As physiotherapists by training, Luke Parkitny and Flavia Di Pietro are both fascinated by pain.
“Pain isn't simple,” says Flavia. “If it were, why do some people continue to have pain from an injury when the vast majority with the same injury recover just fine?”
“I'm interested in why those people don't get better, and what we can do to help. Whatever's happening in the painful part of the body is only one part of a bigger picture,” she says.
Luke and Flavia both left clinical practice behind in Western Australia to move to Sydney and work with Dr Lorimer Moseley on chronic pain research.
In particular, they are looking at the cause of a condition called complex regional pain syndrome, or CRPS, in people who break their wrists, as well as other types of fractures.
CRPS can occur after virtually any physically traumatic event. More than 5,000 Australians are newly diagnosed with CRPS each year and about 5% of people with wrist fractures develop the syndrome.
While CRPS isn’t common, says Luke, those who do have the condition often experience severe symptoms: ongoing pain and swelling, redness, heat and sweating of the affected area, and poor movement. Localised osteoporosis can occur in the longer-term.
“The pain doesn’t make sense when you look at the original injury,” says Luke.
Previous research has suggested that the brain and immune system of people with CRPS may undergo changes, but no one knows when these changes occur – or why.
“No one has looked at the early stages following trauma to see what triggers the condition,” says Flavia.
Over the course of their PhDs, Luke and Flavia will be examining over 1000 people with wrist fractures in the weeks and months following their injury.
Luke will be taking blood samples and seeing whether those people who develop CRPS show an excessive inflammatory response compared to those who recover normally.
“The body may throw out too many inflammatory factors or maybe doesn't inhibit them well enough. That might lead to increased pain and perhaps lead to the development of this condition,” he says.
Flavia will be focussing on those individuals experiencing high levels of pain, as well as other symptoms such as depression and anxiety. In particular, she will be using fMRI to look for changes in the brain’s somatosensory cortex – a kind of neural map of the body's surface.
“Our brain controls our body, so it makes sense to me that the brain is where we have to go to find out more about pain. I’ll be looking for just how early these changes in brain activation appear,” she says.
The hope is that by understanding how chronic pain develops, we will be better able to predict who will get it, and to treat these people early – ideally preventing the condition from developing in the first place.
Luke says he was attracted to pain research because “it’s clear there’s a lot of work to be done in this area”.
“Sometimes you can throw a whole lot of medication at someone in pain and they don't feel any better. If you just stab, fry and jab people, a lot won’t be made better by that. Our approach crosses a lot of boundaries; pain is complex and requires approaches that are targeted to the needs of the patient.”
“Pain affects a lot of people – and a lot of these people will consult innumerable specialists, like physiotherapists, surgeons, to homeopaths, iridology practitioners… the list goes on because they're desperate,” says Flavia.
“Working in the area of pain, you might see 20 people and only able to help one of them. But it’s rewarding to have that one person get their life back on track, because pain can be so debilitating.”
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