IPRCC Meeting - 05/05/2017

Introduction

The May 5, 2017 meeting of the Interagency Pain Research Coordinating Committee (IPRCC) was convened at 2:00 p.m. as a conference call.

In accordance with Public Law 92-463, the meeting was open to the public. Walter Koroshetz, MD, Director National Institute of Neurological Disorders and Stroke presided as chair.

In attendance were the following members of the IPRCC:

Federal Members: Walter Koroshetz, MD; Chester Buckenmaier, MD

Scientific Members: Allan Basbaum, PhD; William Maixner, DDS, PhD; Richard Payne, MD

Public Members: Cindy Steinberg; Catherine Underwood, MBA

Ex-Officio Members:

NIH Staff: NINDS Office of Pain Policy –Linda Porter, PhD; Cheryse A. Sankar, PhD; Leah Pogorzala, PhD

Welcome and Call to Order: Walter Koroshetz, MD, Director NINDS

Dr. Koroshetz welcomed everyone and informed the committee of important ongoing activities across the Department of Health and Human Services to reduce the burden of pain and opioid addiction.  Dr. Collins communicated with HHS and pharmaceutical industry representatives regarding support from companies and the highest levels of government to address the opioid epidemic and chronic pain.  Dr. Collins has set up three meetings with industry to develop action items to move forward. We look forward to the intensive month of meetings and hope to come out of it with public/private partnerships to strengthen efforts to address these crises. The meetings were held:

June 5^th – Develop Treatments for Opioid Use Disorders and Overdose Prevention, which will be led by NIDA with Dr. Volkow

June 16^th – Develop Effective and Non-Addictive Treatments for Pain, which will be led by NIDA and NINDS

July 7^th – Understanding the Neurobiological Mechanisms of Pain, which will be led by NINDS.

Discussion points

• The question was raised as to whether new sources of funding would come out of the meetings. The hope is that an initiative similar o the Alzheimer’s Accelerating Medicines Partnership (AMP) could come out of these discussions.
• The agendas for the meetings have not been set. They are invitation-only meetings, organized by Dr. Collins’ office.
• The invitations are not released yet. NINDS requested IPRCC representation. 

Science Advances: Linda Porter, PhD, Director, NINDS Office of Pain Policy

Each year the IPRCC highlights science advances from the pain care field. For 2016 we received 30 suggestions for science advances to highlight and will present summaries of the ten selected by the IPRCC through a voting process. We will contact the first author, then the summaries will be posted on the IPRCC website. Two of this year’s authors serve on IPRCC.

NPS Implementation Phase: Linda Porter, PhD, Director NINDS Office of Pain Policy

At the previous IPRCC meeting, we gave a brief presentation about the structure for the NPS implementation and how to achieve the objectives of the NPS.

• Principles Council
  • The formation of this council is delayed because of the administration transition. Several participating agencies do not yet have principles.
• Steering committee
  • This committee has met several times.
• Work groups
  • These groups are being established.
• Tracking System
  • We have set up a tracking system to collect deliverables, and the results are posted on the IPRCC website.
• Communication with External Partners        
  • We will hold a stakeholder meeting next week – please listen in for updates on NPS implementation.

NPS Implementation Webinar: Linda Porter, PhD, Director, NINDS Office of Pain Policy

Dr. Porter described a webinar, that will be hosted by the Office of the Assistant Secretary and the NIH Office of Pain Policy to highlight ongoing activities that align with the NPS. View the NPS Implementation Webinar for more information about the meeting.

Some highlights of the session will include;

• The Population Research group has made good progress. The session chaired by Richard Nahin from NCCIH will focus on National Health Interview Survey (NHIS) data.  Charles Helmick from the CDC will talk about changes to the NHIS pain question set and will discuss analysis of the 2016 data. The session also will include Michael Von Korff from the Group Health Research Institute discussing a pilot study with Lynn DeBar to look at electronic health data for surveillance studies on pain.
• The Prevention and Care group will highlight work going on at the Department of Defense, presented by Dr. Buckenmaier and Dr. Kerns. Elizabeth Kato will present an AHRQ systematic review of evidence for non-pharmacological treatments for chronic five chronic pain conditions.
• The Service Delivery and Payment group session will feature Dr. Jones from ASPE discussing a pilot study expansion to a national study on coverage of interventions for low back pain. Catherine Underwood from the American Pain Society will report on a partnership with Pfizer to fund grants targeted to the NPS.
• In the Professional Education and Training session, Scott Fishman will provide an update on core competencies for pain care and a survey of the LCME dataset on pain.  In addition, Sharon Hertz from the FDA will present on the FDA blueprint for opioid prescribing, and David Thomas will present information on CoEPEs.
• There will be an open discussion session with brief presentations from external stakeholders.

Federal Pain Research Strategy: Linda Porter, PhD, Director NINDS Office of Pain Policy and Alan Basbaum, PhD, Stanford University

Development: Dr. Porter and Dr. Basbaum gave an overview of the development of the Federal Pain Research Strategy (FPRS) and led a discussion of the priorities that were developed and how to present them in draft form for a public comment form.

The structure for FPRS development included five thematic work groups based on the continuum of pain and disparities. Each group had approximately 12 people and held calls every two weeks for over a year. Some groups had face to face meetings and contacted outside experts. There was a tremendous amount of time put in by the workgroup members, which resulted in the priorities that are presented in this draft. Only priorities considered to be highly significant remain on the list.

In the course of the discussions, several groups developed overlapping priorities.  The work group co-chairs met in Dallas to merge or distinguish overlapping priories and to refine the full set.

Discussion points

• The work groups will be asked to select the one priority they feel will have the most impact on the field, regardless of whether the science is ready to move forward and to select the one priority that has the potential greatest near-term value.

Scoring: Dr. Porter described the voting process to identify top priorities across the groups.  All members were given the opportunity to vote on the priorities based on the questions:

1. To what extent does this research priority address a significant need?
2. To what extent will this research priority be a catalyst for advancing the relevant pain field?
3. To what extent does this priority have the potential to improve patient outcomes at the     individual and population level?

Members also were asked to comment.

Workgroup members scored all the priorities, and then we analyzed the scores both within and across all workgroups.  The FPRS priorities were ranked by score. The scores were all close, without a clear breakpoint. The steering committee recommended that they be presented by quartile.

The group discussed how to present the priorities, and which priorities to keep. It was proposed that the lowest quartile priorities be put into an appendix, while the highest quartile and mid-range priorities be left in the final document.  It was noted that the prevention group started out with a lot of priorities and dropped many before the voting process. The acute pain group has a relatively large number of priorities which are shorter and more specific than other groups who merged many of theirs. The transition group had several priorities merged into other groups. The disparities group kept their priorities separate rather than merging with other groups to maintain their impact.

Process and timeline:

The steering committee asked the IPRCC to focus on two general questions.

1. Do the collective priorities include interests of the agencies of the IPRCC?
2. Are we missing anything that is important?

The IPRCC was asked for input on comments that arose during scoring.

• Disparities priorities 2 and 3 were identified as too broad. The IPRCC was asked whether they should remain separate, be split into more focused priorities, or moved into the preamble to highlight as important but too broad.
  • It was decided that some of their language would be moved into the preamble, leaving two priorities with less detail. It was agreed that the disparities groups would rewrite the priorities.
• Acute priorities 10 and 11 will be combined, based on comments from the voting process.
• Acute Priorities 3, 4, and 5 will be combined.
  •  It was decided that the priority on the autonomic nervous system was unique and should be kept separate, with 4 and 5 combined.

The group discussed the idea of moving low-quartile priorities into an appendix and how to present the remaining priorities.

• There was concern that not all workgroups had priorities in the highest quartile and that priorities not presented in the highest group would be seen as “low priority.” 
• It was noted that there should be a description of the scoring process and that it was important to note that everything scored well, without invalidating the idea of scoring.

It was decided that the priorities would be presented by group with those scoring in the highest quartile noted. Each grouping will also have a “highest impact”  and a  “most immediate impact” priority highlighted.

Next Steps: Dr. Porter noted that minor changes will be made to the document, then a draft will be released one week before a June 1, 2017 public forum. One representative from each workgroup will attend the meeting and present their priorities. They will take questions from the audience as well as those that come in as public comments based on the posted draft. Comments will be considered and the document modified if necessary.

Adjourn: No public comments were submitted.

The meeting was adjourned.

We certify that, to the best of our knowledge, the foregoing minutes are accurate and complete.
 
Linda Porter, PhD
Designated Federal Official
Interagency Pain Research Coordinating Committee
Director, Office of Pain Policy, National Institute of Neurological Disorders and Stroke
 
Walter Koroshetz, PhD
Chair Interagency Pain Research Coordinating Committee
Director, National Institute of Neurological Disorders and Stroke
 
These minutes have been formally approved by the committee.