$7.1M NIH Grant Supports Study of Opioid Alternatives to Manage SCD Pain

The National Institutes of Health (NIH) has awarded a $7.1 million grant to University of Illinois Chicago (UIC) researchers to evaluate the effectiveness of two therapeutic strategies as alternatives to opioids in the management of chronic pain in people with sickle cell disease (SCD).

The grant was awarded to co-principal investigators Ardith Doorenbos, PhD, a professor of biobehavioral nursing science, Robert Molokie, MD, an assistant clinical professor of medicine, and Judith Schlaeger, PhD, an assistant professor in the department of human development nursing science.

The award is part of NIH’s Helping to End Addiction Long-term Initiative, which was launched in 2018 to improve pain management, promote the prevention of opioid misuse, addiction, and overdose, and to promote long-term recovery from opioid addiction.

“The opioid crisis in the U.S. is very severe, and some states have had more deaths from opioid overdoses than from car accidents,” Doorenbos, the leading award recipient, said in a press release.

“We’re trying to do what we can to reduce opioid use in the sickle cell disease population who have high pain levels and opioid use. If we can find ways to manage their pain and get them off opioids, it’s going to be fabulous,” Doorenbos said.

Chronic pain, as well as episodes of acute pain caused by a vaso-occlusive crisis, are common and disabling complications of SCD. About one third of SCD patients report daily pain and 50% have enough symptoms to meet a diagnosis of chronic pain syndrome.

SCD-associated pain can affect patients of all ages, leading to frequent missed school days in children and adolescents, and impacting adults’ working lives. Notably, pain is the main cause for hospital admission among people with SCD.

“If we can better manage the pain, we could impact the quality of life and change the possibilities for SCD patients. They can have a plan for activities and have a more productive work situation,” said Doorenbos.

While opioids have been the treatment of choice for managing pain, opioid addiction has been acknowledged as a public health crisis in the U.S., highlighting the need for alternative therapies. Increasing efforts are focused on the development and evaluation of non-pharmacological therapies to reduce both chronic pain and the need for opioids in SCD patients.

Now, Doorenbos and her team will conduct a five-year national study to evaluate which non-pharmacological pain management intervention works best for SCD patients: acupuncture or guided relaxation techniques.

Acupuncture is an ancient healing technique of traditional Chinese medicine practiced for more than 3,000 years to treat a variety of disorders. It involves the strategic placement of thin sterile needles through a person’s skin at specific points in the body.

In traditional Chinese medicine, acupuncture is believed to re-balance a person’s energy flow to improve health, while Western medicine thinks it stimulates the nervous system by releasing chemical signals to the muscles, spinal cord, and brain.

Relaxation techniques, such as meditation, seek to bring the body to a relaxed state, characterized by slower breathing, lower blood pressure, and a feeling of increased well-being.

Previous studies have shown that acupuncture and guided meditation effectively help manage pain in SCD patients.

The future study, a hybrid type 1 effectiveness implementation trial, will assess the effectiveness of acupuncture and guided relaxation in 360 people with SCD, while observing and gathering information on its implementation in three health systems.

These include the University of Illinois Hospital & Health Sciences System, University of Florida Health, and Duke University Health System in North Carolina. Each serves a large SCD patient population and uses EPIC as their electronic health record, which will facilitate data collection and analysis.

Participants will be assigned randomly to receive either acupuncture twice a week for five weeks or to perform guided relaxation techniques, accessible through a smartphone or a computer, at least once a day.

The acupuncture regime was determined by Schlaeger, who also is a licensed acupuncturist, while the relaxation techniques were developed by Miriam Ezenwa, PhD, an associate professor at University of Florida College of Nursing, who also is part of the awarded team.

With this trial, the researchers intend to identify which of the two therapeutic approaches is best to manage SCD-associated pain and to understand how to make them regular practice at three research health systems.

According to the release, the researchers expect to be working with SCD patients in the fall of 2021, pending additional approvals from the UIC Institutional Review Board.

The awarded research team also includes Nirmish Shah, MD, an associate professor at Duke University School of Medicine.