Page 17
various aspects related to the pain management process, including addressing the industry's lack of interest to invest in developing non-addictive pain medication and addressing opioid use disorders. Since deterring data concerning the development of successful and failed pain medication is one major stumbling block (32), PPPs can be set up that focus on more precompetitive targets, such as the development of data management tools, registries, and shared databases. These data could facilitate the understanding of heterogeneous patient groups and their characteristics when integrated in clinical trials. Also developing biomarkers to stratify patients for trials and demonstrating target engagement, applying new technologies to facilitate pain medication discovery, creating a research trial network, establishing objective pain sensitivity measures, and reengineering preclinical platforms to improve predictive efficacy are topics that can be the focus of early-phase research PPPs. Further, developing subgroups of large cohort studies and repurposing already existing compound, doing molecular profiling to begin validating targets and working on new chemical entities, developing new bioinformatics tools for target discovery purposes and reverse and forward translation, cellular and mechanistic studies are situated in the precompetitive sphere. Another aim of PPPs could be to screen research using preclinical addiction models with focus on reproducibility and reliability of published data. Moreover, PPPs might do research on pharmacogenetics of addiction and focus on working on programs to deliver extended-release formulations of buprenorphine (opioid to treat opioid addiction) in hospital emergency units to prevent opioid overdose, drug-seeking, and drug-taking behavior (32).Depending on the objectives of the partnership, public and private constituencies affected by this societal crisis need to collaborate, such as healthcare practitioners, patients, professional organizations, researchers, educators, pharmaceutical manufacturers, insurers, public health agencies, the criminal justice system, and various governmental institutions at local, state, and federal level, such as the FDA, the Office of National Drug Control Policy (ONDCP), the Drug Enforcement Administration (DEA), and the Substance Abuse and Mental Health Administration (SAMHSA) (24).The National Institute on Drug Abuse (NIDA) focuses its research toward new analgesics, alternative delivery systems and formulations, treatment of opioid abuse and addiction, and prevention of overdose deaths. The recommendations formulated stipulate the need for collaboration for prevention, education, and outreach (29, 33). The standard measure for pain assessment currently available may lack adequacy or accuracy. New evidence-based tools and technology platforms could help to deliver information on how to better treat various subpopulations of patients (34). Furthermore, registries should be set up to gather and process data related to various drugs, patient monitoring, expanded electronic medical records (EMR), and therapy. The theoretical framework is present. However, the concrete implementation of the collaboration between various healthcare actors involved in pain management and treatment of addiction in terms of (precompetitive) research, treatment, prevention, and education is not adequate to tackle the growing crisis (29). More efforts are needed to investigate the development of curricular core competencies in the field of pain management and how to implement new educational approaches. Guidelines and best practices related to risk assessment and management as well as prescription behavior should be developed and implemented in new educational approaches (29). Collaborations should encompass education and training of multiple healthcare disciplines. This new educational models should be taught to the next generation of healthcare providers, including schools of medicine, nursing, physical therapy, and dentistry as well as part of a continuous learning track for all healthcare actors (29).The search for innovative drugs with reduced abuse, tolerance, and addiction risk is situated in a more competitive