UVA School of Medicine

• The development of the blood supply to the brain; • The use of ultrasound to modulate critical chemical neurotransmitters in the human brain to affect behavior; • The role of breast cancer genes in brain function and development; • The relationship between seizures and microcephaly. Organizers believe that the dialogue and new collaborations stimulated by the program will generate meaningful knowl- edge to benefit society, says Margaret Shupnik, PhD, senior associate dean for research at the UVA School of Medicine. "The proposals speak to the scientific strength at our institutions and the syner- gies that these collaborations will create: studies of the causes of and means of diag- nosing neurological diseases; new methods for understanding brain development, normal function, and dysfunction; models of neural circuitry; and potential interven- tions to restore function to the diseased nervous system," Shupnik says. The University of Virginia—Virginia Tech Carilion Neuroscience Research Collaboration has been several years in the making, Friedlander said. It is part of an ongoing effort to transform Virginia into "The Brain State"—a hub of scientific efforts and leading technological innova- tion to understand brain function and to develop new paradigms for diagnostics and treatments for brain-related disorders. "Research leads to better health care outcomes and better lives for our patients," Carilion Clinic President and CEO Nancy Howell Agee says. "These projects will provide a strong foundation for future research collaborations and funding opportunities, with the ultimate goal of benefiting our patients." Combating Opioid Addiction Reducing opioid use yields improved pain scores A STUDY OF MORE THAN 100,000 surgical cases at the University of Virginia Health System found patients' pain scores improved even as doctors gave fewer opioids. UVA anesthesiologists reviewed 101,484 surgeries between March 2011 and November 2015 where patients received general anesthesia. During that timeframe, the average amount of opioids given per surgery at UVA declined 37 percent. At the same time, surgical patients' self-rated average pain score on a 0-to-10 scale in a post-surgery recovery unit declined from 5.5 to 3.8—a 31 percent improvement. As health officials across the U.S. look for ways to combat a opioid addiction crisis, UVA researchers believe their findings highlight one way to address the problem. "There is very clear evidence that people can become opioid dependent because of the drugs they get during and after surgery," says Marcel Durieux, MD, PhD, Res '91, Fel '93, one of three UVA anesthesiologists who conducted the study. "I think that by substantially limiting opioids during surgery, we've made an important step in addressing that problem." Keys to improving pain scores Durieux points to two factors in how UVA was able to cut patients' pain while using fewer opioids. One factor, he says, is that research has shown opioids make patients more sensitive to pain, though the reason why that occurs is unclear. Thus, reducing the amount of opioids given to patients might by itself improve pain scores. The second factor was a significant increase in the use of non-opioid pain medications, such as lidocaine and acetaminophen, which is commonly used in over-the-counter pain medications. Anesthesiologists at UVA have regularly shared data with their colleagues about the benefits of using fewer opioids, Durieux says; in 2013, UVA also began implementing the Enhanced Recovery After Surgery program, which includes limiting opioids, for colorectal surgery patients. The average amount of non-opioid pain medications given per surgical case at UVA increased 120 percent during the study period. While the non-opioid medications have a lower addiction risk, Durieux said, they cannot be used for all patients. For example, they can cause bleeding in some patients or kidney problems. 3 Vitals Spring 2017

• Cover