AND WE REALLY DO NEED A
PORTFOLIO OF OPTIONS SO PEOPLE
CAN CHOOSE WHAT'S BEST FOR THEM.
IN YOUR TRIAL, DID YOU COLLECT
INFORMATION ON THE VETERANS'
PREFERENCE ABOUT WHICH GROUP
THEY MIGHT BE ASSIGNED TO?
DO YOU HAVE ANY INFORMATION
ABOUT THEIR PREFERENCES
BASICALLY?
I KNOW WHAT YOU'RE STUDYING
RIGHT NOW IS THEIR OUTCOMES AND
THEN TRYING TO DISCERN FROM THAT
WHO BENEFITS MOST, BUT I JUST --
I'M ALWAYS STRUCK THAT WE'RE NOT
DEEPLY CHARACTERIZING THE CHOICE
ENOUGH.
IT DOES SEEM LIKE ONE OF THE
NEXT STEPS IN PAIN RESEARCH IS
TO ACTUALLY ALLOW PEOPLE TO
CHOOSE AND I KNOW THERE'S SOME
DESIGNS DOING THAT.
>> 100%.
WE DID NOT DO THIS.
AND I WISH WE DID.
SO -- AND I DO THINK THAT WE ARE
GOING THROUGH OUR QUALITATIVE
AND WE'RE HOPING TO DISCERN
SOMETHING BUT YOU'RE RIGHT, IT
WOULD BE SO NICE IF YOU WERE
ABLE TO DO THAT.
>> OKAY, OKAY, YEAH.
THANK YOU.
>> AND I SEE ANOTHER QUESTION.
AND I AM PRETTY MUCH FINISHED, I
THINK, SO THIS IS A GREAT TIME
FOR QUESTIONS.
YES?
>> DR. BURGESS, THIS IS MONICA.
WELL, THANK YOU FOR THAT
WONDERFUL PRESENTATION.
A COUPLE THINGS.
ONE, I'M SO HAPPY TO SEE YOU
LOOKING AT SLEEP DISTURBANCES
AND SLEEP DISORDERS.
I WAS CURIOUS, DID ANY SPECIFIC
SLEEP DISORDER STAND OUT FROM
THE ELECTRONIC HEALTH RECORDS
SUCH AS INSOMNIA OR SLEEP APNEA,
AND SECOND, WHEN YOU SAID IN
YOUR RESULTS YOU DID SEE SOME
CHANGES IN SLEEP DISTURBANCES,
CAN YOU DEFINE WHAT YOU ARE
EXACTLY LOOKING AT FOR THE SLEEP
DISTURBANCES?
WAS THAT QUALITY OF SLEEP OR
PEOPLE JUST WAKING UP AND NOTING
THAT, YOU KNOW, THEY WOKE UP
SEVERAL TIMES DURING THE NIGHT?
I WAS JUST CURIOUS ABOUT THAT.
AND FINAL THING, YOU SAID YOU
DIDN'T SEE ANY GENDER
DIFFERENCES TO YOUR PRIMARY
OUTCOMES.
CAN YOU ELABORATE A BIT MORE ON
THAT?
>> YEAH, WE THOUGHT -- SO WE
LOOKED AT AN INTERACTION, LIKE
WAS THERE INTERACTION BETWEEN
THE CONDITIONS AND GENDER, AND
WE DIDN'T SEE IT OVERALL.
BUT THERE WERE A COUPLE OF
OUTCOMES LOOKING, DIGGING DOWN
DEEP INTO THE OUTCOMES WHERE
WOMEN PREFERRED -- DID BETTER IN
THE GROUP INTERVENTION BUT THAT
WAS NOT THE PRIMARY OUTCOME.
THAT'S THE FIRST ONE.
SO WE USED THE PROMIS FATIGUE
AND SLEEP DISTURBANCE SUBSCALE
SO THAT'S WHAT WE USED TO
MEASURE THIS.
BUT WE'RE WORKING WITH SOME
FELLOWS AT THE WESTHAVEN VA AND
YALE WHO ARE INTERESTED IN
DIGGING MORE DEEPLY INTO SLEEP.
SO WE DO HAVE ALL THE EHR STUFF
NEATLY PARSED OUT, SO I THINK
THAT'S A GREAT AREA TO LOOK AT
IN MORE DEPTH.
ESPECIALLY SINCE WE HAVE A LOT
OF WOMEN, YOU ARE MORE AFFECT
BID SLEEP DISTURBANCES IN THIS
POPULATION.
HI, DR. LANGEVIN.
>> I WANT TO THANK YOU SO MUCH
FOR THIS GREAT PRESENTATION, AND
REALLY INSPIRING, I THINK, THE
DIRECTION YOU'RE GOING.
I'M JUST WONDERING, YOU KNOW,
EXPANDING ON THIS THEME OF
LOOKING AT OTHER THINGS BESIDES
PAIN, I'M WONDERING IF WE CAN
JUST EVEN KEEP GOING, LOOK AT
THINGS LIKE BLOOD PRESSURE AND,
YOU KNOW, METABOLISM, YOU KNOW,
MAYBE BY -- WHEN PEOPLE ARE
IMPLYING THIS MINDFULNESS
INTERVENTION, IT MAY CHANGE A
LOT OF THINGS ABOUT THEIR
PHYSIOLOGY THAT YOU MIGHT BE
ABLE TO PICK UP, ESPECIALLY WHEN
YOU FOLLOW PEOPLE OVER A LONG
TERM.
SO PEOPLE MIGHT IMPROVE IN THEIR
METABOLIC INDICES LIKE FASTING
BLOOD SUGAR OR HEMOGLOBIN A1C OR
BLOOD PRESSURE OR THINGS WE KNOW
ARE INFLUENCED BY STRESS.
EVEN IMMUNE MARKERS MIGHT
IMPROVE OVER TIME.
IMPROVEMENT IN THESE MAY BE
SMALL IN EACH OF THESE THINGS,
BUT AGAIN US A POINTED OUT,
BECAUSE YOU MIGHT -- SO MANY
DIFFERENT SYSTEMS MAY IMPROVE
ALL AT ONCE, YOU MIGHT HAVE AN
OVERALL BIG EFFECT AND GET A LOT
OF BANG FROM THE BUCK
ESSENTIALLY.
RIGHT?
HAVE YOU BEEN TALKING ABOUT
SOMETHING LIKE THIS AT THE V.A.
OR DO YOU THINK THAT THEY WOULD
BE INTERESTED?
>> YOU KNOW, I AM WONDERING, NOW
THAT YOU SAY THIS, IF THERE'S
ANY MECHANISM THAT'S APPLIED
FOR, BECAUSE WE DO HAVE THE
MEDICAL RECORDS DATA ON
EVERYBODY OVER 12 MONTHS AND
BEYOND, SO I HADN'T THOUGHT
ABOUT THIS.
I KNOW THERE'S ALSO THE MVP, THE
MILLION VETERAN PROGRAM THAT
COLLECTS A LOT OF
INFORMATION/BIOMARKERS, THAT'S
SORT OF A SEPARATE DATASET.
SO I GUESS TWO THINGS.
WE HAVE FELLOWS THAT ARE SORT OF
DOING THIS, YOU KNOW, AS PART OF
THEIR FELLOWSHIP, BUT IT COULD
BE GOOD IF WE COULD DO SOMETHING
WITH THIS RICH DATASET THAT WE
REALLY HAVEN'T.
WE REALLY DIDN'T PULL THAT
INFORMATION, BUT IT IS THERE.
I DON'T KNOW.
ANY THOUGHTS?
>> I'M CURIOUS WHAT OTHER PEOPLE
THINK, BUT I THINK THIS IS
SOMETHING NOW THAT IF WE HAD
ASKED THAT QUESTION, SAY EVEN 10
YEARS AGO, I THINK THAT PEOPLE
WOULD HAVE SAID, OH, MY GOD, NO,
YOU'RE JUST GOING TO GET INTO A
STATISTICAL NIGHTMARE WITH ALL
THESE MULTIPLE COMPARISONS, ET
CETERA.
BUT NOW WE CAN START THINKING OF
PEOPLE AS INTERACTING,
MULTI-SCALE AND MULTISYSTEM
NETWORKS, WE CAN NOW START
ANALYZING COMPLEX DATASETS IN
WAYS THAT WE COULD NOT EVEN HAVE
THOUGHT ABOUT 10 YEARS AGO.
SO THIS IS WHERE COMBINING THE
KINDS OF DATA THAT YOU'RE ABLE
TO COLLECT IN A SETTING LIKE THE
V.A. WITH OUR LATEST ADVANCES IN
COMPUTATIONAL METHODS COULD
REALLY HELP TO DO THIS KIND OF
RESEARCH IN A WAY THAT IS
RIGOROUS AND IMPACTFUL.
SO REALLY THE TIME IS RIGHT FOR
SOMETHING LIKE THIS.
>> THAT IS A GREAT IDEA.
I'D NOT THOUGHT ABOUT THIS, BUT
DEFINITELY SOMETHING TO EXPLORE.
I MEAN, I LOVE THIS IDEA.
>> ANY OTHER THOUGHTS OR
COMMENTS?
>> I HAD JUST A QUICK QUESTION,
DIANA.
THAT WAS FANTASTIC AND I MAY
HAVE MISSED THIS, BUT OTHER
MEDICATIONS, WERE THE PATIENTS
EXCLUDED IF THEY WERE ON ANY
OTHER TYPES OF PAIN MEDICATIONS?
I SAW YOU HAD SOMETHING ABOUT
SCHIZOPHRENIC AND OTHER TYPES OF
MEDICATIONS, BUT THE REASON WHY
I ASK IS I'M WONDERING IF THERE
WAS ANY OUTCOMES AS FAR AS SORT
OMULTIPLE TYPES OF THERAPY.
LOWERING ANY OF THE MEDICATIONS
THEY WERE ON AND GETTING THIS
TYPE OF THERAPY, IS THAT VERY
EFFECTIVE?
I KNOW IT CAN BE FOR SOME OTHER
TREATMENTS WHERE YOU LOWER THE
NORMAL MEDICATIONS AND THEN
HAVING THESE OTHER TYPES OF
THINGS LIKE MINDFULNESS CAN BE
VERY, VERY BENEFICIAL.
SO I WAS JUST CURIOUS ABOUT
THAT.
>> YES, WE HAD VERY MINIMAL
EXCLUSION CRITERIA, SO PEOPLE
DID ALL THEIR SORT OF USUAL
PAIN, PAIN TREATMENTS INCLUDING
MEDICATION, AND WE HAD
SELF-REPORTED AND MEDICAL RECORD
DATA ON OPIOIDS, AND WE DIDN'T
FIND ANY DIFFERENCES BETWEEN THE
GROUPS.
SO IT DID NOT SEEM TO LOWER OR
CHANGE OPIOID DOSE, AT LEAST
THROUGH THE V.A. SYSTEM AND
THROUGH SELF-REPORT.
>> THANK YOU.
>> OTHER THOUGHTS OR QUESTIONS
OR COMMENTS?
OKAY.
WELL, THIS WAS REALLY, REALLY A
NICE PRESENTATION.
THANK YOU SO MUCH, AND
CONGRATULATIONS ON CONDUCTING
SUCH A GREAT STUDY AND
PUBLISHING THE RESULTS IN SUCH A
NICE PUBLICATION.
SO BRAVO.
>> THANK YOU SO MUCH FOR
INVITING ME AND LISTENING.
I REALLY APPRECIATE THIS.
>> GREAT.
WONDERFUL.
OKAY.
LEAH, ARE WE GOING TO MOVE ON TO
OUR NEXT?
WE'RE A LITTLE BIT AHEAD OF
SCHEDULE BUT NOT THAT MUCH, JUST
A LITTLE BIT.
>> YES, WE'RE JUST A LITTLE BIT
AHEAD OF SCHEDULE, SO WE CAN
KEEP MOVING AS LONG AS -- I'M
JUST MAKING SURE THAT
DR. SPEVAK -- ARE YOU ON AND
READY TO PRESENT IN A COUPLE
MINUTE?
OKAY, GREAT.
THEN I WILL -- JUST WANTED TO
MAKE SURE NOBODY WAS REALLY
COUNTING ON THE -- OKAY.
SO I BELIEVE I AM SHARING -- NO,
I AM NOT.
NOW I BELIEVE I'M SHARING MY
SCREEN.
CAN YOU ALL SEE THAT?
>> YES, WE CAN, LEAH.
>> OKAY.
WONDERFUL.
THANK YOU.
SO I AM NOW GOING TO INTRODUCE
OUR NEXT SECTION WHERE WE'RE
GOING TO HEAR FROM OUR FEDERAL
MEMBERS ABOUT THEIR PAIN-RELATED
ACTIVITIES.
THE GOALS OF THIS SECTION ARE
LISTED HERE.
SO REALLY THE TWO THINGS THAT
WE'RE TRYING TO DO IS DECREASE
SILOING BETWEEN THE AGENCIES AND
IMPROVE COMMUNICATION FROM US IN
THE FEDERAL GOVERNMENT OUT TO
YOU ALL IN THE COMMUNITY.
WE WANT TO PROMOTE PAIN-RELATED
RESOURCES AND ACTIVITIES,
FUNDING OPPORTUNITIES, AND
POLICIES THAT THE AGENCIES ARE
WORKING ON.
WE WANT TO HELP DISSEMINATE THAT
INFORMATION.
WE ALSO WANT TO MAKE RESOURCES
THAT ARE CURRENTLY AVAILABLE
EASIER TO FIND, BECAUSE
SOMETIMES THEY CAN BE BURIED IN
WEBSITES.
SO WE'RE WORKING ON MAKING THAT
EASIER.
WE ARE GOING TO BE HEARING --
I'M SORRY.
WE ARE GOING TO BE HEARING FROM
DR. CHRIS SPEVAK, WHO IS A PAIN
SPECIALIST AT WALTER REED
NATIONAL MILITARY MEDICAL
CENTER, DEPARTMENT OF DEFENSE
REPRESENTATIVE FROM THE AGENCY
FOR HEALTHCARE, RESEARCH AND
QUALITY.
WE'RE GOING TO HEAR FROM
DR. ELISABETH KATO, WHO'S A
MEDICAL OFFICER AT AHRQ.
FROM THE V.A., WE'LL HEAR FROM
DR. FRIEDHELM SANDBRINK,
EXECUTIVE DIRECTOR, PAIN
MANAGEMENT, OPIOID SAFETY AND
PRESCRIPTION DRUG MONITORING
PROGRAM AT THE V.A., AND FROM
THE FDA, WE'RE GOING TO HEAR
FROM DR. TINA DOSHI, ASSOCIATE
DIRECTOR FOR THERAPEUTIC REVIEW
OF PAIN MEDICINE AT THE FDA, AND
SHE WILL BE PRESENTING INSTEAD
OF DR. RIGOBERTO ROCA.
SO I WILL HAND IT OVER TO
DR. SPEVAK, AND WE ARE REALLY
HOPING TO HAVE A DISCUSSION.
WE ASKED SOME MEMBERS TO GIVE
YOU ALL AN OVERVEUL OF THE
AGENCY MISSION, NOT NECESSARILY
RELATED TO PAIN.
AND THEN HOW PAIN ACTIVITY FIT
INTO THAT MISSION.
ALSO AS I SAID, WE WANT TO HELP
FIND ANY MATERIALS OR POLICIES
OR FUNDING ANYTHING THAT THE
OTHER AGENCIES HAVE
DEVELOPED, WE WANT TO BE ABLE TO
USE IT IN THIS COMMITTEE TO HELP
SHARE THEM SO THAT PEOPLE CAN
FIND ALL THE WONDERFUL RESOURCES
THAT ARE OUT THERE.
SO WITH THAT, I WILL TURN IT
OVER TO DR. SPEVAK.
>> THANK YOU, LEAH.
AND THANK YOU FOR PUTTING
TOGETHER YOUR ORGANIZATIONAL
SKILLS ARE ABSOLUTELY
OUTSTANDING, KEEPING US
TOGETHER.
THANK YOU, DR. LANGEVIN AND
DR. DAA BIG THANK YOU TOSOPHIA S
FOR ME BECAUSE THAT REALLY
HELPS.
I'M GOING TO TALK A LITTLE BIT
ABOUT FROM THE DEPARTMENT OF
DEFENSE, THE MILITARY HEALTH
SYSTEM, AND SOME OF OUR RESEARCH
AND TECHNOLOGY RELATED ISSUES.
SO I DO APOLOGIZE FOR THOSE OF
YOU THAT ARE ALREADY FAMILIAR
WITH THIS INFORMATION, BUT
HOPEFULLY THERE WILL BE SOME
THINGS HERE THAT ARE NEW.
NOW THE MILITARY HEALTH SYSTEM
IS ONE OF AMERICA'S LARGEST AND
MOST COMPLEX HEALTH SYSTEMS, AND
IT'S THE WORLD'S PRE-EMINENT
MILITARY HEALTHCARE DELIVERY
OPERATION.
IT SERVES APPROXIMATELY
9.6 MILLION BENEFICIARIES MADE
UP OF 1.4 MILLION ACTIVE DUTY
SERVICE MEMBERS, 331 RESERVE
COMPONENTS, MILITARY RETIREES,
AND FAMILY MEMBERS.
NOW, THE R & D PROGRAM IS ABOUT
$2.2 BILLION, AND WE HAVE
CONSOLIDATED SEVEN RESEARCH LABS
WHERE 2,135 SCIENTISTS AND
SUPPORT STAFF COLLABORATE WITH
ACADEMIA AND INDUSTRY.
THE DEFENSE HEALTH AGENCY, THIS
SUPPORTS THE DELIVERY OF
INTEGRATED AFFORDABLE HIGH
QUALITY HEALTH SERVICES AT ALL
MILITARY MEDICAL TREATMENT
FACILITIES.
FRAWSH PRIOR TO THE
PRIOR TO THE ESTABLISHMENT OF
THE DEFENSE HEALTH AGENCY, EACH
SERVICE HAD THEIR OWN HEALTHCARE
SYSTEM.
SO THAT WAS AIR FORCE, ARMY AND
NAVY.
AS A COMBAT SUPPORT AGENCY, THE
DEFENSE HEALTH AGENCY LEADS THE
MILITARY HEALTH SYSTEM
INTEGRATION OF READINESS AND
HEALTH TO DELIVER WHAT WE CALL
THE QUADRUPLE LANE: INCREASE
READINESS, BETTER HEALTH, BETTER
CARE AND LOWER COST.
SO HERE YOU CAN SEE, I'M NOT
GOING TO READ TO YOU OUR VISION
AND OUR MISSION, BUT HERE YOU
CAN SEE OUR VALUE-BASED CARE.
VALUE EQUALS READINESS PLUS
HEALTH, PLUS CARE OVER COST.
AND HERE YOU CAN SEE HOW WE
FOCUS ON OUR BETTER CARE, OUR
BETTER HEALTH, INCREASE
READINESS AND LOWER COST.
AGAIN, THE QUADRUPLE AIM FOR
MILITARY INCREASED READINESS.
AND THAT'S ONE OF THE KEYS.
NOW, AS A COMBAT SUPPORT AGENCY,
THE DEFENSE HEALTH AGENCY
SUPPORTS DELIVERY OF AN
INTEGRATED, AFFORDABLE, HIGH
QUALITY HEALTH SERVICES AT ALL
MILITARY TREATMENT FACILITIES.
MISSION IS TO SUPPORT THE
NATIONAL DEFENSE STRATEGY AND TO
SERVICE MILITARY DEPARTMENTS BY
LEADING THE MILITARY HEALTH
SYSTEM AS INTEGRATED, HIGH
RELIABLE MEDICAL TRAINING,
READINESS AND HEALTH.
WE HAVE FOUR, AS YOU CAN SEE,
STRATEGIC PRIORITIES: GREAT
OUTCOMES, WHICH IS OUR MOST
IMPORTANT OUTCOME.
THAT MOST IMPORTANT OUTCOME IS A
MEDICALLY READY FORCE.
OUR MTFs SUSTAIN TEAM-BASED
CURRENCY AND PROFICIENCY,
ENABLING A READY MEDICAL FORCE.
THIRD, SATISFIED PATIENTS.
OUR PATIENTS FEEL FORTUNATE FOR
MHS HEALTHCARE.
AND FOUR, FULFILLED STAFF.
NOW, THE CAMPAIGN PLAN DESCRIBES
FUTURE STATE FOR THE DHA WHICH
IS OPTIMIZED TO SUPPORT THE
NATIONAL DEFENSE STRATEGY.
WE CONTINUE TO MATURE AND EXPAND
CAPABILITIES AS A COMBAT SUPPORT
AGENCY, AND DERIVE IMPROVEMENTS
IN HEALTHCARE ADMINISTRATION AS
WELL AS OPERATIONAL SUPPORT FOR
THE COMBAT AND COMMANDS.
THE DHA IS A JOINT OPERATIONAL
HEADQUARTERS MANAGING, EXECUTING
AND DELIVERING THE HIGH QUALITY
HEALTHCARE, EDUCATION, AND
TRAINING.
AS WELL AS MILITARY MEDICAL
RESEARCH DEVELOPMENT AND PUBLIC
HEALTH SUPPORT TO THESE
9.6 MILLION BENEFICIARIES,
ACHIEVING THE END STATE REQUIRES
INTEGRATED EFFORTS ACROSS
8 STRATEGIC INITIATIVES THAT
SUPPORT OUR FOUR PRIORITIES.
NOW, WE HAVE BECOME AND CONTINUE
TO BE A LEARNING ORGANIZATION
AND INCREASE HIGH RELIABILITY
ACROSS THE MHS.
WE CALL THIS APPROACH READY
RELIABLE CARE.
HIGH RELIABILITY ORGANIZATIONS
ACHIEVE TOP OUTCOMES DESPITE
OPERATING COMPLEX OR HIGH RISK
ENVIRONMENTS LIKE A HEALTHCARE
SYSTEM.
AND YOU ALL KNOW THIS, WE GET
TOP RESULTS, STANDARDIZING
PROCESSES, REDUCING AIR O
CELEBRATING TRANSPARENCY,
VALUING INPUT, AND IN ORDER TO
ADVANCE THIS HIGH RELIABILITY,
WE HAVE SEVEN PRINCIPLES.
PREOCCUPATION OF FAILURE,
SENSITIVITY TO OPERATIONS,
DEFERENCE TO EXPERTISE, RESPECT
FOR PEOPLE, COMMITMENT TO
RESILIENCE, CONSTANCY OF
PURPOSE, AND RELUCTANCE TO
SIMPLIFY.
THIS IS A SLIDE THAT SHOWS OUR
SENIOR LEADERSHIP ON THEIR AS WE
ARE A AN ORGANIZATION THAT IS
HIGHLY DYNAMIC, THERE HAS BEEN
SOME CHANGE IN THOSE.
BUT LET'S GO ON TO THE NEXT
SLIDE, WHICH I THINK IS GOING TO
BE IMPORTANT FOR YOU.
I SWITCHED THE ORDER AND I WANT
TO LOOK AT THIS SLIDE BECAUSE I
THINK THIS IS REALLY GOOD
BECAUSE IT SHOWS, IT
DEMONSTRATES THE ORGANIZATIONAL
SUPPORT THAT WE HAVE.
NOW THE DEPUTY ASSISTANT
DIRECTOR, THE DAD FOR RESEARCH
AND ENGINEERING, AS YOU CAN SEE
IS AT THE TOP OF THIS.
HE HAS A DEPUTY DIRECTOR, CHIEF
OF STAFF, AND THEN IT DIVIDES
INTO TWO COMPONENTS.
AND WE'LL BE TALKING ABOUT THIS
MORE IN A FEW MINUTES.
THE RESEARCH PORTFOLIO
MANAGEMENT, AND THE RESEARCH
SUPPORT DIVISION.
NOW UNDER THE PORTFOLIO
MANAGEMENT AND I DO APOLOGIZE
FOR THE TINY WRITING, WE HAVE
THE S & T, THE SCIENCE AND
TECHNOLOGY PORTFOLIO, EXTREMITY
TRAUMA AND AM T AMPUTATION BRAN,
HEARING BRANCH, PSYCHOLOGICAL
LET BRANCH, TRAUMATIC BRAIN
INJURY AND VISION.
SO YOU CAN SEE THOSE SIX
BRANCHES.
NOW THE RESEARCH SUPPORT
DIVISION SUPPORT THE PORTFOLIO
WITH RESEARCH PROTECTION BRANCH,
CLINICAL INVESTIGATION PROGRAM
BRANCH, MHS RESEARCH BRANCH,
NATIONAL MUSEUM OF HEALTH AND
IMPLEMENTATION SCIENCE BRANCH.
NOW YOU CAN SEE IN THE BLUE,
THAT'S WHAT WE JUST TALKED
ABOUT, BUT THIS IS A NICE SLIDE
BECAUSE IT SHOWS WHERE THIS ALL
FITS IN TERMS OF THE ENTIRE
ORGANIZATION, BECAUSE AT THE
TOP, YOU SEE THE DIRECTOR FOR
THE DEFENSE HEALTH AGENCY WITH A
DEPUTY DIRECTOR, AND IMMEDIATELY
UNDER THAT ARE THE ASSISTANT
DIRECTORS.
DIRECTOR OF STAFF, DIRECTOR OF
HEALTHCARE ADMINISTRATION, AND
THEN THE ASSISTANT DIRECTOR OF
SUPPORT.
AND THERE IMMEDIATELY LIES WHERE
THE DEPUTY ASSISTANT DIRECTOR
FOR RESEARCH AND ENGINEERING
LIES.
SO YOU CAN SEE THE HIGH LEVEL OF
IMPORTANCE THAT THIS HAS WITHIN
THE ORGANIZATION.
SO HERE WE'RE GOING TO TALK
ABOUT THE RESEARCH AND
ENGINEERING FROM AN OPERATIONAL
VIEWPOINT.
THE MISSION TO LEAD THE
DISCOVERY OF INNOVATIVE MEDICAL
SOLUTIONS, RESPONSIVE TO THE
NEEDS AGAIN OF THE COMBATANT
COMMANDS.
YOU CAN SEE THE THEME, THE
SUPPORT OF THE COMBATANT
COMMANDS.
THE MILITARY SERVICES AND THE
MILITARY HEALTH SYSTEM.
HERE ARE OUR INPUTS.
IN THE NEXT FOLLOWING SLIDES,
THIS REPEATS ITSELF.
OUR WHITE HOUSE PRIORITY
CONGRESSIONAL MANDATES DOD
LEADERSHIP PRIORITY, DOD AND DHA
DIRECTIVES JOINT VALIDATED
REQUIREMENTS, RTD & E GUIDANCE,
CAMPAIGN PLAN INITIATIVES AND
CLINICAL GAPS AND PRIORITIES.
AND WHAT ARE THE OUTPUTS?
S & T, INVESTMENT STRATEGIES,
RESEARCH TRANSITION AGREEMENTS,
ROAD MAPS, CLINICAL
RECOMMENDATIONS, AGENCY-WIDE
PRIORITIES, EFFICIENT APPROVALS
OF RESEARCH PROTOCOLS, RESICH
INSIGHTS ON MHS QUALITY AND
VARIATION IN READINESS AND
EFFECTIVE IMPLEMENTATION OF
EVIDENCE HIGH PRESSURE BASED
CHANGES.
AND AGAIN YOU CAN SEE THESE TWO
BRANCHES AS WE JUST TALKED
ABOUT, THE RESEARCH PORTFOLIO
MANAGEMENT FOLLOWED BY THE
RESEARCH SUPPORT DIVISION WHICH
SUPPORT THAT.
SO WHAT ABOUT THE RESEARCH
PORTFOLIO MANAGEMENT DIVISION?
AGAIN WE HAVE THE LEAD, THE LEAD
KERNEL,COERNEL.
AGAIN WE SEE THIS AND I REALLY
LIKE THIS SLIDE BECAUSE IT PUTS
IT INTO A BIGGER PICTURE, THE
RESEARCH COMPONENTS.
BECAUSE HERE AGAIN WE SEE THE
INPUTS, WE SEE THE OUTPUTS AS WE
DID BEFORE, BUT LOOK AT IT WHERE
WE SEE THE STRATEGIC DRIVERS,
TAKING CARE OF MILITARY
PERSONNEL, BETTER CARE, GREAT
OUTCOMES, INCREASED READINESS,
MEDICAL READY FORCE, RIGHT?
AND YOU CAN SEE THOSE INPUTS
THERE, NATIONAL DEFENSE
STRATEGY, MHS SYSTEM, THE QUAD
AIM, DEFENSE HEALTH AGENCY
PRIORITIES AND DEFENSE AGENCY
CAMPAIGNS.
THIS IS A NICE SLIDE BECAUSE IT
KIND OF GIVES YOU A BACK -- WHEN
YOU STEP BACK, AN OVERVIEW OF
WHERE THIS IS OCCURRING.
SO THE SCIENCE AND TECHNOLOGY
MANAGEMENT OVERVIEW.
THIS MODEL HAS BEEN IMPROVING
AND EVOLVING OVER TIME.
CURRENT PLANNED REFORMS,
CENTRALIZED MANAGEMENT OF
INVESTMENTS, MANY OF THOSE HAVE
ALREADY OCCURRED, IMPROVE JOINT
REQUIREMENTS ALIGNMENT, FOCUSING
EFFORTS ON AREAS WHERE WE CAN
HAVE THE MOST IMPACT AND
ACCELERATE PRODUCT DELIVERY.
VERY IMPORTANT.
PORTFOLIO MANAGERS ARE
RESPONSIBLE FOR THE DEVELOPMENT
OF STRATEGIC RESEARCH PLANS
ALIGNED TO THE INVESTMENT
STRATEGIES, AND MOVING AWAY FROM
LEVEL OF EFFORT INVESTMENT
STRATEGIES THROUGH IMPROVED
MULTIYEAR PLANNING AND
BUDGETING.
SEE THIS ON THE NEXT SLIDE.
AGAIN, SO WE HAVE ESTABLISHMENT
OF THE PORTFOLIO MANAGERS, AND I
SHOWED YOU THAT FOR ALL THE
MAJOR INVESTMENT AREAS,
DEVELOPING A STRATEGIC RESEARCH
PLAN, INCREASING TRANSPARENCY,
IMPROVING JOINT REQUIREMENTS FOR
ALIGNMENT, IMPROVING TRANSITION
AND EFFECTIVELY LEVERAGING
INTRAMURAL LAB CAPABILITIES.
AND HERE AGAIN, YOU SEE OUR
OUTPUTS AS CLEARLY DEFINED
AUTHORITIES FOR DIRECT COMMAND
AND CONTROL, APPROPRIATELY
BALANCED PORTFOLIOS, FOCUS ON
PRODUCT TRANSITION THROUGH
STRATEGIC PLANNING, ALIGN TO
ACQUISITION/COMMERCIAL LIFECYCLE
AND MANAGEMENT RESOURCE
EFFICIENCIES.
MAJOR INVESTMENT AREAS.
VERY CRUCIAL SLIDE.
ONE OF THE MOST IMPORTANT, I
THINK, FOR OUR GROUP HERE TODAY.
SO NUMBER ONE, RECEIVE MILITARY
OPERATIONAL MEDICINE.
NUMBER TWO, COMBAT CASUALTY
CARE.
AND NUMBER THREE, MILITARY
INFECTIOUS DISEASES.
UNDER OPERATIONAL MEDICINE,
AGAIN, WE HAVE MUSCULOSKELETAL
INJURY PREVENTION AND REDUCTION,
BLAST, BLUNT BLAST, EXCEL
RAYTIVE AND NEUROSENSORY INJURY,
PSYCHOLOGICAL HEALTH AND
RESILIENCE, PERFORMANCE IN ESSEX
TREEM ENVIRONMENTS AND OPTIMIZED
COGNITION AND FATIGUE
MITIGATION.
COMBAT CASUALTY CARE,
NEUROTRAUMA, HEMORRHAGE CONTROL,
PROLONGED CARE, SEVERE BURN, EN
ROUTE CARE, AUTONOMOUS CARE AND
EVACUATION, RADIATION HEALTH
COUNTERMEASURES, SUSTAINMENT OF
MED TALL EXPEDITIONARY SKILLS
AND MILITARY MEDICAL PHOTONICS.
AND AGAIN, MILITARY INFECTIOUS
DISEASE, VIRAL, BACTERIAL AND
WOUND HEALING AND YOU CAN SEE
WHERE PAIN IS REALLY WOVEN IN
THROUGH ALL OF THESE AREAS.
AGAIN, WE HAVE CENTERS OF
EXCELLENCE.
AND YOU'VE PROBABLY HEARD OF ALL
OF OUR CENTERS OF EXCELLENCE.
EXTREMITY TRAUMA AND AMPUTEE
CARE, HEARING, PSYCHOLOGICAL
HEALTH, TRAUMATIC BRAIN INJURY
AND VISION.
AND THE RESEARCH SUPPORT
DIVISION.
THAT'S THE SECOND ARM WE SHOWED
YOU PREVIOUSLY.
AGAIN SHOWS OUR RESEARCH
PROTECTIONS, CLINICAL
INVESTIGATIONS, MHS RESEARCH
BRANCH, NATIONAL MUSEUM OF
HEALTH AND MEDICINE AND
IMPLEMENTATION SCIENCE BRANCH.
THE RESEARCH SUPPORT DIVISION,
AGAIN, PUTTING THIS INTO THAT
LARGER SLIDE TO SHOW HOWL IT
SUPPORTS OUR OVERALL OBJECTIVES
AND WHAT'S IMPORTANT HERE IS, I
THINK WHEN WE LOOK AT OUR
OUTPUTS, OUR GLOBAL
STANDARDIZATION OF RESEARCH AND
PROTECTION POLICIES, EFFICIENT
APPROVALS OF RESEARCH,
INTEGRATED CLINICAL
INVESTIGATIVE PROGRAMS,
AGENCY-WIDE POLICIES AND
PROCEDURES, RESEARCH INSIGHTS ON
MHS ECONOMICS, QUALITY,
VARIATION.
AGAIN, AND THE BRANCHES AGAIN,
AND WE TALKED ABOUT THESE
BRANCHES WITHIN THE SUPPORT
DIVISION, INVESTIGATIONS,
RESEARCH PROTECTIONS, MHS
RESEARCH IMPLEMENTATION AND ALSO
THE NATIONAL MUSEUM OF HEALTH
AND MEDICINE.
IF YOU HAVEN'T SEEN THAT, IT'S A
VERY -- A WONDERFUL, WONDERFUL
TIME TO SPEND DOING THAT.
I'M GOING TO CONCLUDE NOW ON A
FINAL TWO SLIDES.
THE DHA SMALL BUSINESS
INNOVATION SBIR, SMALL BUSINESS
TECHNOLOGY TRANSFER PROGRAM,
THESE WERE CONGRESSIONALLY
MANDATED PROGRAMS TO INCREASE
PARTICIPATION OF U.S. SMALL
BUSINESSES FEDERAL RESEARCH,
SUPPORT BUSINESSES IN DEVELOPING
HIGH RISK, HIGH IMPACT MEDICAL
MATERIAL TECHNOLOGIES WITH
POTENTIAL FOR A WIDER
COMMERCIALIZATION.
AND A LITTLE OLDER FUNDING
SLIDE, BUT FY 22, $67.1 MILLION
AND TECHNOLOGY TRANSFER
$9.4 MILLION, AND YOU CAN SEE
TOPIC AREAS AGAIN, COMBAT
CASUALTY CARE, INFECTIOUS
DISEASE, OPERATIONAL RESOURCES.
AND YOU HAVE THE CONTACTS THERE
FOR THAT.
AND THIS IS IMPORTANT TO
CONCLUDE ON THE OMNIBUS IV
OVERVIEW.
IN 2022, MANY OF YOU HERE ARE
AWARE, DHA AWARDED THE OMNIBUS
IV MULTIPLE AWARD MILITARY
MEDICAL RESEARCH AND
DEVELOPMENT, INDEFINITE QUANTITY
CONTRACT TO SECURE BROAD RANGE
OF MILITARY MEDICAL R & D
ACTIVITIES AND SUPPORT.
IT LARGER THAN THE PREVIOUS ONE
WITH A $10 BILLION CEILING AND
IT'S A 10-YEAR OARING PERIOD
WITH A FIVE-YEAR BASE PLUS
5 OPTION.
IT'S A MEDICAL R & D GO-TO
VEHICLE FOR THE U.S. ARMY
MEDICAL RESEARCH ACQUISITION
ACTIVITY AND NAVAL MEDICAL
LOGISTICS COMMAND AND DHA
CONTRACT, AND AGAIN, THERE'S A
LINK WHERE CAN YOU LOOK AT MORE
ON THAT.
SO FINALLY, I WILL LEAVE YOU
WITH SOME EMAIL ADDRESSES WHERE
YOU CAN OBTAIN MORE INFORMATION
AND WEBSITES THAT I THINK WILL
BE VERY HELPFUL.
AND I WILL END RIGHT THERE.
THANK YOU AGAIN, THANK YOU,
SARAH, AND ANSWER ANY QUESTIONS.
TRYING TO KEEP YOU ON TIME.
>> THANK YOU SO MUCH, CHRIS.
THAT WAS GREAT.
WE WILL SHARE ALL OF THE
RESOURCES THAT WERE PROVIDED, WE
WILL BE SHARING THEM TO OUR
LISTSERV AND ON THE EMAIL -- OR
ON OUR WEBSITE AND I APOLOGIZE,
I WILL BACK UP AND LET
DR. LANGEVIN SPEAK.
>> I JUST WANT TO SAY THANK YOU.
THAT WAS A GREAT OVERVEUL.
AND I REALLY LOVE HOW YOU SHOWED
REALLY THE BIG PICTURE.
THIS IS SO IMPORTANT.
AND TO UNDERSTAND THE
CONNECTIONS TO MILITARY
READINESS WHICH YOU HAVE SO
NICELY DEMONSTRATED AND HOW
SERIOUSLY THIS IS -- YOU KNOW,
THIS IS JUST ALL HOLDING
TOGETHER SO NICELY.
SO CONGRESS GRAT LAITIONS ON ALL
THE -- I'M SURE THIS KIND OF
WORK IS NOT EASY TO DO, BUT TO
POSITION PAIN RESEARCH IN THE
MIDDLE OF ALL OF THIS IS SO
IMPORTANT.
SO THANK YOU.
>> THANK YOU, DR. LANGEVIN.
>> SO ARE THERE ANY COMMENTS OR
QUESTIONS?
AND THANK YOU, WE'LL HAVE ALL
YOUR MATERIALS AVAILABLE.
LAURA?
>> JUST QUICKLY, HI, CHRIS,
THANK YOU FOR A GREAT TALK.
YOU IT DI D DID IT WONDERFUL JO.
ONE QUESTION I HAVE FOR THE
GROUP IS, IF PEOPLE ARE LOOKING
FOR THE MOST UP TO DATE POLICIES
ON THE DHA PUTTING OUT RELATED
TO PAIN OR ANY GRANTS THAT MAYBE
CDMRP ARE PUTTING OUT, DO YOU
HAVE ANY RESOURCES FOR THE
COMMUNITY IN THOSE SITUATIONS?
>> I'M GLAD THAT'S THE ONLY
QUESTION YOU ASKED ME,
DR. WANDNER BECAUSE WHEN YOU CAN
RAISED YOUR HAND I THOUGHT SHE'S
GOING TO ASK ME SOMETHING I
CAN'T EVEN -- BUT I THINK THE
BEST, I DIDN'T EVEN TALK
ABOUT -- FOR EXAMPLE, PAIN
RESEARCH THAT IS SERVICE
LEVEL-SPECIFIC, SO FOR EXAMPLE,
THE ARMY, THE AIR FORCE AND NAVY
TO HAVE PAIN RESEARCH, THAT'S
OUTSIDE OF THIS.
SO IT'S REALLY, I THINK, YOU
KNOW, GETTING ON THOSE WEBSITES
AND THEY HAVE THEIR DISTRIBUTION
LIST THEN WHEN THEY ANNOUNCED
SOME OF THE FUNDING PROGRAMS IS
A GREAT WAY TO DO, AND I JUST
THINK, YOU KNOW, THIS CONTINUED
COLLABORATION WHICH I'M SO
GRATEFUL FOR, YOU KNOW, ALLOWS
US TO MEET EACH OTHER AND TO
KIND OF, YOU KNOW, KNOW EACH
OTHER'S BACKGROUNDS AND WHEN
SOMETHING POPS UP, YOU KNOW, THE
MUTUAL SHARING AND SENDING IT
BETWEEN ALL OF US, I THINK IS SO
IMPORTANT.
OH, HEY, YOU KNOW, THIS CAME UP,
I THOUGHT YOU MIGHT BE
INTERESTED.
I THINK THAT IS A SIGNIFICANT
PORTION OF MY DAY.
A VERY INEFFICIENT WAY, BUT I
THINK, YOU KNOW, NEEDED AND
HELPFUL.
>> GREAT.
THANK YOU.
WE'LL PROBABLY TALK OFFLINE TO
MAKE SURE WE HAVE ALL THE
CORRECT LINKS, BECAUSE I THINK
WE'D LIKE TO TH GET THEM ON TO E
IPRCC WEBSITE TO HAVE A MORE
CENTRALIZED PLACE FOR PEOPLE IN
THE COMMUNITY TO BE ABLE TO KNOW
HOW TO GET TO THEM, SO GREAT,
THANK YOU SO MUCH.
>> ALL RIGHT.
ARE WE READY TO MOVE ON TO OUR
NEXT AHRQ, I THINK?
>> YES.
THANK YOU.
>> SURE.
>> SO ELISABETH KATO, TAKE IT
AWAY.
>> DO YOU WANT ME TO SHARE MY
PRESENTATION?
OKAY.
HOLD ON A SECOND.
SORRY, I'M GOING TO HAVE TO --
IT'S GOING TO TAKE ME A MINUTE
TO FIGURE OUT HOW TO GET TO THE
RIGHT SCREEN, I THINK.
>> SO CAN YOU SEE MY POWERPOINT?
>> IF YOU CAN PUT IT IN
PRESENTATION MODE?
GREAT.
>> THERE NOW?
>> YEP.
>> EXCELLENT.
LET ME JUST SHIFT THINGS AROUND.
I FEEL LIKE EVERY TIME I GO BACK
TO ONE OF THESE THINGS LIKE
TEAMS OR ZOOM, THEY'VE CHANGED
IT AROUND A LITTLE BIT.
ANYWAY, THANK YOU SO MUCH FOR
GIVING ME TIME TO SPEAK TO THIS
GROUP.
I THINK IT'S SO IMPORTANT TO
HAVE A PLACE WHERE THE DIFFERENT
FEDERAL AGENCIES CAN SHARE WHAT
THEY'RE DOING, AND TO BREAK DOWN
SILOS.
SO THE AGENCY FOR HEALTHCARE
RESEARCH AND QUALITY'S MISSION
IS TO IMPROVE HEALTHCARE FOR ALL
BY PRODUCING EVIDENCE TO MAKE
HEALTHCARE OF HIGHER QUALITY SO
IT'S SAFER, PATIENT-CENTERED,
TIMELY, EFFECTIVE, ACCESSIBLE,
EFFICIENTLY PROVIDED AND
EQUITABLY DISTRIBUTED.
AND BECAUSE WE'RE A VERY SMALL
AGENCY, WE REALLY WORK TO
ACCOMPLISH THIS MISSION BY
COOPERATING ACROSS HHS AND THE
STATES, TERRITORIES, TRIBAL
NATIONS AND PRIVATE PARTNERS TO
MAKE SURE THAT THE EVIDENCE IS
UNDERSTOOD AND USED.
UNLIKE NIH, WE DON'T HAVE ORGAN
OR CONDITION-SPECIFIC RESEARCH
GENERALLY.
INSTEAD, WE FOCUS ON HEALTH
SERVICES AND HOW HEALTH SERVICES
ARE PROVIDED.
HOWEVER, PAIN IS AN INTEGRAL
PART OF MANY ACUTE AND CHRONIC
CONDITIONS AND SUBOPTIMAL PAIN
MANAGEMENT IS A SERIOUS
CONSEQUENCE FOR PATIENT
OUTCOMES.
AS A RESULT ENSURING ALL
PATIENTS RECEIVE APPROPRIATE
EVIDENCE-BASED PAIN MANAGEMENT
IS REALLY ONE OF THE MAJOR
CHALLENGES IN HEALTH SYSTEMS
RESEARCH.
SO WE HAVE BEEN DOING A FAIR
AMOUNT OF RESEARCH IN THE AREA
OF PAIN MANAGEMENT.
PARTICULARLY FROM ABOUT 2012 TO
ABOUT 2022, AHRQ HAD A NUMBER OF
DIFFERENT GRANTS AND CONTRACTS
FOCUSED ON HOW TO WE IMPROVE
PAIN MANAGEMENT.
WE'RE KIND OF WINDING DOWN AT
THIS POINT AND SHIFTING MORE TO
BEHAVIORAL HEALTH AND BEHAVIORAL
HEALTH INTEGRATION, AS A MORE --
A BROADER APPROACH TO IMPROVING
PAIN MANAGEMENT.
HOWEVER, WE STILL DO HAVE SOME
PAIN TREATMENT AND PAIN
MANAGEMENT PROJECTS THAT ARE
MAYBE OF SPECIFIC INTEREST TO
THIS GROUP.
ONE OF THEM IS THE NOFO THAT
AHRQ IS IN THE PROCESS OF
WINDING DOWN WHICH WAS IMPROVING
MANAGEMENT OF OPIOIDS AND OPIOID
USE DISORDER IN OLDER ADULTS.
THROUGH OUR MEDIWE HAD REALIZEDA
LOT OF THE EMPHASIS ON OPIOID
OVERDOSES WERE FOCUSED ON
YOUNGER PEOPLE, IN FACT, THE
STEEPEST INCREASE IN
HOSPITALIZATIONS RELATED TO
OPIOIDS IN THE PAST DECADE WERE
IN THE OVER 65 POPULATION.
SO AT THE END OF 2019, WE FUNDED
A TRIO OF GRANTS TO SPECIFICALLY
LOOK AT HOW WE COULD IMPROVE THE
MANAGEMENT OF OPIOIDS AND OPIOID
USE DISORDER IN OLDER ADULTS
SPECIFICALLY IN THE PRIMARY CARE
SETTING.
SO TAKING THE GREAT WORK THAT
NIH HAS BEEN DOING ABOUT WHAT
KINDS OF TREATMENTS
INTERVENTIONS WERE, AND THEN
TRYING TO FIGURE OUT HOW DO WE
CONVINCE PRIMARY CARE PRACTICES
TO START DOING THEM.
AND SO WE FUNDED THREE PROJECTS,
ONE WAS IN OKLAHOMA, ONE WAS IN
CHICAGO, AND ONE WAS IN RURAL
MICHIGAN.
THEY ALL USED SLIGHTLY DIFFERENT
COMBINATIONS OF COMPUTERIZED
DECISION SUPPORT, CLINICIAN
EDUCATION SOMETIMES USING ECHO,
SOMETIMES USING ACADEMIC
DETAILING, AND THEN ALL OF THEM
USED PRACTICE FACILITATION TO
HELP MAKE SURE THAT THE
PRACTICES TOOK THE BEST EVIDENCE
AND THEN CHANGED THE WORKFLOWS,
CHANGED WHATEVER NEEDED TO BE
DONE SO THAT THEY COULD ACTUALLY
DELIVER IT ON A MORE CONSISTENT
BASIS.
SO RMING AS YOU MAY HAVE PICKED
UP FROM THE TIMING, RIGHT WHEN
THEY WERE GETTING THE FIELD,
COVID HIT.
SO THAT REALLY KIND OF DELAYED
THINGS FOR BY ABOUT A YEAR,
HOWEVER, THEY'VE ALL WRAPPED UP
IN THE PAST COUPLE MONTHS, SO WE
EXPECT TO SEE THE PUBLICATIONS
SHOULD BE COMING OUT OVER THE
NEXT YEAR.
AND IF ANYONE IS INTERESTED IN
LEARNING MORE ABOUT ANY OF THEM
SPECIFICALLY, I'D BE HAPPY TO
TALK MORE ABOUT ANY OF THOSE.
SO THAT WAS ACTUALLY THE LAST OF
AHRQ'S KIND OF PROGRAMS FOCUSED
ON PAIN AND PAIN MANAGEMENT.
HOWEVER, JUST DUAL TO THE
UBIQUITOUS NATURE OF PAIN FOR
ALL OTHER CONDITIONS, WE DO HAVE
A NUMBER OF INVESTIGATOR
INITIATED GRANTS WHICH HAPPEN TO
HAVE A CONNECTION TO PAIN
MANAGEMENT.
I JUST PUT THEM UP THERE AND I
THINK THEY GIVE YOU A SENSE OF
THE BREADTH OF THE TYPE OF
RESEARCH THAT AHRQ FUNDS, SO
THERE ARE THINGS AROUND
UNDERSTANDING WHAT PATIENTS
PERCEIVE WHEN THEY'RE TRYING TO
DISCONTINUE OPIOIDS, HOW
POLICIES THAT WERE INTENDED TO
IMPROVE THE SAFETY OF OPIOIDS
MAY HAVE AFFECTED ACCESS TO PAIN
CARE FOR CANCER PATIENTS,
MULTIFACETED INTERVENTIONS
LOOKING AT IMPROVING CHRONIC
PAIN MANAGEMENT.
I'VE GOT A CONFERENCE GOING DOWN
IN ALABAMA, AND THEN A NUMBER OF
THEM LOOKING AT PARTICULAR PARTS
OF THE CARE SYSTEM, ESPECIALLY
AROUND THINGS LIKE SURGERY, POST
SURGERY, TO FIGURE OUT HOW WE
CAN DO A BETTER JOB OF MANAGING
PAIN, AGAIN, ON A VERY
SYSTEMATIC BASIS FOR ALL
PATIENTS SO THEY'RE GETTING THE
BEST CARE POSSIBLE.
IN TERMS OF RESOURCES, ONE THING
WHICH I THINK IS PROBABLY OF
GREAT INTEREST TO ANYBODY IN
THIS FIELD IS THE AHRQ
EVIDENCE-BASED PRACTICE CENTER
PROGRAM.
SO FOR ALMOST 30 YEARS NOW, AHRQ
HAS BEEN SUPPORTING A NETWORK OF
EVIDENCE-BASED PRACTICE CENTERS
THAT DO EVIDENCE REVIEW, OR
SYSTEMATIC REVIEWS TO LOOK AT
WHAT DO WE ACTUALLY KNOW ABOUT
THESE PARTICULAR CLINICAL
CHALLENGES.
AND BETWEEN I THINK 2012 AND
2022, AHRQ ACTUALLY FUNDED A
WHOLE SUITE OF SYSTEMATIC
REVIEWS RELATED TO THE
MANAGEMENT OF PAIN, OPIOIDS,
NON-OPIOID PAIN MANAGEMENT,
NON-PHARMACOLOGIC PAIN
MANAGEMENT, DIFFERENT
INTERVENTIONS, ET CETERA, AND
ALSO THEN UPDATES TO HELP
SUPPORT THE CDC'S GUIDELINES
AROUND PAIN MANAGEMENT AND
OPIOID USE.
THE LAST OF THOSE UPDATES WAS IN
2022, SO THEY'RE STILL AVAILABLE
ON THE WEB.
WE DON'T HAVE A PARTICULAR DATE
FOR WHEN THOSE WOULD NEXT BE
UPDATED.
BUT IN THE MEANTIME, THERE ARE A
NUMBER OF OTHER SYSTEMATIC
REVIEWS THAT EITHER WERE POSTED
IN THE PAST YEAR OR ARE IN THE
PROCESS OF BEING DEVELOPED.
ONE OF THE THINGS ABOUT THE
EVIDENCE-BASED PRACTICE CENTER
PROGRAM IS THAT WE TAKE
NOMINATIONS FOR TOPICS FROM OUR
FEDERAL PARTNER AGENCIES FROM
GUIDELINE GROUPS AND ALSO FROM
THE PUBLIC.
SO I'VE GOT THE LINK THERE TO
THE EFFECTIVE HEALTHCARE WEBSITE
WHERE THE EVIDENCE-BASED PROGRAD
THERE'S A PLACE THERE WHERE YOU
CAN PROPOSE NEW TOPICS FOR
SYSTEMATIC REVIEWS AND WE WILL
CONSIDER THEM.
IF YOU'RE A FEDERAL AGENCY AND
THERE'S A TOPIC WHERE YOU FEEL
HAVING A SYSTEMATIC REVIEW WOULD
HELP YOU JUMPSTART EITHER
FUNDING ANNOUNCEMENTS,
GUIDELINES OR ANYTHING LIKE
THAT, REALLY WOULD BE VERY HAPPY
TO TALK, SO PLEASE REACH OUT AND
WE CAN DISCUSS FURTHER.
AND IF YOU'RE A MEMBER OF THE
PUBLIC, AGAIN, IF YOU GO TO THE
WEBSITE, WE LOOK AT ALL OF THE
SUGGESTIONS RECEIVED.
THE OTHER THING IS OUR PROCESS
FOR DOING SYSTEMATIC REVIEWS
INVOLVES A LOT OF OPPORTUNITIES
FOR PUBLIC INPUT, SO KEY
QUESTIONS GO UP FOR A PERIOD OF
PUBLIC REVIEW AND INPUT, AND
ALSO THE DRAFT REPORTS.
SO YOU CAN SEE DRAFT REPORTS AND
ACTUALLY, YOU KNOW, IF YOU KNOW
OF ADDITIONAL RESEARCH, IF YOU
HAVE THOUGHTS ON HOW THE
CATEGORIZATION WAS MADE OR WHAT
THE OUTCOMES SELECTED WERE, YOU
CAN GIVE INPUT TO US.
FINALLY, WE'VE JUST CONCLUDED A
CONTRACT THAT WAS HOSTING A
COUPLE OF CYCLES OF LEARNING
CLAB TIFS WITH PRIMARY CARE
PRACTICES AGAIN TO TRY TO LOOK
AT HOW COULD WE HELP PRIMARY
CARE PRACTICES CHANGE HOW THEY
DELIVER THE MANAGEMENT OF
OPIOIDS AND PAIN CARE TO OLDER
ADULTS, AND IN THE COURSE OF
THAT, THE CONTRACTOR DID AB
ENVIRONMENTAL SCAN AND PULLED
TOGETHER KIND OF BEST PRACTICES
AND RESOURCES AND THEN TRIALED
THEM WITH A COUPLE OF CYCLES OF
PRIMARY CARE PRACTICES SO THAT
THEY COULD SEE WHAT WAS USEFUL,
WHAT WASN'T USEFUL, AND AS A
RESULT OF THIS, THEY PUT
TOGETHER WHAT WE'RE CALLING A
COMPENDIUM, AND IT'S AN ONLINE
INTERACTIVE TOOLKIT SO THAT
PRIMARY CARE PRACTICES CAN LOOK
AT THE DIFFERENT SORT OF HIGH
LEVEL CHANGES THAT THEY CAN BE
MAKING TO IMPROVE THEIR
MANAGEMENT OF OPIOIDS FOR OLDER
ADULTS, AND THEN IF THEY KIND OF
PICK WHICH ONE THEY WANT TO WORK
ON, IT MIGHT BE PROCESSES AND
WORKFLOWS, MIGHT BE RISK
ASSESSMENT, MIGHT BE HOW THEY
USE OPIOID DATA, BUT THEY CAN
CLICK ON ANY OF THOSE AND IT
WILL THEN TAKE THEM TO DIFFERENT
CHANGE STRATEGIES THEY CAN USE,
THEY CLICK ON A CHANGE STRATEGY,
IT WILL OUTLINE SOME KEY
ACTIVITIES AND THEN LINKS TO
ACTUAL TOOLS AND RESOURCES.
SO THE IDEA IS, IN THE ABSENCE
OF ACTUALLY HAVING A HUMAN
PRACTICE FACILITATOR TO HELP
WALK PRACTICE THROUGH, WHAT DO
WE NEED TO THINK ABOUT, WHAT ARE
OUR OPTIONS, IF WE WANT TO WORK
ON SOMETHING WHERE ARE THE
RESOURCES.
THIS HOPEFULLY WILL HELP BE A
KIND OF AUTOMATICALLY GUIDED
TOUR TO HOW THEY CAN CHANGE HOW
THEY'RE DELIVERING CARE TO OLDER
ADULTS WHO HAVE CHRONIC PAIN AND
MAY BE ON OPIOIDS.
SO WITH THAT, I'LL STOP SHARING,
AND HAPPY TO TAKE ANY QUESTIONS.
>> WOW, I'M REALLY IMPRESSED
WITH THIS COMPENDIUM APPROACH.
HOW LONG DID YOU SAY YOU HAD
THIS UP?
HOW LONG HAS THIS BEEN?
>> I THINK WE PUT IT UP OVER THE
SUMMER.
>> OH, SO THIS IS VERY RECENT.
>> YEAH, IT JUST WENT UP OVER
THE SUMMER.
AND THE LINK IS THERE, SO --
YES, WOULD LOVE TO HEAR FEEDBACK
ON THAT BECAUSE WE'RE TRYING TO
TRANSITION SOME OF OUR OTHER
PRODUCTS AROUND BEHAVIORAL
HEALTH INTEGRATION AND MOUD, SO
ANY FEEDBACK ON HOW EASY IT IS
TO USE, WHAT WOULD MAKE IT
BETTER, WE COULD START APPLYING
VARIOUS --
>> YES, AND YOU'RE HOPING THIS
IS GOING TO BE SPECIFICALLY
TARGETED TO PRIMARY CARE
PRACTITIONERS?
>> YES.
>> DO YOU HAVE ANY DATA ON WHO
IS USING IT?
BECAUSE IT'S INTERESTING, YOU
KNOW, LIKE WITH THE KIND OF DATA
THEY'RE GETTING AT CMS AS TO
WHO'S UTILIZING THEIR BILLING
CODES, THEY'VE GOT SURPRISES IN
TERMS OF WHO ENDED UP USING
THIS.
ARE YOU GOING TO BE ABLE TO TELL
WHO IS USING THIS?
>> UM, IT'S A LITTLE BIT
DIFFICULT BECAUSE THE WAY OUR
WEBSITE IS SET UP, WE CAN'T
TRACK WHO'S ACTUALLY USING IT.
WE DO HAVE A NEW CONTRACT THAT'S
GOING TO ALLOW US TO DO A BIT
MORE EVALUATION, SO WE MAY BE
ABLE TO DO SOME OUTREACH TO
FIGURE OUT WHO'S ACTUALLY
DOWNLOADING.
WE WILL BE TRACKING THE
DOWNLOADS, AT LEAST, AND WHERE
REFERRALS ARE COMING FROM.
>> LAURA?
>> AGAIN, GREAT TALK, IT'S GREAT
TO HEAR ABOUT ALL OF THESE
RESOURCES AND OPPORTUNITIES.
IT SOUNDS LIKE THIS RELEASE
HAPPENED OVER THE SUMMER.
WAS THERE ANY PRESS RELEASES
THAT IF IPRCC TRIES TO AMPLIFY
FOR YOU TO BRING MORE ATTENTION
TO THE RESOURCE, THAT WE COULD
PUSH FORWARD?
>> WE HAVE -- IT'S LOCATED ON
OUR -- THE ACADEMY FOR
INTEGRATING BEHAVIORAL HEALTH IN
PRIMARY CARE, AND I CAN KIND OF
SCRAPE THAT OFF AND MAKE IT INTO
A PRESS RELEASE IF THAT'S
SOMETHING YOU'D BE WILLING TO
DO, THAT WOULD BE TERRIFIC.
>> SO LET'S TALK OFFLINE, THAT
WOULD BE GREAT.
THE GOAL AGAIN, WHAT WE'RE
REALLY TRYING TO WORK TOWARDS
NOW IS MAKING SURE THAT IRPCC IS
ABLE TO PROMOTE THE WORK THAT
THE DIFFERENT FEDERAL AGENCIES
ARE WORKING ON IN THESE SPACES
AND BEING ABLE TO AMPLIFY THAT,
SO WE WOULD LOVE TO DO THAT, SO
PLEASE REACH OUT FOR US.
>> THIS IS SOMETHING THE PURPOSE
NETWORK SHOULD BE --
>> THAT'S THE OTHER THOUGHT,
THAT WE COULD BRING THIS TO
PURPOSE.
>> YEAH, FOR SURE, YEAH.
>> GREAT.
AND WE'RE ACTUALLY -- AND THEN
HOPEFULLY, THE NEXT FEW MONTHS,
WE'RE GOING TO BE TAKING SOME OF
THE BOTH FINDINGS AND TOOLS FROM
THE THREE GRANTS THAT ARE
WRAPPING UP AND ALSO INTEGRATING
THAT ON TO THE WEBSITE, SO WE'LL
HAVE A LITTLE BIT MORE
HOPEFULLY, ALSO A TIMING THING
AND STAFFING THING.
>> IT'S PE FERKT.
PER FORECAST.
PERFECT.IF YOU HAVE THAT INFORMN
THEN WE COULD HELP PROMOTE THAT
INFORMATION ONCE THE RESULTS ARE
RELEASED TO GET THE COMMUNITY TO
LOOK INTO THE MOST RECENT STUDY
RESULTS.
>> OH, THAT WOULD BE FANTASTIC.
BOY, THIS MEETING HAS ALREADY
BEEN INCREDIBLY PR PRODUCTIVE.
>> THAT'S WHY WE'RE HERE.
WE'RE ALL DOING INTERESTING
THINGS THAT WE ALL NEED TO SORT
OF KNOW ABOUT EACH OTHER'S
EFFORTS.
THIS IS WHY THIS MEETING IS SO
IMPORTANT.
ALL RIGHT.
SO WHO IS NEXT?
THANK YOU SO MUCH.
IS THERE ANY OTHER QUESTIONS FOR
ELISABETH?
ALL RIGHT, THANK YOU.
ALL RIGHT.
WHO'S NEXT?
FRIEDHELM SANDBRINK, VETERANS
AFFAIRS.
>> SO I HOPE YOU CAN HEAR ME.
LET ME SEE, HOPEFULLY YOU CAN
SEE ME NOW TOO?
CAN YOU PROVIDE FEEDBACK THAT
YOU HEAR ME WELL?
>> WE CAN HEAR YOU, FRIEDHELM.
>> OKAY, THANK YOU SO MUCH.
SO I'M GOING TO GIVE YOU A
LITTLE BIT OF AN OVERVIEW FROM
THE DEPARTMENT OF VETERANS
AFFAIRS ABOUT OUR PAIN
MANAGEMENT EFFORTS, IN
PARTICULAR WITH EMPHASIS ON
RESEARCH.
SO -- AND PLEASE GO TO THE NEXT
SLIDE.
I DO WANT TO GIVE CREDIT TO
OTHERS WHO HAVE HELPED WITH THIS
PRESENTATION AND PROVIDED INPUT,
BUT AT THE SAME TIME ALSO
ALREADY PROVIDE YOU AN OVERVIEW
OF THOSE CONTACTS.
SO FROM OUR SIDE, THIS IS A
CONTACT INFORMATION FOR THE PAIN
MANAGEMENT OPIOID SAFETY AND
PRESCRIPTION DRUG MONITORING
PROGRAM, THAT'S OUR PMOP
PROGRAM.
I AM UNDER THE SPECIALTY CARE
PROGRAM OFFICE IN THE VETERANS
HEALTH ADMINISTRATION AS A
NATIONAL PROGRAM EXECUTIVE
DIRECTOR FOR PAIN MANAGEMENT AND
HEATHER PATTERSON IS MY
EXECUTIVE ASSISTANT, BUT I WANT
TO GIVE CREDIT TO THE OFFICE OF
RESEARCH AND DEVELOPMENT, IN
PARTICULAR, AUDREY KUSIAK, WHO
PROVIDED INFORMATION AND SOME OF
THE SLIDES HERE, AND THEN FROM
THE PAIN OPIOID CONSORTIA OF
RESEARCH, THE PAIN OPIOID CORE
AS WE CALL IT, ALICIA HEAPY --
[SPEAKER FROZEN]
>> DID WE JUST LOSE FRIEDHELM?
>> AFRAID SO.
>> HOPEFULLY HE'LL COME BACK.
>> FRIEDHELM, MAYBE TURN OFF
YOUR VIDEO?
YOU FROZE.
NOW WE LOST HIM --
>> ALL TOGETHER.
>> ALL RIGHT.
HOPEFULLY YOU CAN HEAR ME AGAIN.
>> YES.
>> MAYBE I'M GOING TO GO OFF
VIDEO IN CASE THERE'S ANY KIND
OF CONNECTIVITY ISSUES.
SOPHIA, COULD YOU ADVANCE THE
SLIDE?
THANK YOU SO MUCH.
SO YOU KNOW, THIS IS JUST A
GENERAL BACKGROUND OF
INFORMATION THAT WE OFTEN SHARE
IN THIS KIND OF CONTEXT, AND THR
COMES FROM THE NATIONAL HEALTH
INTERVIEW SURVEY, AND THANK YOU,
AT THE NIH FOR PROVIDING THIS
DATA, BUT CLEARLY AS YOU CAN SEE
HERE, PAIN IS MORE COMMON IN THE
VETERAN POPULATION THAN IN THE
NON-VETERAN POPULATION, AND YOU
SEE THE NUMBERS HERE, IT ACROSS
THE BOARD FOR INCLUDING IN
PARTICULAR YOUNGER AGE GROUPS,
AND IT'S MORE OFTEN SEVERE.
THIS IS FOR THE NON- -- THIS IS
FOR VETERANS ACROSS THE UNITED
STATES.
IF YOU GO TO THE NEXT SLIDE,
PLEASE, ON THE NEXT SLIDE, YOU
SEE SOME INFORMATION WE GOT
VETERANS WHO ARE IN THE VHA.
ABOUT 1 OUT OF 3 HAS A CHRONIC
PAIN DIAGNOSIS.
AS WE TAKE CARE OF CLOSE TO
10 MILLION VETERANS WHO TOUCH
UPON THE V.A. IN SOME FORM,
THERE ARE ABOUT 6 MILLION WHO
RECEIVE THE PRIMARY CARE FROM
THE V.A. AND THE MAJORITY OF
THEIR CARE IS ORGANIZED BY US,
AND SO OUT OF THOSE 6 MILLION,
2 MILLION VETERANS HAVE A
CHRONIC PAIN DIAGNOSIS.
AND THERE WAS A RECENT STUDY BY
OUR RESEARCH COLLEAGUES WHO
LOOKED SPECIFICALLY AT THE
NUMBER OF PAIN CONDITIONS THAT
PEOPLE HAVE, AND AS YOU CAN SEE
THAT 58% OF WOMEN AND 50% OF MEN
HAVE MORE THAN ONE PAIN
CONDITION, AND IF YOU LOOK AT
MULTIPLE CHRONIC OVERLAPPING
SYNDROMES, RIGHT, I MEAN, CLOSE
TO 10% OF WOMEN AND 4% OF MEN
HAVE MORE THAN -- HAVE MORE THAN
FOUR PAIN CONDITIONS.
SO HAVING OVERLAPPING PAIN
CONDITIONS, HAVING RATHER
COMPLEX PAIN SITUATION IS
COMMON, AND THEN AS YOU SEE HERE
ALSO THE INFORMATION WE GOT IN
MENTAL HEALTH COMORBIDITIES, IN
PARTICULAR PTSD, THAT 50% OF
PATIENTS WITH PTSD HAVE CHRONIC
PAIN, AND THERE'S AN ESTIMATE
THAT ALMOST HALF OF THE PATIENTS
WHO COME AND SE SEEK PAIN CARE A
PAIN SPECIALTY CLINIC HAVE PTSD
LIKELY.
SO HOW DO WE ORGANIZE IN THE
CARE HERE?
REGARD TO THE RESEARCH?
A FEW SLIDES FROM THE OFFICE OF
RESEARCH AND DEVELOPMENT, ORD,
WHO LEADS OUR RESEARCH ACROSS
THE BOARD.
AS YOU CAN SEE HERE, PAIN
OBVIOUSLY COVERS A RANGE OF
TOPICS IN ORD.
IT'S A WHOLE SPECTRUM FROM BASIC
SCIENCE TO CLINICAL TRIALS THAT
WE DO.
SOME ARE SPECIFICALLY FOCUSED ON
PAIN AND OPIOID USE DISORDER AND
OPIOID USE THAT I'M GOING TO
TALK ABOUT, BUT OFTEN PAIN IS AN
ELEMENT IN REGARD TO OTHER
STUDIES AS WELL THAT MAY NOT BE
PRIMARILY DIRECTED AT PAIN.
AND THEN THERE'S A FOCUS NOW
THAT WE HAVE ON PAIN AND OPIOID
USE, IT CALLED THE ACTIVELY
MANAGED PORTFOLIO, AMP, PAIN AND
OPIOID AMP.
THIS FOCUSES SPECIFICALLY ON VHA
AND THE VETERANS WITH HIGH
PRIORITY AREAS.
THIS EXPLAINS IT JUST A LITTLE
BIT BETTER.
IN THE PAST WE HAD THE FOUR
SERVICES OF RESEARCH
DISCIPLINES, RIGHT?
WE HAVE CLINICAL SCIENCE R & D,
REHAB R & D, MENTAL HEALTH R & D
AND THE BIOMEDICAL LAB R & D,
BUT NOW THEY ARE WORK TOGETHER
AND AMONG OTHERS HAVE DEVELOPED
ACTIVELY MANAGED PORTFOLIOS FOR
PARTICULARLY HIGH AREAS OF
RELEVANCE TO VHA IN REGARD TO
VETERAN POPULATION.
AND PAIN AND OPIOID USE AMP ON
THE RIGHT SIDE IS ONE OF THE
ACTIVE MANAGED PORTFOLIOS IN
ADDITION TO SUICIDE PREVENTION,
AS WELL AS TBI.
JUST A LITTLE MORE INFORMATION
ABOUT THE KEY CAPABILITIES FOR
THE PAIN OPIOID USE AMP.
AS YOU CAN SEE HERE, IT FOCUSES
ON TEAM APPROACHES, STRATEGIC
COORDINATION OF THE RESEARCH
PROJECTS WITHIN THE PORTFOLIO
FOSTERS A COLLABORATION,
PROVIDES A ROAD MAP AND SETS
PRIORITIES WITH THAT.
AND IT OBVIOUSLY ENHANCES
UTILIZATION OF THE DATA TO TRULY
IMPROVE THE COORDINATION WITHIN
RESEARCH BUT ALSO TO ALLOW US AS
OPERATIONAL PARTNER TO WORK
BETTER IN REGARD TO
IMPLEMENTATION THE NEXT STEPS
AND PROVIDING APPLICATION OF THE
DATA AND THE OUTCOMES.
IF YOU GO TO THE NEXT SLIDE,
JUST A LITTLE BILTMORE IN THIS
REGARD, THE MANY STAKEHOLDERS
AND PARTNERS THAT ARE INVOLVED
AND SUPPORT THE PAIN OPIOID USE
AMP, THE TOP ONES ARE OF COURSE
AROUND THE CIRCLE THERE, THEY
ARE DIFFERENT DEPARTMENTS WITHIN
THE V.A. AND YOU SEE THE
ABBREVIATIONS EXPLAINED ON THE
RIGHT SIDE, BUT ALSO THE INPUT
FROM DOD AND NIH IS HUGELY
RELEVANT OBVIOUSLY IN REGARD TO
DEVELOPING THE STRATEGIC GOALS
IN OUR APPROACHES.
AND THIS IS AN EXECUTIVE
COMMITTEE THAT SUPPORTS THE PAIN
OPIOID USE AMP THAT INCLUDES THE
CLINICAL STAKEHOLDERS FROM THE
DIFFERENT PAIN AND OPIOID USE
RELEVANT SERVICE LINES, AND
AMONG OTHERS, IT INCLUDES PMOP,
SO OUR PRIMARY CARE CENTER
OFFICE DEPARTMENT OR SERVICE,
THEN THE PRIMARY CARE, THE
OFFICE OF PATIENT-CENTERED CARE
AND CULTURAL TRANSFORMATION,
PHARMACY BENEFITS, PHYSICAL
MEDICINE AND REHABILITATION AND
SUICIDE PREVENTION AS YOU CAN
SEE HERE.
AND THIS IS INFORMED ALSO BY
INPUT FROM THE FIELD, THERE WAS
A SURVEY TO STAKEHOLDERS
ORGANIZED BY QUERI, AND ALSO A
STATE-OF-THE-ART CONFERENCE IN
JULY 2023 THAT DISCUSSED AND
REFINED THE KEY AREAS FOR
CLINICAL CARE OF VETERANS AS IT
RELATES TO RESEARCH.
SO THIS IS JUST A LITTLE BIT
MORE ABOUT THE HIGH PRIORITY
AREAS AS DEFINED FROM THESE
SOURCES.
ONE IS MANAGEMENT OF PAIN OR
OPIOID USE, YOU SEE THAT ON TOP
LISTED HERE.
IN PARTICULAR WE'RE TALKING
ABOUT COMPLEMENTARY INTEGRATIVE
HEALTH MODALITIES WITH OUR
PARTNERS TO FOCUS ON WHOLE
HEALTH APPROACH TO PAIN CARE,
BEHAVIORAL PAIN CARE SUCH AS CBT
AND ACT, AND THEN, OF COURSE,
PHARMACOLOGICAL APPROACHES AS
WELL, FUNCTIONAL APPROACHES YOU
ASYOU SEE HERE, AND PRAGMATIC
APPROACHES IN REGARD TO OPIOID
USE, OPIOID TAPERING AND
PROVIDING AND INCREASING ACCESS
TO OPEN POID USE DISORDER, AS
WELL AS SPECIAL POPULATIONS
WITHIN THE VETERANS POPULATIONS
WITH A FOCUS ON MINORITIES OR
OTHER POSSIBLY DISADVANTAGED
SUBPOPULATIONS.
ANOTHER AREA OF FOCUS IS THE
PAIN MANAGEMENT TEAMS.
HOW CAN WE MAKE OUR TEAMS MORE
EFFICIENT?
WE ARE TRYING TO DEFINE WHAT IS
A HIGH FUNCTIONING TEAM.
AND THEN OF COURSE BIOMARKERS IS
SOMETHING, THE PHARMACOGENOMICS
THAT GUIDES CLINICAL CARE IS
ANOTHER EMPHASIS AND PRIORITY
AREA FOR THE PAIN OPIOID USE
AMP.
IF YOU GO TO THE NEXT SLIDE,
IT'S A LITTLE BIT OF AN OVERVIEW
OF THE DIFFERENT PORTFOLIO WELL
HAVE, THE PORTFOLIO THAT WE
HAVE.
AS YOU CAN SEE HERE, 41 STUDIES
ARE IN THE PRE-CLINICAL AREA, 6E
DIFFERENT FUNDING TERMS ARE
LISTED HERE AS WELL AS, AS YOU
CAN SEE ON THE RIGHT SIDE, A
LITTLE BIT MORE INFORMATION
ABOUT THE DIFFERENT CATEGORIES
THAT FALL UNDER THE PURVIEW.
I BROUGHT JUST MORE INFORMATION
ABOUT THE CLINICAL STUDIES THAT
IS GOING TO BE ON ONE OF THE
FUTURE SLIDES HERE.
IN THIS
REGARD, AND IT JUST SHOWS HERE
THAT, AGAIN, THE FULL RANGE IS
FROM BASIC SCIENCE APPROACHES TO
PAIN CARE AND SUPPORTING PAIN
MANAGEMENT IN REGARD TO ON THE
RIGHT SIDE, YOU KNOW, VETERANS
AND THE PRAGMATIC TRIALS, AS
WELL AS IMPLEMENTATION
STRATEGIES, AND THEN THE TRUE
DISSEMINATION INTO THE FIELD AND
ASSESSING THE VETERANS
SPECIFICALLY IN REGARD TO
OUTCOMES.
THIS IS A LITTLE BIT MORE
INFORMATION ABOUT THE CLINICAL
STUDIES THAT WE HAVE.
ON ONE HAND WE HAVE THE CLINICAL
CONDITIONS YOU CAN SEE LISTED
HERE, CHRONIC PAIN, IN
PARTICULAR MUSCULOSKELETAL PAIN
IS A HUGE AREA OBVIOUSLY IN THE
VHA POPULATION.
PROBABLY EVEN MORE SO THAN IN
THE GENERAL POPULATION.
BUT IT IS THE MOST COMMON PAIN
CONDITIONS.
AND THEN THE LONG TERM OPIOID
THERAPY AS WELL AS OPIOID USE
DISORDER AS A CLINICAL CONDITION
THAT ARE BEING TARGETED.
ON THE RIGHT SIDE IS JUST A
STRATIFICATION IN REGARD TO THE
CLINICAL THERAPEUTIC APPROACHES
AS YOU CAN SEE HERE, IT INCLUDES
NEUROMODULATION, THERE'S AN
EMPHASIS ON OUR SIDE TO BETTER
UNDERSTAND THE IMPACT OF SPINAL
CORD STIMULATION AND HOW TO
OPTIMIZE THIS FURTHER.
IN THE CLINICAL CARE DELIVERY
WITHIN THE VHA, BUT YOU SEE ALL
THE OTHER SPECTRUM AS WELL
THAT'S LISTED HERE IN REGARD TO
BEHAVIORAL PAIN, BIOLOGICS, AND
OTHER APPROACHES.
SO IN THIS REGARD, JUST AS A
SUMMARY HERE, WE HAVE STUDIES
THAT ARE MAINLY FOCUSED ON
CHRONIC DISEASE AND
MUSCULOSKELETAL CONDITIONS,
PROMINENT FOCUS ON LTOT, OPIOID
THERAPY AND OPIOID USE DISORDER.
LARGE NUMBER OF TREATMENT
APPROACHES ARE BEING TESTED IN
THE VETERAN POPULATION.
ANOTHER EMPHASIS IS
TECHNOLOGY-BASED TREATMENT
DELIVERY, CLINICAL APPS, AS WELL
AS WEB-BASED AND TELEHEALTH
APPROACHES THAT WE HAVE
INCORPORATED TO LARGE DEGREE
ALREADY INTO OUR CLINICAL CARE
DELIVERY.
AND AS YOU CAN SEE HERE, IT A
WHOLE SPECTRUM OF CARE THAT WE
HAVE.
NOW, THIS IS REALLY ON THE NEXT
SLIDE THEN FOUNDED AS WE
IMPLEMENT THIS ON VHA, ON THE
NEXT SLIDE, IS OUR STEP CARE
MODEL FOR PAIN MANAGEMENT.
AND I'M JUST GOING TO GIVE YOU A
LITTLE BIT OF AN APPLICATION OF
THIS INFORMATION BASED ON HOW WE
SUPPORTED AS THE OPERATIONAL
PARTNER RESPONSIBLE FOR PAIN
MANAGEMENT OPIOID SAFETY IN VHA.
SO ONE OF THE BIG EMPHASIS
CLEARLY HAS BEEN TO PROMOTE MORE
AND BETTER SELF-CARE AS A
FOUNDATION SERVICE, AND THAT
REALLY GOES ACROSS THE SPECTRUM
OF CARE DELIVERY AND PRIMARY
CARE IN SPECIALTY CARE AS WELL.
WE REALLY HAVE A WHOLE HEALTH
APPROACH THAT HAS TO PERMEATE
THE WHOLE CARE DELIVERY.
BUT WE NEED TO MAKE MORE AND
EASIER ACCESS TO MODALITIES
WITHIN PRIMARY CARE AND THEN
IDENTIFY WHAT IS MOST
APPROPRIATE AT THAT LEVEL.
APPROPRIATELY SUPPORTED THEN BY
SPECIALTY PAIN CARE SERVICES
THAT ARE INTERCESSORY IN NATURE.
INTERDISCIPLINARY IN
NATURE.
HOW CAN WE TRULY ADVANCE ACCESS
TO A SPECIALTY CARE EXPERTISE
AND TREATMENT APPROACHES BY
MAKING IT EASIER, RIGHT?
FOR INSTANCE, BY HAVING
INTERACTIVE VOICE RESPONSE CYST
SYSTEMS THAT I'M GOING TO TALK
ABOUT MORE AT THE END OF THE
PRESENTATION.
SO THIS IS FUNDING AND SUPPORT
THAT COMES FROM THE NATIONAL
PAIN MANAGEMENT PROGRAM IN VHA.
WE PROVIDE FUNDING TO ENHANCE
CARE BASED ON THE FACILITY
IDENTIFIED NEEDS.
WE PROVIDE INCENTIVE FUNDING FOR
BEST PRACTICES DISSEMINATION.
I'M JUST MENTIONING HERE ON THE
LEFT SIDE SOMETHING THAT'S
CALLED ACTIVE MANAGEMENT OF
PAIN.
IT'S A COLLABORATION BETWEEN THE
PHYSICAL THERAPISTS AND THE
BEHAVIORAL SPECIALISTS WHO
DEVELOP A SMALL DYAD OF PAIN
REHABILITATION APPROACH THAT IS
DELIVERED IN A STRUCTURED FORMAT
WITH A DEDICATED WORKBOOK THAT
WE HAVE DEVELOPED FOR THAT AND
THAT'S JUST ONE OF THE EXAMPLE
OF BEST PRACTICE APPROACHES THAT
WE DISSEMINATE, AND THAT'S THE
SAME TIME WE STUDY THE IMPACT OF
HOW TO OPTIMIZE THIS FURTHER.
SO AND AS YOU CAN SEE, WHOLE
HEALTH -- INTEGRATED ASPECT AS
WELL.
THIS IS NOW WHAT WE'VE DONE IN
REGARD WITH THE SUPPORT OF THE
FUNDING, WE'VE REALLY EXPANDED
ACCESS TO PAIN MANAGEMENT TEAMS.
VHA FACILITIES ARE CATEGORIES BY
COMPLEXITY, THE HIGHEST
COMPLEXITY ARE LEVEL
1 FACILITIES.
THEN WE HAVE MEDIUM AND LOW
COMPLEXITIES, SMALLER SIZE AS
YOU CAN SEE HERE, TOTAL NUMBER
IN THIS TRACKING APPLICATION IS
139 FACILITIES, V.A. MEDICAL
CENTERS AND HEALTHCARE SYSTEMS.
AND WE ARE FLOW -- THIS IS NOW S
REALLY -- THE MONTH OF NOVEMBER
WAS THE FIRST MONTH WE COULD SAY
THAT EVERY V.A. FACILITY HAS AT
LEAST A SMALL PAIN MANAGEMENT
TEAM.
THEY'RE NOT ALL FULLY COMPLIANT
WITH THE EXPECTATION AS OUTLINED
BY THE COMPREHENSIVE ADDICTION
AND RECOVERY ACT LEGISLATION,
BUT WE ARE NOW AT THE LEVEL THAT
TWO THIRDS OF THE FACILITIES,
67% OF THE FACILITIES HAVE A
FULLY COMPLIANT PAIN MANAGEMENT
TEAM, AND THEN ANOTHER 33% HAVE
AT LEAST A PARTIAL TEAM NOW
AVAILABLE AT THE SITES.
WE DON'T HAVE ANY V.A. FACILITY
WITHOUT A PAIN MANAGEMENT TEAM
ANYMORE.
AND AS YOU CAN SEE HERE ON THE
RIGHT SIDE, THERE'S A LITTLE BIT
OF TRACKING IN REGARD TO WHAT
PROVIDERS ARE MOST COMMONLY
MISSING, THAT IS AN INTEGRATED
ADDICTION PROVIDER.
THAT DOESN'T MEAN THAT THE
FACILITY DOESN'T HAVE ADDICTION
TREATMENT ACCESS.
IT DOES.
BUT IT MAY NOT BE AS INTEGRATED
AS WE EXPECT AND MANDATES OUR
DIRECTION TO THE FACILITIES
WITHIN THE PAIN MANAGEMENT TEAM
ITSELF.
ON THE RIGHT LOWER HAND SIDE,
YOU CAN SEE THE NUMBER OF
PROVIDERS THAT WE HAVE IN THE
VHA NOW, WE HAVE 549 MEDICAL
PROVIDERS NOW AS YOU CAN SEE
HERE, 252 BEHAVIORAL PROVIDERS,
115 INTEGRATED ADDICTION
PROVIDERS AS WELL AS 218
INTEGRATED REHABILITATION
PROVIDERS.
SO ONE OF THE EMPHASIS THAT WE
DO TOGETHER WITH OUR PARTNERS
FROM THE PRIME CENTER AT YALE AS
WELL AS CONNECTICUT V.A. IS
TRYING TO UNDERSTAND WHAT IS A
HIGH FUNCTIONING PAIN MANAGEMENT
TEAM?
WE'VE ORGANIZED A STUDY IN THIS
REGARD AND WE'RE PUTTING
INFORMATION TOGETHER.
THIS IS A LITTLE BIT TOO MUCH OF
TOO SMALL PRINT TO READ, BUT
CLEARLY WHAT WE FIND OUT, SOME
OF THEM DIFFERENT TEAM
CHARACTERISTICS THAT SET UP A
PAIN CLINIC FOR SUCCESS, BUT
ALSO HOW THEY APPROACH THE
PATIENT IN REGARD TO THE
INTERACTIONS THAT ENGAGE WITH
THE PATIENT AND HOW DO THEY
INTEGRATE WITHIN THE HEALTHCARE
SYSTEM AND THE V.A. MEDICAL
CENTER FACILITY AND THIS IS
SOMETHING THAT WE ARE PUTTING
TOGETHER FOR FURTHER
DISSEMINATION TO CONTINUE TO
OPTIMIZE THE PAIN CARE AT THE
FACILITIES.
IF YOU GO TO THE NEXT SLIDE, ONE
ASPECT THAT WE ALSO HAVE SET UP
NOW IN THIS YEAR IS A ROLLOUT OF
A STANDARDIZED OUTCOME AND
ASSESSMENT MEASURE SET FOR ALL
PATIENTS ENTERING PAIN CLINICS.
SO IF A PATIENT NOW ENTERS A
PAIN CLINIC AT THE V.A.
FACILITIES, AND GETS SEEN BY THE
SPECIALTY CARE PAIN PROVIDER,
THIS IS A SET OF DOMAINS THAT
ARE STUDIED IN STANDARDIZED
APPROACH.
MANY OF THESE ARE RELATIVELY
BRIEF MEASURES BUT THEY'RE
CONSISTENTLY NOW TESTED ACROSS
MANY FACILITIES, AND THEY'RE ALL
DELIVERED IN A PATIENT CENTERED
APPROACH, THE EMAIL OR THE TEXT
MESSAGE GETS SENT OUT TO THE
PATIENT BEFOREHAND, THEY FILL IT
OUT AT HOME ON THEIR SMARTPHONE
OR THE COMPUTER, IT'S AVAILABLE
TO THE PHYSICIAN OR THE PROVIDER
PRIOR TO THE VISIT AND THEN THE
INTAKE IN THE VISIT AND GETS
AUTOMATICALLY CHECKED -- YOU
KNOW, RECORDED IN THE CHART TO
BE PART OF THE CLINICAL CARE.
THIS ALLOWS US THEN ALSO TO DO
THIS CONCRETE ASSESSMENTS ACROSS
THE BOARD, NO MATTER WHETHER THE
PATIENT IS GOING TO GO TO SPINAL
CORD STIMULATION OR ENTERING
PAIN REHABILITATION PROGRAM OR
PHARMACOLOGICAL MANAGEMENT.
WE'RE MAKING SURE THIS WAY WE
GIVE THE TOOLS, WE'RE PROVIDING
THE TOOLS THAT ALL PROVIDERS CAN
CONSISTENTLY USE AT LEAST A
COMMON MINIMUM DATASET THAT
ALLOWS US TO ASSESS PATIENTS IN
REGARD TO THE DIFFERENT DOMAINS
THAT ARE LISTED HERE.
I THINK I DON'T HAVE TO TALK
MORE ABOUT THE PAIN MANAGEMENT
COLLABORATORY.
WE WORK CLOSELY IN MANY WAYS
WITH RESEARCHERS WHO ARE
INVOLVED IN THE PMC.
THIS IS SOMETHING THAT WE, I
THINK, PROVIDE STRONG
OPERATIONAL SUPPORT FOR FROM
FROM OUR SIDE AS MUCH AS WE CAN
TO PROVIDE VISIBILITY IN VHA
REGARDING THE STUDIES THAT ARE
BEING EXECUTED AT OUR SITES BUT
ALSO IN REGARD TO THEN FINDING A
WAY TO IMPLEMENT THE DATA AS
WELL AS PROVIDING AN APPLICATION
IN THE FIELD.
AS YOU CAN SEE ON THE NEXT SLI
SLIDE, I'M JUST PROVIDING AN
EXAMPLE ABOUT THE COPES STUDY,
COOPERATIVE PAIN EDUCATION AND
SELF-MANAGEMENT, COPES, ALISHA
HEALY IS LEAD INVESTIGATOR, THAT
REALLY HAS SHOWN STRONG CLINICAL
EVIDENCE IN RESEARCH STUDIES,
AND WE ARE NOW ADVANCING THIS TO
THE NEXT LEVEL BY STARTING TO
IMPLEMENT IT AT SOME V.A.
MEDICAL CENTERS, ESPECIALLY IN
TINTHE NORTHEAST AND -- JUST
FINDING AN ENTRY INTO THE
CLINICAL CARE DELIVERY FOR
PATIENTS ENTERING AND REQUIRING
PAIN SPECIALTY CARE.
IT'S A TECHNOLOGY-BASED VERSION
OF CBT FOR CHRONIC PAIN THAT
PROVIDES BROADER ACCESS, HAS A
LOWER THRESHOLD IN REGARD TO
ENTRY FROM THE VETERAN SIDE AND
ALSO ALLOWS US OBVIOUSLY TO
MANAGE MORE VETERANS WITH LESS
RESOURCES.
AND THE LAST SLIDE, IF YOU GO TO
THE NEXT SLIDE ONE MORE TIME
HERE, THIS IS WHERE WE UTILIZE
ALSO THROUGH THE PAIN OPIOID
CORVETTE RAN ENGAGEMENT PANEL.
THIS IS NOT THE ONLY VETERAN
ENGAGEMENT PANEL WE HAVE.
THIS IS THE ONE THAT WE FROM
NATIONAL PAIN PROGRAM HAVE
UTILIZED IN SOME WAYS ALSO, FOR
INSTANCE, IN REGARD TO GETTING
INPUT FOR THE PAIN MEASURE SET
THAT I JUST DEMONSTRATED,
WHETHER PROVIDED FEEDBACK IN
REGARD TO MAKING US
USER-FRIENDLY FROM THE VETERAN'S
EXPERIENCE SIDE FROM THE PATIENT
SIDE.
LAST SLIDE THEN, I WANT TO MAKE
SURE THAT I AGAIN PROVIDE YOU
WITH THAT INFORMATION AND
EXPRESS MY THANKS TO OTHERS WHO
HAVE CONTRIBUTED TO THE SLIDE
DECK, BUT THERE ARE MANY, MANY
MORE THAT OBVIOUSLY NEED TO BE
THANKED FOR HAVING SUCH GREAT
ACCESS TO RESEARCH WITHIN VHA
THAT COVER SUCH A BROAD SPECTRUM
AND THAT IS TRULY, I THINK,
INFORMING US IN A VERY
MEANINGFUL WAY TO IMPROVE CARE
FOR VETERANS IN VHA ACROSS THE
BOARD.
SO WITH THAT, I'M LOOKING
FORWARD TO ANY FEEDBACK OR
QUESTIONS.
>> THANK YOU SO MUCH.
WHAT A GREAT OVERVIEW.
AND REALLY ALWAYS SO IMPRESSED
WITH WHAT THE V.A. IS DOG,
AA. IS DOING,ALWAYS SEEM TO BE E
CURVE.
ANY QUESTIONS, ANY COMMENTS FROM
MEMBERS?
LAURA?
>> I FEEL LIKE I'M JUST THE
REOCCURRING THEME BUT FRIEDHELM,
AGAIN, THANK YOU SO MUCH, THIS
WAS SO COMPREHENSIVE AND WAS
REALLY HELPFUL TO GET A SENSE OF
BOTH THE RESEARCH THAT WAS
HAPPENING AS WELL AS THE
CLINICAL WORK THAT'S HAPPENING
AT V.A.
I KNOW WE DO HAVE A LOT OF EARLY
CAREER RESEARCHERS WHO ARE
EXPRESSING INTEREST AND ALSO
LEARNING MORE ABOUT CAREER
DEVELOPMENT AWARDS AT V.A.
SO IN THOSE CASES WOULD YOU BE
RECOMMENDING THAT THEY REACH OUT
TO SOME OF THE CONTACTS YOU HAD
ON YOUR SLIDE OR WOULD YOU
RECOMMEND THEY REACH OUT TO HS
R & D FOR THOSE TYPES OF
CONVERSATIONS?
>> I THINK THE CONTACTS ARE VERY
APPROPRIATE THAT I'VE LISTED
THERE.
I THINK THEY ARE -- BECAUSE THE
PAIN OPIOID, YOU KNOW, AMP,
ACTIVE MANAGEMENT PORTFOLIO,
THEY HAVE A REALLY GOOD OVERVIEW
ACROSS THE BOARD WHEREAS HS R &
D IS OBVIOUSLY A SUBSET OF
RESEARCH THAT WE DO, SO IF
YOU'RE REALLY MORE IN THE HUMAN
SERVICES-RELATED AREAS AND BY
ALL MEANS, HS R & D AND THE
LEADERS THERE, BUT ALSO OTHER
RESEARCHERS I THINK THAT ARE
OBVIOUSLY I THINK AS YOU KNOW,
IF YOU KNOW A RESEARCHER WHO IS
WORKING IN THAT AREA WHO IS PART
OF HS R & D, CERTAINLY YOU CAN
GET MORE INFORMATION THAT WAY,
BUT THE OTHERS ARE PROVIDING THE
CONTACT INFORMATIO INFORMATIONI-
THERE SHOULD BE NO THRESHOLD TO
REACHING OUT TO THEM.
>> VERY HELPFUL.
THANK YOU SO MUCH.
APPRECIATE IT.
>> MONICA HAS A HAPPENED UP AS .
>> I DO.
THAT WAS A GREAT PRESENTATION.
THANK YOU.
JUST CURIOUS, I LOVED YOUR SLIDE
WITH ALL THE TRANSLATIONAL
RESEARCH SPECTRUM.
ARE YOU HAVING ANY TROUBLE LIKE
BRIDGING FROM ONE TRANSLATIONAL
T1 TO T2 -- ARE YOU NOTICING ANY
BARRIERS THERE?
JUST CURIOUS.
SOMETIMES THERE'S ALSO TROUBLE
BRIDGING THE GAPS BETWEEN
PRE-CLINICAL OR BASIC RESEARCH
TO CLINICAL.
AGAIN, IS THAT SOMETHING YOU'RE
PAYING ATTENTION TO?
AND FINALLY, I KNOW THERE'S
ALWAYS TROUBLE RECRUITING.
I THINK WE'RE RUNNING SHORT OF
BASIC RESEARCHERS IN GENERAL IN
SOME AREAS OF PAIN.
AGAIN, THAT'S SOMETHING I THINK
THAT'S FOLLOW-UP TO SORT OF
LAURA'S QUESTION, ARE YOU HAVING
ANY, AGAIN, TRYING TO RECRUIT
MORE BASIC RESEARCHERS OR
TRAINEES INTO, YOU KNOW, OR
SUPPORTING THEM IN SOME WAYS
WITH FUNDING?
>> YEAH, SO YOU KNOW, PART OF
WHAT YOU'RE ASKING IS PROBABLY
BEST ASKED TO -- KUZIAK FOR
THAT, I'M COMING MORE FROM THE
BACK END THERE, FROM THE
CLINICAL SIDE, BUT I WANT TO
EMPHASIZE THAT PAIN OPIOID AND
ACTIVE MANAGED PORTFOLIO WAS
SPECIFICALLY CREATED TO BREAK
DOWN THE BARRIERS BETWEEN THESE
TRANSLATIONAL SILOS, SO THAT IT
IS EASIER TO BRIDGE FROM ONE TO
THE OTHER.
AS WE HAD THESE DIFFERENT
CATEGORIES WITHIN VHA RESEARCH
AND ORD, THEY WERE MORE OR LESS
SET UP IN THE SILO WAY AND THE
PAIN OPIOID AMP NOW BREAKS THAT
DOWN, MAKES SURE THAT THE
TRANSITIONS ARE EASIER, THAT
THINGS CAN ADVANCE THROUGH THE
PIPELINE FASTER, AND HOPEFULLY
THAT IN MANY WAYS ADDRESSES SOME
OF THE CONCERNS, MONICA, THAT
YOU'RE HAVING ABOUT HOW TO
ADVANCE TO THE NEXT LEVEL.
AUDREY IS PROBABLY THE ONE BEST
SUITED TO GIVE YOU THAT BECAUSE
SHE CAN PROVIDE YOU THE
FRAMEWORK IN THIS REGARD, BUT I
KNOW THAT THAT'S EXACTLY WHY WE
SET IT UP THIS WAY, SO THAT IT
WOULD BE EASY TO ADVANCE THIS
FORWARD.
AND THAT'S WHY I THINK THE PAIN
OPIOID AMP IS ALSO REALLY GOOD
INFORMATION FOR ANYBODY
INTERESTED IN RESEARCH TO SEE
WHERE IT FITS SPECIFICALLY BEST
IF SOMEBODY HAS INTEREST TO
JOIN.
>> GREAT.
OKAY.
ANY OTHER QUESTIONS?
WE HAVE ONE MORE PRESENTATION
BEFORE LUNCH, DR. RIGOBERTO ROCA
FROM FDA.
>> SO I'M NOT DR. RIGOBERTO
ROCA.
I'M PRESENTING ON HIS BEHALF.
>> OKAY.
SORRY.
>> I'M TINA DOSHI.
>> OKAY.
TAKE IT AWAY THEN.
>> BUT I'M TINA DOS HI.,
ASSOCIATE DIRECTOR FOR
THERAPEUTIC REVIEW.
DR. ROCA IS ON LEAVE AND WILL BE
RETIRING AT THE END OF THIS
YEAR, SO I'LL BE TAKING OVER FOR
HIM.
BUT I REALLY -- SO I'M
RELATIVELY NEW TO THE FEDERAL
GOVERNMENT, BUT I REALLY
APPRECIATE THE OPPORTUNITY TO
HAVE THIS MEETING AND SHARE
INFORMATION AND OPPORTUNITIES.
I REALIZE I'M THE ONLY ONE --
>> WELL, WELCOME!
ALL RIGHT, WONDERFUL.
>> SO I REALIZE I'M THE ONLY
THING STANDING BETWEEN YOU AND
LUNCH SO I WILL GO FAIRLY
QUICKLY THROUGH OUR SNAPSHOT OF
FDA ACTIVITIES.
SO THE FDA MISSION IS ACTUALLY
QUITE LONG IF YOU LOOK AT OUR
WEBSITE, BUT I PICKED OUT SOME
KEY PHRASES TO REALLY HIGHLIGHT
HOW WE ARE INTERESTED IN PAIN
RESEARCH.
THE MOST WELL-KNOWN ROLE FOR US
IS TO BE RESPONSIBLE FOR
PROTECTING THE PUBLIC HEALTH BY
ENSURING THE SAFETY, EFFICACY
AND SECURITY OF HUMAN AND
VETERINARY DRUGS, BIOLOGICAL
PRODUCTS AND MEDICAL DEVICES.
THE FDA IS ALSO RESPONSIBLE FOR
ADVANCING PUBLIC HEALTH BY
HELPING TO SPEED THE INNOVATIONS
THAT MAKE MEDICAL PRODUCTS MORE
EFFECTIVE, SAFER, AND MORE
AFFORDABLE, AND BY HELPING THE
PUBLIC GET ACCURATE
SCIENCE-BASED INFORMATION THAT
THEY NEED TO USE THE MEDICAL
PRODUCT AND FOODS THAT MAINTAIN
AND IMPROVE THEIR HEALTH.
AND THE BEST CONTEXT FOR THAT IS
WHEN WE ARE THINKING ABOUT NEW
ANALGESIC DEVELOPMENT, AND
PROVIDING GUIDANCE ON THE
ANALGESIC DEVELOPMENT THROUGH
MEETINGS, COMMENTS TO SPONSORS
AND PUBLICATIONS TO DRUG AND
DEVICE COMPANIES.
WE ALSO COMMUNICATE WITH THE
PUBLIC REGARDING ANALGESIC DRUGS
AND DEVICES, PARTICULARLY WITH
RESPECT TO SAFETY.
AND LASTLY, THE FDA FOSTERS
DEVELOPMENT OF MEDICAL PRODUCTS
TO RESPOND TO DELIBERATE AND
NATURALLY EMERGING PUBLIC HEALTH
THREAT.
AND THIS INCLUDES THINGS LIKE
RESPONDING TO THE OPIOID CRISIS,
AS WELL AS COUNTERTERRORISM
EFFORTS AND ALSO THE CRITICAL
TREATMENT OF OUR SERVICE
MEMBERS.
SO PAIN RESEARCH CAN
SPECIFICALLY INFORM HOW WE CARRY
OUT THIS MISSION THROUGH OUR
REGULATORY GUIDANCE, DRUG
LABELING AND INCORPORATION OF
PATIENT-CENTERED OUTCOMES INTO
OUR DRUG EVALUATION AND CLINICAL
PAIN TRIALS.
PROMINENT AND VERY PERSIST AT
THE PRESENT TIME PRIORITY IN THE
AGENCY'S WORK OVER THE PAST FEW
YEARS HAS BEEN TO ADDRESS THE
OPIOID EPIDEMIC, AND THAT'S A
RECURRING THEME.
IN TERMS OF FUNDED RESEARCH
THROUGH THE FDA, THERE ARE
ACTUALLY MANY OPPORTUNITIES
THROUGHOUT DIFFERENT CENTERS,
DIFFERENT INITIATIVES WITHIN
FDA, AND THIS IS REALLY A
SNAPSHOT OF ALL OF THE POTENTIAL
OPPORTUNITIES THAT WE HAVE.
BUT I'LL GO THROUGH SOME OF THE
MOST COMMON MECHANISMS THAT WE
USE TO FUND PAIN RESEARCH.
ONE REALLY WELL-KNOWN MECHANISM
IS A GRANT THROUGH THE CENTERS
OF EXCELLENCE IN REGULATORY
SCIENCE AND INNOVATION, AND IT A
PARTNERSHIP BETWEEN ACADEMIA,
INDUSTRY AND THE FDA TO SELECTED
INSTITUTIONS.
THESE INSTITUTIONS PUT IN
APPLICATIONS AND ARE AWARDED
THROUGH A COMPETITIVE PROCESS
FOR THIS COOPERATIVE AGREEMENT
AND THEY HAVE ALL SORTS OF
ACTIVITIES INCLUDING WORKSHOPS,
LECTURES SERIES, AND JUST
CONDUCT OF VARIOUS RESEARCH
PROJECTS WITHIN AND OUTSIDE OF
THE INSTITUTION.
THERE IS A FORTHCOMING
ANNOUNCEMENT FOR COLLABORATION
TO ENHANCE DRUG DEVELOPMENT AND
REGULATORY SCIENCE, AND CLINICAL
TRIALS ARE INCLUDED IN THIS.
AND IN IT, FDA AND THE GRANTEES
WILL WORK TOGETHER TO DEVELOP
INNOVATIVE AND COLLABORATIVE
PROJECTS IN RESEARCH, EDUCATION
AND OUTREACH.
AND SO PAIN MANAGEMENT COULD
BE -- PAIN RESEARCH COULD BE
PART OF THIS.
BUT ESSENTIALLY THESE PROJECTS
ARE INTENDED TO HELP FOSTER DRUG
PRODUCT INNOVATION AND TO
SUPPORT EFFORTS IN ACCELERATING
THE DRUG DEVELOPMENT PROCESS TO
SUPPORT APPROACHES TO ADVANCED
MANUFACTURING, FACILITATE
TRANSLATION OF BASIC SCIENCE
DISCOVERIES INTO THERAPEUTICS,
SO A VERY IMPORTANT PRIORITY I
KNOW FOR ALL OF US, AND TO
FACILITATE APPROACHES TO ENHANCE
THE SAFETY, EFFICACY, QUALITY
AND PERFORMANCE OF DRUG
PRODUCTS, ALSO A BIG PRIORITY
FOR ALL OF US.
SO THOSE ARE GRANT MECHANISMS,
BUT WE ALSO HAVE CONTRACTS THAT
ARE FUNDED THROUGH THE AGENCY.
AND SO M OUR BROAD AGENCY
ANNOUNCEMENTS OR BAAs ALLOW US
TO ACCEPT PROPOSALS THAT HELP US
BETTER UNDERSTAND THE BREADTH OF
INNOVATIVE SCIENTIFIC AND
TECHNICAL SOLUTIONS THAT ARE
AVAILABLE IN INDUSTRY, ACADEMIA,
OR OTHER GOVERNMENT AGENCIES,
AND I'LL GIVE YOU AN EXAMPLE OF
ONE OF OUR REALLY WELL-KNOWN
BAAs THAT'S IN PROGRESS RIGHT
NOW ON THE NEXT SLIDE.
WE HAVE INTERAGENCY AGREEMENTS,
MEMORANDA OF UNDERSTANDING
WITH -- MEMORANDA OF
UNDERSTANDING WITH FEDERAL,
STATE AND LOCAL GOVERNMENT
AGENCIES, ACADEMIC INSTITUTIONS,
AND ENTITIES LIKE NON-PROFIT
ORGANIZATIONS.
WE HAVE PUBLIC-PRIVATE
PARTNERSHIPS AND CONSORTIA, THE
MOST WELL-KNOWN OF WHICH IS IN
THE CONTEXT OF PAIN ACTION,
WHICH I'M SURE MANY OF YOU ARE
FAMILIAR WITH.
BUT IT IS A STRATEGIC
COLLABORATION AMONG ACADEMIA,
NATIONAL, INTERNATIONAL
GOVERNMENT AGENCIES AS WELL AS
PATIENT GROUPS, PROFESSIONAL
SOCIETIES, INDUSTRY, AND
FOUNDATIONS.
AND THEY HAVE PUT OUT JUST A
TREMENDOUS AMOUNT OF WORK IN THE
FORM OF SYSTEMATIC REVIEWS,
META-ANALYSES, EVIDENCE-BASED
CONSENSUS MEETINGS, AND
PRE-CLINICAL AND CLINICAL
STUDIES.
THERE'S ALSO SOME -- THERE ARE
ALSO SOME INTRAMURAL FUNDING
OPPORTUNITIES FOR PAIN RESEARCH.
WE HAVE SOMETHING CALLED THE
ORISE FELLOWS.
SO THIS IS THROUGH THE OAK RIDGE
INSTITUTE FOR SCIENCE AND
EDUCATION WHICH ALLOWS FELLOWS
TO HAVE AN INSIDE LOOK AT THE
FDA THROUGH VARIOUS PROJECTS,
AND WE HAVE JUST A TON OF
DIFFERENT PROJECTS ACROSS A
RANGE OF DISCIPLINES, AND WE DO
ACTUALLY HAVE AN ORISE FELLOW
WORKING WITH US ON THE PROJECT
MANAGEMENT SIDE WITHIN THE
DIVISION RIGHT NOW.
SO IN TERMS OF THE RESEARCH
RESOURCES THAT WE HAVE TO
EXECUTE SOME OF THIS PAIN
RESEARCH, WE HAVE MANY
ENGAGEMENT OPPORTUNITIES WITH
PATIENTS, FAMILIES, HEALTHCARE
PROVIDERS, ALSO WITH INDUSTRY
AND ACADEMIA, WE HAVE PATIENT
LISTENING SESSIONS WHERE THE FDA
STAFF WILL MEET WITH PATIENTS IN
INFORMAL, NON-REGULATORY,
NON-PUBLIC MEETINGS.
WE ALSO HAVE AN OPPORTUNITY FOR
PROFESSIONAL ORGANIZATIONS AND
ADVOCACY GROUPS TO MEET WITH US
THROUGH THE PROFESSIONAL AFFAIRS
AND STAKEHOLDER ENGAGEMENT
PROGRAM OR PASE, AND IN THOSE,
WE HAVE MEETINGS IN WHICH WE CAN
ENGAGE IN TWO-WAY COMMUNICATION
ON HUMAN DRUG-RELATED PRODUCTS.
AND TOPICS.
WE ALSO HAVE A PATIENT FOCUSED
DRUG DEVELOPMENT GUIDANCE
SERIES.
THESE ARE PUBLIC, IT'S A
PUBLISHED SERIES OF GUIDANCES TO
PROVIDE INDUSTRY WITH SPECIFIC
CONSIDERATIONS FOR HOW WE CAN
INCORPORATE PATIENT FOCUS INTO
OUR DRUG DEVELOPMENT AND
REGULATION.
IN TERMS OF ENGAGEMENT WITH
INDUSTRY AND ACADEMIA, TWO OF
OUR MOST PROMINENT MECHANISMS
ARE THE REAGAN-UDALL FOUNDATION,
A 501(C)(3) ORGANIZATION CROW
ATED BY CONGRESS TO ADVANCE THE
MISSION OF THE FDA TO MODERNIZE
THINGS, AND THEY DO A LOT OF
RESEARCH AND ANALYSIS, PATIENT,
PROVIDER, CONSUMER SERVICES
EDUCATION AND ENGAGEMENT, AND
MANY OF YOU HAVE PROBABLY HEARD
OF OR BEEN TO A REAGAN-UDALL
WORKSHOP WHICH IS A REALLY GREAT
OPPORTUNITY TO ENGAGE IN ALL
THESE DIFFERENT RELATIONSHIPS
AND SHARE INFORMATION.
THE DUKE MARGOLIS INSTITUTE ALSO
WORKS VERY CLOSELY WITH THE FDA,
AND THAT'S AN INSTITUTE THAT
PROVIDES INTERDISCIPLINARY
ACADEMIC RESEARCH, AND CAPACITY
FOR EDUCATION, ENGAGEMENT, AND
THEY USE WHAT THEY DO TO INFORM
POLICYMAKING AND IMPLEMENTATION
FOR BETTER HEALTHCARE.
A FEW EXAMPLES, THIS IS JUST A
SMALL SAMPLING OF THE TYPES OF
PAIN RESEARCH THAT HAVE BEEN
SUPPORTED BY THE FDA.
WE HAVE AN ACUTE PAIN PATHWAY
STUDY THAT HAS RECENTLY COME OUT
AND THAT WAS THROUGH THAT CERSI
MECHANISM AND IT WAS A
PROSPECTIVE COHORT STUDY TO
BETTER UNDERSTAND PAIN
MANAGEMENT AND PAIN CONTROL JU
REALLY T,JUST REALLY TRYING TO D
THE EXPERIENCE OF INDIVIDUALS
WHO HAD ACUTE PAIN, LEARNING
ABOUT THEIR PAIN TRAJECTORIES
AFTER THE PAIN ONSET, THE TYPES
OF MEDICATIONS THEY USE
INCLUDING AND SPECIFICALLY
INTERESTED IN OPIOIDS, AND WHAT
HAPPENED TO THEIR MEDICATIONS
AFTER THE PAIN RESOLVED.
SO JOHN FARRAR, I MENTIONED HIS
WORK AS ONE OF THE GREAT IMAMS
OF A BAA, AND HE HAS DONE
SOMETHING REALLY IMPRESSIVE BY
TAKING A LOT OF THE INFORMATION
THAT THE FDA HAS RECEIVED FROM
PHARMACEUTICAL COMPANIES AND
HARMONIZING THESE DATA ELEMENTS
OF BOTH PLACEBO AND ACTIVE
CONTROL AND PERFORMING THESE
POOLED ANALYSES OF VARIOUS
ASPECTS OF PAIN AND PAIN
OUTCOMES BASED ON THAT DATA.
AND SO I HAVE HERE JUST ONE
EXAMPLE OF A RECENT PUBLICATION
THAT HE'S HAD WITH THIS PROJECT
THAT WAS SUPPORTED BY THE BAA.
ACTTION, I ALREADY MENTIONED AND
THEN WE ALSO HAVE SEVERAL OTHER
INTERNAL PROJECTS THAT HAVE BEEN
RELATED TO OPIOID PRESCRIBING,
AND THOSE HAVE BEEN RECENTLY --
THE FIRST TWO HAVE BEEN RECENTLY
PUBLISHED AND THE THIRD IS GOING
TO BE PUBLISHED HOPEFULLY SOON.
IN TERMS OF THE FDA PAIN
MATERIALS WE HAVE AVAILABLE AS
RESOURCES, SO THE SUPPORT ACT
WAS SIGNED INTO LAW IN 2018 AND
ONE OF THE PROVISIONS OF THE
SUPPORT ACT, WHICH STANDS FOR
SUBSTANCE USE DISORDER
PREVENTION, THAT PROMOTES OPIOID
RECOVERY AND TREATMENT, ONE OF
THE PROVISIONS WAS TO SUPPORT
CLINICAL PRACTICE GUIDELINES FOR
DRUGS WITH ABUSE POTENTIAL.
SO WE DON'T ACTUALLY HAVE AN
ACTIVE ROLE IN WRITING THESE.
WE CAN COMMISSION THESE USING
PARTNERS IN ACADEMIA AND
RESEARCH, AND WE HELP GUIDE THE
PROCESS, BUT WE HAVE RELEASED
THOSE FOR ACUTE DENTAL PAIN,
POSTOPERATIVE PAIN AND OBSTETRIC
PATIENTS POSTOPERATIVE PAIN FOR
LALAPAROSCOPIC ABDOMINAL SURGERY
AND PRACTICE GUIDELINES FOR
ACUTE LOW BACK PAIN.
WE ALSO HAVE PATIENT CONSUMER
INFORMATION, INCLUDING SAFE
OPIOID DISPOSAL.
THERE WAS RECENTLY ANNOUNCEMENT
FOR A MAIL-BACK ENVELOPE PROGRAM
FOR OPIOIDS.
FOR PRESCRIBER INFORMATION, WE
HAVE A RECENT COLLABORATION WITH
THE NATIONAL ACADEMY OF MEDICINE
FOR OUR FOUR COMPETENCIES FOR
EDUCATION PRACTICE IN PAIN
MANAGEMENT.
AND THEN LASTLY, WE HAVE FDA
GUIDANCE DOCUMENTS TO INDUSTRY
ABOUT DEVELOPMENT OF ANALGESIC
PRODUCTS, AND THIS IS ALSO A
MANDATE FROM THE SUPPORT ACT.
WE HAVE ALREADY PUBLISHED THE
FIRST THREE, AND CHRONIC PAIN
GUIDANCE IS ACTUALLY IN THE
FINAL ROUNDS OF CLEARANCE WITHIN
THE CENTER, BUT HOPEFULLY IT
WILL MOVE ON UP AND WE'LL BE
ABLE TO PUBLISH THAT EARLY NEXT
YEAR.
SO WITH THAT, I THANK YOU FOR
YOUR ATTENTION AND HAPPY TO TAKE
ANY QUESTIONS.
>> MONICA.
>> MONICA, YOU'RE MUTED.
>> SORRY ABOUT THAT.
THANK YOU FOR THAT PRESENTATION.
I HAD A QUESTION ABOUT THE PFDD
MEETINGS, I BELIEVE THERE WAS
ONE IN 2018.
DO YOU ENCOURAGE -- I MEAN, DO
YOU TYPICALLY REPEAT -- THIS IS
REGARDING CONDITION-SPECIFIC
MEETINGS.
DO YOU ENCOURAGE REPETITION OR
IS THERE A TIME BAR?
I MEAN, 2018 HAS BEEN A WHILE
SINCE, YOU KNOW -- SIX YEARS.
IS THERE ANY LIMIT TO -- AGAIN,
JUST CURIOUS, DO YOU ENCOURAGE
REPETITION OF CERTAIN TOPICS?
>> DEFINITELY REVISITING TOPICS,
ESPECIALLY IF WE KNOW THAT
THERE'S A LOT OF CHANGE IN THE
OVERALL ENVIRONMENT, YEAH, AND
IT'S SOMETHING THAT WE KEEP --
WHEN WE START NOTICING RECURRING
THINGS LIKE OH, THIS GUIDANCE
DOESN'T REALLY FIT WHAT WE SAID
THEN DOESN'T REALLY FIT WITH
WHAT WE'RE DOING NOW KIND OF
STARTS THE PROCESS OF LIKE OKAY,
MAYBE WE SHOULD COME BACK TO
THIS IDEA AND GET MORE EXPERT,
GET A BETTER SENSE OF THE STATE
OF THE SCIENCE.
AND A TON OF EXAMPLES WITHIN
PAIN THAT WE'RE ACTIVELY LOOKING
AT, YEAH.
>> ALSO UNDER YOUR GRANT, DO YOU
PARTNER WITH THE NON-PROFIT
ORGANIZATIONS?
>> IT DEPENDS ON THE INDIVIDUAL
MECHANISM, AND I APOLOGIZE
BECAUSE I'M RELATIVELY NEW TO
THE AGENCY AND SO THERE ARE
DEFINITELY LIKE DIFFERENT
MECHANISMS THAT I'M SURE THERE
ARE DIFFERENT NUANCES, BUT THERE
ARE EXAMPLES OF US PARTNERING
WITH THEM, IN SOME CASES IT'S
NOT NECESSARILY A GRANT BUT IT'S
A CONTRACT, SO THERE ARE CERTAIN
TIMELINES AND DELIVERABLES WE
WERE EXPECTING FROM THEM.
BUT THERE ARE CERTAINLY EXAMPLES
OF US WORKING WITH ACADEMIA,
INDUSTRY, NON-PROFITS, ALL OF
THOSE.
>> THANK YOU.
>> OKAY, I GUESS WE ARE -- THANK
YOU SO MUCH.
WE ARE JUST A LITTLE BIT PAST
TIME.
WE WILL BE TAKING A BREAK NOW
UNTIL 1:00 AND BE BACK WITH THE
REST OF OUR PROGRAM.
SO WE'LL BE STARTING SHARPLY AT
1:00.
SEE YOU ALL SOON.
A PRESENTATION ON RESILIENCE AND
WELLNESS, ALONG WITH DR. BROWN.
SO LAURA --
>> I WILL DO A BRIEF
INTRODUCTION.
THANK YOU SO MUCH.
I APPRECIATE IT.
SO AS WE JUST SAID, THE GOAL OF
THIS AFTERNOON'S SESSION IS TO
HAVE SOME TIME TO TALK A LITTLE
BIT MORE IN DEPTH ABOUT
RESILIENCY.
SO THE FIRST SPEAKER YOU'RE
GOING TO HEAR FROM IS
DR. LAVERNE BROWN, AND SHE IS
THE DIRECTOR OF THE RESILIENCE
IN HEALTH STUDIES PROGRAM AT THE
NIH OFFICE OF DIETARY
SUPPLEMENTS.
SHE'S INTERESTED IN STIMULATING
RESEARCH ON DIETARY SUPPLEMENTS
THAT ACT ON PROTECTING PATHWAYS
TO PROMOTE RESILIENT OUTCOMES.
DR. BROWN CHAIRS THE TRANS-NIH
RESILIENCY WORK GROUP AND HAS
LED THE GROUP THROUGH
DEVELOPMENT OF RESILIENCY
DEFINITION AND A RESILIENCE
CONCEPTUAL MODEL AND RESILIENCE
RESEARCH DESIGN TOOL.
THESE RESOURCES WERE DEVELOPED
TO BRING HARMONY TO THE DESIGN
OF STUDIES, DO NOT FOCUS SOLELY
ON THE MITIGATION OF DISEASE
PATHWAYS ORIS BEING OF OR RISK .
SO WE'LL START WITH DR. BROWN,
SHE'LL GIVE US A KIND OF
OVERARCHING CONTEXT AND THEN DRT
AFTER DR. BROWN AND TALK A
LITTLE ABOUT RESILIENCE AND
WELLNESS RELATED TO PAIN AND
THINKING ABOUT HOW WE CAN
INTEGRATE SOME OF THOSE CONCEPTS
FROM DR. BROWN'S TALK INTO
RESILIENCY.
SO DR. FISHMAN IS DISTINGUISHED
PROFESSOR IN ANESTHESIOLOGY AND
MEDICINE AT THE ANDERSEN UNDO ED
CHAIR IN WELLNESS AND THE
EXECUTIVE DIRECTOR OF THE OFFICE
OF WELLNESS AT THE UNIVERSITY OF
CALIFORNIA DAVIS SCHOOL OF
MEDICINE.
HE'S THE FOUNDING CHIEF OF THE
U.C. DAVIS DIVISION OF PAIN
MEDICINE, HAS HELD THIS POSITION
FOR 20 YEARS.
SO I'M GOING TO HAND THIS OVER
TO DR. BROWN TO START OUR
DISCUSSION.
THANK YOU SO MUCH.
>> HI, THANK YOU.
AM I SHARING MY SCREEN?
>> YOU ARE INDEED.
>> THANK YOU.
THANK YOU FOR THE NICE
INTRODUCTION, AND THANK YOU ALL
FOR THE OPPORTUNITY TO SPEAK TO
THE INTERAGENCY PAIN RESEARCH
COORDINATING COMMITTEE.
I AM ALWAYS EXCITED TO TALK
ABOUT THE WORK THAT WE'RE DOING
THROUGH THE TRANS-NIH RESILIENCE
RESEARCH WORKING GROUP, AND
SPECIFICALLY TODAY, I'M HAPPY TO
WALK YOU THROUGH SOME OF THE
STEPS, SOME OF THE ACTIVITIES
WE'VE TAKEN IN HELPING TO DEFINE
AND CONCEPTUALIZE RESILIENCE AS
INTENDED FOR SCIENTIFIC
ADVANCEMENT.
NOW, BEFORE, THOUGH, I TELL YOU
ALL ABOUT THE PROGRESS WE'VE
MADE TOWARDS ADVANCING THE
SCIENCE OF RESILIENCE, I'D LIKE
TO FIRST TALK TO YOU A LITTLE
BIT ABOUT WHY WE FELT THE NEED
TO DO THIS.
BECAUSE REALLY, CONTRARY TO
POPULAR BELIEF, RESILIENCE AS A
SCIENTIFIC CONCEPT IS ACTUALLY
NOT NEW AT ALL.
IN FACT, THE CONCEPT OF
RESILIENCE HAS BEEN DOCUMENTED
IN THE BIOMEDICAL SCIENCES
LITERATURE SINCE AT LEAST THE
MID 1900s.
AND NOT ONLY IS THE CONCEPT OF
RESILIENCE NOT NEW TO THE
BIOMEDICAL SCIENCE, BUT THIS
NEED TO OPERATIONALIZE THE
DEFINITION OF RESILIENCE IS
ACTUALLY ALSO NOT NEW.
SO FOR EXAMPLE, ONE SUCH NEED TO
OPERATIONALIZE THE DEFINITION OF
RESILIENCE WAS DOCUMENTED IN THE
LITERATURE MORE THAN 30 YEARS
AGO.
THIS ARTICLE TITLED PROSPECTS
AND PROMS IN THE PROMISES IN TF
RESILIENCE WAS PUBLISHED IN THE
DEVELOPMENT IN PSYCHOPATHOLOGY
JOURNAL BACK IN 1993, AND HERE
THE AUTHOR WARNED THAT
RESILIENCE WAS AT RISK FOR BEING
VIEWED AS A POPULARIZED TREND
THAT HAD NOT BEEN VERIFIED
THROUGH RESEARCH AND, THEREBY,
WAS IN DANGER OF LOSING
CREDIBILITY WITHIN THE
SCIENTIFIC COMMUNITY.
THE AUTHOR ALSO STATES THAT
DEFINITIONAL DIVERSITY COULD
RESULT IN VASTLY DIFFERENT
CONCLUSIONS DRAWN AMONGST
SIMILAR PROFILES OR SYSTEMS OR
STUDIES, AND, THEREFORE, THE
AUTHOR ENCOURAGED THAT WHILE IT
WAS SOMEWHAT PREMATURE TO AGREE
ON A DEFINITION OF RESILIENCE
BACK THEN, IN 1993, THERE WAS
SOME HOPE THAT AT SOME POINT,
THERE COULD BE A CONSENSUS, A
FUTURE GOAL FOR INVESTIGATORS TO
AGREE ON A COMMON DEFINITION OF
RESILIENCE.
SO THEN FAST FORWARD TO 2014,
ABOUT 10 YEARS AGO, WHEN THE
APA, THE AMERICAN PSYCHOLOGICAL
ASSOCIATION, ACTUALLY DID
ESTABLISH A DEFINITION OF
RESILIENCE.
THAT DEFINITION STATES THAT
RESILIENCE CAN BE DEFINEDS A THE
PROCESS OF ADAPTING WELL IN THE
FACE OF ADVERSITY, TRAUMA,
TRAGEDY, THREAT, SO EVEN
SIGNIFICANT SOURCES OF STRESS.
BUT THIS DEFINITION WAS INTENDED
TO BE APPLICABLE TO
PSYCHOLOGICAL PROCESSES AND NOT
NECESSARILY APPLICABLE ACROSS
MULTIPLE DOMAINS.
BUT YET HERE AT THE NATIONAL
INSTITUTES OF HEALTH, EFFORTS
OVER THE PAST 10 YEARS CERTAINLY
REFLECT THE COMPLEX NATURE OF
RESILIENCE AND DEMONSTRATE THE
NEED FOR RESILIENCE DEFINITION
THAT CAPTURED THE INTERACTIONS
OF MULTIPLE DOMAINS, INCLUDING
PSYCHOLOGICAL, SOCIAL,
BIOLOGICAL, AND EVEN COMMUNITY
AND ENVIRONMENTAL RESILIENCE.
LET ME GO BACK FOR ONE SECOND
AND JUST SAY WHY ODS IS INVOLVED
IN THIS.
SO ODS, THE OFFI OFFICE OF DIETY
SUPPLEMENTS, IS WHERE I
CURRENTLY CONDUCT THE RESILIENCE
IN HEALTH STUDIES PROGRAM, IS A
PART OF THE DIVISION OF PROGRAM
COORDINATION, PLANNING AND
STRATEGIC INITIATIVES HERE AT
ODS, HERE AT NIH.
AND SO IN THAT UNIQUE POSITION,
IN THAT UNIQUE ROLE, THE OFFICE
OF DIETARY SUPPLEMENTS FELT IT
COULD BRING THESE DIFFERENT
GROUPS AND DOMAINS TOGETHER AND
ESTABLISH A MORE INTEGRATED
APPROACH TO ADDRESSING THE GAPS
IN RESILIENCE RESEARCH, AND AS A
RESULT IN 2019, MY TEAM AND I AT
THE OFFICE OF DIETARY
SUPPLEMENTS ESTABLISHED A
TRANS-NIH RESILIENCE WORKING
GROUP.
NOW THAT WORKING GROUP, WHICH
AGAIN I MENTIONED WAS
ESTABLISHED IN 2019, ONE OF THE
FIRST ACTIVITIES OF THAT GROUP
WAS TO HOST A FORUM TO DEVELOP
AN NIH-WIDE OPERATIONAL
DEFINITION OF RESILIENCE.
PARTICIPANTS OF THE FORUM
INCLUDED REPRESENTATIVES FROM
NINE INSTITUTES AND CENTERS FROM
ACROSS THE NIH.
AND THAT FORM TOOK PLACE ON
MARCH 10TH OF 2020, ATTENDEES AT
THE FORUM ENGAGED IN
PRESENTATIONS IN WHICH THEY
TALKED ABOUT EXAMPLES OF
RESILIENCE RESEARCH THAT THEIR
OWN INSTITUTES, CENTERS AND
OFFICES HAVE BEEN FUNDING OR
SOME ACTIVITIES THAT THEY HAVE
BEEN LEADING, BUT ALSO THE
GROUP, THE PARTICIPANTS,
PARTICIPATED IN DISCUSSIONS
THROUGH BREAKOUT GROUP SESSIONS
IN WHICH THEY HAD A SERIES OF
INTENSE DELIBERATIONS.
I MEAN, WE WERE RIPPING UP
PAPERS AND, YOU KNOW, BATTLING
OVER WHAT SHOULD BE THE
DEFINITION OF RESILIENCE.
WHAT WE CAME UP WITH, THOUGH, IS
THAT THROUGH THOSE
DELIBERATIONS, THE FOUR
PARTICI -- THE FORUMPARTICIPANTE
TOGETHER AND SUGGEST CRITERIA
FOR CONSIDERATION OF AN NIH-WIDE
DEFINITION OF RESILIENCE.
AND THEN FOR THE NEXT SEVERAL
MONTHS, I PROBABLY -- FOR ALMOST
A YEAR FOLLOWING THAT FORUM, THE
NIH RESILIENCE WORKING GROUP
USED THAT CRITERIA THAT HAD BEEN
DEVELOPED DURING THE FORUM TO
ESTABLISH A RESILIENCE
DEFINITION AND CONCEPT MODEL.
AND THE DEFINITION STATES THAT
RESILIENCE CAN BE DEFINED AS THE
SYSTEMS CAPACITY TO RESIST,
RECOVER, GROW OR ADAPT IN
RESPONSE TO A CHALLENGE OR
STRESSOR.
AND THEN OUR CONCEPT MODEL SHOWS
THAT WE WEREN'T -- YOU COULDN'T
REALLY TRULY CAPTURE OR MEASURE
RESILIENCE WITHOUT A STRESSOR OR
CHALLENGE.
SO THE VERY FIRST THING WE HAD
TO DO THROUGH OUR CONCEPT MODEL
WAS THAT THERE WAS A NEED TO
IDENTIFY A STRESSOR OR CHALLENGE
AND CHARACTERIZE THAT STRESSOR
OR CHALLENGE.
WE NEEDED TO KNOW A LITTLE BIT
ABOUT THE TYPE, MAGNITUDE AND
DURATION OF A STRESSOR AND
CHALLENGE HAS IT IMPACTED THE
SYSTEM.
AND IN OUR MODEL WE SUGGESTED A
SYSTEM COULD REPRESENT ANYTHING
AS BROAD AS THE ENVIRONMENT, IT
COULD REPRESENT THE COMMUNITY,
IT COULD EVEN REPRESENT THE
INDIVIDUAL LEVEL.
AND WHEN WE TALK ABOUT THE
SYSTEM AT THE INDIVIDUAL LEVEL,
THAT INCLUDED PSYCHOLOGICAL
DOMAINS, SOCIAL DOMAINS,
PHYSIOLOGICAL DOMAINS, GENETICS,
MOLECULAR, EVEN DOWN TO THE
CELLULAR LEVEL.
AND WHAT WE HOPED THIS MODEL
COULD DEMONSTRATE WAS THAT OVER
TIME, A SYSTEMS RESPONSE TO A
CHALLENGE OR STRESSOR MIGHT SHOW
VARIED DEGREES OF REACTIONS THAT
LIKELY FLUCTUATE IN RESPONSE TO
THE SEVERITY OF THE CHALLENGE,
LENGTH OF TIME EXPOSED TO THE
CHALLENGE AND/OR INNATE OR
INTRINSIC FACTORS.
NOW, SINCE THE DEVELOPMENT OF
THAT RESILIENCE DEFINITION, MY
TEAM AND I AT THE OFFICE OF
DIETARY SUPPLEMENTS DEVELOPED A
CATEGORIZATION CODE THAT MAPS
NIH FUNDING TO THE NEW TRANS-NIH
RESILIENCE DEFINITION.
NOW WITH THIS TOOL, WE WERE ABLE
TO IDENTIFY RESILIENCE RESEARCH
FUNDING THAT WAS CONSISTENT WITH
THE NEW DEFINITION.
AND WE LOOKED AT THAT FUNDING
ACROSS THE VARIOUS NIH DOMAINS.
AND WHAT WE NOTICED WAS AN
OBVIOUS TREND TOWARDS INCREASING
IN THE NUMBER OF PROJECTS THAT
MAP TO THE NEW TRANS-NIH
DEFINITION OF RESILIENCE.
AND WE LIKE TO ATTRIBUTE THIS
INCREASE TO IMPROVED CONSISTENCY
AND HARMONIZATION WITH RESPECT
TO THE SCIENCE OF RESILIENCE.
NOW, AN OBVIOUS NEXT STEP OF THE
RESILIENCE RESEARCH WORKING
GROUP HERE AT NIH IS TO NOW HELP
TO HARMONIZE MEASURES AND
METRICS FOR CAPTURING RESILIENCE
OUTCOMES.
THE TRANS-NIH RESILIENCE WORKING
GROUP ACTUALLY CAME TOGETHER
AGAIN TO PLAN ANOTHER WORKSHOP
AND THINK TANK SESSION TO HELP
ADVANCE THE SCIENCE OF
RESILIENCE THROUGH A DISCUSSION
OF MEASURES AND METRICS.
SHOWN HERE ARE THE NIH
INSTITUTES, CENTERS AND OFFICES
THAT ARE CURRENTLY REPRESENTED
ON A TRANS-NIH RESILIENCE
WORKING GROUP.
WE WENT FROM NINE PARTNERS ON
THE WORKING GROUP TO NOW WE HAVE
13 PARTNERS ON THE WORKING
GROUP, AND OF THOSE 13 PARTNERS,
SIX NIH INSTITUTES, CENTERS AND
OFFICES ACTUALLY PARTICIPATED IN
THE PLANNING OR EVEN ENGAGED
ACTIVELY IN THE WORKSHOP ITSELF.
AND THOSE INSTITUTES, CENTERS
AND OFFICES WERE OS ODS, OFFICEF
DIETARY SUPPLEMENTS, NATIONAL
CANCER INSTITUTE, NATIONAL
HEART, LUNG AND BLOOD INSTITUTE,
OFFICE OF DISEASE PREVENTION,
NATIONAL CENTER FOR COMPLEN MI
COMPLEMENTARY AND INTEGRATIVE
HEALTH AS WELL AS THE WORK
GROUP.
SO THAT TWO-DAY WORKSHOP TOOK
PLACE SEPTEMBER 24TH TO THE
25TH, AND THE OBJECTIVES OF THE
WORKSHOP WERE NOT ONLY TO DEFINE
MEASURES AND METRICS THAT ARE
BEST WITHIN AND ACROSS DOMAINS
BUT ALSO TO STIMULATE ACROSS
DOMAIN COLLABORATIONS.
SO SOME OF THE HIGHLIGHTS THAT
CAME OUT OF THAT WORKSHOP WAS
THAT THERE WAS WITHIN DOMAIN,
FOR SHORT IT WAS ALREADY WITHIN
DOMAIN AGREEMENT OF APPROPRIATE
MEASURES FOR CAPTURING
RESILIENCE.
BUT THERE WAS ALSO SOME
AGREEMENT THAT SOME MEASURES OF
RESILIENCE SHOULD BE APPLICABLE
AND POTENTIALLY VALIDATED ACROSS
MULTIPLE DOMAINS.
SO THERE WAS NO NEED TO JUST
STAY WITHIN YOUR OWN LITTLE
DOMAIN WHEN TALKING ABOUT
RESILIENCE THAT SOME OF THOSE
MEASURES WERE NOT ONLY
BENEFICIAL ACROSS DOMAINS BUT
THAT THERE'S A POSSIBILITY THAT
THEY COULD BE VALIDATED.
AND WHAT'S REALLY NICE IS TO SEE
SOME OF THE AHA MOMENTS AT THAT
WORKSHOP WHERE PARTICIPANTS
REALIZE, HEY, YOU KNOW, WHAT I'M
DOING HERE IS VERY RELEVANT IN
THAT DOMAIN OVER THERE.
THERE WAS ALSO SOME AGREEMENT
THAT MORE CROSSTALKS AMONGST THE
DIFFERENT DOMAINS -- LET ME SHOW
YOU AN EXAMPLE OF WHAT I MEAN.
WHILE AT THAT MOST RECENT
WORKSHOP IN SEPTEMBER, AGAIN, WE
HAD THINK TANK SESSIONS WHERE WE
BROUGHT TOGETHER ALL THE
PARTICIPANTS, THE IN-PERSON
PARTICIPANTS, AS WELL AS THE
VIRTUAL PARTICIPANTS, GOT
TOGETHER IN DIFFERENT GROUPS AND
THOSE DIFFERENT GROUPS WERE
INTENTIONALLY MIXED, SO
INDIVIDUALS IN THOSE GROUPS CAME
FROM VERY DIFFERENT DOMAINS.
AND WHAT WE FOUND IS THAT WHEN
WE TALKED ABOUT CERTAIN -- SOME
MEASURES AND METRICS LIKE, FOR
EXAMPLE, SLEEP QUALITY, WE FOUND
THAT UNDERSTANDING OR CAPTURING
SLEEP QUALITY IN AN INDIVIDUAL
WAS THOUGHT TO ALLOW SOMEONE TO
BE ABLE TO UNDERSTAND BETTER THE
RESILIENCE OUTCOMES FOR THAT
INDIVIDUAL.
AND THAT MEASURE TENDED TO SPAN
ACROSS MULTIPLE DOMAINS, SO THAT
METRICS TENDED TO SPAN ACROSS
MULTIPLE DOMAINS.
FOR EXAMPLE, SLEEP QUALITY WAS
MENTIONED AS A REASONABLE METRIC
OF RESILIENCE IN THE CELLULAR
DOMAIN, PHYSIOLOGICAL DOMAIN,
PSYCHOLOGICAL DOMAIN, EVEN IN
COMMUNITY DOMAIN.
SO THIS CHART IS JUST ONE
EXAMPLE OF HOW ALL OF THOSE
DOMAINS WERE INTERCONNECTED WHEN
TALKING ABOUT RESILIENCE
OUTCOMES, AND HOW IT IS
IMPORTANT NOW WHEN WE'RE TALKING
ABOUT METRICS OF RESILIENCE,
PERHAPS WE'RE CONSIDERING WHICH
OF THOSE METRICS CAN SPAN ACROSS
MULTIPLE DOMAINS.
SO BEFORE I LET YOU ALL GO
TODAY, I JUST DO WANT TO BRING
UP ONE OTHER ASPECT THAT'S BEEN
COMING UP LATELY AS WE TALK
ABOUT RESILIENCE AND CAPTURING
MEASURES OF RESILIENCE OUTCOMES.
AND THAT IS, IF WE'RE DESIGNING
STUDIES OR EVEN DESIGNING
PROGRAMS OR WANTING TO
UNDERSTAND IF WE'RE CAPTURING
THE RIGHT RESILIENCE OUTCOMES
FOR CERTAIN PROGRAMS OR STUDIES,
THE QUESTION BECOMES THEN, HOW
DO WE DISTINGUISH, HOW DO WE
DECIDE THAT OUR STUDY IS TRULY
DESIGNED TO CAPTURE RESILIENCE
VERSUS PREVENTION, VERSUS
DISEASE, TREATMENT, OR EVEN RISK
AVERSION?
AND IN ORDER TO ANSWER THIS
QUESTION, I'D LIKE TO REMIND
OURSELVES OF THE DEFINITIONS OF
RESILIENCE, PREVENTION AND
DISEASE TREATMENT.
BECAUSE I THINK BURIED IN THE
DEFINITION, WE'LL FIND THAT,
YES, THERE'S QUITE A BIT OF
OVERLAP.
THERE IS SOME OVERLAP BETWEEN
RESILIENCE PREVENTION AND
DISEASE TREATMENT AND WHAT THOSE
PROGRAMS OR STUDY DESIGNS MEET
MIGHTTRY TO ACHIEVE, BUT THERE S
SOME DISTINCTION, AND IF WE CAN
UNDERSTAND THE DISTINCTION, THE
DIFFERENCE, THEN WE CAN BE SURE
THAT WE'RE DESIGNING OUR STUDIES
TO TRULY CAPTURE RESILIENCE.
SO FOR EXAMPLE, LET ME JUST
REMIND OURSELVES OF THE
DEFINITION OF RESILIENCE.
THE TRANS-NIH RESILIENCE WORKING
GROUP DEFINES RESILIENCE AS THE
CAPACITY TO REDYS, A RESIST, RER
ADAPT FROM A CHALLENGE, NOW
INTERVENTIONS THAT STRENGTHEN
THIS SYSTEM ARE BELIEVED TO ACT
VIA PROTECTIVE PATHWAYS.
THAT COULD BE IN THE CELLULAR,
MOLECULAR OR PHYSIOLOGICAL
SYSTEM OR MAYBE YOU CALL IT A
PROTECTIVE FACTOR IF YOU'RE
REFERRING TO A BEHAVIORAL, AN
ENVIRONMENTAL SYSTEM.
BUT THE NIH DEFINES DISEASE
PREVENTION A LITTLE DIFFERENTLY.
DISEASE PREVENTION ARE ACTIONS
TO REDUCE OR ELIMINATE EXPOSURE
TO RISKS THAT MIGHT INCREASE THE
CHANCES THAT AN INDIVIDUAL OR
GROUP WILL INCUR DISEASE,
DISABILITY, OR PREMATURE DEATH.
AND DISEASE TREATMENT CAN BE
DEFINED AS RESTORATION OF A
NORMAL PHYSIOLOGICAL STATE VIA
MITIGATING OR COMBATING A
DISEASE OR DISORDER.
SO AGAIN, THERE'S CLEARLY SOME
OVERLAP THERE.
BUT I'D LIKE TO SUGGEST THAT THE
DISTINCTION HERE IS THAT
PREVENTION, DISEASE TREATMENT,
AND EVEN RISK AVERSION, THE
FOCUS, THE FOCUS OF THE
INTERVENTION IS ON THE CHALLENGE
OR THE STRESSOR OR THE DISEASE
ITSELF.
WHEREAS THE FOCUS OF RESILIENCE
IS ON THE SYSTEM, ON
STRENGTHENING THE SYSTEM SO
HERE'S A LITTLE CARTOON, I
GUESS, IL ILLUSTRATION TO REALLY
DRIVE HOME THAT POINT, THAT THE
TWO CONCEPTS ARE ACTUALLY
COMPLEMENTARY.
IT'S NOT THAT ONE SHOULD BE IN
THE ABSENCE OF THE OTHER.
IT'S THAT WE NEED BOTH IN ORDER
TO GET THE BEST, THE HEALTHIEST
LIVES AS POSSIBLE.
SO FOR RESILIENCE INTERVENTION,
YOU SEE THE GOAL IS TO
STRENGTHEN THE SYSTEM,
STRENGTHEN THE SYSTEM'S ABILITY
TO RESIST OR RECOVER FROM
PERTURBATION, WHEREAS I'D LIKE
TO SUGGEST THAT WITH PREVENTION
AND DISEASE TREATMENT, THE GOAL
IS TO MITIGATE THE PATHOLOGY OR
THE RISK.
SO THIS IS, OF COURSE, THE PAIN
COORDINATE, PAIN RESEARCH
COORDINATING COMMITTEE, SO I'D
LIKE TO AT LEAST BRING THE
EXAMPLE, ILLUSTRATE AN EXAMPLE
USING PAIN AS TO WHY AND HOW
THESE TWO CONCEPTS ARE
COMPLEMENTARY.
SO FOR INSTANCE, WE'RE TALKING
ABOUT A TARGETED INTERVENTION
LIKE A MEDICAL TREATMENT THAT'S
TARGET PAIN.
TYPICALLY WHEN YOU'RE TRYING TO
UNDERSTAND YOUR OUTCOME, DID THE
INTERVENTION WORK, YOU'RE
LOOKING AT WHETHER OR NOT THE
MAGNITUDE OF THE PAIN WAS
REDUCED, WHETHER OR NOT THE
DURATION OF THE PAIN WAS
REDUCED, BUT THAT'S A LITTLE BIT
DIFFERENT.
THAT TARGETED INTERVENTION,
WHILE HELPFUL, IS A LITTLE BIT
DIFFERENT THAN A SYSTEMIC
EXHIBIT VENGS.
AND I WOULD SUGGEST THAT A
SYSTEMIC INTERVENTION IS ONE
THAT YOUR GOAL, YOUR GOAL IS TO
ACTUALLY STRENGTHEN THE SYSTEM
TOWARDS A RESILIENCE OUTCOME.
SO THAT SYSTEMIC INTERVENTION
COULD INCLUDE INTERVENTIONS SUCH
AS EXERCISE, DIETARY
INTERVENTIONS, MIND-BODY
INTERVENTIONS, ET CETERA.
AND THEN YOUR OUTCOME THAT
YOU'RE MEASURING, YOU'RE GOING
TO WANT TO KNOW WHETHER OR NOT
THAT INTERVENTION ALLOWED THE
SYSTEM TO RESPOND BETTER DESPITE
THE PAIN OR IN THE PRESENCE OF
THE PAIN, OR RESPOND BETTER TO
THE PAIN INTERVENTION ITSELF.
AND SO AGAIN, MY TAKE-HOME POINT
HERE IS THAT THE GOAL IS NOT TO
SAY THAT ONE CONCEPT SHOULD BE
PREFERRED OVER THE OTHER.
THE GOAL IS TO SAY THAT WE NEED
BOTH.
WE NEED BOTH THE TARGETED
INTERVENTION AS WELL AS THE
SYSTEMIC INTERVENTION, BUT I'D
LIKE TO ARGUE THAT WE HAVEN'T
PUT ENOUGH ENERGY INTO FOCUSING
ON THAT INTERVENTION THAT IS
DESIGNED TO STRENGTHEN THE
SYSTEM IN A WAY THAT WE CAN GAIN
GREATER RESILIENCE OUTCOMES.
SO I'LL CLOSE HERE AND JUST
OFFER A FEW RESOURCES.
WE DO HAVE A TRANS-NIH WORKING
GROUP AND IF YOU LIKE TO KNOW
EVEN MORE ABOUT WHAT THAT
WORKING GROUP HAS BEEN DOING,
SOME OF THE ACTIVITIES WE'VE
BEEN INVOLVED IN, THERE'S A
WEBPAGE THAT YOU CAN ACCESS.
WE ALSO HAVE A RESILIENCE
RESEARCH SCIENTIFIC INTEREST
GROUP, SO IF YOU'RE INTERESTED
IN JOINING US AND TAKING PART IN
SOME OF THE CONVERSATIONS AND
DISCUSSIONS WE'RE HAVING ABOUT
RESILIENCE AND HOW TO ADVANCE
THE SCIENCE, THERE'S A LISTSERV
THAT YOU CAN SIGN ON TO AND JOIN
THE LISTSERV AND PARTICIPATE IN
SOME OF THOSE MEETINGS.
THERE IS A RECENT SPECIAL ISSUE,
SPECIAL SUPPLEMENT THAT THE
TRANS-NIH RESILIENCE WORKING
GROUP WORKED TOGETHER TO PUBL
PUBLISH.
THAT PUBLICATION CAME OUT IN
STRESS & HEALTH JOURNAL BACK IN
SEPTEMBER OF 2023.
THEN THE OFFICE OF DIETARY
SUPPLEMENTS, OUR STRATEGIC PLAN
HAS JUST RECENTLY BEEN RELEASED,
AND IN THAT STRATEGIC PLAN,
THERE IS A PRIORITY AREA ON
RESILIENCE, SO IF YOU WANT TO
LEARN MORE ABOUT WHAT ODS IS
DOING WITH RESPECT TO
RESILIENCE, THAT'S A GOOD
RESOURCE FOR YOU AS WELL.
SO AGAIN I'D LIKE TO THANK YOU
ALL AND I'M HAPPY TO HANG AROUND
FOR QUESTIONS IF THERE'S TIME.
>> THANK YOU SO MUCH, DR. BROWN.
THIS IS AN AMAZING TALK AND IT
WAS GREAT TO SEE ALL THESE
RESOURCES.
I WANT TO OPEN UP THE FLOOR AND
SEE IF THERE'S ANY QUESTIONS FOR
DR. BROWN.
MONICA, DO YOU WANT TO GO?
I THINK YOU'RE MUTED IF YOU WANT
TO UNMUTE YOURSELF.
>> YEAH, THANKS.
SORRY.
THANK YOU FOR THE PRESENTATION,
DR. BROWN.
I DON'T KNOW MUCH ABOUT THIS
TOPIC BUT IT'S DEFINITELY VERY
INTERESTING.
I HEARD YOU SAY OUTCOMES AND I
HEARD YOU SAY INTERVENTIONS, BUT
I'M JUST CURIOUS, DO WE KNOW
ANYTHING ABOUT THE FACTORS THAT
AFFECT INDIVIDUALS' ABILITY TO
DEVELOP RESILIENCE?
JUST CURIOUS ABOUT THAT.
YOU MUST HAVE MENTIONED
SOMETHING, PROBABLY --
>> SO THAT'S WHAT WE'RE STILL
TRYING TO LEARN.
SO FOLKS HAVE SUGGESTED THAT
FACTORS SUCH AS YOUR COMMUNITY,
YOUR CONNECTION TO YOUR
COMMUNITY HAVE BEEN LINKED TO
ENHANCED RESILIENCE OUTCOMES.
FACTORS SUCH AS YOUR MENTAL
STATE, YOUR PERCEPTIONS HAVE
BEEN LINKED TO RESILIENCE
OUTCOMES.
BUT THAT'S EXACTLY THE POINT
WE'RE MAKING HERE.
THOSE FACTORS AND THOSE
INTERVENTIONS AND THOSE
OUTCOMES, WE WANT TO STUDY THEM
USING A CLEAR DESIGN, A CLEAR
RESILIENT STUDY DESIGN TO ENSURE
THAT WE'RE LOOKING AT RESILIENCE
OUT COME AND NOT JUST THINKING
ABOUT LIKE IS THAT RISK AVERSION
OR IS THAT PREVENTION.
SO THE GOAL IS TO SAY THAT
MEASURE OR THAT METRIC WAS VERY
USEFUL FOR US IN PREVENTION
WORK, RIGHT?
BUT AS THAT SAME MEASURE OR
METRIC, IS IT USEFUL FOR
CAPTURING RESILIENCE OUTCOMES?
AND THAT'S THE QUESTION THAT WE
NEED MORE WORK TO TRULY
UNDERSTAND.
>> JUST A QUICK FOLLOW-UP.
I'M ACTUALLY TRAINED AS A BASIC
RESEARCHER AND I'VE STUDIED
STRESS PATHWAYS IN CELLS SO I'M
JUST CURIOUS, ARE THERE ANY
CONNECTIONS BEING MADE THAT YOU
DID MENTION SEVERAL MOLECULAR
PATHWAYS, AND DO WE KNOW, THAT'S
WHAT I THINK IT COMES DOWN TO
SORT OF SOME OF THE STRESSORS
THAT ARE PUT NOT EVEN AT THE
CELLULAR LEVEL.
AND IF ANY WORK IS BEING DONE
SORT OF IN THAT REALM.
>> SO THAT'S SOMETHING THAT MY
TEAM AND I AT THE OFFICE OF
DIETARY SUPPLEMENTS, WE WERE
VERY INTERESTED IN THOSE
BIOLOGICAL PATHWAYS BECAUSE IF
THERE IS A DIETARY SUPPLEMENT
THAT CAN ENHANCE RESILIENCE,
THAT WE NEED TO KNOW WHAT ARE
THOSE BIOLOGICAL PATHWAYS THAT
UPREGULATE PROTECTIVE PATHWAYS.
AND I'M GLAD YOU ASKED THAT
QUESTION BECAUSE WE ARE GOING
ABOUT THIS WITH THIS IDEA THAT
THERE ARE PERHAPS PROTECTIVE
PATHWAYS OUT THERE DIFFERENT
FROM DISEASE PATHWAYS, AND WE'RE
EXPLORING THE POSSIBILITY, YOU
KNOW, MAYBE NERVE TOO, YOU KNOW,
THERE ARE CURRENTLY SOME
POSSIBILITIES OUT THERE, BUT
IT'S A CHALLENGE TO FIND IT IN
LITERATURE, RIGHT?
BECAUSE NOBODY CALLS IT A
PROTECTIVE PATHWAY.
NOBODY WANT TO SAY RESILIENCE
PATHWAY.
SO WHAT WE'RE DOING IS WE'RE
REALLY TRYING TO DO A DEEP DIVE
INTO THE LITERATURE TO SEE IF WE
CAN TRULY IDENTIFY THOSE
PATHWAYS THAT ARE TRULY
PROTECTIVE PATHWAYS, THAT IF WE
UPREGULATE OR ENHANCE THOSE
PATHWAYS, THAT DESPITE THE
DISEASE OR DESPITE THE RISK,
THAT THOSE PATHWAYS CAN SOMEHOW
OFFER SOME PROTECTION TO THE
SYSTEM.
YES, THERE IS WORK BEING DONE
THERE.
IS IT TRICKY TO FIND IT IN THE
LITERATURE, BUT WE HAVE FOUND
SOME EVIDENCE OF THAT WORK, AND
EVEN YESTERDAY, WE HAD OUR SIG
MEETING, OUR SCIENTIFIC INTEREST
GROUP, RESILIENCE SCIENTIFIC
INTEREST GROUP MEETING AND IN
THAT TALK WAS A FASCINATING TALK
BY DR. MONICA FISHNER WHO TALKED
ABOUT PHYSICAL ACTIVITY AND SHE
HAD I BELIEVE A RODENT MODEL IN
WHICH SHE'S ABLE TO LOOK AT
BRAIN SLICES AFTER PHYSICAL
ACTIVITY, AND WHAT SHE EXPECTED
WAS THAT, YOU KNOW, ALL OF THESE
CHANGES WOULD TAKE PLACE IN THIS
MOUSE THAT HAD BEEN CHALLENGED
BUT DIDN'T HAVE ANY PHYSICAL
AK FIFTH BUT YET WHAT SHE SAW
WAS THAT THE MOUSE THAT DID
PARTICIPATE IN PHYSICAL ACTIVITY
ALSO HAD SOME REALLY SIGNIFICANT
CHANGES IN THESE BRAIN SLICES,
AND WHAT SHE'S THINKING IS,
MAYBE THAT'S SOME CLUE AS TO A
PROTECTIVE PATHWAY THAT'S
RESULTING FROM PHYSICAL
ACTIVITY.
SO YES, THAT WORK IS OUT THERE,
IT'S VERY EXCITING, BUT WE'RE
TRYING TO GET A HANDLE ON IT ALL
AND TRYING TO MAKE SENSE OF IT
ALL.
>> I THINK SOMETHING LIKE AN
EAST MODEL OR SOMETHING LIKE
THAT WOULD BE GREAT TO STUDY
SOME OF THESE THINGS.
I DON'T KNOW HOW MUCH IS KNOWN
ABOUT THE SUBJECT, EVEN WITHIN
BASIC RESEARCH.
>> THAT WOULD ACTUALLY BE A
GREAT TRANSITION BECAUSE
DR. FSHMAN IS GOING TO PICK UP
AND ALSO CONTINUE TO TALK ABOUT
RESILIENCY, SO MAYBE WE'LL
ANSWER SOME MORE OF YOUR
QUESTIONS.
BUT DR. BROWN, THANK YOU SO
MUCH.
YOUR INTEREST AND PASSION ON
THIS IS SO INFECTIOUS, SO IT'S
VERY EXCITING TO SEE THIS WORK
AND SO IF YOU'RE ABLE TO STICK
AROUND TO SEE SOME OF
DR. FISHMAN'S PRESENTATION,
PLEASE FEEL FREE TO DO SO.
WITH THIS, TWHEEL LAND IT OVER O
DR. FISHMAN SO YOU CAN PICK UP
AND TALK ABOUT PAIN, RESILIENCE
AND WELLNESS.
SO DR. FISHMAN, PLEASE TAKE IT
AWAY.
>> CAN YOU HEAR ME?
>> WE CAN HEAR YOU, YEP.
>> ALL RIGHT.
WELL, THANK YOU, AND CAN YOU SEE
MY SLIDES OKAY?
>> YES, NOW THEY'RE IN
PRESENTATION MODE.
>> GREAT.
WELL, THANK YOU.
THIS IS REALLY EXTRAORDINARY, AS
SOMEONE -- A AS A PAIN SPECIALIT
ALL THESE YEARS TO START LOOKING
AT THE ISSUE OF WELLNESS AND THE
FACT THAT OUR FIELD AS A
SPECIALTY FIELD HASN'T BEEN ALL
THAT CONCERNED ABOUT PREVENTION.
THIS HAS BECOME A HEIGHTENED
TOPIC, AND AS SUCH, THIS WORK
THAT WAS JUST PRESENTED TO YOU
IS INCREDIBLY PROFOUND AND
TIMELY, LARGELY BECAUSE THIS
WHOLE AREA OF WELLNESS IS A BIT
OF A MORASS.
THE WORD WELLNESS IS KIND OF
USED WIDELY, MOST PEOPLE ARE FOR
IT, AND FEW AGREE ON WHAT IT
MEANS.
AND THE EVOLUTION OF THE TERM
RESILIENCE AS A DEFINABLE, EVEN
AN OBJECTIVE MEASUREMENT OR
TARGET, HAS BEEN EXACTLY WHAT
WE'VE NEEDED, LARGELY BECAUSE
THE WORLD OF WELLNESS IS JUST
WRAPPED WITH MISINFORMATION,
MOSTLY INFORMATION THAT IS
TARGETING PROFIT OR PERSUASION
WITHOUT REALLY VALIDITY OR
RELIABILITY FOR CONSUMERS.
MORE SO THAN MISINFORMATION IS A
PROBLEM IN MANY, MANY AREAS OF
OUR SOCIETY, BUT WELLNESS IS
JUST EVERYWHERE.
SO AT A TIME WHEN WE'RE IN KIND
OF A VERY POLARIZED POLITICAL
ENVIRONMENT, IT'S UNUSUAL TO
FIND ACTUALLY AGREEMENT IN THIS
AREA.
OUR CURRENT SECRETARY OF HEALTH
AND HUMAN SERVICES HAS NUMEROUS
TIMES IDENTIFIED THE FACT THAT
WE'VE GOT TO SHIFT FROM AN ILL
CARE HEALTH SYSTEM TO A WELL
CARE SYSTEM, LARGELY BASED ON
THE ECONOMIC AND OTHER PROBLEMS
INCURRED BY PREVENTABLE CHRONIC
ILLNESS.
AND THIS IS AN ISSUE THAT THE
NOMINEE FOR -- OR THE PROPOSED
NOMINEE FOR HHS HAS ALSO SAID IS
A MAJOR CONCERN FOR US.
SECOND BY SSECRETARY BECERRA HAO
CALLED IT A PROBLEM OF NATIONAL
SECURITY, AND IT REALLY IS
REFLECTED HERE IN THIS CMS --
THIS DIAGRAM FROM CMS OF CHRONIC
ILLNESS PREVALENCE AMONGST
BENEFICIARIES, AND WHAT YOU CAN
SEE HERE IS CHRONIC ILLNESS IS
JUST SO PREVALENT, 68% HAVE TWO
OR MORE CHRONIC ILLNESSES AND A
LARGE MINORITY HAVE FOUR OR MORE
COMORBIDITIES OR CHRONIC
ILLNESSES.
YOU CAN SEE HERE THAT THE CMS
HAS -- I JUST UNFORTUNATELY LOST
MY SCREEN VIEW.
DID YOU GUYS -- ARE YOU STILL
SEEING MY SLIDES?
>> WE ARE STILL SEEING YOUR
SLIDES.
WE'RE SEEING THE CMS GRAPH THAT
YOU HAVE UP.
>> SORRY, I'M JUST GOING TO TRY
TO GET -- I'M NOT SEEING MY
SLIDES NOW.
SOMETHING JUST HAPPENED TO MY
VIEW.
I APOLOGIZE.
MAYBE I'LL TAKE A SECOND AND TRY
AND GET THEM BACK UP.
ALL RIGHT.
WELL, HERE WE GO.
OKAY.
SO THIS IS CMS DATA ON THE MAJOR
CHRONIC ILLNESSES THAT THEY
TRACK, AND WHAT I THINK IS
STRIKING ABOUT THIS GRAPH IS
SIMPLY THAT PAIN ISN'T INCLUDED.
MANY OF YOU PROBABLY KNOW IS
THAT PAIN IS THE MOST COMMON
CHRONIC ILLNESS, I THINK IT'S
CERTAINLY BEEN PUBLISHED AS SUCH
AND IT'S PROBABLY THE MOST
EXPENSIVE AS WELL, AND IT'S A
LEADING CAUSE OF DISABILITY
WORLDWIDE.
IESM GOING TOI'M GOING TO MOVE Y
THROUGH THESE SLIDES BECAUSE I
THINK THEY'RE FAIRLY
INTRODUCTORY FOR MOST OF US.
BUT THESE ARE VERY PROFOUND
ISSUES, AND RECENTLY THERE WAS A
STUDY THAT LOOKED AT MORTALITY
RATES WITH PATIENTS WITH CHRONIC
PAIN AND THEY SHOWED THAT THE
MORTALITY RISK DOUBLES WITH
CHRONIC PAIN AND MORE THAN
DOUBLES IF YOU HAVE HIGH
INTENSITY CHRONIC PAIN.
THERE ARE MANY THINGS WE CAN DO
ABOUT CHRONIC ILLNESS AND
CHRONIC PAIN AS WELL.
THERE ARE SOME MODIFIABLE THINGS
THAT WE CAN'T CHANGE, BUT THINGS
LIKE GENETICS WHICH WE THOUGHT
WERE NON-MODIFIABLE, THERE'S
EMERGING EVIDENCE THAT EVEN THAT
MAY BE MODIFIABLE BY LIFESTYLE
CHANGES.
BUT CERTAINLY MENTAL HEALTH,
SLEEP AND ACTIVITY, DIET,
DIFFERENT CONSUMPTIONS, ET
CETERA, ARE ALL MODIFIABLE, AND
I'M GOING TO WALK THROUGH THIS.
IN 2020, THE IESP MADE --
ACTUALLY I'M SORRY, 2022, I
THINK THEY MADE PAIN PREVENTION
THE GLOBAL YEAR FOR THAT
SOCIETY, AND THEY CAME UP
WITH A LIST OF THINGS THAT OFFER
STRONG PREVENTION OF CHRONIC
PAIN AND THEY'RE ALL THE THINGS
THAT YOU WOULD IMAGINE, LIKE A
HEALTHY DIET, REGULAR EXERCISE,
UNHEALTHY CONSUMPTIONS, BALANCED
POSTURE AND WORK, MANAGING
STRESS, ENJOYABLE ACTIVITIES AND
REDUCING UNNECESSARY STRESS WHEN
POSSIBLE.
THOSE OF US IN PAIN MANAGEMENT
ARE WELL AWARE OF THE IMPACT OF
MENTAL HEALTH AND MENTAL
WELLNESS IN PAIN.
WE KNOW THAT IT'S A
BIDIRECTIONAL RELATIONSHIP WHERE
MENTAL INSTABILITY OR MENTAL
VULNERABILITIES WILL INCREASE
THE POTENTIAL FOR PAIN AND PAIN
WILL INCREASE THE POTENTIAL TO
DESTABILIZE THE MIND.
WE KNOW THERE ARE MANY, A
MULTITUDE OF TREATMENTS, THEY'RE
NONINVASIVE TREATMENTS THAT CAN
POSITIVELY EFFECT, I WOULD SAY,
MENTAL RESILIENCE AS A NEW
EMERGING TERM.
THIS IS JUST ONE OF MANY YOU'RE
PROBABLY FAMILIAR WITH
MINDFULNESS-BASED STRESS
REDUCTION.
WE HAVE DATA ACROSS THE FIELD
THAT IN THESE INTERVENTIONS CAN
CHANGE THE WAY THE BRAIN
PROCESSES PAIN USUALLY IN A
POSITIVE WAY.
WE KNOW THAT WE CAN PREVENT
AMPLIFICATION OF PAIN PRIOR TO
IT OCCURRING AND THESE ARE PRE
AND POST SURGICAL STUDIES WHERE
PATIENTS HAVE BEEN PREPARED TO
HAVE PAIN AND HAVE LESS PAIN
BECAUSE OF THAT.
YOU'RE ALL FAMILIAR WITH THE
NEED FOR ACTIVITY AND AGAIN PAIN
IS NO DIFFERENT THERE.
WE HAVE DATA ON THE NEGATIVE
IMPACT OF INACTIVITY AND THE
BURDEN OF DISEASE.
WE KNOW THAT SEDENTARY BEHAVIOR
INCREASES IN MOST OF THE RISK
FOR CHRONIC ILLNESSES, AND
INCREASES ALL OF THE CAUSES OF
DEATH RELATED TO CARDIOVASCULAR
DISEASE, TYPE 2 DIABETES AND
SEVERAL CAP SERS INCLUDING
BREAST CANCER, COLON CANCER, ET
CETERA.
WE KNOW PHYSICAL ACTIVITY
IMPROVES ALL THOSE CONDITIONS
AND IT'S REALLY, AGAIN, A BACK
AND FORTH RELATIONSHIP.
IT TURNS OUT WE ALL EAT AS WELL,
AND THIS IS AN AREA OF LIFESTYLE
CHANGE THAT CAN BENEFIT PEOPLE
BUT IT'S NOT QUITE AS SIMPLE AS
IT MIGHT SEEM.
IN TERMS OF WHAT TO EAT.
YOU KNOW, THERE'S A LOT OUT
THERE ABOUT CHRONIC PAIN DIET,
ANTI-INFLAMMATORY DIETS, BUT
WHAT WE KNOW IS THAT HEALTHY
EATING PATTERNS REDUCE ALL RISKS
OF SPECIFIC MORTALITY SPECIFIC
TO MOST CHRONIC ILLNESSES, AND
WE KNOW THAT ULTRAPROCESSED
FOOD, WHICH WOULD BE, I WOULD
SAY, THE OPPOSITE OF WHOLE FOOD,
IS PROBABLY THE ENEMY AND
EXACTLY WHERE THIS BALANCE POINT
BETWEEN WHOLE FOOD AND
ULTRAPROCESSED FOOD AND WHERE WE
SHOULD BE EATING JUST ISN'T
COMPLETELY CLEAR, BUT WE KNOW
THAT EATING WHOLE FOOD FROM
PRETTY GOOD SCIENCE REDUCES THE
RISKS THAT WE HAVE WITH ALL
CHRONIC ILLNESSES, INCLUDING
CHRONIC PAIN.
BUT AGAIN, THERE NEEDS TO BE
MORE RESEARCH.
THERE IS A PLETHORA OF
INFORMATION OUT THERE.
MOST OF THE DATA IS ON THE
MEDITERRANEAN DIET, AND WHAT
I'VE LEARNED, MY REACTION TO
THIS IS THAT THERE ARE MANY GOOD
DIETS AND THE MEDITERRANEAN DIET
ISN'T THE ONLY ONE, AND IT'S
PROBABLY CALLED OUT BECAUSE IT'S
CLEARLY THE MOST STUDIED, BUT
WHAT I'VE LEARNED IS THAT THE
ELEMENTS IN THE MEDITERRANEAN
DIET ARE PART OF MOST DIETS
AROUND THE WORLD, BUT AGAIN, YOU
DON'T HAVE TO HAVE A STRICT
MEDITERRANEAN DIET, BUT THE
ELEMENTS IN THIS DIET SEEM TO BE
THE ONES THAT -- AT LEAST THE
SCIENCE TO DATE HAVE SHOWN US
SUPPORT HEALTH AND REDUCING
RISK.
WHEN PEOPLE ASK ME WHAT TO EAT,
I JUST GO BACK TO MICHAEL
POLLAN'S GUIDE OF EAT FOOD, AND
FOOD REALLY MEANS WHOLE FOOD,
STAY AWAY FROM HIGHLY PROCESSED
FOOD, DON'T EAT TOO MUCH, AND
EAT MOSTLY PLANTS.
DEPENDING ON WHERE YOUR PLANTS
COME FROM AND HOW THEY'RE GROWN.
SO THIS IS AS MUCH AS WE KNOW,
AND I THINK WE CAN ASSOCIATE
MUCH OF IT WITH THE CHRONIC
DISEASE OF CHRONIC PAIN.
THE SAME IS TRUE WITH SLEEP.
BIDIRECTIONAL, SLEEP CAN AFFECT
PAIN AND PAIN CAN AFFECT SLEEP.
ONE OF THE AREAS THAT IS
EMERGING IN TERMS OF OUR
KNOWLEDGE IN PAIN, THERE MAY BE
MORE KNOWLEDGE ABOUT PAIN THAN
OTHER AREAS, IS THIS AREA OF
SOCIAL CONNECTIVITY.
AND REALLY SOCIAL ISOLATION.
THERE'S A GREAT DEAL OF RESEARCH
OUT THERE.
THIS IS JUST ONE ARTICLE OF MANY
THAT SHOWS THAT SOCIAL ISOLATION
IMPACTS PAIN, WE KNOW
INTERVENTIONS FOR SOCIAL
ISOLATION CAN REDUCE PAIN.
THIS IS JUST A STUDY WE HAD DONE
AROUND BRINGING PATIENTS WHO
WERE SOCIALLY ISOLATED TO ART
MUSEUMS AND SEEING THAT IT
ACTUALLY DID HAVE AN IMPACT ON
THEIR SOCIAL ISOLATION AND
ULTIMATELY ON THEIR PAIN
INTENSITY, BUT THERE ARE MANY
INTERVENTIONS THERE THAT HAVE
BEEN OR CAN BE EFFECTIVE.
I JUST CALL YOUR ATTENTION TO
THE SURGEON GENERAL'S MESSAGE TO
THE COUNTRY ABOUT THE EPIDEMIC
OF LONELINESS AND SOCIAL
ISOLATION, AND THIS REALLY CAME
OUT OF THE PANDEMIC, THE COVID
PANDEMIC, WHICH AGAIN SAW A
HEIGHTENED RISE IN CHRONIC PAIN
IN PATIENTS WHO EITHER HAD PAIN
OR NEW ONSET CHRONIC PAIN.
MANY OF YOU MAY BE AWARE OF THE
BLUE ZONES.
THESE ARE AREAS THAT HAVE BEEN
OBSERVED AROUND THE WORLD BY A
NATIONAL GEOGRAPHIC REPORTER.
IT'S NOT THE GREATEST SCIENCE IN
THE WORLD, BUT THE OBSERVATIONS
ARE COMPELLING IN TERMS OF WHAT
WE UNDERSTAND ABOUT WHAT GOES
INTO A WELL LIFE.
THERE ARE NINE CATEGORIES THAT
THEY SEE THAT KIND OF OVERLAP,
BUT I CALL OUT THESE FOUR, WHICH
IS PEOPLE WITH PURPOSE, PEOPLE
WHO FEEL LIKE THEY BELONG,
PEOPLE WHO HAVE LOVED ONES CLOSE
TO THEM, EITHER PHYSICALLY OR
OTHERWISE, AND THEN THE RIGHT
TRIBE IS REALLY SPEAKING TO
HAVING COMMUNITIES THAT SUPPORT
WELLNESS OR I WOULD SAY
RESILIENCE.
AND THESE ARE INCREASINGLY
UNDERSTOOD AS COMPONENTS OF A
WELL LIFE THAT PROMOTE ALL THE
OTHER HEALTHFUL BENEFITS THAT
YOU MIGHT GET FROM THE OTHER
ASPECTS OF WELLNESS.
SO TRYING TO PUT THIS TOGETHER
IN TERMS OF CHRONIC PAIN, YOU
KNOW, CHRONIC PAIN IS COMMON,
IT'S EXPENSIVE, AND WE KNOW THAT
IT'S IMPACTED BY LIFESTYLE.
AND WE KNOW THAT THE BEST DATA
IS THAT LIFESTYLE CHANGES AFFECT
CHRONIC ILLNESSES, AND WHAT'S
MOST INTERESTING TO ME IS THAT
WHEN YOU LOOK AT THE CHRONIC
LIFESTYLE CHANGES THAT AFFECT
MOST CHRONIC ILLNESSES, THEY'RE
LARGELY THE SAME ONES FOR EACH
CHRONIC ILLNESS.
SO I THINK WE CAN EXTRAPOLATE
THAT TO A LARGE DEGREE TO
CHRONIC PAIN AS NOT ONLY ONE OF
THE CHRONIC ILLNESSES BUT THE
MOST COMMON AND MOST EXPENSIVE,
BUT WE HAVE WORK TO DO TO PULL
THAT TOGETHER.
WE'RE ALL AWARE OF PAIN AS A
BIOPSYCHOSOCIAL ENTITY, BUT I
WANTED TO ADD THIS TERM
ENVIRONMENTAL TO THAT.
REALLY THIS WAS DONE BY
DR. LANGEVIN A WHILE BACK AND
MAYBE OTHERS, BUT THIS IS
IMPORTANT BECAUSE WHEN WE LOOK
AT WHOLE PERSON HEALTHCARE,ED, E
IDEA WE TAKE INTO ACCOUNT REALLY
ALL OF THE VARIABLES, NOT JUST
SOME OF THE VARIABLES THAT WE
LOOK AT PEOPLE AS NOT JUST PARTS
BUT AS A WHOLE, AND WHEN WE LOOK
AT A WHOLE, WE LOOK AT NOT JUST
THE ORGANISM, BUT THE CONTEXT OF
THE ORGANISM.
SO THERE ARE MULTIPLE FACTORS
THAT PROMOTE EITHER HEALTH OR
DISEASE.
IT INCLUDES INDIVIDUALS,
FAMILIES, THEIR COMMUNITIES,
CAREGIVERS, POPULATION -- THE
POPULATIONS THAT THEY'RE PART
OF, ENVIRONMENTAL INFLUENCES,
BOTH PHYSICAL AND SOCIAL.
THEIR ECONOMICS, EDUCATION AND
OTHER THINGS.
SO OUR INTERVENTIONS THEN, WHEN
WE LOOK AT INDIVIDUALS WITH
CHRONIC PAIN, SHOULD BE AS BROAD
AS THESE ENTITIES.
I WANTED TO SHARE A DIAGRAM THAT
WAS PUBLISHED BY DR. LANGEVIN
THIS PAST YEAR THAT I THINK IS
REALLY COMPELLING IN TERMS OF
PULLING TOGETHER THE DIFFERENCE
BETWEEN KIND OF HEALTH AND
WELL-BEING.
AND SHE LOOKED AT HEALTH AS THE
FUNCTIONAL, THE PHYSICAL
EMOTIONAL SPIRITUAL WELL-BEING
AS WELL AS THE BEHAVIORS THAT WE
HAVE, AND THEN THERE ARE THESE
DETERMINANTS OF HEALTH.
AT SOME POINT WE MIGHT LOOK AT
DETERMINANTS OF RESILIENCE,
WHICH ARE SOCIAL, ENVIRONMENTAL,
ECONOMIC, EDUCATIONAL,
VOCATIONAL, ET CETERA.
WHICH I THINK PULLS TOGETHER
THAT WHOLE IDEA OF WHOLE PERSON
HEALTHCARE.
SO NOW AS WE COME BACK TO
WELLNESS, WE CAN SEE VERY MUCH
APROPOS TO DR. BROWN'S COMMENTS
THAT RESILIENCE HISTORICALLY,
AND THE COMMENTS OF THE EARLY
SCHOLARS ON RESILIENCE, THAT IT
HAS BEEN USED IN A WAY THAT
HASN'T BEEN USEFUL TO US UNTIL
WE'VE COME TO REFINE THE
DEFINITION AND REFINE TOOLS THAT
WE CAN USE TO TEST THE CONCEPT
OF RESILIENCE.
SO THIS IS REALLY THE ELEMENTS
THAT WE LOOK AT WHEN WE LOOK AT
THIS TOPIC OF WELLNESS, WHICH I
THINK IS A WORD THAT PROBABLY
WE'RE GOING TO STOP USING DOWN
THE ROAD.
BUT WE THINK OF IT AS WHAT WE
PUT IN OUR BODY, WHAT WE DO WITH
OUR BODY, WHAT WE PUT IN OUR
MINDS, WHAT WE DO WITH OUR
MINDS, AND IT'S INFLUENCED BY
THIS CIRCLE OF DIFFERENT
INFLUENCES THAT WE HAVE AND
DIFFERENT INTENSITIES IN OUR
LIVES.
AND THIS IS PROBABLY NOT JUST
THE ONLY ONES.
SO I WANTED TO PRESENT SOMETHING
THAT DR. LANGEVIN KINDLY SHARED
WITH ME WHEN I VISITED NIH A
COUPLE WEEKS AGO THAT THIS IS
WORK THAT SHE AND HER GROUP HAVE
BEEN WORKING ON, AND IT'S REALLY
STRIKING IN THAT YOU'RE LOOKING
AT NOT ONLY WHOLE PERSON HEALTH
BUT AN INDEX THAT I UNDERSTAND,
AND THIS IS IN DRAFT FORM AND I
DON'T THINK IT'S OUT THERE IN
THE PUBLIC YET, BUT SHE GAVE ME
PERMISSION TO SHOW TO YOU AND
SPEAK TO IT.
IF YOU REALLY LOOK AT WHAT
THEY'RE LOOKING AT IN TERMS OF
WHOLE PERSON HEALTH, IT'S REALLY
ALL OF THOSE ENTITIES THAT WERE
IN THAT WELLNESS SPHERE OF WHAT
ARE THE INFLUENCES THAT MAKE US
WELL, AND I WOULD SAY WE CAN
CHANGE THE WORD TO RESILIENT.
I THINK DR. BROWN'S POINT ABOUT
IS RESILIENCE PREVENTIVE, IS
RESILIENCE INTERVENTIONAL OR
TREATMENT ORIENTED.
AND I LIKE TO SAY WE CALL
OURSELVES HEALTH SYSTEMS BUT
WE'RE REALLY DISEASE RESPONSE
SYSTEMS.
AND WE'RE TRAINING OUR
CLINICIANS AND OUR SCIENTISTS TO
REALLY BE DISEASE RESPONDERS,
BUT THE FULL SPECTRUM IS
PREVENTION ALL THE WAY TO
TREATMENT, AND I THINK
RESILIENCE, AS WELL AS WHOLE
PERSON HEALTH, SPANS THAT FULL
SPECTRUM.
BUT WE TEND TO GIVE MORE FOCUS,
WE TEND TO GIVE MORE IMPORTANCE
TO THE POST DISEASE STATE, AND
NOT SO MUCH THE PREDISEASE
STATE.
SO THIS IS A REALLY WONDERFUL
SET OF NINE QUESTIONS THAT I
UNDERSTAND HAVE BEEN VALIDATED
SO FAR BY THE CDC, AND THAT
COULD BE USED AS RESEARCH TOOLS
BUT ALSO AS CLINICAL TOOLS THAT
REALLY LOOK AT ALL OF THE
ASPECTS THAT ARE ON THIS PAGE
HERE.
AND YOU KNOW, WHAT YOU CAN SEE
IS BASICALLY THE MORE GEOGRAPHY
YOU CAN -- THE MORE THAT THIS
SCALE CAN FILL IN ALL OF THE
POSITIVE INFLUENCES THAT SUPPORT
RESILIENCE AND HEALTH LEAD TO A
HEALTHIER STATE, AND IF YOUR
GEOGRAPHY OR YOUR SURFACE AREA
FOR RESILIENCE OR HEALTH IN THIS
MODEL IS DIMINISHED, YOU'LL HAVE
A LESS HEALTHY STATE.
YOU KNOW, THIS, TO ME, SEEMS
SELF-EVIDENT, BUT I THINK IT'S
REVOLUTIONARY IN THE SENSE THAT
WE HAVEN'T HAD THIS KIND OF TOOL
AND IT'S BEEN A STUMBLING BLOCK
TO MOVE THE FIELD FORWARD.
WITH THAT, I JUST WANTED TO END
WITH JUST TELLING YOU A LITTLE
BIT ABOUT -- AND I'M GOING TO DO
THIS VERY BRIEFLY ABOUT SOME
SYMPOSIA THAT WE HELD NATIONALLY
AND INTERNATIONALLY OVER THE
LAST YEAR AROUND THIS SUBJECT
AREA.
IT WAS SPONSORED BY THE MAY DAY
FUND.
DR. SPELLMAN WAS GOING TO BE
HERE TODAY TO SPEAK BUT SHE
WASN'T ABLE, BUT THEY WERE A
FUNDER OF THIS PROJECT AND MANY
OF YOU MAY KNOW THE MAYDAY FUND
IS A PAIN FOCUSED PHILANTHROPY
ORGANIZATION, NO STRINGS
ATTACHED, AND THEY GRACIOUSLY OR
GENEROUSLY FUNDED THIS PROGRAM
TO RAISE ATTENTION TO THIS
IMPORTANT AREA OF PAIN SCIENCE
THAT WE THINK IS
UNDERREPRESENTED IN PROFESSIONAL
ORGANIZATIONS, SOME RESEARCH
FUNDERS AND HEALTH EDUCATION
ORGANIZATIONS, AND THE GOAL WAS
TO CONSIDER REALLY WHERE THIS
SHOULD GO.
WHAT IS THE STATE OF PRIMARY
PREVENTION FOR PAIN, FROM A
RESEARCH PERSPECTIVE, AN
EDUCATION PERSPECTIVE, AND TO
TRY TO DEVELOP -- SEE IF THERE
WAS SOME CONSENSUS AROUND PATHS
FORWARD IN TERMS OF RESEARCH AND
EDUCATIONAL STRATEGIES AND
AGENDAS.
AND THIS IS WHAT WE FOUND, THAT
THE CURRENT KNOWLEDGE REALLY
DOES SUPPORT IMMEDIATE ACTION IN
TERMS OF EDUCATION.
BUT IT'S NOT SUFFICIENT TO SHIFT
THE FORCES FOR SYSTEM-WIDE
CHANGE YET AND WE NEED MORE
RESEARCH TO SUPPORT THIS.
AS IS THE CASE FOR MOST THINGS.
BUT THIS WAS THE OUTCOME THAT
THE GROUPS FELT CLEARLY THAT WE
HAVE ENOUGH INFORMATION TO SPEAK
TO PERSONS WITH LIFE EXPERIENCE
AND CONSUMERS AROUND WHAT WE
KNOW, WHAT WE KNOW IS SOMEWHAT
FROM ADJACENT LITERATURE, BUT
ALSO DIRECT LITERATURES, AND TO
DO THE SAME WITH CLINICIANS, BUT
CLINICIANS ARE GOING TO NEED TO
SEE MODELS OF HOW WELL CARE OR
WHOLE PERSON HEALTHCARE CAN BE
MODELED IN THEIR PRACTICES
BECAUSE THEY'RE SO STRAINED IN
WHERE THEY ARE NOW, AND AGAIN,
THEY'RE CLEARLY FORCED INTO A
DISEASE RESPONSE MODEL.
THAT I THINK WE'RE HEARING FROM
OUR REGULATORS AND OUR
LEGISLATORS, THAT HAS TO CHANGE
IF NOT JUST, YOU KNOW, FROM A
PERSPECTIVE OF THE IMMENSE
SUFFERING THAT PEOPLE HAVE, AND
VERY LEAST FROM THE ECONOMIC
BURDEN THAT IT PORTENDS.
AND THAT WE NEED TO LOOK AT THE
BASIS OF HOW WE EDUCATE OUR
STUDENTS IN HEALTH PROFESSIONS
ACROSS THE BOARD.
MY BELIEF IS THAT MOST HEALTH
PROFESSIONAL, WHILE I THINK THEY
WOULD SEE IT AS COMMON SENSE
THAT THEY SHOULD BE PREVENTING
ILLNESS DON'T SEE IT AS PART OF
THEIR SCOPE OF PRACTICE BECAUSE
IT'S NOT REALLY PART OF THE
CULTURE OF THEIR EDUCATION.
IT'S NOT PART OF THEIR CORE
COMPETENCIES AND, THEREFORE, NOT
PART OF THEIR CURRICULA.
SO PART OF THIS WAS TO GET --
WHAT WE HEARD WAS WE NEED TO GET
THE ACCREDITORS TO TAKE THIS ON
SO THAT SCHOOLS CLEARLY CREATE
CURRICULUM THAT LEADS TO
COMPETENCY IN WHOLE PERSON
HEALTH AND IN PREVENTIVE CARE AS
WELL.
WE NEED TO EDUCATE SCIENTISTS
ABOUT HOW TO USE THE WORK THAT
DR. BROWN JUST PRESENTED TO US
SO CLEARLY, AND I THINK THERE'S
MORE WORK TO BE DONE, BUT I
THINK IT'S REALLY READY FOR
PRIME TIME NOW, AND WE SHOULD
BRING THAT FORWARD, AND WE WANT
TO ENCOURAGE PROFESSIONAL
ORGANIZATIONS THAT CLAIM TO BE
THE PRINCIPAL DRIVERS FOR PAIN
RESEARCH TO TAKE THIS ON.
THERE'S A WHOLE RESEARCH
STRATEGY THAT WE'RE LOOKING AT,
AND I'LL GO QUICKLY THROUGH
THIS, BUT WHAT WE HEARD IS THAT
THERE ARE DIFFERENT VIEWS ABOUT
RESEARCH IN DIFFERENT COUNTRIES
THAT HAVE DIFFERENT KINDS OF
HEALTH SYSTEMS AND THERE WERE
ARGUMENTS FOR DOING TARGETED
INTERVIEWS NOW WITH SPECIFIC
AREAS OF THE WORLD LIKE
SCANDINAVIA AND THE NETHERLANDS,
WHERE THEY HAVE DIFFERENT
APPROACHES.
AND THEN LOOK AT MORE RESEARCH
ON -- HERE IT SAYS DEFINING
WELLNESS IN THE WORK THAT
DR. BROWN IS DOING, BUT ALSO
MOLECULAR APPROACHES,
EPIGENETICS, PUBLIC HEALTH AND
POPULATION SCIENCE,
TRANSLATIONAL AND IMPLEMENTATION
SCIENCE, AND THEN ACTUALLY
EDUCATION SCIENCE TO LOOK AT THE
IMPACT OF THE EDUCATION WORK
THAT WE THINK NEEDS TO BE DONE
AND THE RETURN ON INVESTMENT FOR
THAT WORK GOING FORWARD.
SO WITH THAT, WHAT I'LL SAY, AND
I'LL STOP HERE, IS THAT THE PAIN
ALARM IS A VULNERABLE OR
RESILIENT SYSTEM, AND YOU CAN
LOOK AT IT BOTH WAYS.
I WISH I TOOK THAT GRAPH THAT
DR. BROWN HAD OF THE SCALE
SLIDING UP AND DOWN WITH
RESILIENCE.
SO I THINK THE SAME APPLIES TO
PAIN, AND LIKE MOST THINGS, WE
HAVE ENOUGH INFORMATION HERE TO
BE ABLE TO MAKE A PRETTY STRONG
STATEMENT, BUT WE ALSO NEED MORE
RESEARCH AND WE CLEARLY NEED TO
CHANGE EDUCATION.
AND WITH THAT, I'M GOING TO
CONCLUDE.
SORRY FOR GOING SO FAST, AND
HAPPY TO ANSWER ANY QUESTIONS.
THANK YOU.
>> THANK YOU SO MUCH, SCOTT.
WE REALLY APPRECIATE IT.
I KNOW WE'RE A LITTLE OVER BUT I
THINK WE WANT TO MAKE SURE -- WE
HAVE A COUPLE OF QUESTIONS, I
THINK WE'LL MAKE UP THE TIME IN
THE NEXT SECTION OF OUR
PRESENTATIONS.
DR. FISHMAN, DR. BROWN, THERE'S
A QUESTION IN THE CHAT, IF YOU
GUYS MIGHT WANT TO ANSWER THAT,
AND IF THERE ARE ANY OTHER
QUESTIONS, PEOPLE PLEASE FEEL
FREE TO RAISE THEIR HAND.
SO IN THE CHAT THE QUESTION IS,
DR. BROWN I'M CURIOUS ABOUT YOUR
POINT THAT RESILIENCE PATHWAYS
OR NETWORKS MIGHT BE DIFFERENT
FROM DISEASE PATHWAYS, AND I'VE
NOT BEEN THINKING ABOUT IT THAT
WAY.
RATHER I WAS THINKING THAT
RESILIENCE WOULD BE A BUFFER
DISEASE PATHWAYS, HOW AND WHY IS
THAT IMPORTANT?
DO EITHER YOU OR DR. FISHMAN
WANT TO COMMENT ON THAT FURTHER?
>> SURE.
THANK YOU FOR THE QUESTION.
SO OF COURSE IF WE'RE LOOKING AT
IT THROUGH THE LENS THAT ALL THE
PATHWAYS ARE INTERCONNECTED,
RIGHT, THEN OF COURSE SOMEWHERE
DOWNSTREAM, THOSE PATHWAYS THAT
ARE CONSIDERED PROTECTIVE
PATHWAYS ARE LIKELY BUFFERING OR
HAVING SOME IMPACT ON THE
DISEASE PATHWAYS.
BUT THE GOAL, THOUGH, IS FOR OUR
INTERVENTIONS, IN ORDER TO STUDY
THE INTERVENTIONS, ESPECIALLY AT
THE MOLECULAR AND CELLULAR
LEVEL, WE WANT TO KNOW WHAT ARE
THOSE PROTECTIVE PATHWAYS THAT
ARE CLEARLY DIFFERENT FROM A
DISEASE PATHWAY SO WE CAN
UPREGULATE THOSE PROTECTIVE
PATHWAYS IN SUCH A WAY THAT THE
DOWNSTREAM NETWORK ACTIVITY IS
ACTING AS A BUFFER TO THE
DISEASE PATHWAYS.
AND SO IT'S KIND OF NUANCED, BUT
I HOPE I ANSWERED YOUR QUESTION.
>> THANK YOU, DR. BROWN AND
THANK YOU, LAURA, FOR READING MY
QUESTION.
I DIDN'T MEAN TO MAKE YOU READ
MY QUESTION ON THE CHAT, BUT DR,
SO I'LL HOPE TO TALK TO YOU
AGAIN.
THANK YOU.
>> IF I CAN JUST COMMENT THAT
IT'S INTERESTING, I JUST SEE THE
QUESTION IS WHEN DOES RESILIENCE
OCCUR, WHEN DOES RESILIENCE
DEVELOP, AND I SUSPECT IT'S ANY
TIME, I THINK.
AND I'D BE INTERESTED IN
DR. BROWN'S COMMENT ON THAT,
THAT YOU KNOW, I THINK THAT
THERE'S -- YOU KNOW, THERE'S --
WE'RE NATURALLY RESILIENT
BEINGS, THAT WE TEND TO
RESILIENCE UNLESS SOMETHING
HAPPENS THAT CHANGES THAT, MAYBE
AGING IS ONE THING THAT MAYBE
CHANGES THAT, BUT THAT THERE ARE
STRATEGYS THAT WE CAN HAVE THAT
SUSTAIN OUR RESILIENCE OR REGAIN
OUR RESILIENCE OR GAIN
RESILIENCE WE'VE NEVER HAD AFTER
THE -- WHEN WE FIND OUT THAT
IT'S EITHER GONE OR WE NEED IT
AFTER ILLNESS.
DR. BROWN, PLEASE, IF YOU HAVE
COMMENTS.
YOUR MIC IS OFF, I BELIEVE.
>> THANK YOU, DR. FISHMAN.
THERE'S A MEMBER ON OUR WORKING
GROUP THAT ALWAYS REMINDS US
THAT IF WE ARE HERE AND LIVING,
THEN WE HAVE SOME ASPECT OF
RESILIENCE, RIGHT?
BECAUSE WE ARE ALL THE TIME,
EVERY DAY, EXPOSED TO SOME
CHALLENGES OR STRESSORS, AND OUR
BODIES HAVE AN INNATE ABILITY TO
RESPOND TO THOSE CHALLENGES AND
STRESSORS IN SUCH A WAY THAT
WE'RE EITHER RESPONDING
HOPEFULLY BETTER OR AT LEAST
RESISTING OR PERHAPS JUST
RECOVERING.
BUT LIKE YOU SAID, DR. FISHMAN,
THERE'S ALWAYS THIS OPPORTUNITY
THAT WE CAN GROW FROM A
CHALLENGE OR STRESSOR.
IN FACT, FROM THE PRESENTATION
AT OUR RESILIENCE SIG MEETING
YESTERDAY, ONE OF THE POINTS
THAT DR. FLESHNER MADE WAS THAT
SHE LEARNED WITH HER RODENT
MODELS IS THAT YOU NEED THAT
STRESSOR SOMETIMES IN ORDER TO
BUILD THAT RESILIENCE.
SO WE DON'T ALWAYS WANT TO
MITIGATE OR PREVENT OR BLOCK THE
STRESSOR, BECAUSE SIEMS THERE IS
GROWTH THAT HAPPENS BECAUSE OF
OUR EXPOSURE TO THAT STRESSOR,
AND THAT GROWTH IS WHAT WE WANT
TO UNDERSTAND BY DESIGNING
STUDIES THAT APPROPRIATELY
CAPTURE RESILIENCE OUTCOMES.
>> GREAT.
THANK YOU SO MUCH.
AND WE'RE GOING TO GIVE BETH THE
LAST QUESTION AND THEN WE'LL
TRANSITION INTO THE NEXT PHASE
OF THE PROGRAM.
SO BETH, DO YOU WANT TO ASK YOUR
QUESTION?
>> YEAH.
THANK YOU SO MUCH.
AND THANK YOU BOTH FOR SOME
REALLY GREAT PRESENTATIONS.
THIS ONE MIGHT BE FOR SCOTT.
I'M NOT SURE, BUT SCOTT, I
WHOLEHEARTEDLY AGREE WITH THIS
EDUCATION GAP AND WE TALK ABOUT
THAT A LOT.
I'M CURIOUS ABOUT YOUR
PERSPECTIVE ABOUT A POTENTIAL
REIMBURSEMENT GAP.
DOES THAT EXIST?
IS THERE SORT OF A SURVEY OF THE
LANDSCAPE THERE, BECAUSE AS WE
KNOW, THE EDUCATION ONLY GOES SO
FAR WHEN IT COMES TO CLINICAL
IMPLEMENTATION, THERE'S GOT TO
BE THE PAYOFF.
GL YEAH,
>> YEAH, IT'S AN INTERESTING
THING, THINK WE ALL JUST ASSUME
THAT GAP IS THERE.
I DON'T KNOW THAT IT'S EVER BEEN
COMPLETELY EXAMINED THAT I KNOW
OF, BUT IT JUST THAT REALLY,
AGAIN, WE'RE DISEASE-RESPONSE
SYSTEMS, SO WE PAY FOR DISEASE
RESPONSE.
EVEN IF YOU LOOK AT THE WAY THAT
INTEGRATIVE MEDICINE WORKS IN
MOST HEALTH SYSTEMS, YOU'VE GOT
TO HAVE A DIAGNOSIS TO GET IN,
YOU KNOW?
GOT TO HAVE A DIAGNOSIS TO PLAY.
AND CAN YOU GO TO YOUR DOCTOR
AND SAY, HEY, I FEEL GREAT, I
JUST WANT TO STAY THAT WAY.
AND
GET TREATED, YOU KNOW, WE'RE FAR
FROM THAT.
AND THAT ACTUALLY, I THINK,
SHOULD BE THE CASE, THAT, YOU
KNOW, I WANT TO STAY RESILIENT.
AND HELP ME DO THAT.
AND I SENSE THAT MY WHOLE PERSON
HEALTH INDEX IS DROPPING, HELP
ME.
SO I THINK THAT YOU'RE RIGHT ON,
BUT I ALSO THINK THAT THE
EDUCATION SYSTEM AND THE
REIMBURSEMENT SYSTEM ARE TIED,
BECAUSE EVEN IF WE CHANGE THE
REIMBURSEMENT, THE CULTURE OF
HEALTHCARE HAS TO CHANGE TO BE
ABLE TO SUPPORT THAT CHANGE, AND
A LOT OF THE DRIVERS WERE REALLY
LOOKING AT A RESPONSE TO CHRONIC
PREVENTIVE -- OR PR PREVENTABLE
CHRONIC ILLNESS IS REALLY
ECONOMIC, SO THE REIMBURSEMENT
WILL BE AVAILABLE, I'M JUST
WORRIED THAT IF THEY MAKE THE
CHANGE, WE REALLY DON'T HAVE THE
CULTURE OF CARE TO SUPPORT THAT
CHANGE YET.
SO I THINK BOTH ARE IMPORTANT.
>> DO YOU WANT TO QUICKLY JUMP
IN THERE?
DO YOU HAVE A POINT YOU WANTED
TO JUMP IN OR IS YOUR HAND NOT
UP?
>> ARE YOU TALKING TO WHO?
>> TO YOU, YOUR HAND WAS UP.
>> ME?
I'M SORRY.
FIRST OF ALL, I WANTED TO REALLY
THANK BOTH PRESENTERS.
THAT'S WERE GREAT PRESENTATIONS.
I JUST WANTED TO ADD A LITTLE
COMMENT REGARDING THE WHOLE
PERSON INDEX SLIDES THAT SCOTT
SHOWED.
SO THIS IS A MEASURE THAT IS
STILL IN PROGRESS, BUT IT'S
BEING -- IT WAS TESTED AND
VALIDATED BY THE CDC ON A SAMPLE
OF 10,000 INDIVIDUALS.
IT WILL BE INCLUDED IN THE
NATIONAL HEALTH INTERVIEW SURVEY
THIS DWREER AND ALSO IN THE
ALL-OF-US COHORT.
THERE IS ONE QUESTION, QUESTION
NUMBER EIGHT, I JUST WANTED TO
SPECIFY, THAT QUESTION HAS BEEN
MODIFIED.
INSTEAD OF ASKING ABOUT
SPIRITUALITY, WE'LL BE ASKING
ABOUT MEANING AND PURPOSE.
THIS WAS AFTER SOME FOCUS GROUP,
SO THAT'S THE ONLY DIFFERENCE OF
THE -- TO THAT PRELIMINARY
VERSION THAT YOU SAW.
SO WE'RE VERY EXCITED ABOUT
THIS, WE THINK THIS IS GOING TO
HAVE BROAD APPLICATION, SO THANK
YOU, SCOTT, FOR SHOWING --
>> YAR, SO I WANT TO THANK YOU
BOTH.
I KNOW THERE'S ONE MORE HAND
RAISED, MONICA, IF CAN YOU PUT
YOUR QUESTION IN THE CHAT JUST
SO WE CAN MAKE SURE WE CAN MOVE
ON TO THE NEXT TOPICS AND STILL
HAVE TIME.
I KNOW PEOPLE ARE VERY EXCITED
ABOUT THIS TOPIC SO I WOULD
DEFINITELY ENCOURAGE THE IPRCC
TO BE ABLE TO COMMUNICATE WITH
EACH OTHER ABOUT THIS TOPIC AND
ONE WAY THAT WE CAN DO MORE OF
THAT IS A WORK GROUP THAT THE
IPRCC HAS SET UP, SO IT'S GOING
TO KIND OF TRANSITION US INTO
THE NEXT PHASE OF THIS PROGRAM,
IS THAT THE IPRCC HAS
ESTABLISHED THREE WORK GROUPS
THAT WERE IDENTIFIED AS
IMPORTANT AREAS TO PUT MORE TIME
AND EFFORT INTO.
THE FIRST ONE IS RESILIENCE,
PREVENTION AND CHRONIC PAIN.
THE SECOND IS THE WORKFORCE AND
PROVIDER TRAINING WORK GROUP,
AND THE THIRD IS THE
IMPLEMENTATION SCIENCE WORK
GROUP.
SO WHAT WE'RE GOING TO DO NOW IN
THIS NEXT BLOCK OF TIME IS HAVE
ONE REPRESENTATIVE FROM THE WORK
GROUP PRESENT THE OBJECTIVES AND
ACTION ITEMS THAT THE GROUP HAS
BEEN TALKING ABOUT FOR THE LAST
COUPLE OF MONTHS.
THEY'RE REALLY INTERESTED IN
GETTING THIS GROUP'S FEEDBACK
ABOUT THE WORK THAT THEY'RE
PLANNING ON STARTING TO DO IN
THE WORK GROUP, AND IF ANYBODY
HERE ON THIS CALL TODAY ON THE
IPRCC THAT'S A FEDERAL MEMBER OR
ONE OF OUR PUBLIC OR SCIENTIFIC
MEMBERS IS INTERESTED IN JOINING
ONE OF THESE WORK GROUPS, PLEASE
FEEL FREE TO REACH OUT TO US,
WE'RE HAPPY TO ADD YOU INTO THAT
WORK GROUP.
SO WITH THAT, WE WILL TRANSITION
BACK TO SCOTT, WHO'S GOING TO
PROVIDE THE OVERVIEW OF THE
RESILIENCY AND PREVENTION WORK
GROUP'S EFFORTS TO DATE.
SO PLEASE TAKE IT AWAY, WE'LL DO
A BRIEF OVERVIEW AND THEN PLEASE
FEEL FREE FOR THE REST OF THE
GROUP TO ASK ANY QUESTIONS YOU
MAY HAVE.
>> OKAY.
AND I AM GOING TO SWITCH MY
SCREEN HERE AND CAN YOU SEE
THAT?
>> WE CAN SEE IT, YES.
>> AWESOME.
SO THIS IS THE GROUP, AND THANK
YOU FOR LETTING ME PRESENT THIS
HERE.
IT'S BEEN A ROBUST TOPIC.
WE'VE ONLY MET TWICE, SO WE'RE
EARLY IN THE STAGE, AND I'M JUST
GOING TO TRY TO QUICKLY GIVE AN
OVERVIEW OF THE TWO MEETINGS
THAT WE'VE HAD AND THEN A SENSE
OF OUR OBJECTIVES.
YOU KNOW, KEY PRINCIPLES ARE
THAT BUILDING RESILIENCE CAN
TRANSFORM A PERSON'S PAIN
EXPERIENCE, AND AS I SAID, WE'VE
HAD TWO MEETINGS.
YOU KNOW, THE FIRST WAS REALLY
AN OPEN DISCUSSION ABOUT PAIN
AND RESILIENCE AND LOOKING AT
THESE GENERAL PRINCIPLES.
AND WE REALLY LOOKED AT THE
ISSUE THAT I THINK EVEN
DR. BROWN BROUGHT UP AND I
MENTIONED THAT, WELL, IS
RESILIENCE, IS THAT PREVENTION,
IS IT SOMETHING THAT WE JUST
DEAL WITH AFTERWARDS, AND I
THINK THAT THESE TALKS TODAY AND
DR. BROWN'S TACK IN PARTICULAR
PUT THAT IN BETTER FOCUS THAN WE
HAD AT OUR FIRST MEETING, BUT IN
PART, BRINGING DR. BROWN HERE
WAS GENERATED FROM THIS MEETING
THAT WE WANTED TO GET MORE
KNOWLEDGE ABOUT THIS.
SO PART OF THIS MEETING WAS
REALLY A CALL TO FIND OUT MORE
ABOUT RESILIENCE AND SPECIFICITY
AND DISEASE OR A LIFESTYLE
CHOICE INDEPENDENT OF THE
SPECIFIC DISEASE IS RESILIENCE
TRAINING EFFECTIVE FOR THOSE
ALREADY EXPERIENCING PAIN, CAN
PEOPLE REALLY BECOME MORE MORE
RESILIENT AFTER THE ONSET,
AGAIN, APROPOS TO SOME OF THE
DISCUSSION WE'VE HAD HERE TODAY.
AND THEN ASSESSING SOME OF THE
DIRECT AND ADJACENT SCIENCE OF
RESILIENCE AND PAIN.
AND THAT'S WHERE WE LEFT, I
THINK, OUR FIRST MEETING AND A
CALL TO KIND OF LOOK AT WHETHER
IT ADJACENT OR DIRECT WORK, AND
LOOK AT REALLY A LIFESTYLE VIEW
OF RESILIENCE.
AND THE IDEA OF PREVENTION OF
REDUCING HIGH IMPACT PAIN FROM
JUST CHRONIC PAIN.
THE SECOND MEETING WAS A LITTLE
MORE FOCUSED, AND WE LOOKED AT
WHO'S OUR AUDIENCE, WHO DO WE
WANT TO PROVIDE THIS INFORMATION
FOFOR.
I THINK WE RECOGNIZE IT'S A
PRETTY BROAD AUDIENCE, IT'S
NEEDED FOR OUR RESEARCHERS TO
CLARIFY THEIR QUESTIONS AND THE
FUNDERS TO CLARIFY THEIR TARGETS
OF WHAT WILL BE HIGH IMPACT
RESEARCH.
IT'S IMPORTANT FOR OUR
HEALTHCARE PROVIDERS AND IT'S
IMPORTANT FOR PERSONS WITH LIVED
EXPERIENCE, CAREGIVERS,
COMMUNITY AND THE GENERAL PUBLIC
AS WELL.
SO THOSE WERE THE TARGETS, I
THINK THAT WAS VERY BROAD, AND
THEN REALLY THE AREAS OF
PROMOTION IS THERE WAS
DISCUSSION ABOUT TRYING TO
PROMOTE A CONTEXT AND SOME
MEASURES FOR THIS, AND CLEARLY
THAT WHOLE PERSON HEALTHCARE
MODEL IS ONE THAT IS COMPELLING
AS AN OVERARCHING MODEL LOOKING
AT THE WHOLE PERSON BEFORE AND
AFTER DISEASE.
AND THE WHOLE PERSON HEALTH
INDEX, SORRY I'M MISSING AN X
THERE AT THE END, THE WHOLE
PERSON HEALTH INDEXES ARE VERY
COMPELLING TOOL AS IT'S EMERGING
FOR US TO LOOK AT.
AND THEN WE WANT TO PROMOTE
TRAINING FOR SCIENTISTS,
CLINICIANS AND PERSONS WITH
LIVED EXPERIENCE, ET CETERA.
AND WE WANT TO LOOK AT THE DATA.
SO WE CAME UP WITH TWO
OBJECTIVES.
ONE IS TO DEVELOP AND
DISSEMINATE A REPOSITORY OF PAIN
RESILIENCY RESOURCES, AND FIRST
WE'VE GOT TO FIND OUT WHAT THAT
IS, DECIDE ON THE INTENDED
AUDIENCE, WHETHER IT'S FOR THE
PUBLIC OR JUST SCIENTISTS AND
HEALTHCARE PROVIDERS, AND WHAT
DO WE WANT TO INCLUDE IN IT.
SO THIS IS STILL UNDER
DISCUSSION AND OPEN AREA OF
THOUGHT FOR US AS A WORK GROUP.
OBJECTIVE TWO IS TO DEVELOP AND
COLLECT POPULATION HEALTH DATA,
AND LOOK INTO THE LARGE SCALE
HEALTH SURVEYS THAT ALREADY HE
EXIST AND LOOKS FOR PARTNERS IN
TERMS OF MOVING THIS FORWARD,
PARTNERS WHO HAVE REPORTED OUT
THIS MORNING AS WELL FOR LOOKING
AT DATA AND EXTENSIVE REVIEW OF
THE FIELD, WHETHER THAT'S
SCOPING REVIEWS OR OTHERS, TO
HELP US UNDERSTAND WHAT IS
THERE, AND WHERE DO WE NEED TO
GO.
SO THESE WERE JUST TWO MEETINGS,
AND I HOPE THAT WE HAVE OTHER
MEMBERS HERE FROM THE WORK
GROUP, SO IF I'VE MISSED
SOMETHING, I APOLOGIZE.
AND THIS IS ONGOING, AND THERE'S
A LOT OF EXCITEMENT ABOUT THIS
NEW AREA OF FOCUS IN THE IPRCC.
SO THANK YOU.
>> THANK YOU SO MUCH FOR THAT
OVERVIEW.
CURIOUS TO SEE IF THE GROUP HAS
ANY QUESTIONS OR THOUGHTS ABOUT
THE WORK THAT THIS WORK GROUP IS
WORKING ON.
IF THERE ARE NO QUESTION, WE CAN
MOVE ON BUT WE'LL JUST SAY HERE
THAT IF THERE ARE PEOPLE ON THE
IPRCC WHO DO WANT TO JOIN OR DO
HAVE INTEREST IN THIS TOPIC,
PLEASE FEEL FREE TO REACH OUT.
I THINK THERE'S A LOT OF REALLY
IMPORTANT WORK THAT THIS WORK
GROUP IS GOING TO BE TRYING TO
ADDRESS, AND WE APPRECIATE YOU
PRESENTING, SCOTT, THANK YOU SO
MUCH.
SO WE'LL MOVE ON OVER TO THE
NEXT WORK GROUP, WHICH IS THE
WORKFORCE AND TRAINING WORK
GROUP.
KATE NICHOLSON WILL BE GIVING US
AN UPDATE ON THE WORK THAT THIS
WORK GROUP HAS BEEN WORK ON FOR
THE LAST TWO OR THREE MONTHS.
>> HI, EVERYONE.
I'M HAPPY TO REPORT ON OUR
WORKFORCE AND PROVIDER TRAINING
WORK GROUP.
THESE ARE OUR MEMBERS.
IT'S A LITTLE LARGER WORK GROUP
THAN THE RESILIENCE ONE.
SO OUR OBJECTIVE IS TO ADVANCE
TRAINING IN PAIN MANAGEMENT BY
IDENTIFYING GAPS, PRIORITIZING
AUDIENCE NEEDS, COLLECTING
RELEVANT RESOURCES AND
IMPLEMENTING AN EFFECTIVE
DISSEMINATION STRATEGY.
SO THE FIRST TASK OF THE WORK
GROUP WOULD BE TO CONDUCT A GAP
ANALYSIS TO ASSESS SORT OF
WHAT'S OUT THERE IN TERMS OF
TRAINING RESOURCES, IDENTIFY ANY
UNMET NEEDS, AND THEN TAILOR
WHAT WE FIND BY THE NEEDS OF
DIFFERENT AUDIENCES.
A SECONDARY POINT THAT WAS MADE
ABOUT THE GAP ANALYSIS IS THAT
WE SEPARATE OUT THOSE TRAINING
MODULES THAT ARE ABOUT PAIN AND
ITS MECHANISMS FROM TRAINING
MODULES ABOUT TREATING PAIN OR
PAIN MANAGEMENT.
SCOTT HAD PRESENTED EARLIER TO
THIS GROUP ABOUT EVEN A GAP IN
THE CREDENTIALING AND EXAMS THAT
SORT OF ASK ABOUT IDENTIFICATION
OF PAIN BUT NOT REALLY ABOUT
OPTIMIZING PAIN TREATMENT.
SO THE AUDIENCE IS PRETTY BROAD.
WE WANT TO ADDRESS PRELICENSURE
AUDIENCES, IN TERMS OF POST
LICENSURE AUDIENCES, WE WANT TO
LOOK AT BOTH PROVIDERS AND
PRESCRIBERS, PRIMARY CARE, PAIN
SPECIALISTS, DENTISTS,
PHARMACISTS, RNs AND
PSYCHOLOGISTS.
IT IMPORTANT ALSO THAT WE
INCLUDE CONSIDERATION OF PEOPLE
WITH LIVED EXPERIENCE AND
CAREGIVERS.
WE WILL NEED TO ADDRESS
UNIVERSITIES, TESTING AND
ACCREDITATION SOCIETIES, THE
PROFESSIONAL ASSOCIATIONS THAT
OFFER A LOT OF THE TRAININGS AS
WELL AS RESEARCHERS AND PAYORS.
AND IN OUR DISCUSSION ABOUT
AUDIENCES, WE TALKED ABOUT
PRIORITIZATION IN TERMS OF HOW
LONG THIS PROCESS MIGHT BE AND
WHO WE WANT TO TARGET FIRST, AND
PRIMARY CARE PROVIDERS CAME UP
EARLY AND WE ALSO TALKED ABOUT
THE FACT THAT THERE ARE A LOT OF
DIFFERENT TRAINING MODULES OUT
THERE.
IT MAY NOT BE AS MUCH A PROBLEM
OF WHAT'S IN EXISTENCE, BUT
WHETHER PEOPLE ARE ACTUALLY
USING THE MODULES THAT ARE OUT
THERE, AND WE TALKED ABOUT
ENGAGING PEOPLE WITH
EXPERIENCING CAREGIVERS TO
CONTEXTUALIZE SOME OF THIS AS
MAYBE A WAY OF MAKING SOME OF IT
OF GREATER INTEREST, BUT ALSO
AGAIN ENGAGING THE ACCREDITATION
SOCIETIES BECAUSE MODULES ARE
USED WHEN THERE'S TESTING
INVOLVED.
SO WE WOULD COLLECT THE
RESOURCES, WE WOULD LOOK AT THE
NEEDS OF SPECIFIC AUDIENCES TO
TRY AND TARGET THEM, AND THEN
ALSO LOOK AT THE DEVELOPMENT OF
TOOL KITS AND PERHAPS EVEN A
LARGER WHITE PAPER.
AND THEN WE REALLY DO NEED AN
EFFECTIVE DISSEMINATION
STRATEGY.
BECAUSE OF THIS PROBLEM THAT I
MENTIONED EARLIER, IN WHICH WE
DO HAVE A LOT OF MODULES ON LOTS
OF WEP WEB SITES EVERYWHERE, BUT
THEY'RE NOT REALLY BEING
IMPLEMENTED AND EMPLOYED.
AGAIN AS SCOTT SAID, THERE ARE
MEMBERS OF THE GROUP HERE, SO IF
THERE ARE THINGS I MISSED,
PLEASE FEEL FREE TO PIPE IN.
[SPEAKER MUTED]
>> BETH, I THINK FOR SOME REASON
WE CAN'T HEAR YOU.
>> OH, CAN YOU HEAR ME THERE?
>> WE CAN HEAR YOU NOW.
>> GREAT, THANKS.
I WAS JUST SAYING THANK YOU,
KATE.
AND I JUST WANT TO SURFACE FOR
DISCUSSION, WITH THIS SORT OF
WORKFORCE TRAINING AND
EDUCATION, THE IDEA IS BROADLY
TO DO THIS SURVEY, BUT ALSO TO
UNDERSTAND, LIKE, IS THERE ANY
EVIDENCE AROUND THE EDUCATION,
IS THERE ANY RESEARCH AROUND
WHAT'S HAPPENING NOW AND THEN BE
ABLE TO IDENTIFY SORT OF THE
GAPS IN UNDERSTANDING, SO I'M
JUST -- I GUESS WHAT I'M
POINTING OUT IS LIKE TWO
DIFFERENT PATHWAYS.
I MEAN, ONE IS JUST LIKE WHAT'S
HAPPENING, IN TERMS OF TRAINING,
BUT LIKE WHAT'S THE EVIDENCE
AROUND THE TRAINING AND THE
WORKFORCE IMPLEMENTATION, AND
ARE THERE GAPS IN UNDERSTANDING
AROUND THAT.
I MEAN, I KNOW WE KAR CAN'T REAY
POINT WITH THE IPRCC, WE CAN'T
POINT TO, YOU KNOW, DIRECTING
ANY RESEARCH, BUT SORT OF
IDENTIFYING THOSE GAPS TO MAKE
RECOMMENDATIONS MAYBE AROUND
THOSE.
>> I THINK THAT'S AN IMPORTANT
DISTINCTION, I THINK AS KATE
ALSO SAYS IN THE CHAT, SO JUST
SEEING IF ANYBODY ELSE WANTS TO
COMMENT EITHER ON THESE
DISTINCTIONS OR ANY OF THE IDEAS
OF WHAT THIS WORK GROUP IS
PLANNING ON WORKING ON.
>> HI, THIS IS PAUL.
I JUST REMEMBERED EARLIER IN THE
PRESENTATION THIS MORNING, WE
TALKED ABOUT PERSONALIZED
TRAINING, GROUP VERSUS
SELF-DIRECTED LEARNING.
AND I DO THINK AMONG THE
DIFFERENT GROUPS THAT WE'VE
IDENTIFIED AS BEING TARGETS OF
WORKFORCE DEVELOPMENT AND
TRAINING, THAT THERE ARE SOME
THAT WILL DO BETTER IN A GROUP
SETTING, AND OTHERS WHO WILL DO
BETTER WITH SELF-DIRECTED
LEARNING, AND SOME OF THAT MIGHT
COME DOWN TO THEIR PRE-EXISTING
KNOWLEDGE, SKILLS, OR ATTITUDES
AS IT RELATES TO PAIN MANAGEMENT
RESILIENCE AND THE OTHER THINGS
THAT WE'RE TALKING ABOUT.
>> THANKS FOR SHARING, PAUL.
MONICA?
>> I JUST WANT TO ADD AGAIN, WE
HAD THAT EXTENSIVE LIST OF
PROVIDERS AND OTHERS, BUT JUST
TO KIND OF KEEP IN MIND ALSO
EXTENDING THAT TRAINING TO
MENTAL HEALTH PROFESSIONALS AND
PERHAPS SLEEP SPECIALISTS
BECAUSE IT'S COME UP QUITE A BIT
TODAY, THE ROLE OF SLEEP AND
ALSO MENTAL HEALTH IN
CONJUNCTION WITH PAIN.
>> THANKS, MONICA.
ANY OTHER POINTS OF DISCUSSION
WIABOUT THIS WORK GROUP'S EFFOR?
HEARING NONE, AGAIN, THIS IS A
VERY ACTIVE WORK GROUP AND A
TOPIC THAT I KNOW IS GETTING A
LOT OF DISCUSSION IN THE
COMMUNITY NOW, SO IF PEOPLE ARE
INTERESTED IN WORKING ON THESE
IDEAS AND FLESHING OUT THE NEXT
STEP AND YOU'RE NOT ON THE WORK
GROUP YET, PLEASE FEEL FREE TO
JOIN.
AND ALL THESE WORK GROUPS ARE
GOING TO BE CONTINUING TO MEET
AFTER THIS MEETING AND WILL
REPORT OUT ON THE NEXT STEPS AT
THE NEXT MEETING.
SO WITH THAT, WE WILL -- WE'RE
JUST GOING THROUGH THE AGENDA AT
THIS POINT.
WE'LL SWITCH OVER TO THE
IMPLEMENTATION SCIENCE WORK
GROUP, AND BETH HAS OFFERED TO
PRESENT FOR THIS TALK, SO BETH,
PLEASE FEEL FREE TO TAKE IT
AWAY.
>> YEAH, AND I WOULD LOVE --
LAURA, ARE YOU PRESENTING OR
SHARING THE SLIDES?
>> SOPHIA IS SHARING THE SLIDES.
>> SOPHIA, THANK YOU, SOPHIA.
OKAY.
TERRIFIC.
JUST WAIT FOR THOSE TO COME UP.
OKAY, GREAT.
SO JUST AN OVERVIEW -- OH, AND
COULD WE GO TO THE FIRST SLIDE,
PLEASE?
I WASN'T SURE IF THE MEMBERS
WERE THERE.
OKAY, SO IT'S ME AND DR. SANG,
KATE AND DR. ARNSTEIN AND
DR. MANWORREN.
OKAY.
THANK YOU.
SO IMPLEMENTATION SCIENCE, SO
IT'S REALLY THE STUDY OF
INTEGRATING EVIDENCE-BASED
PRACTICES, INTERVENTIONS AND
POLICIES INTO ROUTINE HEALTHCARE
AND PUBLIC HEALTH SETTINGS.
AND SO THERE'S SEVERAL GOALS TO
IMPLEMENTATION SCIENCE TO
IMPROVE POPULATION HEALTH, SO
THAT CAN INCLUDE IDENTIFYING
BARRIERS TO EFFECTIVE
POLICY-MAKING AND PROGRAMMING,
DEVELOPING EVIDENCE-BASED
INNOVATIONS, AND THEN CLOSING
THE GAP BETWEEN WHAT IS KNOWN
AND WHAT IS DONE, AND OBVIOUSLY
THIS IMPLEMENTATION SCIENCE WORK
GROUP IS VERY MUCH FOCUSED ON
IMPLEMENTATION SCIENCE AS IT
PERTAINS TO PAIN, AND PAIN
RELIEF.
SO OUR WORK GROUP HAS MET TWICE
SO FAR.
AND WE'RE MEETING BASICALLY ON A
MONTHLY CADENCE AT THIS POINT,
AND I JUST WANTED TO SUMMARIZE
SOME OF THE KEY TAKEAWAYS FROM
OUR TWO MEETINGS, SO RECOGNIZING
THAT THIS IS A PRETTY BROAD
SWATH OF SCIENCE IN TERMS OF
IMPLEMENTATION SCIENCE, WE
REALLY WANTED TO LEARN MORE FROM
THE EXPERTS IN THIS SPACE, BUT
PEOPLE WHO WERE EITHER DOING
IMPLEMENTATION SCIENCE OR ARE
SPECIFICALLY IMPLEMENTATION
SCIENCE EXPERTS.
AND REALLY COLLECT A LOT OF
INFORMATION AND EXPERTISE FROM
THEM SO THAT WE COULD IDENTIFY
AND SYNTHESIZE THE GAPS AN IN
UNDERSTANDINGS AND WHERE WE
MIGHT HONE OUR FOCUS.
WE HEARD FROM PCORI STAFF JUST A
FEW WEEKS AGO, AND THEY
PRESENTED THE PAIN PORTFOLIO AND
ALSO SOME WORK AROUND
DISSEMINATION AND
IMPLEMENTATION.
THIS IS ONE OF THE FOCI OF
PCORI.
WE IDENTIFIED SOME KEY EXPERTS
THAT WILL BE PRESENTING TO OUR
WORK GROUP IN THE COMING MONTHS
AT OUR MONTHLY MEETINGS, AND SO
ONE IS DR. MARK MCGOVERN AT STAN
STANFORD, ALSO DR. LIN DEBAR AND
SCOTT STRASSELS.
THEY WILL BE PRESENTING ON
IMPLEMENTATION SCIENCE
METHODOLOGIES, DELIVERABLES AND
ALSO NATIONAL PRIORITIES RELATED
TO IMPLEMENTATION SCIENCE FOR
PAIN.
WE RECOGNIZE THAT IN ADDITION TO
THESE KEY MEETINGS AND LEARNINGS
FROM THESE SPEAKERS AND
POTENTIALLY OTHERS THAT WILL BE
ADDED LATER, THAT THERE MAY BE A
NEED TO CONSULT WITH EXPERTS ON
AN AS-NEEDED BASIS.
WE WANT TO REALLY ENSURE THAT WE
HAVE EXPERT FEEDBACK TO GUIDE US
AS WE ARE SERVING THE LANDSCAPE,
DISTILLING THE INFORMATION, AND
IDENTIFYING THOSE PRIORITIES
THAT WILL BE MOST IMPACTFUL.
AND WE ALSO RECOGNIZE, THIS IS
TRUE FOR OUR WORK GROUP BUT ALL
WORK GROUPS, THAT THE IPRCC
CANNOT IDENTIFY GAPS IN RESEARCH
FUNDING AND/OR MAKE
RECOMMENDATIONS ABOUT RESEARCH
FUNDING.
BUT WE CAN IDENTIFY GAPS IN
RESEARCH TOPICS OR JUST SORT OF
LIKE NEEDS, TOPICAL NEEDS AND
WHERE THERE MIGHT BE A NEED FOR
GREATER ATTENTION IN LEARNING.
SO AS ONE SPECIFIC EXAMPLE, NIH
FUNDS A LARGE NUMBER OF PAIN
TREATMENT EFFICACY TRIALS, AND
YET FOLLOWING THE PUBLICATION OF
THOSE RESULTS OR THE TRIAL
RESULTS, DISSEMINATION AND
IMPLEMENTATION IS OFTEN LESS
STUDIED AND DISSEMINATION MAY
ACTUALLY FALL SHORT BECAUSE THE
RIGHT METHODOLOGIES AREN'T IN
PLACE.
THE RIGHT SYSTEMS, THE EVIDENCE
TO SUPPORT THOSE SYSTEMS, AND SO
THE IDEA THERE IS THAT WE MAY
BE -- AND THIS IS JUST NIH, OF
COURSE THE IPRCC IS BIGGER THAN
NIH, BUT JUST FOCUSING ON THIS
EXAMPLE, THE IDEA IS THAT WE MAY
BE INVESTING MILLIONS AND
MILLIONS AND MILLIONS OF DOLLARS
TO IDENTIFY EFFICACIOUS
TREATMENTS, BUT THEN THEY DON'T
NECESSARILY GET INTO THE HANDS
OF THE PEOPLE WHO NEED THEM, AT
LEAST NOT AT THE SCALE THAT WE
WOULD HOPE THAT THEY WOULD.
THERE MIGHT BE A LOT OF GAPS AND
BARRIERS TO IMPLEMENTATION AND
COULD OUR WORK GROUP IDENTIFY
WAYS TO CREATE EFFICIENCIES SO
THAT EXISTING FEDERAL INVESTMENT
IN PAIN TREATMENT RESEARCH
WOULD, FOR EXAMPLE, YIELD LARGER
DIVIDENDS BY HAVING THESE
EFFICIENT SYSTEMS FOR
DISSEMINATION.
SO THAT'S ONE IDEA.
WE IDENTIFIED AN ACTION ITEM,
WHICH IS A BIBLIOMETRIC ANALYSIS
OF THE PAIN RESEARCH PORTFOLIO
IN THE PAST FIVE YEARS JUST
BEGINNING WITH SOME KEY TERMS
SEARCHES AROUND EFFICACY,
EFFECTIVENESS, COMPARATIVE
EFFECTIVENESS,
COST-EFFECTIVENESS,
DISSEMINATION AND IMPLEMENTATION
SCIENCE.
SO REALLY JUST TRYING TO GET A
SENSE OF THE LANDSCAPE FOR WHAT
IS CURRENT RESEARCH, PUBLISHED
RESEARCH PERTAINING TO PAIN THAT
INVOLVES THESE KEY TERMS AND
THEN BEING ABLE TO SORT OF
BUCKETTIZE THOSE AND GET A SENSE
WHERE SOME GAPS EXIST AND WHERE
THE OPPORTUNITIES EXIST FOR
GREATER ATTENTION.
AND WE RECOGNIZE THAT THERE'S A
NEED TO UNDERSTAND RIGOR IN
IMPLIMPLEMENTATION SCIENCE IN OR
TO MEET THIS LARGER GOAL OF
TRULY HAVING IMPACT, THE LARGEST
IMPACT POSSIBLE ON PAIN CARE AND
ALSO PAIN POLICY.
OKAY.
SO IMPLEMENTATION SCIENCE
TRAINING, TO SOME EXTENT THIS
KIND OF GETS BACK TO THE
EDUCATION WORKFORCE.
THIS IS A NICHE GROUP IN TERMS
OF TRAINING, BUT IT IS A
TRAINING GOAL, SO WE BELIEVE
THAT THERE'S AN IMPLEMENTATION
SCIENCE TRAINING GAP, SO
SPECIFICALLY FOR WITHIN PAIN
RESEARCH BUT UPSKILLING PAIN
RESEARCHERS AROUND THE RIGOR OF
IMPLEMENTATION SCIENCE IN
PERFORMING THAT.
AND OF COURSE THIS IS PERCEPTUAL
BASED ON WHAT WE SEE AND KNOW,
BUT IT'S NOT NECESSARILY
GROUNDED IN EVIDENCE AND IN THE
REAL DATA, SO QUANTIFICATION IS
REALLY NEEDED.
SO CONDUCTING A GAP ANALYSIS
THERE, BUT WE SORT OF BROADLY
HAVE RECOGNIZED THAT THERE'S A
NEED FOR INCREASED AWARENESS,
ATTENTION AND RESOURCES FOR
TRAINING RESEARCHERS IN THIS
SPACE, AND WE HOPE TO PROVIDE
SOME OF THAT FOUNDATIONAL
EVIDENCE THAT WOULD JUSTIFY.
SO AS AN EXAMPLE, ONE FUTURE
OBJECTIVE COULD BE IDENTIFYING
BARRIERS IN IMPLEMENTATION
SCIENCE TRAINING, WHAT ARE THE
BARRIERS, WHAT ARE THE NEEDS,
AND WHAT ARE SOME POTENTIAL
PATHWAY FORWARD, PATHWAYS
FORWARD SO THAT WE CAN REALLY
ENSURE THAT WE'RE CONDUCTING
IMPLEMENTATION AND DISSEMINATION
SCIENCE IN PAIN RESEARCH BROADLY
TO ITS MOST IMPACTFUL, IMPACTFUL
LEVEL.
SO I THINK THAT'S ALL I HAVE,
BUT HAPPY TO ANSWER ANY
QUESTIONS, AND ALSO MY WORK
GROUP COLLEAGUES ARE ON THIS
CALL AS WELL AND THEY ARE
WELCOME TO CLIMB IN.
TO CHIME IN.
>> THANK YOU SO MUCH FOR THAT
SUMMARY.
IT'S REALLY HELPFUL TO GET A
SENSE OF WHAT THE IMPLEMENTATION
WORK GROUP IS WORKING ON.
CAN DEFINITELY SEE THERE'S SOME
OVERLAP WITH SOME OTHER GROUPS.
HELENE I SEE YOUR HAND IS
RAISED.
PLEASE FEEL FREE TO ASK YOUR
QUESTION.
>> THANKS.
THANK YOU, BETH.
I MEAN, I WAS ACTUALLY ALSO
IMPRESSED WITH HOW MUCH OF WHAT
WE HEARD THIS MORNING FROM OUR
FEDERAL PARTNERS, AHRQ, THE
V.A., THE DOD, HOW MUCH OF THAT
KIND OF WAS IN THE
IMPLEMENTATION SPACE?
>> SORE' G AHEAD.
I DIDN'T MEAN TO INTERRUPT YOU.
>> IT'S OKAY, IT JUST STRUCK ME,
THIS IS REALLY BECOMING VERY,
VERY PREVALENT, BUT NOT ALWAYS
CALLED THAT WAY.
>> YEAH, I AGREEMENT AND I
THINK, YOU KNOW, IN OUR WORK
GROUP MEETINGS, WE'VE ACTUALLY
DISCUSSED THAT, LOOKING BEYOND
NIH AND LOOKING AT V.A. AND, YOU
KNOW, OTHER GROUPS AND JUST
REALLY SORT OF SYNTHESIZING
LEARNINGS AS WELL AS ACTIVE
FUNDING, PUBLISHED EVIDENCE FROM
THESE DIFFERENT AREAS BUT
SYNTHESIZING IT ALL IN REGARDS
TO PAPER, BECAUSE I THINK VERY
BROADLY, AND THIS IS PROBABLY
TRUE FOR EVERY WORK GROUP
HONESTLY, IS THAT INFORMATION IS
JUST SILOED, AND I THINK THAT'S
THE OPPORTUNITY, THE IPRCC
BROADLY AND WITHIN EACH WORK
GROUP IS TO PULL FROM ALL OF
THESE OTHER GREAT AGENCIES OR
INSTITUTES OR EFFORTS, BUT
SYNTHESIZE IT IN A WAY WHERE WE
CAN REALLY IDENTIFY WHAT ARE THE
STRENGTHS, WHAT ARE THE GAPS,
WHAT ARE THE OPPORTUNITIES, AND
THEN MAYBE THAT COULD CREATE
THOSE EFFICIENCIES FOR PEOPLE
WHO DO MAKE DECISIONS ABOUT
FUNDING.
>> YEAH, TOTALLY AGREE.
IN FACT, YOU GO BACK TO THE
OTHER WORK GROUPS, A LOT OF THE
WORK IN PREVENTION, ALL THAT, WE
HEARD SO MUCH ABOUT THAT THIS
MORNING TOO.
IN THE V.A., IN THE DOD.
A LOT OF IT FALLS IN THAT
CATEGORY SO WE SHOULD DO
SOMETHING ABOUT THIS.
MAYBE NEXT -- MAYBE A NEXT STEP,
A MEETING SHOULD BE DEVOTED TO
THAT, TO TRY TO REALLY SEE -- TO
DO MORE OF A CROSS GOVERNMENT
PICTURE OF THESE TOPICS MIGHT BE
NICE.
>> YEAH, THAT'S A GREAT IDEA.
>> HELENE AND BETH, I THINK YOU
GUYS HAVE HIT IT RIGHT ON THE
HEAD, I THINK THAT'S EXACTLY
WHAT PPP IS HOPING TO DO AND WAS
HOPING TO SET UP FOR THIS
MEETING, IS BEING ABLE TO SEE
WHERE ARE THOSE OVERLAPSE BY
HAVING THE FEDERAL PARTNERS
PRESENTING TODAY, TO BE ABLE TO
THEN DRAW THAT INFORMATION INTO
THE WORK GROUPS FOR THE NEXT
COUPLE OF MONTHS, IN BETWEEN NOW
AND THE NEXT WORK GROUP, TO BE
ABLE TO BRING THAT BACK TO THE
GROUP NEXT TIME.
SO YOU GUYS HAVE DONE A GREAT
JOB OF HIGHLIGHTING WHAT THE
NEXT STEPS WILL BE.
SO THANK YOU.
>> EXACTLY.
AND EACH ORGANIZATION IS LOOKING
AT THIS FROM THEIR OWN VANTAGE
POINT.
>> YEP.
>> SO IT'S NOT GOING TO BE
DUPLICATIVE, IN FACT, IF
ANYTHING, IT'S GOING TO BE
SYNERGISTIC.
SO THAT'S GREAT.
>> CHRISTINE, I SEE YOUR HAND IS
RAISED.
DO YOU WANT TO GO NEXT?
>> GREAT.
THANK YOU.
BETH, THAT WAS TERRIFIC.
I COMPLETELY AGREE, IT WAS
ENCOURAGING TO SEE THAT
IMPLEMENTATION SCIENCE IS PRETTY
MUCH MENTIONED IN MOST TALKS
THIS MORNING, AND IT WAS
PARTICULARLY ENCOURAGING TO SEE
THAT IT WAS RECOGNIZED AS
BASICALLY BEING ALONG THAT
SPECTRUM, THAT TRANSLATIONAL
RESEARCH SPECTRUM AT THE V.A. AS
PART OF THEIR SETS OF
INITIATIVES.
I DID WANT TO JUST REITERATE
WHAT IS AT THE DOORSTEP, WHICH
IS, FOR EXAMPLE, IN THE CASE OF
THE NCI, AND WE DISCUSSED THIS
AT OUR WORK GROUP, THEIR
IMPLEMENTATION SCIENCE IS A
FOCUS OF THE DIVISION OF CANCER
CONTROL AND POPULATION SCIENCES,
AND SO THE NCI ACTUALLY HAS BEEN
FOCUSED ON THIS FOR QUITE SOME
TIME.
THEY HAVE THEMSELVES A SPECIFIC
INTEREST IN PAIN.
THERE COULD BE AN OPPORTUNITY TO
CROSS FERTILIZE, I MEAN, THIS IS
AN OPPORTUNITY LEVERAGE, AND AS
WE'VE SAID HERE, ONE OF
POTENTIALLY SEVERAL
OPPORTUNITIES ACROSS HHS.
>> GREAT.
WALTER, DO YOU WANT TO GO NEXT?
>> THANKS A LOT, BETH.
SO I GUESS I HAVE A WORRY AND
POTENTIALLY A SUGGESTION, AND
THE WORRY IS THAT, YOU KNOW, THE
IMPLEMENTATION SCIENCE IS
VALUABLE IF IT PICKED UP BY THE
PEOPLE WHO IMPLEMENT.
SO IN THESE DISCUSSIONS, I
WONDER WHETHER IT'S POSSIBLE TO
BRING IN THE PEOPLE WHO MAKE
THESE DECISIONS IN THE
HEALTHCARE SYSTEM.
SO THE V.A. IS A GREAT EXAMPLE
OF HOW THE SCIENCE AFFECTS
PRACTICE, BUT THAT'S A UNIQUE
SITUATION, AND TO ACTUALLY DO
SOMETHING FOR THE MAJORITY, IT
WOULD REALLY HAVE TO BE
SOMETHING THAT'S PICKED UP BY
THE HEALTHCARE SYSTEMS AND IF WE
DO RESEARCH THAT THEY, LIKE, NO
MATTER WHAT YOU FIND, IT NOT
GOING TO MAKE ANY DIFFERENCE TO
ME, THEN WE'RE NOT GOING
ANYWHERE.
SO DO YOU THINK THERE'S A CHANCE
OF TRYING TO REACH OUT AND
GETTING PEOPLE IN THE HEALTHCARE
SYSTEMS TO KIND OF GIVE
DIRECTIONS ON WHAT WOULD BE
VALUABLE TO THEM IN TERMS OF
PICKUP?
>> YEAH, IT'S A GREAT POINT,
WALTER, AND I THINK YOU'RE
HITTING THE NAIL ON THE HEAD.
WE'VE DEFINITELY TALKED ABOUT
THAT.
THERE'S ABSOLUTELY FANTASTIC
STUFF HAPPENING WITHIN V.A., AND
I REALLY VIEW THEM AS BEING
LEADERS IN THIS SPACE IN A LOT
OF WAYS, AND THERE ARE ASPECTS
THAT DON'T NECESSARILY
GENERALIZE.
I DO THINK THAT THE SCIENCE OF
IMPLEMENTATION AND HOW WE STUDY
IMPLEMENTATION IS INSTITUTE AND
SORT OF SITUATION AGNOSTIC, OR
AT LEAST MORE AGNOSTIC.
SO THERE MAY BE FACTORS THAT ARE
MORE RELEVANT IN V.A. THAN OTHER
PLACES BUT STUDYING AND REALLY
IMPLYING IMPLEMENTATION SCIENCE
AND HOW WE APPROACH IT, THE
FACTORS THAT ARE IMPORTANT TO
INVESTIGATE, YOU KNOW, THAT MAY
BE MORE COMMON THAN NOT.
I DO AGREE WITH YOU, WE NEED TO
DO A BROAD SURVEY OF DIFFERENT
INSTITUTES, AGENCIES, GET A LAY
OF THE LAND AND ALSO INCLUDE
THESE STAKEHOLDERS WHO DO MAKE
THE DECISIONS, BECAUSE I THINK
IN PART, WHAT YOU'RE TALKING
ABOUT IS ADOPTION AND IT'S GOT
TO MAKE SENSE IN THE CIVILIAN
SECTOR VERY BROADLY, OR THERE
ISN'T IMPLEMENTATION SCIENCE
BECAUSE THAT'S A BARRIER TO IT
OCCURRING AT ALL.
>> YEAH, MAYBE, BETH, ONE OF THE
THINGS ALSO TO WALTER'S POINT
THAT THE GROUP HAS TALKED ABOUT
IS THAT THERE ARE SOME GROUPS
LIKE PCORI THAT WHEN THEY
DEVELOP PROJECTS, THAT THEY HAVE
THE PAYORS AT THE TABLE TOE BE
ATO BEABLE TO HAVE THE CONVERSAN
ABOUT HOW THAT STUDY WOULD BE
IMPLEMENTED, SO THIS GROUP HAS
STARTED TO TALK ABOUT WHAT MIGHT
BE HELPFUL AND WHEN SHOULD
PAYORS GET INVOLVED, PAYORS
AND/OR HEALTHCARE SYSTEMS GET
INVOLVED IN STUDY PROCESSES TO
HELP MAKE THEM THE MOST
EFFECTIVE.
SO I THINK THAT HAS BEEN A TOPIC
THAT THE GROUP IS THINKING
ABOUT, AND IS, I THINK -- WE CAN
TAKE BACK TO THE GROUP TO
CONTINUE WORKING ON BETWEEN NOW
AND THE NEXT IPRCC MEETING TO
REPORT OUT ON.
>> AND HELENE, WHAT'S YOUR REACH
TO THE HEALTHCARE SYSTEM AND THE
COLLABORATORY?
WOULD THEY BE INTERESTED IN --
>> THAT WAS GOING TO BE MY
COMMENT.
YOU'RE BREAKING UP A LITTLE BIT,
WALTER.
ANYWAY I'M GOING TO ANSWER WHAT
I THINK THE QUESTION WAS.
YES, THE HEALTHCARE SYSTEMS
COLLABORATORY WHICH IS WHAT I
PRESENTED THIS MORNING REMEMBER
I DREW THAT, ONE OF THE SLIDES I
SHOWED WAS ABOUT THE LEARNING
HEALTHCARE SYSTEM AND THE WHOLE
POINT OF THE HEALTHCARE SYSTEMS
COLLABORATORY WHICH NOW SUPPORTS
ALL THE TRIALS IN THE HEAL
INITIATIVE, ON PRI SM, RURAL
PAIN AND NOW THIS FULL NEW
COORDINATED PAIN CARE PROGRAM
ARE BUILT ON THAT PREMISE, IN
THAT HEALTHCARE SYSTEMS ARE
INVOLVED IN DESIGNING THE
QUESTION, IN DESIGNING THE
STUDY, AND ALSO INVESTED IN
ACTUALLY TAKING ACTION ON THE
RESULTS.
AND WE HAVE ALREADY SOME
EXAMPLES OF THAT.
WE HAD OUR 25TH ANNIVERSARY
PRESENTATION JUST THIS WEEKEND
AT NCCIH, AND LYNN DEBAR
PRESENTED ON SEVERAL STUDIES
THAT SHE'S DONE IN OREGON, FOR
EXAMPLE, IN SOME OF THE
HEALTHCARE SYSTEMS OVER THERE,
WHERE THE HEALTHCARE SYSTEMS ARE
ENGAGED AND THEY'RE ITERATING,
THEY'RE REFINING THE
INTERVENTIONS SUCH THAT IT
BECOMES MORE AND MORE AND MORE
LIKELY THAT THE HEALTHCARE
SYSTEMS ARE GOING TO TAKE IT.
IT DOESN'T HAPPEN ALL AT ONCE.
BUT WE HAVE PROCESSES IN PLACE,
ESPECIALLY WITH THE HEALTHCARE
SYSTEM COLLABORATORY AND THE
PRISM PROGRAM TO DO THAT
EXACTLY.
>> AND I WILL JUST MENTION, AND
I KNOW A COUPLE OF PEOPLE HAVE
THEIR HANDS UP, BUT JUST IN
RESPONSE TO THAT, PCORI DOES
SIMILARLY AND PCORI ALSO OFFERS
DISSEMINATION AND IMPLEMENTATION
GRANTS, LIKE FUNDING
OPPORTUNITIES SPECIFIC TO
IMPLEMENTATION, SO THAT WAS
ANOTHER GAP WE JUST SORT OF
SERVING THE LANDSCAPE OR MAYBE A
DIFFERENCE, AND WE HAVEN'T
REALLY DIVED INTO ALL OF THE
ENTITIES TO PROVIDE A
COMPREHENSIVE REPORT, BUT THAT
WAS A DISTINCTION WITH PCORI, IS
THAT THERE'S SEPARATE FUNDING
MECHANISMS FOR THAT.
>> I'LL JUST JUMP IN BEFORE I --
SORRY TO INTERRUPT, BUT I GUESS
WHAT I'M SUGGESTING IS WE HAVE
MAYBE A SWITCH IN THE USUAL
PARADIGM WHERE WE DO RESEARCH
AND WE'RE TRYING TO TELL THE
HEALTHCARE SYSTEMS WHAT TO DO,
INSTEAD TRY TO LEARN FROM THE
HEALTHCARE SYSTEMS WHAT THEY
WANT IN THIS SPACE THAT'S
RELEVANT TO US AND THEN KIND OF
COMPROMISE AND PURSUE IN A
DIRECTION THAT I THINK --
ANSWERING QUESTIONS THAT ARE
IMPORTANT TO THEM.
-- MORE THAN LIKELY BE ADOPTED.
BUT ANYWAY, JUST MY 2 CENTS.
>> SORRY, YOU WERE BREAKING UP A
LITTLE BIT, WALTER, BUT WE GOT
THE GIST OF IT, YEAH.
FIGURE OUT THE QUESTIONS THAT
ARE IMPORTANT TO THE HEALTHCARE
SYSTEM AND DESIGN THE STUDIES
WITH THAT IN MIND, ABSOLUTELY,
YES.
WE JUMPED AHEAD OF PAUL AND
CHRISTINE.
PAUL?
>> THIS DISCUSSION, I THINK IS
REALLY IMPORTANT.
AND TO RESPOND TO ONE OF
WALTER'S COMMENTS, IT MADE ME
THINK THAT ONE OF THE
STAKEHOLDERS THAT WE HAVEN'T
NECESSARILY TALKED ABOUT ARE THE
ELECTRONIC HEALTH RECORD CONTENT
PRODUCERS.
SO LIKE THE CERNERS OR THE
EPICS, THEY HAVE BEST PRACTICE
ADVISORIES, AND IF THERE'S ANY
WAYS TO IDENTIFY HOW DO WE MAKE
AN IMPACT THAT WAY, THAT THOSE
THINGS POP UP WHEN CERTAIN
DIAGNOSES, CERTAIN PROBLEMS WITH
FACING THE CLINICIANS AS FAR AS
HAVING SOME OUTREACH.
AND I DON'T KNOW WHETHER OR NOT
THAT'S WITHIN SCOPE OR WITHOUT
SCOPE, BUT I DON'T RECALL HAVING
DISCUSSED THAT.
>> GREAT POINT, PAUL.
>> CHRISTINE, I THINK I SEE YOUR
HAND RAISED AS WELL?
>> TWO ADDITIONAL POINTS.
ONE, SPEAKING TO WHAT PAUL JUST
SAID WHICH ACTUALLY SPEAKS TO
THE IMPORTANCE OF PROMOTING DATA
AND ACTUALLY THE DEVELOPMENT OF
SPECIFIC METHODOLOGIES LOOKING
AT REAL WORLD EVIDENCE.
AND THEN THE SECOND POINT GOES
TO SOMETHING THAT I THINK IS
REALLY IMPORTANT, WE'RE NOT
TALKING ABOUT FUNDING
MECHANISMS, I KNOW, BUT NCI HAS
LISTED AS MANY AS NINE FUNDING
OPPORTUNITIES SPECIFICALLY ON
IMPLEMENTATION SCIENCE AND
METHODOLOGIES WITHIN
IMPLEMENTATION SCIENCE.
SO I THINK IT'S CERTAINLY
WORTH -- AND THEY'RE NOT THE
ONLY ONES, OF COURSE, AND PCORI
THANKFULLY IS REPRESENTED IN
THIS WORK GROUP.
BUT I DO THINK IT'S WORTHWHILE,
DOING OUR DUE DILIGENCE AND
SEEING WHAT'S OUT THERE BECAUSE
THERE'S SO MUCH WORK TO BE DONE.
>> I THINK THERE'S A REALLY
ROBUST DISCUSSION HERE.
WE REALLY APPRECIATE EVERYBODY'S
THOUGHTS AND OPINIONS ON THIS
WORK GROUP, BUT REALLY ALL OF
THE WORK GROUPS.
SO I THINK WE CAN REALLY TAKE
THIS INFORMATION BACK AND WORK
FOR THE NEXT COUPLE OF MONTHS ON
ADDRESSING A LOT OF THE TOPICS
THAT CAME UP DURING TODAY'S CALL
AS WELL AS THE OBJECTIVES AND
ACTION ITEMS THAT WERE PRESENTED
TO BE ABLE TO REPORT OUT TO THIS
GROUP AGAIN IN ABOUT SIX MONTHS.
SO THANK YOU ALL.
WE REALLY APPRECIATE YOUR HARD
WORK ON THESE PROJECTS AND
EFFORTS, SO JUST THANK YOU.
WE ARE GOING TO MAKE A LITTLE
BIT OF A TRANSITION NOW, SO
WE'RE GOING TO MOVE AWAY FROM
THE WORK GROUPS AND WE'RE GOING
TO ENTER A THEME OF
COMMUNICATION NOW, ONE OF THE
TOPICS THAT KEEPS ON COMING UP
WITHIN THE WORK GROUPS IS HOW DO
WE COMMUNICATE OUR RESULTS OUT
AND HOW DO WE DISSEMINATE OUR
RESULTS TO THE PUBLIC.
AND SO WE'RE GOING TO HAVE TWO
CONVERSATIONS.
THE FIRST ONE IS GOING TO BE
FROM JUL GIULIA BOVA ON A PWE
COMEUPCATIONS SURVEY AN
TENTATIVE COMMUNICATION PLAN SO
WE'LL GET STARTED THERE AND THE
NEXT TALK WILL BE COMMUNICATION
AND DISSEMINATION WORK GROUP
THAT WE MAY POTENTIALLY START.
SO TO START OFF WITH, GIULIA,
ARE YOU READY?
>> I AM READY.
LET ME JUST PULL UP MY SLIDES.
>> MY NAME IS GIULIA BOVA, AND
I'M A PROGRAM ANALYST IN THE
OFFICE OF PAIN POLICY AND
PLANNING, AND WHAT I'M
PRESENTING ON TODAY ARE THE
RESULTS OF A SURVEY THAT WE DID
WITH JUST OVER 100 PEOPLE WITH
LIVED EXPERIENCE FROM OUR
PATIENT ADVOCACY NETWORKS.
AND BEFORE I GET INTO THE
RESULTS OF THE SURVEY, I JUST
WANT TO GIVE A HUGE THANK YOU TO
ALL THE PEOPLE THAT
PARTICIPATED.
WE WEREN'T ABLE TO COMPENSATE
THEM FOR THEIR TIME, BUT THE
INFORMATION THAT WE GOT IS VERY
VALUABLE, AND WE'RE HOPING TO
SHAPE SOME OF OUR COMMUNICATION
EFFORTS FROM OUR OFFICE GOING
FORWARD.
BASED OFF THESE RESULTS, AND
THEN ALSO JUST SHARE THE RESULTS
WITH THE COMMUNITY SINCE I KNOW
A LOT OF OTHER ORGANIZATIONS
INCLUDING THE ORGANIZATIONS THAT
PARTICIPATED MAY FIND THE
RESULTS USEFUL.
SO FOR A LITTLE BIT OF
BACKGROUND, WE WERE THINKING
ABOUT HOW TO COMMUNICATE RESULTS
OF PAIN RESEARCH TO PEOPLE WITH
LIVED EXPERIENCE AND THE IDEA OF
A PODCAST CAME UP.
BUT P FER BEFORE STARTING A
PODCAST, WE WANTED TO SURVEY THE
COMMUNITY TO SEE WHETHER THIS
WOULD BE SOMETHING THEY WOULD BE
INTERESTED IN IN THE FIRST PLACE
AND WHAT TOPICS THEY WOULD BE
INTERESTED IN LEARNING ABOUT
RELATED TO EITHER PAIN RESEARCH
OR BECOMING INVOLVED IN THE
RESEARCH PROCESS.
SO IN DEVELOPING THE SURVEY, WE
ASKED SPECIFICALLY ABOUT THE
PODCAST BUT WE TOOK IT A LITTLE
BROADER AS WELL SINCE WE WERE
GOING TO DISTRIBUTE THIS ANYWAY
TO ASK ABOUT COMMUNICATION
PREFERENCES OVERALL.
SO THIS IS THE MAKEUP OF THE
RESPONDENTS.
MOST RESPONDENTS AS YOU CAN SEE
HERE HAVE LIVED EXPERIENCE WITH
PAIN AND RESPONDENTS COULD
ANSWER MORE THAN ONE CATEGORY
FOR THIS QUESTION SO IT'S LIKELY
THAT SEVERAL THAT ANSWERED IN
OTHER CATEGORIES WERE ALSO THOSE
WERE LIVED EXPERIENCE, AND IN
TOTAL, WE HAD 111 RESPONDENTS
FOR THIS SURVEY.
SO THE FIRST QUESTION WE ASKED
IS WHAT IS THE MOST COMMON
SOURCE OF INFORMATION ABOUT PAIN
TO UNDERSTAND CURRENTLY WHERE
ARE YOU GETTING YOUR
INFORMATION.
THIS WAS OPEN RESPONSE,
RESPONDENTS COULD ANSWER AS MANY
OPTIONS AS THEY WANTED AND WE
RECEIVED 99 RESPONSES SO AS YOU
CAN SEE, THE MOST POPULAR
RESPONSE WAS FACEBOOK, FOLLOWED
BY ACADEMIC LITERATURE, AND THEN
SUPPORT/ADVOCACY GROUPS,
HEALTHCARE PROFESSIONALS, AND
THE INTERNET.
AND THESE WERE NOT CATEGORIES WE
CREATED, THESE WERE ALL OPEN
RESPONSES I MENTIONED.
JUST BRIEFLY,LY GO OVER ALL OF,L
OF THE RESULTS BUT AT THE END, I
WILL SAVE TIME FOR QUESTIONS.
AND THEN WE ALSO ASKED ABOUT
PREFERENCES FOR LEARNING ABOUT
PAIN RESEARCH AND FOR THIS, WE
DID CREATE THE CATEGORIES INTO
AUDIO, AUDIO-VISUAL, DIGITAL,
SOCIAL MEDIA, AND PREFER NOT TO
ANSWER AND THE MOST POPULAR
RESPONSE WAS DIGITAL
ENCOMPASSING THINGS LIKE NEWS
AND JOURNAL ARTICLES, MAGAZINES,
ACADEMIC LITERATURE, BROCHURES,
INFOGRAPHICS, BLOGS AND
WEBSITES, AND THAT WAS FOLLOWED
BY AUDIO-VISUAL, SO THINGS LIKE
WEBINARS.
AND THEN WE GAVE THE OPTION TO
HAVE AN OTHER CATEGORY AND SOME
OF THE OPTIONS THAT WERE GIVEN
WERE HEALTHCARE PROFESSIONALS,
ZOOM MEETINGS, PRINT JOURNALS,
PHONE APPLICATIONS AND
HEALTHCARE PROFESSIONALS.
THIS INFORMATION WAS PRETTY
CONSISTENT THROUGH THE REST OF
THE SURVEY.
WE DID EXPLICITLY ASK RESPOND
DENTS IF THEY WOULD LISTEN TO A
PODCAST ABOUT WHAT GOES INTO
STARTING, RUNNING AND GETTING
INVOLVED IN PAIN RESEARCH.
THIS WAS ONLY SELECT ONE OPTION
AND WE DID RECEIVE 111
RESPONSES.
OVER 70% SAID THEY WOULD SUPPORT
A PODCAST, BUT WE HAVE CHOSEN
NOT TO MOVE FORWARD WITH THIS
OPTION JUST BECAUSE AS YOU SAW
PREVIOUSLY, THE MORE POPULAR
RESPONSES WERE DIGITAL CONTENT
AND THEN VIDEO CONTENT.
THEN WE ALSO ASKED ABOUT
PREFERENCES IN TERMS OF LENGTH
OF EPISODES AND EPISODES PER
SEASON.
WE RECEIVED ABOUT 80 RESPONSES
FOR THESE QUESTIONS AND THE
PREFERENCE WAS TO HAVE EPISODES
ABOUT 30 MINUTES LONG AND TO
HAVE ABOUT FOUR TO SIX EPISODES
PER SEASON.
SO THEN WE ASKED IF A PODCAST
DOES NOT INTEREST YOU, WHAT
OTHER COMMUNICATION METHODS THAT
YOU WOULD PREFER TO LEARN ABOUT
PAIN RESEARCH?
FOR THIS WE RECEIVED 26
RESPONSES, AND THOSE WERE FROM
THE PREVIOUS QUESTION THAT SAID
THEY WOULD NOT PREFER A PODCAST
AND THESE WERE SELECT ALL THAT
APPLY.
AND AS I MENTIONED EARLIER, THIS
ALIGNS WITH THE EARLIER
RESPONSES WE RECEIVED, SO THE
MOST POPULAR RESPONSE BEING
GETTING INFORMATION THROUGH
DIGITAL FORMATS.
AND THESE WERE OPTIONS THAT WE
GAVE THE NEWS JOURNAL ARTICLES,
MAGAZINES, PROFESSIONAL
JOURNALS, ET CETERA.
IMPORTANT TO MENTION HERE THAT
SINCE WE PROVIDED THIS CATEGORY,
THERE COULD BE OTHER RESPONSES
AND WE DID RECEIVE TWO OTHER
RESPONSES AND THOSE WERE ZOOM
WEBINARS, BODY VISUAL MEDIA THAT
WAS ACCESSIBLE, IE, INCLUDING
CAPTIONS AND THEN OTHER PRINTED
MATERIALS UNSPECIFIED.
WE ALSO ASKED IN TERMS OF
COMMUNICATING ABOUT PAIN
RESEARCH, WHAT IS THE BEST WAY
TO GET THE WORD OUT TO YOU AND
YOUR COMMUNITY, AND FOR THIS,
THE MOST POPULAR RESPONSE WAS
SOCIAL MEDIA, SO THINGS LIKE
LINKEDIN AND FACEBOOK, WHICH
AGAIN ALIGNS REALLY WELL WITH
THE FIRST RESPONSE WHERE YOU SAW
MOST PEOPLE ARE GETTING THEIR
INFORMATION FROM FACEBOOK,
SOCIAL MEDIA, AND THE INTERNET,
AND THEN ALSO INTERESTINGLY, THE
SECOND MOST POPULAR OPTION HERE
WAS THROUGH EMAIL, SO LIKE LIST
SERVES.
THEN IN TERMS OF OTHER
RESPONSES, WORD OF MOUTH LIKE
THROUGH CLINICIANS DOING ACTUAL
PODCASTS OR TV ALZHEIMER'S
DISALZHEIMTV ADS, INVITINGSOMEON
ADVOCATE AND TO ADVERTISE AND
THEN THROUGH SOME OF OUR
WEBSITES THAT ARE CONNECTED TO
OUR OFFICE SUCH AS THE PURPOSE
NETWORK AND THE HEAL WEBSITE AND
THEN ALSO SUPPORT ADVOCACY
GROUPS AGAIN IS ONE OF THE MAJOR
THEMES THAT CAME UP THROUGHOUT
THIS SURVEY.
WE ALSO ASKED RESPONDENTS WHAT
TOPICS THEY'RE INTERESTED IN
LEARNING ABOUT.
THIS WAS AN OPEN RESPONSE THAT I
CODED AND WE RECEIVED
21 RESPONSES AND I'M NOT SEWING
THIS ON THIS PRESENTATION, BUT
THE RESPONSES HERE DO ALIGN WITH
OTHER OPEN RESPONSE QUESTIONS
THAT WERE TARGETING A VERY
SIMILAR THEME, WHICH WAS JUST
WHAT ARE YOU INTERESTED IN
LEARNING ABOUT?
SO THE MAIN THINGS HERE THAT
RESPOP DENTS EXPRESSED INTEREST
IN WERE UNDERSTANDING EMERGING
RESEARCH SO HOW TO ACTUALLY
UNDERSTAND RESEARCH FINDINGS
THAT YOU'RE READING ABOUT, AND
THEN ALSO HOW THE RESEARCH
PROCESS IS -- OR IN THE RESEARCH
PROCESS HOW RESEARCH IS
TRANSLATED INTO INTERVENTIONS
AND TREATMENTS THAT THEN AFFECT
THOSE WITH LIVED EXPERIENCE.
THERE WAS A HUGE INTEREST IN
UNDERSTANDING THE RESEARCH
FUNDING PROCESS ITSELF IN TERMS
OF LIKE HOW GRANTS GET FUNDED
THROUGH NIH, IF SOMEONE IS
INTERESTED THEMSELVES IN
APPLYING FOR A GRANT, HOW THEY
WOULD GO ABOUT DOING THAT, AND
THEN FOR A PARTICIPANT WHO IS
PARTICIPATING IN RESEARCH,
WHETHER IT'S LIKE SERVING ON AN
ADVISORY BOARD, JUST
PARTICIPATING IN A STUDY, HOW
COMPENSATION IS DEALT WITH.
AND THEN A LOT OF RESPONDENTS
EXPRESSED INTEREST IN HOW TO
ACTUALLY FIND OPPORTUNITIES TO
PARTICIPATE IN RESEARCH, AND
THIS CAME UP A LOT AND WE SEE A
PRETTY SIGNIFICANT GAP IN TERMS
OF LIKE BRIDGING THE RESEARCHER
AND PERSON WITH LIVED EXPERIENCE
BRIDGE TO BE ABLE TO FIND EACH
OTHER.
AND THEN ANOTHER TOPIC THAT CAME
UP WAS HEARING FROM PEOPLE THAT
PARTICIPATE IN RESEARCH OR HAVE
SERVED ON ADVISORY BOARDS IN
TALKING ABOUT THEIR EXPERIENCES
BOTH IN TERMS OF WHAT THE
EXPERIENCE WAS LIKE, WHAT WENT
WELL, WITH YOU ALSO BUT ALSO HN
EFFECTIVE RESEARCH PARTNER.
ANOTHER TOPIC THAT CAME UP WAS
ALTERNATIVE TREATMENTS IN TERMS
OF HEARING ABOUT EMERGING
RESEARCH FOR ALTERNATIVE
TREATMENTS AND THEN ALSO PAIN
PREVENTION MANAGEMENT, LIVING
AND WORKING WITH PAIN, CAUSES OF
PAIN.
I'M NOT GOING INTO THE DETAILS
HERE, BUT I GAVE A FEW EXAMPLES,
BUT SEVERAL RESPONDENTS
DISCUSSED WANTING TO LEARN ABOUT
RESEARCH ON SPECIFIC PAIN
TOPICS, WHICH I WOULD ASSUME ARE
THOSE THAT AFFECT THEM
PERSONALLY OR THEIR LOVED ONES.
AND THEN SELF ADVOCACY CAME UP
IN TERMS OF TOPICS SUCH AS
NAVIGATING INSURANCE, BUT ALSO
LIKE THE ETHICS OF PARTICIPATING
IN RESEARCH, HOW TO NAVIGATE
POWER DYNAMICS BETWEEN YOURSELF
AND SOMEONE WHO'S LEADING THE
RESEARCH, AND THE COMMUNICATION
IN THAT REALM.
AND THE NEXT SLIDE BASICALLY
SHOWS WHAT I JUST TALKED ABOUT
BUT THROUGH A WORD CLOUD WITH
SOME OF THE QUALITATIVE DATA
THAT WE HAD FOR THAT QUESTION
WHERE WORDS HERE THAT APPEAR
LARGER SHOWED UP MORE FREQUENTLY
ON THE OPEN RESPONSE PARTS OF
THE SURVEY.
SO AGAIN, JUST HIGHLIGHTING THAT
PEOPLE ARE MOST INTERESTED IN
LEARNING ABOUT ALTERNATIVE
TREATMENTS, EMERGING RESEARCH,
EXPERIENCES, PERSONALLY OF THOSE
WHO HAVE PARTICIPATED IN
RESEARCH, AND NON-MEDICATION
PAIN -- SO THE KEY TAKEAWAYS ARE
THAT THE PAIN SOURCES OF
INFORMATION FROM RESPONDENTS IN
THIS SURVEY WERE FACEBOOK,
ACADEMIC LITERATURE, AND THEN
WORD OF MOUTH THROUGH THEIR
SUPPORT AND ADVOCACY GROUPS OR
THEIR HEALTHCARE PROVIDERS AND
THEN MORE GENERALLY INTERNET
SEARCHES AND USING TOOLS SUCH AS
GOOGLE.
THERE IS A PREFERENCE FOR
DIGITAL CONTENT IN TERMS OF THE
METHOD OF DELIVERING
COMMUNICATION SO THINGS LIKE
NEWS AND JOURNAL ARTICLES,
INFOGRAPHICS, WEBSITES, EMAIL,
ET CETERA, AND THAT IS FOLLOWED
BY AUDIO-VISUAL MEDIA, SO THINGS
LIKE ZOOM WEBINARS, MEETINGS
THAT HAPPEN -- LICK THIS ONE
VIRDLY, AND THEN ALSO SAI MAJJI
IS WHERE PEOPLE PREFER TO HEAR
ABOUT RESEARCH, SPECIFICALLY
FACEBOOK AND LINKEDIN.
IN TERMS OF THE TOPICS OF
INTEREST, AGAIN, I ALREADY
TOUCHED ON THIS, BUT EMERGING
RESEARCH, THE OVERALL RESEARCH
PROCESS AT NIH AND HOW FUNDING
IS ALLOCATED AT NIH, BUT THROUGH
OTHER FUNDING ENTITIES AS WELL,
AND THEN FROM PEOPLE WITH THE
EXPERIENCE SIDE, HOW TO BECOME
OPPORTUNITIES TO BECOME INVOLVE
THE WITH RESEARCH, WHAT ARE THE
OPTIONS IN TERMS OF BEING
MINIMALLY INVOLVED TO MOST
INVOLVED AND HOW TO BE AN
EFFECTIVE PARTNER OR PARTICIPANT
AND QUALIFY FOR STUDIES AWELL.
AND THEN ANOTHER TOPIC THAT CAME
UP A LOT WAS THAT THERE WAS A
DESIRE THAT RESEARCHERS WERE
ADEQUATELY TRAINED ON INCLUDING
PEOPLE WITH LIVED EXPERIENCE IN
TERMS OF THE ETHICAL
CONSIDERATIONS, ENSURING THAT
THERE'S RESPECT AND EQUALITY
WHEN INCLUDING PEOPLE WITH LIVED
EXPERIENCE.
AND THEN GOING BACK TO THE
RESEARCH PROCESS, UNDERSTANDING
THE DISSEMINATION AND
TRANSLATION, SO ONCE THE
RESEARCH ACTUALLY HAPPENS, WHAT
HAPPENS AFTER THAT.
AND THEN -- WITH UNDERSTANDING
THOSE RESULTS THEN APPLYING THEM
TO SELF OR TO LOVED ONES AND
FAMILY MEMBERS, AND HIGHLIGHTING
HERE, REQUEST THAT CAME UP A LOT
WITH HEARING PERSONAL EXPERIENCE
IS PEOPLE THAT PARTICIPATE IN
RESEARCH.
SO BEFORE I MOVE ON TO THE NEXT
SLIDE, WHICH IS KIND OF SHIFTING
GEAR, I JUST WANTED TO TAKE A
MOMENT AND SEE IF THERE ARE ANY
QUESTIONS?
I MIGHT JUST STOP SHARING MY
SCREEN SO I CAN --
>> THERE'S A QUESTION.
>> WA WAS THAT FOR ME?
SORRY THE AUDIO CUT OUT A LITTLE
BIT.
>> YES, BETH, PLEASE FEEL FREE
TO GO.
>> YEAH, GIULIA, THANK YOU.
GREAT PRESENTATION.
AND THIS DATA IS SO HELPFUL.
I WAS STRUCK BY THE ONE
QUESTION, WOULD YOU LISTEN TO A
PODCAST TO LEARN ABOUT WHAT GOES
INTO STARTING RUNNING AND GET
BEING INVOLVED IN PAIN RESEARCH
STUDIES.
WAS THERE A DIRECT QUESTION
ASKED TO PATIENT, ARE YOU OR HOW
INTEREST THE ARE YOU IN LEARNING
ABOUT THE RESULTS OF NIH-FUNDED
RESEARCH?
LIKE NEW PAIN TREATMENTS OR
THEIR INTEREST IN UNDERSTANDING
THE RESULTS OF THE RESEARCH?
>> THERE WAS NOT A QUESTION
DIRECTLY ASKING THAT, THAT ALL
CAME UP THROUGH OPEN RESPONSE,
QUALITATIVE DATA.
SO ON OUR SURVEY, WE DID
SPECIFICALLY ASK ABOUT THE
PODCAST, AND THEN WE HAD
BASICALLY IMAGINED TWO THEMES.
AND WITHIN THOSE THEMES, I CAN
PULL THEM UP BECAUSE I DO HAVE
THE EXCEL FILE.
SO ONE THEME WAS HOW DOES
RESEARCH WORK, AND WE BASICALLY
GAVE LIKE OPTIONS OF WHAT
PODCAST TOPICS COULD COVER, SO
LIKE TYPES OF RESEARCH, WHY IS
PAIN RESEARCH IMPORTANT, AND
THEN THE SECOND THEME WAS HOW TO
GET INVOLVED IN RESEARCH.
AND SO IT WAS PRESENT ON THE
SURVEY ITSELF IN TERMS OF THEMES
WE WERE ASKING THEM IF THEY WERE
INTERESTED ABOUT.
BUT WE DIDN'T EXPLICITLY ASK THE
QUESTION THAT YOU'RE GETTING AT,
BUT I THINK BECAUSE IT WAS
INCLUDED IN THE SURVEY,
PARTICIPANTS KNEW THAT THAT WAS
ONE.
MAJOR THEMES, SO IN THEIR OPEN
RESPONSES THEY CAME UP WITH THE
FUNDING PROCESS.
>> YEAH, I SAW -- I MEAN, I SAW
THAT IT KIND OF EMERGED IN THE
OPEN-ENDED WHERE PEOPLE WOULD
SPONTANEOUSLY SAY, OH, I'M
INTERESTED IN THESE ALTERNATIVE
TREATMENTS AND WHAT IT MAY MEAN
OR, YOU KNOW, AS ONE EXAMPLE.
BUT I JUST FOUND MYSELF REALLY
CURIOUS ABOUT THAT PIECE BECAUSE
HAVING WORKED WITH PATIENTS FOR
20 YEARS, THEY'RE LOOKING FOR
RELIEF, AND I'M JUST THINKING,
YOU KNOW, IF NIH IS DOING ALL
THIS GREAT RESEARCH AND WE'RE
FUNDING IT AND WE HAVE THOSE
RESULTS THAT WOULD BE MEANINGFUL
TO PATIENTS BUT THIS WOULD BE A
PATHWAY TO DISSEMINATE THOSE
FINDINGS TO THEM, THAT THAT
MIGHT BE OF HUGE INTEREST BUT IT
MIGHT HAVE BEEN REVEALED IN A
DIMINISHED WAY IN THE SURVEY
BECAUSE IT WASN'T EXPLICITLY
TARGETED, IT WAS A LITTLE BIT
MORE AT THE OUTSET ABOUT THEM
BEING INVOLVED IN PAIN RESEARCH.
BUT CORRECT ME IF I'M WRONG.
>> NO, NO, I THINK YOU'RE RIGHT.
UNFORTUNATELY FOR TIME'S SAKE, I
DIDN'T PRESENT EVERY SINGLE
QUESTION THAT WE ASKED ON THE
SURVEY.
AND I CAN SEND YOU THE SLIDE
DECK THAT I SENT TO THE
PARTICIPANTS THAT HAS A MORE
COMPREHENSIVE LIST OF THE
QUESTIONS, AND YOU WILL SEE THAT
THAT QUESTION WAS SORT OF MORE
EXPLICITLY ASKED, AND RECEIVED
LIKE A POSITIVE REVIEW, I THINK
IT WAS ABOUT 70% THAT SAID THAT
WAS SOMETHING THEY'D BE
INTERESTED IN.
>> THANK YOU.
>> KATE, DO YOU HAVE A QUESTION?
>> I WANTED TO JUST FIRST THANK
YOU FOR A GREAT PRESENTATION,
GIULIA, HAVING TAKEN THE SURVEY
AND DISTRIBUTED TO A LOT OF
PEOPLE WITH LIVED EXPERIENCE.
IT WAS INTERESTING TO SEE HOW
YOU PRESENTED WHAT PEOPLE CAME
UP WITH, AND YOU MAY BE
ADDRESSING THIS IN YOUR NEXT
SLIDE SO I MAY BE ANTICIPATING,
BUT WHAT WOULD THE PLAN BE THEN
FOR NIH TO DO SOMETHING LIKE
OPPOSITE PAIN POLICY DIRECTOR'S
TYPE BLOG THAT GOES OUT TO THE
PUBLIC AS A DIGITAL THING TO
HOSE SOME WEBINARS?
WHAT IS THE THINKING ABOUT HOW
TO USE THIS INFORMATION?
>> YEAH, GREAT QUESTION.
AND WE'RE STILL WORKING ON THIS
BECAUSE WE'RE STILL WORKING WITH
OUR COMMS OFFICE TO SEE WHERE WE
CAN COLLABORATE AND WHAT WE CAN
GET APPROVED, BUT IT ESSENTIALLY
LIKE YOU SAID, WE WOULD LOVE TO
SEE A SERIES OF WEBINARS THAT
ARE BASICALLY PROVIDING
EDUCATION AND TRAINING ON THESE
TOPICS THAT PEOPLE WITH LIVED
EXPERIENCE EXPRESSED INTEREST IN
LEARNING ABOUT.
AND HOW FUNDING GETS ALLOCATED,
WE THINK THERE ARE A LOT OF
OPPORTUNITIES TO BASICALLY,
LIKE, AMPLIFY ALREADY EXISTING
RESOURCES.
AND THEN FIND A WAY TO, LIKE
POSSIBLY THROUGH A NEWSLETTER OR
A BLOG HIGHLIGHT SOME OF THAT
CONTINUING RESEARCH ONCE PEOPLE
UNDERSTAND HOW THE RESEARCH
PROCESS WORKS, AND HOW TO DIGEST
RESEARCH AND, LIKE, DIGEST AN
ARTICLE.
>> I MEAN PURPOSE HAS A LOT OF
GOOD WEBINARS ON THAT ALREADY,
SO HIGHLIGHTING THOSE WOULD BE
GREAT.
THANKS.
>> YEAH, OF COURSE.
CHRISTINE, I SAW YOUR COMMENT IN
THE CHAT AND I AGREE AND VERY
WELL ALIGNED WITH THE RESULTS AT
LEAST THAT WE SAW IN THIS
SURVEY.
IF THERE AREN'T ANY OTHER
QUESTIONS, I ACTUALLY WOULD LIKE
TO SHARE MY SCREEN AGAIN BECAUSE
I DO HAVE SORT OF AN ASK FOR THE
GROUP.
BASICALLY WE DID THIS SURVEY --
ARE YOU SEEING THE REGULAR
PRESENTATION VIEW?
>> WE ARE, YES.
>> OKAY.
SO WE DID THE SURVEY WITH OUR
PATIENT ADVOCACY NETWORKS.
AS I MENTIONED, A AND IT JUST GT
US THINKING THAT IF WE DO SOME
REVAMPING OF THE NIH PAIN
CONSORTIUM AND OFFICE OF PAIN
POLICY WEBSITE AND POSSIBLY THE
IPRCC WEBSITE, WHAT ARE WAYS
THAT WE COULD MAKE THE WEBSITE
MORE MEANINGFUL TO DIFFERENT
AUDIENCES, NOT ONLY THOSE WITH
LIVED EXPERIENCE BUT
RESEARCHERS, HEALTHCARE
PERSONNEL, CLINICIANS,
POLICYMAKERS, ET CETERA.
SO WE'RE THINKING OF DOING A
SORT OF SIMILAR SURVEY WHERE WE
SURVEYED THE COMMUNITY THAT
INTERACTS WITH OUR WEBSITES AND
SEE HOW WE CAN MAKE THE CONTENT
MORE FINDABLE, MORE MEANINGFUL,
ET CETERA.
SO FROM THIS GROUP, I WOULD LOVE
FEEDBACK.
YOU CAN EITHER SAY THIS IN THE
CHAT, FOLLOW UP WITH US AFTER,
OR RAISE YOUR HAND AND LET US
KNOW NOW, BUT TO BE ABLE TO MAKE
THE WEBSITE MORE RELEVANT TO
DIFFERENT AUDIENCE, WHAT
QUESTIONS DO YOU THINK WE SHOULD
ASK ON SUMP A SURVEY TO GAUGE
INTEREST ON WEBSITE CONTENT, AND
THEN IF YOU HAVE THOUGHTS ON
SPECIFICALLY WHAT CONTENT YOU
THINK RESEARCHERS WOULD WANT TO
SEE, SAME FOR CLINICIANS,
HEALTHCARE PERSONNEL, THOSE WITH
LIVED EXPERIENCE, POLICYMAKERS
AND OTHER FEDERAL COLLEAGUES,
AND THE OTHER CONTENT LIKE I
MENTIONED, NOT TO ALWAYS HAVE TO
REINVENT THE WHEEL BUT CONTENT
THAT WE COULD LINK TO FROM OTHER
AGENCIES OR ANY OTHER GENERAL
FEEDBACK FOR A SURVEY THAT WE
COULD DISTRIBUTE TO SOME OF
THOSE OTHER STAKEHOLDERS THAT
MIGHT VISIT OUR WEBSITE.
BETH?
>> I LOVE THE IDEA OF MAKING
CONTENT THAT KIND OF HITS A LOT
OF THE POINT THAT HAVE BEEN REA
VEALED IN YOUR SURVEY, AND MAYBE
WOULD BE REVEALED IN FUTURE
SURVEYS.
SO LIKE FOR INSTANCE, YOU
COULD -- THERE'S A NEW STUDY
THAT CAME OUT THAT WAS FUNDED BY
SORT OF A RELEVANT INSTITUTE OR
AGENCY, COULD BE HIGHLIGHTED IN
A RESEARCH SPOTLIGHT, BUT YOU
COULD ALSO HIGHLIGHT BOTH WHAT
IT MEANS, IS THIS ACCESSIBLE,
ARE THERE OTHER SIMILAR STUDIES
CURRENTLY UNDERWAY SO THEN
PATIENTS COULD SEE IF THEY WANT
TO GET INVOLVED, SO FINDING WAYS
TO KIND OF LIKE KEY OFF OF
SOMETHING THAT'S BEING
SPOTLIGHTED, AND THEN KIND OF
DIVE INTO THESE OTHER AREAS THAT
THEY'RE SAYING IS -- THAT
THEY'RE INTERESTED IN.
ARE THERE STUDIES THAT ARE
ENROLLING, HOW DO I GET
INVOLVED, THOSE TYPES OF THINGS
THAT MIGHT KEEP PEOPLE FOCUSED
ON THE PAGE AND INTERESTED IN
LEARNING MORE.
>> YEAH, I LIKE THAT IDEA.
THANK YOU.
>> KATE?
>> I THINK IT'S A GREAT IDEA TO
SURVEY MORE BROADLY.
I THINK MAKING THE INFORMATION
SORT OF LITERATE TO A BROAD
AUDIENCE, WHETHER IT BE A PERSON
WITH LIVED EXPERIENCE OR
POLICYMAKER, AND I AGREE IT'S
IMPORTANT IF YOU'RE DOING THESE
COMMUNICATIONS TO TARGET ALL OF
THESE SORT OF AUDIENCES BECAUSE
THEY ARE ALL RELEVANT.
I MEAN, ONE OF THE WAYS THAT I
KNOW THIS GRANT IS BEING
SUNSETTED BUT ONE OF THE WAYS
THAT THAT HAPPENED WITH HEAL
CONNECTIONS WAS JUST HAVING
STAKEHOLDERS INVOLVED IN THE
COMMUNICATION PROCESS THAT WOULD
REVIEW EVERYTHING THAT WENT OUT,
SOMETHING THAT DOESN'T WORK FOR
THIS INTEREST GROUP, BUT I THINK
THE IDEA OF A PULMONARY SURVEY
OF OTHER SORT OF RELEVANT
INTEREST HOLDERS IS A GREAT ONE.
>> YEAH, THANKS.
AND I DO THINK THAT'S AN
IMPORTANT POINT THAT ONE OF THE
THINGS THAT DID COME UP IN THE
SURVEY BUT I DIDN'T INCLUDE ON
THE RESULTS BECAUSE IT WASN'T
ANSWERING A SPECIFIC QUESTION
WAS JUST THE FRUSTRATION OF
RESEARCHERS OR LIKE ENTITIES
GOING AHEAD AND DOING THINGS
WITHOUT INVOLVE THOSE WITH LIVED
EXPERIENCE, SO WE WOULD LIKE TO
HAVE RELEVANT STAKEHOLDERS
PROVIDE INPUT ON PART OF OURS OR
WEBSITE THAT ARE RELEVANT TO
THEM, TO MAKE SURE IT'S USEFUL
OBVIOUSLY.
SO IF THERE AREN'T ANY OTHER
COMMENTS, I CAN STAY ON AND JUST
CHECK THE CHAT, AND THEN I CAN
ALSO PUT MY EMAIL IN THE CHAT
AND THE SLIDES WILL GO OUT SO IF
OTHER IDEAS COME UP, YOU CAN
FEEL FREE TO REACH OUT, OF
COURSE.
>> THANK YOU SO MUCH, GIULIA,
REALLY APPRECIATE YOU PRESENTING
AND THANK YOU FOR ALL YOUR
FEEDBACK.
LOOK FORWARD TO ANI ANY OTHER
FEEDBACK YOU END UP HAVING.
WITH THAT WE'LL TRANSITION TO
OUR LAST SPEAKER, CAROLYN
CONLIN, WHO IS ALSO A MEMBER OF
THE OFFICE OF PAIN POLICY AND
PLANNING, PROGRAM MAN JER HERE
INJER HEREIN THE OFFICE AND I WR
TAKE IT AWAY TO PRESENT OUR LAST
IDEA.
>> AWESOME.
THANK YOU, LAURA.
AND THANK YOU FOR SHARI SLID SHY
SLIDES AS WELL.
AND LLOYD, IF YOU COULD PUT IT
IN PRESENTATION MODE, I'D
APPRECIATE THAT.
SO WE'RE LOOKING AT POTENTIALLY
CREATING A WORK GROUP ON
COMMUNICATION AND DISSEMINATION.
BASED ON THESE CONVERSATIONS, I
THINK THEY'D BE REALLY GREAT.
WE CAN TALK ABOUT EXACTLY
DIFFERENT OPTIONS ON CREATING
IT, IF YOU SEE A NEED IN IT.
SO WHAT WE'RE SEEING ON OUR SIDE
IS WE'RE HAVING CHALLENGES WITH
FRAGMENTED RESEARCH.
THERE'S A LACK OF CENTRALIZED
INFORMATION, AND LIMITED SHARED
FINDINGS ON OUR RESEARCH, WHAT
THE V.A. IS DOING, AHRQ AND SO
ON, AND SO WHAT WE'D LIKE TO SEE
IS TO ADDRESS COMMUNICATION GAPS
AND REDUCE SILOING, INCREASE
OPPORTUNITIES AND INTERVENTIONS
ACROSS THE FEDERAL AGENCIES.
SO WHAT A SOLUTION THAT WE'RE
THINKING ABOUT IS CREATING A
COMMUNICATIONS AND DISSEMINATION
WORK GROUP WITHIN THE IPRCC.
THE WORK GROUP'S ROLE WOULD
SERVE AS A QHEUN COMEUNCATION
LIAISON AND CONNECT AGENCY
CONTACTS AND ENHANCE WEBSITE
RESOURCES.
THE WORK GROUP COMPOSITION IS UP
FOR DISCUSSION AND WE CAN TALK
ABOUT THAT IN A MOMENT.
IT COULD CONSIST OF IPRCC MEM
MEMBERS, THEIR COMMUNICATIONS
TEAMS, JUST THEIR COMMUNICATIONS
AND THEN OR, LIKE COMMUNICATIONS
TEAMS WITHIN ALL THE IPRCC
MEMBER, JUST THE FEDERAL
AGENCIES, IS SOMETHING WE CAN
TALK ABOUT MORE.
AND THIS WOULD REALLY HELP
DISCUSS BEST PRACTICES AND
SUCCESSFUL COMMUNICATION
STRATEGIES.
I KNOW IT'S WITHIN OUR PAST WORK
GROUPS, SPECIFICALLY I THINK IT
WAS IMPLEMENTATION SCIENCE, WE
TALKED ABOUT HOW OTHER AGENCIES
HAVE DONE REALLY WELL, SO THIS
WOULD BE A GOOD OPPORTUNITY TO
TALK MORE ABOUT THOSE LESSONS
LEARNED FROM AGENCIES THAT HAVE
DONE REALLY WELL ON
DISSEMINATING DIFFERENT
EFFECTIVE APPROACHES.
AND THEN WE CAN ALSO LEARN FROM
INDIVIDUALS WITH LIVED
EXPERIENCES AND RESEARCHERS IN
THIS WORK GROUP.
SO THERE'S DIFFERENT OPTIONS IF
THIS TEAM FEELS THERE IS A NEED
TO INCREASE COMMUNICATION AND
DISSEMINATION ON PAIN.
SO A FEW OPTIONS, ONE, THIS
GROUP DOESN'T FEEL THERE IS A
NEED, A WORK GROUP IS NOT
NEEDED.
TWO, THERE IS A NEED AND WE CAN
ADDRESS THOSE COMMUNICATION
NEEDS WITHIN EXISTING WORK
GROUPS, SUCH AS THE RESILIENCE
OF PREVENTION, WORKFORCE AND
IMPLEMENTATION SCIENCE.
OR OPTION THREE, THERE IS A
NEED, AND WE NEED A WORK GROUP
TO CREATE -- TO ADDRESS THESE
COMMUNICATION CHALLENGES, AND
THE MEMBERS WOULD CONSIST OF
ONLY FEDERAL COMMUNICATIONS
TEAMS.
AND THEN OPTION FOUR, THERE IS A
NEED, WE COULD CREATE A WORK
GROUP ON THIS AS WELL, AND THE
MEMBERS WOULD BE OPEN TO ANY
IPRCC MEMBERS AND THEIR
COMMUNICATIONS TEAMS.
SO THAT'S IT.
SO WHAT I'D BE INTERESTED IN,
WHAT WE'D ALL BE INTERESTED IN
IS IF YOU COULD PUT IN THE CHAT,
RAISE YOUR HAND, EMAIL ME, WE
COULD GET UP A VOTE AND SEE WHAT
OPTIONS THE GROUP IS WANTING AS
A WHOLE.
AND THEN AFTER I WOULD LIKE TO
ASK THE FEDERAL MEMBERS TO SEND
ME WEBSITES, SPECIFIC
COMMUNICATIONS CONTACTS, TO GET
THE WORD OUT ON RESEARCH, ON
TREATMENTS AND EVERYTHING THAT
WE'RE DOING IN THE IPRCC.
SO ACTUALLY SOPHIA, IF YOU COULD
GO BACK TO THE -- ACTUALLY YOU
CAN UNSHARE.
I'M TRYING TO THINK HOW THIS
WOULD BE BEST.
YOU COULD UNSHARE AND THEN WE
CAN TALK MORE ABOUT THE
DIFFERENT OPTIONS.
THANK YOU, SOPHIA.
AND I'M JUST READING THE CHAT
NOW.
SO IT LOOKS LIKE SOME PEOPLE
THINK THERE IS A NEED, I'M GLAD
TO HEAR THAT, WE DO AS WELL.
I'D LIKE TO HAVE YOUR IDEAS ON,
LIKE, IF IT SHOULD BE ALL IPRCC
MEMBERS AND THEIR COMMUNICATIONS
TEAMS OR JUST COMMUNICATIONS
TEAMS OF THE FEDERAL MEMBERS.
I'M SEEING MORE OPTION FOUR.
THANK YOU ALL FOR -- THANK YOU,
MONICA AND SCOTT, KATE, BETH,
FOR PUTTING ALL THIS IN THE
CHAT.
>> IT DOES LOOK LIKE BETH AS
HAND IS RAISED.
DO YOU ALSO WANT TO JUMP IN AS
PEOPLE ARE PUTTING INFORMATION
IN THE CHAT?
>> YEAH, THANK YOU.
THIS IS TERRIFIC, CAROLYN.
AND I MEAN, I WAS JUST STRUCK BY
COMMONALITIES IN THE WORK GROUP
PRESENTATIONS, AND EVERYBODY IS
SERVING THE NATIONAL LANDSCAPE
IN THEIR RESPECTIVE AREAS, AND
SO DI JUST SORT OF FEEL LIKE --
IT'S ALMOST LIKE THERE NEEDS TO
BE A CORD NATEED UMBRELLA WHERE
YOU KNOW -- AND MAYBE THIS WOULD
BE THE PURVIEW OF THIS
COMMUNICATION GROUP WHERE IT'S
JUST LIKE -- WHICH ARE ALL OF
THE RELEVANT INSTITUTES,
AGENCIES, WHO ARE THE CONTACTS,
AND SORT OF LIKE SYNTHESIZING
THAT SO THEN WHEN EACH WORK
GROUP HAS A SURVEY OR WE'RE
READY TO REACH OUT, WE MIGHT
WANT TO COMBINE THAT ACROSS WORK
GROUPS OR MAYBE IT'S INDIVIDUAL,
BUT JUST SO THAT WE'RE NOT EACH
WORK GROUP REINVENTING THE WHEEL
BUT THERE IS, YOU KNOW, REALLY
SHARED INFORMATION AND I THINK
THAT BECAUSE WE'RE ALL TRYING TO
GET UP TO SPEED ON THE NATIONAL
LANDSCAPE, WE'RE ALL DOING THIS
SAME THING, SO THIS COULD CREATE
MASSIVE EFFICIENCIES FOR ALL OF
US, IF WE JUST KIND OF -- I
MEAN, EVEN A SPREADSHEET, LIKE
THESE ARE THE PEOPLE -- BUT
THERE MAY ACTUALLY BE ADVANTAGES
TO REALLY THINKING IT THROUGH
BEFORE WE REACH OUT TO PEOPLE
INDIVIDUALLY, JUST TO BE SURE
WE'RE BEING STRATEGIC IN OUR
COMMUNICATIONS SO WE'RE NOT
BLASTING PEOPLE EITHER WITH
OVERLAPPING QUESTIONS OR
MULTIPLE EMAILS AND THEN RISKING
NOT ANSWERING SOME OF THEM.
I DON'T KNOW.
BUT IT FELT TO ME LIKE AS YOU
WERE PRESENTING THAT IT'S REALLY
GREAT BECAUSE THERE'S A BIT OF A
STRATEGY HERE THAT COULD BEING
APPLIED TO EVERYTHING THAT WE'RE
DOING.
>> I AGREE, BETH.
IT IS SOMETHING THAT EVERY
SINGLE WORK GROUP, THERE HAS TO
BE A DISSEMINATION IN WHATEVER
WE'RE CREATING.
AND THEN I THINK SPECIFICALLY
TOO, JUST FROM THE FEDERAL
PARTNERS, IT WOULD BE REALLY
HELPFUL IF WE COULD DIVE IN AND
FIGURE OUT WHO THOSE PEOPLE ARE
AND DO THE WORK ON THAT.
WELL, BASED ON THE CHAT, IT
LOOKS LIKE OPTION FOUR IS WHAT
MOST MEMBERS WANT TO DO.
IF YOU DISAGREE, PLEASE EMAIL,
PUT IN THE CHAT OR SPEAK UP NOW.
WHAT WE CAN DO IS START WORKING
ON THIS AND THEN TINA -- I WILL
CONNECT WITH YOU.
WE'RE FINE TO DO THE WORK IF YOU
COULD POINT US IN THE DIRECTION
OF WHO THOSE COMMUNICATION
MEMBERS COULD BE AND THEN WE CAN
EVEN GO FURTHER.
SO THAT WOULD BE GREAT IF YOU
COULD HELP WITH THAT, AND THEN
THE REST OF THE IPRCC MEMBERS,
YOUR COMMUNICATIONS TEAMS AS
WELL WOULD BE GREAT.
SO THANK YOU.
>> THANKS, CAROLYN.
JUST WANT TO OPEN IT UP TO SEE
IF THERE'S ANY PUBLIC COMMENTS
THAT THE GROUP HAS.
HEARING NONE, I WILL HAND THIS
BACK OVER TO HELENE.
>> THANK YOU SO MUCH, LAURA,
WOW, THIS HAS BEEN SUCH A GREAT
MEETING.
I REALLY WANT TO THANK
EVERYBODY.
WE ALL SURVIVED WITHOUT LI LIND.
I REALLY, REALLY WANT TO THANK
ESPECIALLY LEAH AND CAROLYN FOR
HELPING, YOU KNOW, RUNNING THE
MEETING SMOOTHLY AND FOR LAURA
FOR DOING SUCH A GREAT JOB
MODERATING, AND I WANT TO THANK
ALL OF YOU BECAUSE WHAT WE'VE
REALLY HEARD IS A LOT OF
ENGAGEMENT, ALL THE WORK THAT
YOU ALL DID IN BETWEEN OUR --
SINCE OUR LAST MEETING ON THE
WORKING GROUP REALLY CAME
THROUGH BEAUTIFULLY.
SO I REALLY LOVE HOW THIS
MORNING, WE SAW ALL THE UPDATES
FROM THE DIFFERENT AGENCIES, AND
THEN THIS AFTERNOON, WE SAW A
WHOLE BUNCH OF THEMES WHERE THEY
LOOK LIKE THERE COULD BE A LOT
OF SYNERGY THAT WE CAN NOW START
BUILDING ON.
SO I FEEL LIKE MORNING AND
AFTERNOON SESSIONS COMPLEMENTED
EACH OTHER REALLY WELL.
WE DIDN'T NECESSARILY PLAN IT
THIS WAY, BUT IT JUST HAPPENED.
MAYBE WE DID PLAN IT THIS WAY.
SO I REALLY WANT TO THANK 'ER
ONE.
WE KNOW THIS IS A LOT OF WORK
AND SOMETIMES, YOU KNOW, WHEN
YOU SEE A WHOLE LOT OF REPORTS
ON GOVERNMENT AGENCIES, YOU CAN
GET SORT OF LOST IN THE WEEDS,
BUT I FEEL LIKE WE DID SOME GOOD
WEEDING IN PRESENTING THINGS
HERE THAT WE CAN ACTUALLY ALL
DIGEST TOGETHER AND WORK ON.
SO I'M VERY EXCITED ABOUT ALL OF
THIS.
AND SO IF THERE ARE ANY OTHER
COMMENTS OR ANYTHING THAT
ANYBODY WANTS TO HIGHLIGHT OR
WHAT YOU LIKED OR WHAT YOU
DIDN'T LIKE?
UNTIL NEXT TIME?
OKAY.
WELL, WE'RE GOING TO LET PEOPLE
GO, MAYBE A LITTLE BIT EARLY,
WHICH IS FINE.
AND I REALLY WANT TO THANK
EVERYONE FOR SPENDING THE DAY
TOGETHER.
GREAT MEETING.
I AGREE.
AND WE'LL SEE YOU NEXT TIME.
AND HAVE GOOD HOLIDAYS AND STAY
WARM.
IT'S COLD HERE.
>> THANK YOU SO MUCH.
>> YEAH, THANKS, EVERYONE.
>> THANK YOU.