Building a Comprehensive Approach to Treating Pain and Addiction

Approximately 100 million people in the U.S. are affected by chronic and acute pain, which negatively impacts people’s lives in significant ways and increases rates of morbidity, mortality and disability. The opiates traditionally used to treat chronic pain, however, have been implicated in a growing public health crisis known as the opioid epidemic.

In 2017, the U.S. Department of Health and Human Services declared a public health emergency to address the opioid epidemic, which is responsible for the deaths of more than 47,000 people a year in the U.S.

Both issues – chronic pain and the opioid epidemic – are complex, and finding a solution will require a collaborative mindset and a multifaceted approach. That’s where the University of Arizona Health Sciences Comprehensive Center for Pain and Addiction (CCPA comes in.

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“Everybody seems to know somebody with an addiction problem,” said Todd Vanderah, PhD, professor and head of the College of Medicine - Tucson’s Department of Pharmacology, and who also spearheaded the strategic initiative to develop the CCPA. “We don’t do a great job of treating chronic pain, since physicians and insurance plans have been limited to the idea of simply prescribing a medication like opiates. When you look at how many people have troubles with pain and addiction, it’s interesting that nobody has organized a center that focuses on all the aspects – i.e., health care, education, research, clinical trials, legislation, technology – to improve outcomes. That's our goal – we're going to look at all of it as a cohesive group.”

Many CCPA scientists, Dr. Vanderah included, are researching alternatives to opioids and testing those novel molecular compounds in preclinical studies at UArizona. Other CCPA members, including Mohab Ibrahim, MD, PhD, specialize in studying and treating chronic pain.

“When someone comes to us with a chronic pain condition, we do a comprehensive medical exam and history. We try to find out everything that's medically related to the condition, and based on that, we'll come up with a complete plan,” said Dr. Ibrahim, an associate professor of anesthesiology who is CCPA’s interim medical director and director of the Comprehensive Pain Management Clinic. “It's not always medications that help. Sometimes, it’s something as simple as lifestyle modification.”

The CCPA offers researchers an opportunity to build on preclinical studies in medicinal chemistry, drug formulation and pharmacokinetics, with potential clinical trials of Food and Drug Administration-approved investigational new drugs. 

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“It would be like a dream to go from the chemistry of actually making new compounds, all the way through to patient clinical trials and having a novel medication or therapy accepted by the FDA for use worldwide,” Dr. Vanderah said.

“The only way to advance and move forward is to propose new ideas and explore them and see if they can provide any benefits for the patients,” Dr. Ibrahim added. “One of the ways to do that is through research, and that's where the CCPA becomes the perfect bridge between clinical medicine and research medicine. It’s where the pain physicians, pharmacologists, chemists, pharmacists, neuroscientist and biomedical engineers can come together and share ideas.”

In addition to drug development, key parts of the center’s mission include community outreach, education, legislation and technology development.

“I think many physicians don’t know enough about opiates and addiction, but in addition to educating our clinicians is getting the information to the public and into the schools,” Dr. Vanderah said. “I think the biggest impact the new center will have is on our community here, in the state of Arizona. We can help the community with their chronic pain. We can help with understanding one’s addiction, and we can get education out to everybody to better understand how these things can influence the health and wellbeing of patients, their families and friends.”