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.
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Central, MEDLINE, Embase, PsycInfo, and CINAHL) for published studies and on clinical trial registries for completed unpublished studies.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.
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.
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).
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
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.
|What is Complex Regional Pain Syndrome (CRPS)?
CRPS is a disabling pain disorder. It affects approximately 5,000 people in Australia annually. CRPS is characterised by severe burning, stinging and stabbing pain. People with CRPS may not be able to use their affected limb and their ability to work or participate in normal social activities can be severely restricted. Currently, there are no interventions for CRPS whose efficacy is supported by high-quality evidence.
What is the MEMOIR Trial?
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, produce greater improvements in pain intensity and pain interference than placebo and standard care for CRPS.
The MEMOIR trial will be delivered remotely, via Telehealth, allowing Australia-wide recruitment of 160 participants. Eligible participants will be randomly allocated to one of the four treatment groups:
· Memantine & Graded Motor Imagery
· Placebo memantine & Graded Motor Imagery
· Memantine & usual care
· Placebo memantine & usual care
What is Memantine?
Memantine is currently approved in Australia for the treatment of moderately severe Alzheimer’s disease, but not for CRPS. Preliminary evidence suggests that memantine may be effective in reducing pain intensity in people with CRPS.
What is Graded Motor Imagery?
Graded Motor Imagery is a graded rehabilitation program that uses a combination of brain-directed movement activities and patient education. The Graded Motor Imagery activities include laterality tasks, imagined movements, mirror therapy and functional rehabilitation tasks. Preliminary evidence suggests that Graded Motor Imagery may be effective in reducing pain intensity and improving function in people with CRPS. The Graded Motor Imagery treatment protocol has been recently updated to be delivered in the MEMOIR trial.
What is usual care?
Usual care is the continuation of your current management for CRPS, excluding the therapies outlined in the exclusion criteria. This might include medical, physical or psychological management of CRPS.
|Will these treatments improve my CRPS?
The effectiveness of these treatments is not known. We are attempting to find this out by conducting this research study. MEMOIR is the first, large, high-quality clinical trial to evaluate of the effects of memantine and Graded Motor Imagery for CRPS.
What is required as a MEMOIR participant?
Participation in this trial requires a large time commitment for participants. The time commitment varies depending on the group that you are allocated to. Study participants will be asked to:
· Take oral memantine or placebo for 16 weeks and maintain daily records
· Complete outcome questionnaires, four times throughout the study (these will take approximately 30 minutes to complete)
· Participants receiving Graded Motor Imagery will attend 7, 60-minute physiotherapy sessions via Zoom and will complete online modules incorporating education and rehabilitative activities, for approximately 30-60 minutes each day, for 16 weeks
· Participants receiving usual care will continue their current treatment, excluding any treatments that are listed in the study exclusion criteria
The trial treatment period will run for a period of 16 weeks. After this, we will require you to complete two further assessments at 6 months and 12 months.
Will I get paid to be a participant?
Participation in this study will not cost you anything, nor will you be paid.
What is MEMOIR’s eligibility criteria?
To be eligible for the MEMOIR trial, you must:
· Have (or suspected to have) chronic CRPS of 6-36 months duration
· Have at least moderate pain intensity and disability as measured by validated scales
· Be 18 years of age or over
· Have access to a computer (or tablet) and internet
· Have CRPS in a single limb only
You will not be eligible to participate in the MEMOIR trial if:
· You are female, of child-bearing potential and not using reliable contraceptive method(s)
· You are pregnant and lactating
· You have an allergy to the study drug family (NMDA antagonists)
· You are taking high dose opioid analgesics or methadone
· You are taking high dose anticonvulsant medicines
· You are taking certain types of antidepressant medicines
· You are taking anti-psychotic medicines
· You have high blood pressure, or your blood pressure is managed with medicine
· You have a heart-rhythm disorder, or you are taking a medicine to manage this condition
· You have a kidney condition
· You have a history of neurological conditions (stroke, seizure, Alzheimer’s)
· You have an implanted spinal cord or nerve stimulator
· You are currently using Graded Motor Imagery
How do I participate?
If you meet the above criteria, are interested in participating and would like to assess your eligibility, please visit:
|Please note that you will be informed of your preliminary eligibility at the conclusion of the survey. If you are preliminarily eligible, you will be provided with further details of the next screening steps and a copy of the MEMOIR Participant Information Statement.
How can I contact the MEMOIR study team?
02 9399 1627
MEMOIR Research Team
MEMOIR consolidates the expertise of the following international scientists and clinicians:
· Prof James McAuley, School of Health 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
· Dr Aidan Cashin, NeuRA, University of New South Wales
· Dr Saurab Sharma, NeuRA, University of New South Wales
The MEMOIR trial has been approved by the Ethics Review Committee (RPAH Zone) of the Sydney Local Health District, protocol number: X20-0325.
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.
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 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:
Medicines for Back Pain – Publications:
Medicines for Back Pain – Registrations of Study Protocols:
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.
Associate Professor James McAuley, says the Australian Government’s Therapeutic Goods Administration’s rescheduling of over the counter opioids is a positive step in curbing opioid addiction, but it is now more important than ever for clinicians and patients to be aware of opioid-free treatment options for chronic pain. “Drugs are a great solution to pain for the first one to two […]