Dr. Martucci Awarded NIH Grant for Chronic Pain Research

The National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA) has awarded Duke Anesthesiology’s Katherine Martucci, PhD, a $746,654 R00 grant for her project, titled “The Impact of Opioids on Chronic Pain: Clinical Research and Career Training in Spinal Cord fMRI and Brain Reward Systems.” This work is expected to characterize the effects of long-term opioid use on the central nervous system (CNS) and clinical outcomes in fibromyalgia (FM).

Studies show that there is some evidence of less improvement over time for FM patients taking opioids, yet some FM patients continue to advocate for them, thus creating a controversial issue regarding the use of opioids in this patient population. Martucci’s preliminary data from her previous NIH/NIDA K99 projects reveals that opioids may benefit CNS sensory and reward processes in FM. Her work indicates that spinal cord activity is altered in FM, and that opioids may, in part, normalize the transmission of nociceptive and non-nociceptive information; further suggesting that spinal cord activity may provide an objective measure of opioid effects independent of pain and sensory testing results. However, how spinal cord activity may change over time in opioid and non-opioid FM patients remains unknown.

“Based on earlier findings, I hypothesize that opioids improve CNS abnormalities in FM, despite failing to benefit long-term clinical outcomes,” says Martucci, who joined Duke Anesthesiology as assistant professor within the Center for Translational Pain Medicine on August 31. “To test this hypothesis, the R00 grant provides me the opportunity to extend my initial research by evaluating the effects of opioids on CNS activity in FM longitudinally.” During the R00 phase, she will measure clinical symptoms (e.g. pain, hyperalgesia), reward behavior and CNS activity in FM patients and healthy controls. She will also evaluate how neurophysiology and symptoms change over time in FM patients taking and not taking opioids, with the goal of informing clinical practice about the appropriate use of opioids.

Martucci plans to further characterize opioid effects on CNS activity, brain reward systems and clinical outcomes in FM using 1) clinical trials modulating reward psychology and opioid dose, 2) physiological manipulations of peripheral, spinal and supraspinal activity, and 3) combined analysis of phenotype, neuroimaging and sensory testing data to predict risk/benefits of opioids. Ultimately, these future studies could impact clinical practice by identifying which patients derive physiological benefits from opioids and how much these benefits may be offset by risks of addiction, tolerance or worsening symptoms.