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University of Rochester Medical Center (URMC) researchers have been selected as part of a national initiative by the National Institutes of Health (NIH) to develop new non-addictive treatments for pain to improve patient care and curb the use and abuse of opioids.

The URMC awards are part of a $945 million in grants recently announced under the NIH Helping to End Addition Long-term Initiative (NIH HEAL), which was created to improve treatments for chronic pain, reduce opioid use disorder and overdoses, and achieve long-term recovery from opioid addiction. This initiative represents the largest ever financial commitment by NIH to a single research program.

It is estimated that 50 million adults in the U.S. suffer from chronic pain and 10 million people misuse opioids, including heroin. More than 400,000 Americans have died from overdoses of prescription pain narcotics, heroin, and fentanyl since 1999.

URMC researchers have been selected to carry out clinical trials for new non-addictive pain therapies and provide national leadership to the NIH Early Phase Pain Investigation Clinical Network (EPPIC-Net), which consists of clinical research experts from across different specialties in academia, foundations, and industry.

One URMC project will be led by John Markman, M.D., director of the Department of Neurosurgery's Translational Pair Research Program and Jennifer Gewandter, Ph.D., M.P.H., assistant professor in the Department of Anesthesiology and Perioperative Medicine. The Medical Center will serve as a hub for a group of institutions that includes the Children's Hospitals and Clinics of Minnesota, the University of Miami, Rutgers University, and the Carolinas Pain Institute that will conduct clinical trials for new pain relief therapies. Thirteen dedicated principal investigators at URMC will recruit subjects with a broad range of pain conditions from anesthesiology, dentistry, emergency medicine, gastroenterology, gynecology, neurology, neurosurgery, oncology, orthopedics, pediatrics, rheumatology, and urology.

The URMC-led project is one of 12 hub-and-spoke research clusters chosen as part of the NIH EPPIC-Net program.

"The urgency to develop more effective and safer pain treatments has never been greater," said Markman. "This initiative will enable us to better understand chronic pain mechanisms and the biologic basis for different pain conditions and why some patients respond differently to pain treatments."

The UR Medicine Mobile Stroke Unit (MSU) is now being dispatched to provide stroke care to patients throughout Monroe County. The MSU had been operating on a pilot basis in the City of Rochester since its launch in October 2018.

The MSU, which is operated in partnership with American Medical Response (AMR) and is the only unit of its kind in upstate New York, serves as an "emergency department on wheels" and brings the medical expertise and technology necessary to diagnose and treat stroke directly to the patient. Immediate care is essential during a stroke, during which millions of brain cells die every minute. However, if caught early, many stroke victims can make a full recovery.

It is estimated that 3,000 people in Monroe County suffer from a stroke every year. Stroke is the fifth leading cause of death and the number one cause of long-term disability in the U.S.

The MSU is equipped with a portable CT scanner that scans the patient's brain to determine the type of stroke they are experiencing. These scans and results from a mobile lab on the unit are transmitted to stroke experts at UR Medicine's Comprehensive Stroke Center at Strong Memorial Hospital, who consult via an on board teleconferencing system with the EMS personnel and determine if treatment -- in the form of the clot busting drug tissue plasminogen activator (tPA) -- can be administered immediately on scene.

"The ability to diagnose and start care in a patient's driveway is a game changer for our region," said Tarun Bhalla, M.D., Ph.D., Chief of Stroke and Cerebrovascular Surgery at the UR Medicine Comprehensive Stroke Center and director of the Mobile Stroke Unit initiative. "We are grateful to our partners in the EMS community for their cooperation in making this lifesaving technology available to stroke patients across Monroe County."

"The sooner patients receive care, the more likely they are to return to their lives," said Curtis Benesch, M.D., M.P.H., Chief of Stroke and Medical Director of the UR Medicine Comprehensive Stroke Center. "The time saved by delivering care directly to a stroke patient on scene can mean the difference between recovery of function or a lifetime of disability."

The MSU is dispatched by the City of Rochester/Monroe County 9-1-1 Emergency Communications Center in coordination with the following EMS agencies:

• Brighton Volunteer Ambulance
• Churchville Fire Department Rescue Squad
• CHS Mobile Integrated Health Care (Chili, Henrietta, Scottsville, Caledonia)
• Gates Volunteer Ambulance
• Greece Volunteer Ambulance
• Hilton Fire Department Ambulance
• Honeoye Falls-Mendon Volunteer Ambulance
• Irondequoit Ambulance
• Monroe Ambulance
• Northeast Quadrant Advanced Life Support
• Penfield Volunteer Emergency Ambulance Service
• Perinton Ambulance
• Pittsford Volunteer Ambulance
• Point Pleasant Fire Department Ambulance
• Rush Fire Department Ambulance
• RIT Ambulance
• Seabreeze Fire Department Ambulance
• Union Hill Volunteer Ambulance
• Webster Emergency Medical Services

"AMR is proud to partner with the University of Rochester and Monroe County to expand the available care options in Monroe County," said Tim Frost, regional director for AMR Western New York. "We are focused on providing the best possible care for the communities we serve, and bringing this new technology to the area is a testament to that."

The University of Rochester Medical Center (URMC), Burke Neurological Institute, and Wadsworth Center of the New York State Department of Health (NYSDOH) have been awarded a $5 million grant from the Empire State Development Corporation to speed the development of ground-breaking neurological treatments for those disabled from stroke.

The project is a part of the NeuroCuresNY (NCNY) initiative, a new non-profit formed by the three institutions to accelerate the discovery of novel treatments for chronic neurological impairment and disability. The new state funding will support a two-year pilot study that will be launched in January 2020. This study design will be unique because it will test the efficacy of state-of-the-art robotic-assisted rehabilitation technology combined with drugs to improve the functional recovery of stroke patients.

Neurological conditions such as stroke, traumatic brain injury and spinal cord injury permanently disable more than one million people each year in the U.S., and stroke is the nation's leading cause of disability. Clinical trials for neurological disabilities and impairments are usually passed over because of unclear results, high costs, and challenges in recruiting participants. NCNY will seek to lower the barriers to participation in clinical trials by assisting with travel funding for patients, while providing a supportive and guiding environment for patients and their families.

Clinical and research faculty from URMC Departments of Neurology, Neurosurgery, and Physical Medicine & Rehabilitation will collaborate with the UR Neurorestoration Institute during the pilot study.

After actor Luke Perry died of a stroke last week, there has been an increased interest in learning about and preventing strokes.

Six months after UR Medicine launched the first mobile stroke unit in New York outside of New York City, patients are being treated within minutes, instead of hours.

The first steps to take for any potential stroke patient are to undergo a brain scan and then be given a life-saving drug called TPA.

The national standard response time for those steps to be administered is just under 60 minutes. With UR Medicine, they averaged about 50 minutes.

But when the Mobile Stroke Unit was brought in, UR Medicine cut its response time down to nine minutes. That is among the fastest in the nation.

"This is progress, but I think we can do better," said Dr. Tarun Bhalla, director of the Stroke and Cerebrovascular Services at UR Medicine. "I think the full potential of this unit has yet to realized. We're still in the pilot phase and we're gonna continue to push the envelope."

Dr. Bhalla said the ambulance is also sparking discussion about recognizing the signs and symptoms of a stroke. Strokes are commonly referred to as "brain attacks" caused by a blocked or burst blood vessel.

"Learn to recognize the signs of a stroke," Dr. Bhalla said "If you see someone with weakness in their face or arm or has speech difficulty, realize that time is of the essence and you need to call 911 immediately to get to your local emergency room."

The UR Mobile Stroke Unit is an emergency room on wheels. A specialized crew on board performs CT scans, blood tests, and administers life-saving medicines before arriving at the hospital.

Time saved means fewer dead brain cells - and that can mean a world of difference to stroke patients.