Fibromyalgia Research: Challenges and Opportunities, Page 2
If you suffer from fibromyalgia, sometimes called fibrositis, you may experience widespread musculoskeletal pain, fatigue, and tender points; also see the separate “Fibromyalgia Q&A”.
Why Is Basic Research Important to Understanding Fibromyalgia?
The research mission of NIAMS is broad and diverse. Progress in one area of the Institute provides important clues for research in other areas. Similarly, progress in areas supported by other NIH institutes can and does provide valuable information for diseases within the NIAMS research portfolio. That is why it is essential to support studies across the research spectrum and to encourage cross-fertilization of knowledge from experts in many disciplines. Studies on the neuroendocrine system, pain and sleep disorders, and rheumatic and autoimmune diseases all may lead to a better understanding of fibromyalgia.
Since not all the outcomes can be anticipated, and it is hard to know where scientific advances will come from, NIAMS strives to support and maintain a diverse research portfolio. This is especially important in fibromyalgia, where many areas are being developed simultaneously. Advances against fibromyalgia require both basic and clinical research projects. Because basic research appears so far removed from actual patients coping with the disease, the benefits derived from this type of research may not be so obvious.
For many diseases and conditions, including fibromyalgia, basic research must be done in order to obtain fundamental clues that direct research in humans. Basic research is usually done in systems that are simpler than the human system, so that the experimental variables can be manipulated to observe changes in structure and function. This provides a general understanding of biological events that may affect humans. Simpler organisms used include bacteria, yeast, fruit flies (Drosophila), and mice. For example, researchers study the fruit fly because it is more complex than a bacterium, but can easily be maintained in a laboratory. In addition, fruit flies have been studied for many years, and a great deal is known about their genetics, biochemistry, and behavior. Scientists recently discovered that mutations in the human version of a gene that controls fruit fly growth and development are the likely cause of both the basal cell nevus syndrome, a rare inherited disorder, and sporadic basal cell carcinoma of the skin, the most common human cancer. In terms of fibromyalgia research, studies in fruit flies may tell us which molecules link sleep and consolidation of long-term memory. Understanding this relationship in fruit flies may provide clues and research tools that will enable investigators to learn why people with chronic sleep disturbances experience problems with memory.
Why Is Behavioral Research Important to Understanding Fibromyalgia?
Behavioral and social sciences research is an important area of investigation at NIH and cuts across a wide range of research topics. NIAMS has long supported behavioral research related to many rheumatic and musculoskeletal conditions. Behavioral and social factors are significant contributors to health and illness, frequently interact with biological factors to influence health outcomes, and represent critical avenues for treatment and prevention.
Behavioral and social sciences research encompasses a wide array of disciplines. The field employs a variety of methodological approaches including surveys and questionnaires, interviews, randomized clinical trials, direct observation, physiological manipulation and recording, descriptive methods, laboratory and field experiments, standardized tests, economic analyses, statistical modeling, ethnography, and evaluation. In addition, several key crosscutting themes are characteristic of social and behavioral sciences research. These include an emphasis on theory-driven research; the search for general principles of behavioral and social functioning; the importance ascribed to a developmental, life-span perspective; an emphasis on individual variation and variation across sociodemographic categories such as gender, age, and sociocultural status; and a focus on both the social and biological context of behavior.
Behavioral and social sciences research is important to understanding how to better treat some of the clinically challenging symptoms that are experienced by fibromyalgia patients. Research opportunities include behavioral research on all aspects of fibromyalgia, including the relationships among disturbed sleep, inactivity, pain, and depression that are often observed in patients with fibromyalgia, and the development of innovative approaches for treatment.
How Are Fibromyalgia Grants Selected for Funding by NIAMS?
NIAMS currently supports research on fibromyalgia through investigator-initiated research projects, Institute-solicited studies (funded in response to a request for applications [RFA]), and Multipurpose Arthritis and Musculoskeletal Diseases Research Centers. In general, most of the research projects funded by NIH are unsolicited investigator-initiated grants. NIAMS has made awards in the area of fibromyalgia for projects resulting from both solicited and unsolicited applications.
Applications submitted to NIH go through a two-step peer review system. The design of this system is such that applications from researchers are reviewed first by study sections for their scientific merit. Applications for research on fibromyalgia may be reviewed by the Chronic Fatigue Syndrome Special Emphasis Panel or by other relevant panels, depending on the expertise required. The second level of review is each Institute’s advisory council, which assesses the relevance and priority of proposed projects, and makes recommendations on funding particular meritorious applications.
Primary consideration for funding is scientific merit. This is determined during the review process and is reflective of the soundness and innovativeness of the approach, the qualifications of the investigators, the potential significance of the work, and the overall research environment. This process is used throughout NIH for applications in all diseases and areas of science. The reviewers are asked to evaluate the significance of the research proposal in terms of improving understanding of an area of research or disease, advancing scientific knowledge, learning about the mechanisms that cause symptoms and signs of disease, or developing new treatments or prevention strategies.
Research Initiatives
New Directions in Pain Research — Program Announcement. In September 1998, NIAMS joined 10 other NIH components in issuing a program announcement (PA) entitled “New Directions in Pain Research.” The purpose of the PA is to inform the scientific community of broad, shared interests in pain research across the various components of the NIH, and to stimulate and encourage a wide range of basic, translational, and patient-oriented clinical studies on pain. Applications are encouraged to study pain throughout the life span from the perspectives of molecular genetics; transcriptional controls; signal transduction, including cellular/molecular mechanisms; innovative imaging technologies; plasticity; and hormonal or gender influences. The goal of the PA is to advance the development of novel pain interventions, treatments, and management strategies.
Basic and Clinical Research on Fibromyalgia — Request for Applications. In March 1998, NIAMS issued an RFA to promote research studies and exploratory/developmental projects to advance understanding of fibromyalgia and related disorders and provide critical new knowledge needed for the treatment and prevention of the syndrome. Several NIH institutes and offices joined NIAMS in issuing this RFA. These include the National Institute of Dental and Craniofacial Research (NIDCR), which has an interest in pain and the relationship between temporomandibular disorders and fibromyalgia; the National Institute of Neurological Disorders and Stroke (NINDS), which has an interest in pain research; and three offices within the NIH Office of the Director: the National Center for Complementary and Alternative Medicine, the Office of Research on Women’s Health, and the Office of Behavioral and Social Sciences Research.
In addition to the announcement being listed in the usual manner on the World Wide Web in the NIH Guide to Grants and Contracts, NIAMS distributed over 1,600 copies of the announcement to individual investigators and organizations to stimulate an interest in fibromyalgia research. NIAMS grantees in fibromyalgia, arthritis, and muscle diseases, as well as in the Centers program, received copies, as did grantees NIH-wide in the fields of chronic pain, chronic fatigue syndrome, sleep, neuroendocrinology, and other related fields.
As a result of the RFA, NIAMS and its sister institutes and offices funded 15 new fibromyalgia projects — totaling more than $3.6 million — in 1999.
Acupuncture Clinical Trials — Program Announcement. In February 1998, the NIH Office of Alternative Medicine (now the National Center for Complementary and Alternative Medicine), along with six NIH institutes, including NIAMS and NINDS, and the Agency for Health Care Policy and Research, issued a PA entitled “Acupuncture Clinical Trial Pilot Grants.” The objective of the PA is to increase the quality of clinical research evaluating the efficacy of acupuncture for the treatment or prevention of disease and accompanying symptoms. Back pain, cancer, fibromyalgia, temporomandibular disorders, HIV/AIDS, and reflex sympathetic dystrophy are among the diseases and conditions identified in the PA.
NIH Pain Research Consortium — Conferences. The NIH-wide Pain Research Consortium encourages information sharing and collaborative research efforts, provides coordination of pain research across all NIH components, and ensures that results of NIH-sponsored pain research are widely communicated. A major goal of the Consortium is to coordinate efforts across the many NIH components to develop a better understanding of what causes pain, so better treatments are available to people with painful disorders such as fibromyalgia. The Consortium sponsored a symposium entitled “New Directions in Pain Research” on November 20-21, 1997, and a second conference entitled “Gender and Pain” on April 7-8, 1998.
Molecular Biology and Genetics of Sleep and Sleep Disorders — Request for Applications. In fiscal year 1997, NIAMS awarded two grants submitted in response to an RFA issued by the National Heart, Lung, and Blood Institute, NIAMS, and several other NIH institutes. The NIAMS grants are basic research studies and focus on rest and long-term memory consolidation in fruit flies and on the genetics of sleep and rest behavior in mice.
The Neuroscience and Endocrinology of Fibromyalgia: A Scientific Workshop. In July 1996, NIAMS and several other NIH organizations sponsored a scientific workshop that explored advances in the neuroscience and endocrinology of fibromyalgia. The workshop focused on chronic pain, neuroendocrinology, and sleep disorders associated with fibromyalgia. What made this workshop so unusual and effective was its design, which brought together researchers in the basic sciences of chronic pain, neuroendocrinology, circadian rhythms, and sleep disorders — all challenges for patients with fibromyalgia. These experts in basic research were joined by clinicians who treat patients with fibromyalgia and by a significant number of patients themselves. This multidisciplinary workshop helped to identify research needs and opportunities, and the gaps in understanding of this clinically challenging condition.
The summary report of the workshop presentations and discussion was published in Arthritis and Rheumatism, Vol. 40, No. 11, November 1997. Publication of the summary of the workshop in this peer-reviewed journal provides for wide distribution of the discussion of research opportunities to the scientific community with interest in this disorder. The workshop also led to the March 1998 RFA described previously.
Fibromyalgia Advocate on Institute Advisory Council. A leading advocate for fibromyalgia, Ms. Tamara Liller, President of the Fibromyalgia Association of Greater Washington, Inc., is a member of the National Arthritis and Musculoskeletal and Skin Diseases Advisory Council. The Advisory Council, which includes both scientific and public members, meets three times a year and provides valuable input to the Institute’s priority-setting process.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. For more information about NIAMS programs and topics, call our information clearinghouse at (301) 495-4484.
Publication Date: December 1999
Source: NIAMS
