November 30, 2021—(BRONX, NY)—Albert Einstein College of Medicine and Montefiore Health System have been awarded a National Institutes of Health (NIH) grant to establish a multidisciplinary research center focused on treatments for people with both chronic pain and opioid use disorder (OUD). The Integrative Management of Chronic Pain and OUD for Whole Recovery Research Center at Montefiore Einstein (IMPOWR-ME) will receive $5.1 million for its first two years; additional funding at the same level is expected for the following three years. The grant is part of the NIH’s Helping to End Addiction Long-term Initiative, or HEAL Initiative, which aims to accelerate the pace of scientific solutions to stem the national opioid public health crisis.
In the 12-month period ending in April 2021, more than 75,000 people died in the U.S. from a drug overdose involving an opioid, an increase of 28.5% from the same time last year. During this same time, approximately 600 Bronx residents died from an opioid overdose, signifying the highest overdose death rate in New York City. People with chronic pain and individuals with mental health disorders or who live in poverty are especially vulnerable for opioid overdose deaths.
“People who live with chronic pain are often undiagnosed and untreated for opioid use disorder. At the same time, those with opioid use disorder often have difficulty accessing care for their chronic pain,” said Joanna Starrels, M.D., M.S., the IMPOWR-ME director and principal investigator, associate professor of medicine at Einstein, and an internist and addiction medicine physician at Montefiore. “We need a cohesive approach to find evidence-based treatments that work for people with both conditions. The center will treat the whole person using new approaches to save lives and reduce the devastating impact on our communities.”
Improved Care Access and Integrated Treatment
IMPOWR-ME, one of just four centers in the US, will initially enroll people with OUD to begin three clinical trials at Montefiore and Einstein. In the first study, which will take place at methadone clinics, researchers will evaluate newly available on-site yoga and physical therapy treatments for back pain. The project’s leaders are Dr. Starrels and Shadi Nahvi, M.D., M.S., associate professor of medicine and of psychiatry and behavioral sciences at Einstein, and an internist and addiction medicine physician at Montefiore.
Another study will enroll participants in buprenorphine primary care clinics. Researchers will test the effectiveness of Acceptance and Commitment Therapy (ACT), with and without the Valera smartphone app in addition to existing treatment. ACT promotes mindfulness, acceptance of emotions, and commitment to behavior change while the Valera app provides enhanced care-management and psychological education focusing on self-care, depression, anxiety, pain, and other topics. Vilma Gabbay, M.D., M.S., co-primary investigator on the grant and director of the Psychiatry Research Institute at Montefiore Einstein (PRIME), and Brianna Norton, D.O., M.P.H., associate professor of medicine at Einstein and an internist at Montefiore, will lead this project.
For the third study, physicians seek to help people with chronic pain and OUD start buprenorphine treatment, which is effective for both conditions, while they are hospitalized. Investigators will test a novel strategy for starting buprenorphine treatment that is designed to minimize opioid withdrawal symptoms. Aaron Fox, M.D., M.S., associate professor of medicine at Einstein and a primary care physician at Montefiore, will lead this project.
Engaging the Community, Advancing Health Equity, and Training New Researchers
A distinctive value of the IMPOWR-ME center is its commitment to listen to and respect the experiences of people who have been affected by OUD and chronic pain. Individuals with OUD and chronic pain have faced stigma in healthcare settings and systemic barriers to accessing care. For people of color with OUD and chronic pain, these issues are compounded by racial and ethnic discrimination. Through research, IMPOWR-ME aims to understand and dismantle these hurdles to care.
“We must make sure people affected by chronic pain and OUD are part of the conversation,” said Julia Arnsten, M.D., M.P.H., co-primary investigator on the grant and chief of the division of general internal medicine at Einstein and Montefiore. “Bronx community members and people with chronic pain and OUD will help guide IMPOWR-ME research. They will help develop additional pilot research projects for the center, which will be led by our early-stage investigators.”
The center will treat the whole person using new approaches to save lives and reduce the devastating impact on our communities.
Joanna Starrels, M.D., M.S.
The grant, titled “Integrated Care for Chronic Pain and Opioid Use Disorder: The IMPOWR Research Center at Montefiore/Einstein (IMPOWR-ME),” is funded by the National Institute on Drug Abuse, part of the NIH (RM1DA055437). The HEAL Initiative, Iaunched in April 2018, is focused on improving prevention and treatment strategies for opioid misuse and addiction, and enhancing pain management. For more information, visit: https://heal.nih.gov.