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Chronic pain

HEALTH INFORMATION

Understanding how the brain is involved in chronic pain

WHAT WE KNOW

One in five Australians experience chronic pain that is serious enough to disable them, costing the country approximately $35 billion a year. People who experience chronic pain (pain that continues for more than three months) often struggle to find effective treatment, and can experience disability and even depression.

We are conducting research into the nature of chronic pain, looking at the role of our brain in the experience of persistent pain, and changes in the central nervous system that may also occur.

To register your interest in being contacted about our upcoming trials investigating treatments for chronic pain conditions, please enter your details here. 

We are also investigating why some people develop excessive pain in response to injury, developing a disorder called Complex Regional Pain Syndrome.

OUR LATEST RESEARCH

What is the analgesic effect of EEG neurofeedback for people with chronic pain? A systematic review

Researchers: A/Prof Sylvia Gustin, Dr Negin Hesam-Shariati, Dr Wei-Ju Chang, A/Prof James McAuley, Dr Andrew Booth, A/Prof Toby Newton-John, Prof Chin-Teng Lin, A/Prof Zina Trost

Chronic pain is a global health problem, affecting around one in five individuals in the general population. The understanding of the key role of functional brain alterations in the generation of chronic pain has led researchers to focus on pain treatments that target brain activity. Electroencephalographic (EEG) neurofeedback attempts to modulate the power of maladaptive EEG frequency powers to decrease chronic pain. Although several studies provide promising evidence, the effect of EEG neurofeedback on chronic pain is uncertain. This systematic review aims to synthesise the evidence from randomised controlled trials (RCTs) to evaluate the analgesic effect of EEG neurofeedback.

The search strategy will be performed on five electronic databases (Cochrane Central, MEDLINE, Embase, PsycInfo, and CINAHL) for published studies and on clinical trial registries for completed unpublished studies. We will include studies that used EEG neurofeedback as an intervention for people with chronic pain. Risk of bias tools will be used to assess methodological quality of the included studies. RCTs will be included if they have compared EEG neurofeedback with any other intervention or placebo control. The data from RCTs will be aggregated to perform a meta-analysis for quantitative synthesis. In addition, non-randomised studies will be included for a narrative synthesis. The data from non-randomised studies will be extracted and summarised in a descriptive table. The primary outcome measure is pain intensity assessed by self-report scales. Secondary outcome measures include depressive symptoms, anxiety symptoms, and sleep quality measured by self-reported questionnaires. Further, we will investigate the non-randomised studies for additional outcomes addressing safety, feasibility, and resting-state EEG analysis.

MODULATE: Altering the brains sensitivity to pain

Pain is the single most common reason for seeking medical attention. Under normal circumstances, pain acts to signal injury and is a protective response that prevents further damage and promotes tissue healing. People differ not only in their ability to detect and tolerate pain, but also in their ability to recover from an injury, with some people experiencing pain that outlasts the duration of tissue healing. Interventions to treat or cure chronic pain have had limited success.

Recent research has identified a novel cortical biomarker that could identify individuals at risk of developing chronic pain, which could be used to identify individuals at high risk of transitioning from acute to chronic pain (PREDICT project). However, whether a causal relationship exists between this cortical biomarker and pain is unknown.

The pain biomarker is based on rhythmic patterns of electrical activity in the brain and is measured using electroencephalography (EEG). Previous research suggests that the speed of this rhythmic activity can be altered through the administration of nicotine. MODULATE will attempt to alter the speed of the brain’s rhythmic activity, using nicotine gum, and observe the impact on pain. The project will help determine whether a causal relationship exists between the biomarker and pain.

 

PREDICT: A novel cortical biomarker signature for predicting pain sensitivity

Temporomandibular disorder (TMD) is the second most common musculoskeletal pain condition and is associated with pain and tenderness of the jaw. Although a number of biological factors have shown an association with chronic TMD in cross-sectional and case control studies, there are currently no biomarkers that can predict the development of chronic symptoms. Because of the difficulty in treating chronic pain, development of brain signal predictive biomarkers is of growing interest.

The PREDICT project will aim to develop a predictive biomarker signature of pain severity and duration using two commonly available techniques – electroencephalogram (EEG) and transcranial magnetic stimulation (TMS) – and perform initial clinical validation in first onset TMD. The biomarker could have utility in identifying patients at high risk of transitioning from acute to chronic pain and has additional potential for clinical application in the treatment and prevention of chronic pain.

This project will be carried out in collaboration with a team at the University of Maryland, Baltimore lead by A/Prof David Seminowicz (see more information here).

PREDICT Publications

Seminowicz DA, Bilska K, Chowdhury NS, Skippen P, Millard SK, Chiang A, Chen S, Furman AJ, & Schabrun SM. (2020). A novel cortical biomarker signature for predicting pain sensitivity: protocol for the PREDICT longitudinal analytical validation study. Pain Reports, 5(4), e833. doi: 10.1097/PR9.0000000000000833

The No Worries Trial

Researchers: Associate Professor Sylvia Gustin, Nell-Norman-Nott, Dr Negin Hesam- Shariati, Dr. Chelsey Wilks (University of Washington).

Emerging evidence has shown that negative emotional states play a key role in the development and maintenance of chronic pain. The No Worries Trial will evaluate the effectiveness of a four-week internet-delivered Dialectical Behaviour Therapy (DBT) skills training to help chronic pain sufferers cope with painful, fearful, worrisome, anxious, and negative thoughts and emotions. Moreover, by having the DBT skills training online it is more accessible to those in remote communities, to those with restricted mobility, and more broadly it adds to the knowledge of internet-delivered therapies at a time when online is increasingly necessary to deliver treatment due to COVID-19.

MEMOIR – a clinical trial for Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a disabling pain disorder, affecting approximately 5,000 people in Australia annually. It is characterised by severe burning, stinging and stabbing pain. People with CRPS are unable to use their painful limb and their ability to work or participate in normal social activities is severely restricted. Currently, there are no effective treatments for CRPS.

The MEMOIR Trial is a Commonwealth Government-funded, randomised controlled trial testing two novel treatments for CRPS. MEMOIR will test whether a drug, memantine, and a rehabilitation program, Graded Motor Imagery (GMI), produce greater improvements in pain intensity and function than placebo and standard care for CRPS.

The MEMOIR trial will be delivered remotely, via Telehealth, allowing Australia-wide recruitment of participants. Recruitment for MEMOIR will begin in early 2021. If you are interested in being contacted once recruitment has begun, please enter your details below.

MEMOIR Investigators

MEMOIR consolidates the expertise of scientists and clinicians:

  • A/Prof James McAuley, School of Medical Sciences & NeuRA, University of New South Wales
  • A/Prof Sylvia Gustin, School of Psychology & NeuRA, University of New South Wales
  • Prof Andrew McLachlan, Dean of Pharmacy, University of Sydney
  • Prof Lorimer Moseley, University of South Australia
  • Prof Benedict Wand, School of Physiotherapy, University of Notre Dame Australia
  • Dr Neil O’Connell, Brunel University London
  • Dr Hopin Lee, University of Oxford
  • Prof Eric Visser, School of Medicine, University of Notre Dame Australia
  • Prof Sallie Lamb, University of Exeter
  • Mr Michael Ferraro, NeuRA, University of New South Wales

 

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Social Media for Low Back Pain

Social media is a potentially powerful tool to provide a message of education and reassurance to the general public about low back pain. This project will use social media to educate the general public about low back pain and promote self-management.

The project involves three stages. Firstly, we will conduct a content analysis to gain an insight into social media users’ perceptions and understanding about low back pain. This could determine whether social media could serve as an educational tool through which accurate information related to low back pain could be disseminated to the public.

Second, a recent Delphi survey of 150 low back pain researchers identified 30 key messages considered to be important for the general public to know about LBP. These statements provide evidence-based information on the diagnosis, prognosis and management of LBP and are intended to educate, reassure and promote self-management. We will investigate the attitude of the general public towards these messages.

Third, working in conjunction with a media company Y&R, we will design and test a social media campaign to encourage self-management for people with low back pain.

Unravelling the link between chronic pain and mental health disorders

Chronic pain is a significant problem worldwide that results in enormous suffering and costs to affected individuals, their loved ones, and society. The experience of chronic pain is so much more than a sensation. Chronic pain impacts our emotions, cognition and social life.

The STOPain Study: Using brain-computer-interface intervention for people with neuropathic pain

Chronic pain is a significant problem worldwide affecting nearly 8 million Australians. Unfortunately, despite the availability of analgesics and other pain therapies, no treatment has been found that benefits the majority of individuals, and most of the available treatments have significant side effects or risks for serious adverse events, e.g. kidney failure.

Medicines for Back Pain

Medicines are the most common treatment for back pain. The aim of this program of research is to improve our understanding of the clinical effects of medicines.

Studies currently in progress:

  1. Scoping review of paracetamol, NSAIDs and opioid analgesics for chronic low back pain (led by Matthew K Bagg). The objective of this study is to identify and describe the characteristics of available clinical trials of commonly used analgesic medicines for chronic low back pain. This information will inform the design and conduct of other studies in the research program.
  2. Paracetamol, NSAIDs and opioid analgesics for chronic low back pain: a network meta-analysis (led by Matthew K Bagg). The objective of this study is to produce information about the clinical effects of available analgesic medicines for chronic low back pain. This information will be available in a Cochrane review to assist clinical prescription of medicines. The protocol is published and available here.
  3. Prescribing practices of medicines for adults with low back pain: a systematic review (led by Michael Wewege). The objective of this study is to determine how different medicines are prescribed to adults with low back pain and how this differs across countries. The protocol for this study is being developed.
  4. Analgesic medicines for adults with low back pain: a network meta-analysis (led by Michael Wewege). The objective of this study is to evaluate the comparative effectiveness of a range of analgesic medicines for adults across different classifications of low back pain. The protocol for this study has been submitted for publication.
  5. Muscle relaxant medicines for low back pain: a systematic review and meta-analysis (led by Aidan Cashin and Thiago Folly). The objective of this study is to determine the effectiveness and tolerability of muscle relaxant medicines for adults with low back pain. The protocol is available here.
  6. Novel biologic medicines for low back pain: a systematic review and meta-analysis (led by Rodrigo Rizzo). The objective of this study is to determine the effectiveness and tolerability of novel biologic medicines for adults with low back pain. The protocol is available here.

Completed studies:

  1. Evaluation of the impact of unpublished data from clinical trial registries on the effects of medicines for low back pain (led by Matthew Bagg). The objective of this study was to evaluate whether there is a difference between clinical trial data that are published and those that are not published. The findings are published in the Journal of Clinical Epidemiology.
  2. Antidepressant medicines for low back pain: a systematic review and meta-analysis (led by Michael Ferraro). The objective of this study was to determine the effectiveness and tolerability of antidepressant medicines for adults with low back pain. The findings have been submitted for publication. The protocol is available here.

Medicines for Back Pain – Publications:

  • Bagg MK, McLachlan AJ, Maher CG, Kamper SJ, Williams CM, Henschke N, Wand BM, Moseley GL, Hübscher M, O’Connell NE, van Tulder MW, Nikolakopoulou A, McAuley JH. (2018). Paracetamol, NSAIDS and opioid analgesics for chronic low back pain: a network meta-analysis [Protocol]. Cochrane Database of Systematic Reviews, Issue 6. doi: 10.1002/14651858.CD013045. PMCID: PMC6513465
  • Bagg MK, O’Hagan E, Zahara P, Wand BM, Hübscher M, Moseley GL, McAuley JH. (2020). Reviews may overestimate the effectiveness of medicines for back pain: systematic review and meta-analysis. Journal of Clinical Epidemiology. doi: 10.1016/ j.jclinepi.2019.12.006. PMID: 31816418

Medicines for Back Pain – Registrations of Study Protocols:

  • Folly T, Bagg MK, Wewege M, Ferraro MC, Schabrun S, Gustin SM, Day R, McAuley JH. (2019) UMbRELLA: Understanding efficacy and safety of Muscle RELaxant medicines for Low back pain – systematic Literature review and meta-Analysis (protocol).Open Science Framework, available at: https://osf.io/xuw5h
  • Rizzo RN, Bagg MK, Ferraro MC, Wewege M, Cashin A, Leake HB, O’Hagan E, Jones M, McAuley JH. (2020). Efficacy and safety of medicines targeting neurotrophic factors in the management of low back pain: protocol for a systematic review and meta-analysis. Open Science Framework, available at: https://osf.io/zax6d
  • Ferraro MC, Bagg MK, McAuley JH. (2019). RADICAL: Systematic Review of Anti-Depressant Medicines if Considered Analgesics for Low Back Pain (protocol). Open Science Framework, available at: https://osf.io/cedm3

SLEEPain

For people with back pain who are having trouble with their sleep. We are testing whether a simple sleep tablet will help people reduce their pain and sleep better.

RESOLVE Trial for Chronic Low Back Pain

For people with long term back pain that is not getting better. We are testing two pain treatment programs that target the brain, for people with chronic low back pain.

Patient Education to PREVENT Chronic Low Back Pain

For people with a new low back pain episode. We are testing early intervention to reduce the risk of developing chronic low back pain.

Identifying cortical and subcortical sites responsible for the divergent sympathetic responses to long-lasting muscle pain

We are trying to identify how a constant sensory input (muscle pain) causes two divergent patterns of sympathetic response: an increase in MSNA and blood pressure in some individuals and a decrease in others.

The effects of tonic muscle pain on the sympathetic and somatic motor systems

Chronic pain, defined as pain lasting for >3 months, typically develops from injuries to deep tissues such as muscle, yet little is known about how long-lasting pain affects a person’s blood pressure or capacity to control their muscles. This project assesses the effects of tonic muscle pain on sympathetic nerve activity and stretch sensitivity of muscle spindles.

What else is happening in Chronic pain research at NeuRA?

FEEL THE BUZZ IN THE AIR? US TOO.

What is the analgesic effect of EEG neurofeedback for people with chronic pain? A systematic review

Researchers: A/Prof Sylvia Gustin, Dr Negin Hesam-Shariati, Dr Wei-Ju Chang, A/Prof James McAuley, Dr Andrew Booth, A/Prof Toby Newton-John, Prof Chin-Teng Lin, A/Prof Zina Trost Chronic pain is a global health problem, affecting around one in five individuals in the general population. The understanding of the key role of functional brain alterations in the generation of chronic pain has led researchers to focus on pain treatments that target brain activity. Electroencephalographic (EEG) neurofeedback attempts to modulate the power of maladaptive EEG frequency powers to decrease chronic pain. Although several studies provide promising evidence, the effect of EEG neurofeedback on chronic pain is uncertain. This systematic review aims to synthesise the evidence from randomised controlled trials (RCTs) to evaluate the analgesic effect of EEG neurofeedback. The search strategy will be performed on five electronic databases (Cochrane Central, MEDLINE, Embase, PsycInfo, and CINAHL) for published studies and on clinical trial registries for completed unpublished studies. We will include studies that used EEG neurofeedback as an intervention for people with chronic pain. Risk of bias tools will be used to assess methodological quality of the included studies. RCTs will be included if they have compared EEG neurofeedback with any other intervention or placebo control. The data from RCTs will be aggregated to perform a meta-analysis for quantitative synthesis. In addition, non-randomised studies will be included for a narrative synthesis. The data from non-randomised studies will be extracted and summarised in a descriptive table. The primary outcome measure is pain intensity assessed by self-report scales. Secondary outcome measures include depressive symptoms, anxiety symptoms, and sleep quality measured by self-reported questionnaires. Further, we will investigate the non-randomised studies for additional outcomes addressing safety, feasibility, and resting-state EEG analysis.
PROJECT