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ARRA Investments in Symptom Management

Public Health Burden
There is a critical need for a better understanding of the causes and treatments for adverse symptoms such as pain, fatigue, and insomnia given the growing number of people living with chronic illnesses, and the debilitating symptom burden faced by many patients undergoing treatment for acute conditions. NIH research supported by ARRA on symptom management focuses on understanding the underlying biological and genetic causes of adverse symptoms, and on developing innovative means to manage and alleviate these symptoms and improve quality of life.

Millions of Americans suffer from pain. A national survey revealed that twenty-six percent of adults experienced pain that lasted throughout the day in the month prior, and of those adults, forty-two percent experienced the pain a year or longer.1 Some people develop pain as a consequence of serious illness, while for others, chronic pain itself is a disease. Understanding the biologic and genetic mechanisms of pain is vital for developing effective treatments for managing pain and improving quality of life. ARRA funded grants are:
  • Using symptom data and biological samples from 500 women and girls with irritable bowel syndrome (IBS) to identify novel biological markers that could someday allow for better determination of the causes of IBS, and ultimately, better treatments for this common and costly health care problem.2
  • Developing standardized measures of pain to help researchers and clinicians better assess patients’ levels of pain and allow for better use and testing of treatments and interventions to reduce such pain.3
  • Testing the effectiveness of  nonpharmacologic interventions in improving abdominal pain in children with IBS.4
Symptoms Associated with Cancer
Those undergoing treatment for cancer frequently experience various types of pain as a consequence of chemotherapy regimens that, while potentially very effective in treating the cancer, can have adverse impacts elsewhere in the body. ARRA-supported grants seek to reduce symptom burden and improve quality of life for cancer patients by:
  • Using genetic techniques to develop a model for identifying patients most at risk for developing severe mucositis. Oral mucositis is a painful symptom experienced by many patients undergoing chemotherapy. Knowledge from this study could be used to monitor doses of chemotherapeutic agents and potentially spare at-risk patients the development of debilitating adverse symptoms.5
  • Examining symptoms, such as pain, sleep disturbance, and fatigue, as well as health outcomes experienced by children and adolescents undergoing chemotherapy for acute lymphoblastic leukemia (ALL) for three years after treatment begins, and beyond. Knowledge of these experiences could help to develop future interventions targeted to improving quality of life for young patients with ALL.6
  • Assessing clusters of symptoms, such as fatigue, insomnia, pain, and depression, experienced by breast cancer patients, and how these symptoms are affected by a symptom management intervention tailored to the individual symptom experiences of the patient.7
  • Improving the way cancer patients communicate their symptoms to their providers through the development and testing of a remote, web-based symptom-reporting assessment program, and to integrate these data into an electronic records database.8
Sleep and Insomnia
Sleep disturbances, including insomnia, are frequently associated with trauma or chronic illnesses, and can severely reduce the quality of life of those experiencing such symptoms. ARRA-supported grants are exploring ways to reduce the burden of these symptoms through studies that are:
  • Testing targeted interventions for treating insomnia and occurrence of nightmares to improve health and quality of life in individuals with post traumatic stress disorder who have been exposed to war-related trauma.9
  • Examining better methods for studying sleep in older patients admitted to an ICU who require mechanical ventilation and determining patterns of sleep disturbances and sleep characteristics of these patients in order to develop better ways to manage sleep and improve outcomes in this population.10
Reduced Mobility/Muscle Weakness
Impaired mobility and/or muscle weakness can accompany many acute and chronic conditions, leading to a reduced ability to accomplish the normal activities of daily living. ARRA-supported grants address this area of symptom management by:
  • Seeking an improved understanding of the genetic and molecular mechanisms that regulate muscle strength, which could someday lead to better therapeutic targets for improving muscle function in patients with muscular dystrophy.11
  • Developing a novel method for identifying patients with acute respiratory failure requiring mechanical ventilation that will develop neuromuscular weakness, and to test a physical therapy program for patients recovering from acute respiratory failure who have developed neuromuscular weakness.12

  1. National Center for Health Statistics, Health, United States, 2006, With Chart Book on Trends in the Health of Americans, Hyattsville, MD: 2006; p. 68-70.
  2. 1RC2NR011959-01 -- Abdominal Symptom Phenotypes: Pathways to New Biomarkers -- Heitkemper, Margaret (WA)
  3. 1R21NR010778-01A2 -- The Visual Time Analog Scale for Enhanced Measurement of Acute and Chronic Pain-- Donaldson, Gary (UT)
  4. 3R01NR005997-07S1 -- Recurrent Abdominal Pain in Children -- Shulman, Robert (TX)
  5. 1RC2NR011945-01 -- Predicting Chemotherapy Induced Mucositis with Genetic and Clinical Factors -- Coleman, Elizabeth (AR)
  6. 3R01NR008570-05S1 -- Chemotherapy, Pain, Sleep, Fatigue in Children and Parents -- Gedaly-Duff, Vivian (OR)
  7. 1R21NR010615-01A1 -- Symptom Cluster Assessment and Intervention Trial -- Barsevick, Andrea (PA)
  8. 3R01NR008726-06S1 - Computerized Assessment for Patients with Cancer: ESRA-C II -- Berry, Donna (MA)
  9. 1RC1NR011728-01 -- Treating Insomnia & Nightmares After Trauma: Impact on Symptoms and Quality of Life -- Drummond, Sean (CA)
  10. 1R21NR011066-01A1 -- Feasibility of Measuring Sleep in a Critical Care Environment -- Pisani, Margaret (CT)
  11. 1RC2NR011968-01 -- TrkB.T1 as a Genetic Disease Modifier of Muscular Dystrophy -- Dorsey, Susan (MD)
  12. 1R01NR011051-01 -- The Diagnosis and Treatment of Critical Illness Polyneuromyopathy in Patients with Acute Respiratory Failure -- Moss, Marc (CO)

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