NeuRA Magazine #21

Feature Story

UNLOCKING THE REASONS FOR CHRONIC PAIN

Chronic pain is a significant problem worldwide and locally, impacting one in three Australians. It results in enormous suffering and costs to the individual, as well as their loved ones and society in general. Despite the availability of medications and other pain therapies, there is still no ideal treatment which benefits the majority of sufferers and most of the available therapies have significant side effects or risks of serious adverse events. Thus, there is an urgent need to identify, develop, and evaluate new chronic pain therapies.

Dr Sylvia Gustin’s research program addresses this need by developing and evaluating treatments which can provide pain relief via the primary source of pain: the human brain. Her research has identified biochemical, structural and functional alterations within the thalamus that are now known to play a key role in the development and maintenance of chronic neuropathic pain.

The thalamus is a small structure within the brain located just above the brain stem and acts as a gateway to and from the cortex. Dr Gustin’s new approach targets these thalamic changes to ultimately treat chronic pain.

In a new study these thalamic changes will be modulated, which Dr Gustin hopes will lead to significant pain reduction. This teaches individuals to gain control over their brain activity in a way which reduces their pain. An important part of the program is a nested mechanisms study which applies causal mediation analysis to state-of-the-art brain imaging data so that the precise brain processes which underlie therapeutic change can be identified.

Part of the reason behind our inadequate ability to provide satisfactory pain relief in people with chronic pain is our limited understanding of the pathophysiology under
lying chronic pain. Consequently, it is important that we determine the mechanisms underlying the development and maintenance of chronic pain.

Research has identified anatomical changes within the medial prefrontal cortex in chronic pain sufferers. The medial prefrontal cortex is the brain’s major processing centre for emotions. In a new study, Dr Gustin will determine the nature of these anatomical changes using state-of-the-art brain imaging techniques.

The results from this study will provide vital information which will help to unlock the reasons for chronic pain. In addition, it will provide new information which is needed to develop pain drugs which specifically target discrete brain regions.

Current pain medications are not targeted and therefore have significant side effects or risks of adverse events.

 

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Exploring the electrophysiology and heritability of wellbeing and resilience

The majority of adults without a mental illness still experience poor mental health, indicating a need for a better understanding of what separates mental wellness from mental illness. One way of exploring what separates those with good mental health from those with poor mental health is to use electroencephalography (EEG) to explore differences in brain activity within the healthy population. Previous research has shown that EEG measures differ between clinical groups and healthy participants, suggesting that these measures are useful indicators of mental functioning. Miranda Chilver’s current project aims to examine how different EEG measures relate to each other and to test if they can be used to predict mental wellbeing. Furthermore, she hopes to distinguish between EEG markers of symptoms including depression and anxiety, and markers of positive symptoms of wellbeing to better understand how wellbeing can exist independently of mental illness. This will be done by obtaining measures of wellbeing and depression and anxiety symptoms using the COMPAS-W and DASS-42 questionnaires, respectively. Because EEG measures and mental wellbeing are both impacted by genetics as well as the environment, Miranda will also be testing whether the links found between EEG activity and Wellbeing are driven primarily by heritable or by environmental factors. This information will inform the development of future interventions that will aim to improve wellbeing in the general population. To achieve these goals, the project will assess the relationship between EEG activity and wellbeing, and between EEG and depression and anxiety symptoms to first test whether there is an association between EEG and mental health. Second, the heritability of the EEG, wellbeing, depression, and anxiety will be assessed to determine the extent to which these variables are explained through heritable or environmental factors. Finally, a model assessing the overlap between the heritable versus environmental contributions to each measure will be developed to assess whether genetics or environment drive the relationship between EEG and mental health. This project is based on a sample of over 400 healthy adult twins from the Australian TWIN-E study of resilience led by Dr Justine Gatt. This research will pave the way for improved mental health interventions based on individual needs.
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