A study published in the May 2005 issues of The Journal of Pain looked at the National Institutes of Health (NIH) funding given for pain and pain-related research. The NIH is the US government's agency for medical research. Its goal is to gain new knowledge to help prevent, detect, diagnose, and treat disease and disability. The authors of the study, David H. Bradshaw, Yoshio Nakamura, and C. Richard Chapman, developed a tool to track grant activity and funding for NIH projects to determine 1) how much money is going toward pain research and 2) the percentage of money pain research receives compared to other research areas.

The idea behind developing the tool and studying funding and grants was to determine if pain is a research priority in the United States. The project was originally started by the United States Cancer Pain Relief Committee. The American Pain Society took over the project in October 2003 and plans to monitor money given to pain research each year.

According to Dr. David Bradshaw, the lead author, cancer is the area currently receiving the most money. "Data recently provided by NIH show that, in 2003 and with projections into 2006, cancer is, by far, the highest funded disease area, and our data on pain grants in 2003 confirm that," Dr. Bradshaw said. The problem is, there is no way of knowing how many of these studies are pain focused, he said. "The NIH tends to lump anything that has to do with pain into a particular definition, and they don't define how they make the decision. The NIH method for tracking research doesn't give us a very well focused picture of what is actually going on with pain," Dr. Bradshaw said.

Dr. Bradshaw and his colleagues came up with a strategy that categorizes research according to how principle investigators describe their own research by reviewing all abstracts in the NIH database of grant awards containing key words relevant to pain. They then assigned a value to the research, depending on its relevance to pain (eg, directly related to pain issues versus an implied or limited relation to pain issues). "Sometimes the abstract or key words never use a pain term, but the focus is very germane to pain issues," Dr. Bradshaw explained.

The results were a little surprising to the researchers. Overall, Dr. Bradshaw and his colleagues set out thinking there was going to be very little funding or grant activity for pain, but were somewhat surprised to find more activity than they expected. "The actual funding amount that NIH reported — about 1% of their budget going to pain research — was in close agreement with what we found," Dr. Bradshaw explained. This has implications for public policy and pain medicine, as policy makers look to researchers to help determine interest and priorities in an area. "Policy makers are looking at the number of researchers interested in pain. In order for the field of pain medicine to move forward, there needs to be researchers active in pain research. There's a bill — the National Pain Care Policy Act, HR 1020 — before Congress right now, that would, among other things, establish a center for research on pain and palliative care as part of NIH. It may be that the work we're doing will help inform that discussion," explained Dr. Bradshaw.

Dr. Bradshaw says that the difficult thing about tracking funding and grants with regard to pain is that many diseases involve pain. "Pain is what brings a patient to a doctor in the first place. The experience of pain can be an indicator that something is wrong, but there is some debate about how to characterize pain when pain is part of a disease process," he explains. "The pain community is specifically interested in research that focuses on pain processes, such as what causes pain and how to relieve it. Research that focuses on the disease process in order to find a cure does not necessarily tell us very much about pain," he said.

According to Dr. Bradshaw, the NIH tends to respond to emergent issues, thus diverting attention and funding from pain research. "Lots of areas are clamoring for attention right now. For example, projected funding for West Nile Virus research will see a 45% increase from $37 million in 2003 to $54 million in 2006, while funding for fibromyalgia research is projected to decrease by 10% from $10 million to $9 million over the same period," he explains. "In order to keep research going in the pain arena, there needs to be some vocal activity, keeping the focus on pain."

Dr. Bradshaw is keeping his focus on pain as well, and currently has an NIH grant in pain and music therapy, where he is "combining several interests in the domain of pain" — complementary and alternative therapies, music theory, and pain. Originally interested in music, Dr. Bradshaw earned his Master's in Music Theory from Indiana University and became interested in psychological responses to music. Dr. Bradshaw received his PhD in Music Psychology from the University of Washington in Seattle and now studies the body's responses to music and the ways in which listening to music reduces the body's psychological and physiological responses to pain. Currently, he's studying how actively listening to music changes how people experience pain. "We bring in normal subjects and measure brain waves, heart rate, skin response and pupil size while applying an electrical stimulation to their fingers. Part of the time, subjects simply sit quietly, and part of the time, they listen to a familiar tune and try to detect pitch errors that we've placed in the tune. The normal physiological responses to pain decrease when subjects are engaged in the listening task, compared to when they have no task," he explained. This grant will probably conclude in another 18 months, Dr. Bradshaw said, underscoring the time and effort every clinical study and grant takes.