This commentary highlights current NIH efforts aimed at addressing the opioid crisis, specifically activities related to behavioral and social science research. Implications for this commentary will inform researchers, practitioners, and policymakers on current endeavors and future funding opportunities.

'The Role of Opioids in the Treatment of Chronic Pain' was the title of a recent workshop (September 29–30, 2014) supported by the National Institutes of Health (NIH) Office of Disease Prevention that highlights the relevance and urgency of the topic. High-quality research presently does not exist to definitively answer questions about opioid safety, efficacy and abuse potential with long-term use 1. However, prescriptions for opioids increased from 76 million in 1991 to 207 million in 2013, which were associated with parallel increases in opioid-related morbidity and mortality 2. Currently, in the U.S., close to 100 million Americans suffer from chronic pain and may be given prescription opioids, along with close to two million Americans who abuse opioid analgesics 3, with over 16 000 overdose deaths attributed to prescription opioids 4. This situation reflects both the challenge to effectively treat the complex condition of chronic pain and the lack of understanding about opioid abuse potential and the risk of addiction in healthcare settings. The medical needs of so many people in chronic pain overwhelm much of our healthcare system, and this problem continues to worsen. Inadequate provider education of how to treat chronic pain compounds the problem. U.S. medical students get a median of only 9 h of training that relate in some way to pain over their 4 years of medical school 5, resulting in inadequate training for many physicians on the effective use of opioids. This is further compounded by the minimal training that medical students get regarding substance use disorders 6, resulting in many of them being unprepared to recognize and monitor risks or signs of addiction in their patients. Furthermore, the structure of the American healthcare system may hinder access to adequate pain management. Opioids are frequently used as the first and only option for treating chronic pain, which is partly explained by a medical treatment reimbursement system that generally does not cover the multimodal treatment approaches for effective management of chronic pain 7. As the Pathways to Prevention workshop report identifies, there is a necessity to focus on developing a rigorous research base to inform clinical and policy decision-making. Research funders and pharma should increase support for studies to establish better data on the utility of opioids in the treatment of chronic pain. Specifically, studies are needed to understand the efficacy of long-term opioid use in the treatment of chronic pain; efficacy of opioid treatment for individuals who might have had prior problems with prescription opioids or other drugs of abuse, and what might be the best treatment course for this population; the potential for misuse, abuse and addiction in the long-term use of opioids for pain; and potential individual differences that could predict who might respond best to which treatments (e.g. pharmacogenetics, pain/drug history, pain subtypes, length of chronic pain). Whilst providing funding for additional research is one strategy, the NIH (and the National Institute on Drug Abuse, in particular) also supports additional approaches to reducing opioid misuse, abuse and addiction. Expanding curriculum for education on chronic pain management in medical, nursing, pharmacy, dental and other professional schools is being addressed by the NIH Pain Consortium (a multi-institute consortium that deals with pain issues across the NIH) through the Centers of Excellence in Pain Education programme (http://painconsortium.nih.gov/NIH_Pain_Programs/CoEPES.html). Another strategy for an effective pain management focuses on the development and use of nonopioid pain medications, complementary and alternative medical treatments, other medications, physical therapy, stress management and cognitive/behavioural therapy 8. Systematic reviews of acupuncture have revealed benefits for pain management in postoperative patients and in tension headache treatment 9, 10. There is also evidence that cognitive-behavioural therapy helped individuals with chronic pain 11, 12. A meta-analysis of interdisciplinary pain management programmes that included physical therapy showed both intensity of pain and consumption of pain medication decreased significantly 13. These options may offer pain patients treatments that could improve pain, function and quality of life and decrease the reliance on opioid medications. More comprehensive systems for treating pain are needed, for the current options fail to deliver significant relief for individuals with severe chronic pain 7. Dersh et al. 14 concluded that treatments without a biopsychosocial approach will most likely put a great number of chronic pain patients at a higher risk for prolonged disability. Existing data on multidisciplinary pain management show consistently effective benefits for chronic back pain relief that exceed surgical results, enabling patients to return to work and live more active and productive lives 15. Yet, these more integrative and individualized therapies may not be reimbursed by health insurance, making them less accessible to patients 7. Importantly, individualized care for chronic pain may still involve prescription opioids. Because their role will vary from patient to patient, potentially changing during the scope of treatment, individualized therapy for chronic pain should also include careful prescription drug monitoring. Especially when integrated into electronic healthcare records, such information will help healthcare providers better detect opioid misuse, abuse and diversion. Including prescription drug monitoring in individualized treatment for chronic pain could help identify those struggling with addiction and lead to their treatment for this problem. More careful monitoring can also aid in determining exactly what treatments for pain management an individual receives, and what works for that patient. The provider can then use this information to adjust individualized treatment plans for chronic pain. Even with careful monitoring of prescription opioid use, overdose may still occur with misuse, abuse and also with ordinary use of opioids in pain patients. Therefore, strategies that minimize the risks of overdose should be emphasized as well. For example, naloxone, an opioid antagonist that can reverse the life-threatening effects of an overdose, saves lives when made more accessible 16. As overdoses are more likely to occur in patients that receive higher doses of opioid medication and in those using benzodiazepines, special care should be given to properly monitor these patients and educate their relatives or caregivers on the proper use of naloxone. In summary, a critical need exists for better and more comprehensive chronic pain treatment in the United States. Required research must determine the efficacy of various treatment options for chronic pain, including the role of opioids. In addition to having an in-depth understanding of the physical nature of this condition, healthcare professionals treating chronic pain should also have a keen clinical understanding of the psychosocial, emotional and affective aspects of this condition. Furthermore, treatment systems may need to be modified to make available the intensive, interprofessional/integrative and much more individualized treatment requirements of the most complex of these patients. The growing numbers of patients with chronic pain, along with the increases in the abuse and overdoses from prescription opioids in the U.S., highlight the urgency to instate better education for healthcare providers in the management of chronic pain and addiction, but also the need to develop better systems for managing and treating chronic pain. No conflict of interest was declared.

The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), is among the leading funders of pain research at the NIH. By law, the NIH must issue announcements of areas of research interest. One major series of pain research funding announcements, issued by 11 Institutes and developed in cooperation with the NIH Pain Consortium, is titled Mechanisms, Models, Measurement, and Management in Pain Research (see http://grants.nih.gov/grants/guide/pa-files/PA-13-118.html). In these announcements, the NIH states that they are interested in research on “…non-pharmacological and novel (e.g. virtual reality) therapies for pain treatment in diverse populations such as ethnic minority groups and persons with disabilities.” The specific mention of virtual reality (VR) is not by chance. There is a genuine understanding at the NIH of VR's potential to treat pain, and this has translated to the NIH funding a substantial amount of VR pain research. Using the NIH RePORT system (www.report.nih.gov/) to search NIH funded projects VR and pain projects, dozens of funded projects can be found, representing tens of millions of dollars in funding over the past decade. Why such an interest at NIDA, and across the NIH, in VR to treat pain? First, there is a huge need for new pain treatments. Approximately 100 million people in the United States suffer from chronic pain,1 and each case is somewhat different. No single pain treatment exists that is good for everyone, or even the majority of people. VR is proving itself as one viable option for reducing pain in suffering, and thus its development must be a priority. Second, while opioids can be effective in the treatment of pain, they have a significant side effect profile, and the rates of misuse and addiction are staggering. In the United States alone, according to the Centers for Disease Control and Prevention, approximately 16,000 people die each year from a prescription opioid overdose. That exceeds deaths from cocaine and heroin overdoses combined. The last decade of research has established that VR, in a variety of situations, offers a safe and effective treatment of pain, without the possibility of drug addiction or many side effects common to opioids. And progress has accelerated in the development of using VR for the treatment of pain. This special issue of Cyberpsychology, Behavior, & Social Networking is just another demonstration of how this field has developed and grown, and what a positive impact VR can have in alleviating pain. I expect advancements in this field to continue for many years to come.

The opinions expressed herein and the interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official recommendation, interpretation, or policy of the National Institutes of Health or the US Government. As noted by the recent Institute of Medicine report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, chronic pain affects about 116 million American adults and costs the nation up to $635 billion each year in healthcare-related costs and lost productivity [1]. As such, research into understanding pain and improving pain management spans the missions of most of the National Institutes of Health (NIH) Institutes and Centers. This column will highlight just a few of the many NIH activities related to pain management. A trans-NIH Pain Consortium initiative is described along with two studies. One study highlights research to test new and improved treatments to control cancer pain. Another study highlights research to advance the field of pain assessment. These studies are just a small sampling of the kinds of translational pain research conducted at NIH but hopefully they serve to illustrate some exciting research directions and the breadth of pain management research at the NIH.

In the last few years, the Web has been established as a platform for interactive applications. However, creating Web applications involves numerous challenges since the Web has been created to serve static content. In particular, the separation of the client- and the server-side, being only connected through the unidirectional Hypertext Transfer Protocol, forces developers to apply two programming languages including different libraries, conventions, and tools. Developers create expert knowledge by specializing on a few of all involved technologies. Consequently, the diverse knowledge of team members makes collaboration in Web development laboriously. We present the Orca framework that allows developers to work collaboratively on client-server applications in a single object-oriented programming language. Based on the Smalltalk programming language, full access to existing libraries, and a bidirectional messaging abstraction, Orca provides a consistent environment that supports common idioms and patterns in client- and server-side code. It reduces expert knowledge and the number of development tools and, thus, facilitates the collaboration of Web developers.

This paper gives a shortest path algorithm for CFG (context free grammar) labeled and weighted digraphs where edge weights may be positive or negative, but negative-weight cycles are not allowed in the underlying unlabeled graph. These results build directly on an algorithm of Barrett et al. [SIAM J. Comput. 30(2000)809-837]. In addition to many other results, they gave a shortest path algorithm for CFG labeled and weighted digraphs where all edges are nonnegative. Our algorithm is based closely on Barrett et al.'s algorithm as well as Johnson's algorithm for shortest paths in digraphs whose edges may have positive or negative weights.

The World Wide Web is evolving in response to users who demand faster and more efficient access to information, portability, and reusability of digital objects between Web-based and computer-based applications and powerful communication, publication, collaboration, and teaching and learning tools. This article reviews current uses of Web-based technologies in distance learning mathematics and mathematics education courses and discusses the pedagogical implications of Web 2.0 for students and teachers of mathematics.

During the past decade, virtual reality (VR) has gained recognition as a means of attenuating pain during medical procedures. However, while investigators have examined the effects of virtual environments on level of distraction, subjective pain intensity, and brain activity, there have been only a handful of investigations into the neurobiological mechanisms associated with VR's efficacy. In an effort to explain how VR may alter pain perception and produce analgesia, as well as to guide the development of novel and improved VR pain treatments, this review aims to link the wealth of empirical data examining the neurobiology of pain to the growing field of VR. This review is separated into three main sections: (a) a brief overview of the current literature on the use of VR for the treatment of pain; (b) a review of the basic neurobiology of how pain is detected, processed, and controlled by the brain; and (c) an exploration into how current VR pain treatments may impact the pain system to produce analgesia. In addition, the future of VR for pain treatment is discussed, including how current treatments might be improved and novel ways to use VR to treat pain might be developed. Speculation on future VR interventions is based on our current understanding of how the brain processes pain and how VR appears to alter this process and produce analgesia.

Various efforts made to redesign and implement important class libraries are discussed. ClassLibs.com is a company dedicated to producing well-engineered quality class libraries and associated compliance test suites with related services. It also provides support, training and customization as additional for fee services. The major vendors have licensed the libraries ensuring that ClassLilbs.com will be able to continue to produce high quality libraries.

We administered capsaicin or vehicle in 2-day-old rat pups, and for over 6 months examined the rats for damaged skin and for the behaviors of scratching, gnawing and biting their skin. By 35 days of age, all rats in the capsaicin group (n = 10) had damaged skin (i.e., lesions, hair loss and red skin) on the rostral half of their bodies. Skin damage remained prevalent over 6 months, whereas vehicle-treated rats (n = 8) had virtually no skin damage. Gnawing and biting behaviors were rarely observed, however, rats in the capsaicin group frequently scratched themselves. There was a significant positive correlation between the frequency at which rats scratched themselves and the total area of skin damage. Morphine (3.0 mg/kg, i.p.) greatly increased scratching behavior in only the capsaicin-treated rats and naloxone (0.5 mg/kg, i.p.) significantly reduced scratching in these rats. Thus, neonatal capsaicin, in its destruction of the majority of primary afferent C-fibers, is capable of inducing opioid-sensitive scratching behavior.