MEMOIR – a clinical trial for Complex Regional Pain Syndrome - NeuRA

MEMOIR – a clinical trial for Complex Regional Pain Syndrome

Pain Neural injury Chronic pain

MATTHEW K BAGG, MICHAEL FERRARO, ASSOCIATE PROFESSOR JAMES MCAULEY, ASSOCIATE PROFESSOR SYLVIA GUSTIN, DR HOPIN LEE, AIDAN CASHIN, ANIKA HAIGH

Complex Regional Pain Syndrome (CRPS) is a serious health condition, affecting approximately 20,000 people in Australia. 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.

A vast body of research has demonstrated changes in brain processes in CRPS. The MEMOIR trial will investigate the effectiveness of two novel brain-directed treatments to reduce pain and improve function in people with CRPS.

MEMOIR consolidates the expertise of scientists and clinicians from NeuRA (A/Prof James McAuley, A/Prof Sylvia Gustin, Mr Michael Ferraro), the University of South Australia (Prof Lorimer Moseley), the University of Sydney (Prof Andrew McLachlan), the University of Notre Dame Australia Fremantle (Prof Benedict Wand, Prof Eric Visser), the University of Exeter (Prof Sallie Lamb), Brunel University London (Dr Neil O’Connell) and the University of Oxford (Dr Hopin Lee).

Due to the COVID-19 global pandemic, the commencement of MEMOIR has been delayed. Recruitment for MEMOIR will commence in September 2020.

If you are interested in being contacted about our CRPS research, please leave your details below and we will be in touch once recruitment begins.

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RELATED PROJECTS

The RESTORE Trial: Immersive Virtual Reality Treatment for Restoring Touch Perception in People with

ASSOCIATE PROFESSOR SYLVIA GUSTIN, DR NEGIN HESAM-SHARIATI

Chief Investigators: Associate Professor Sylvia Gustin, Prof James Middleton, A/Prof Zina Trost, Prof Ashley Craig, Prof Jim Elliott, Dr Negin Hesam-Shariati, Corey Shum and James Stanley

While recognition of surviving pathways in complete injuries has tremendous implications for SCI rehabilitation, currently no effective treatments exist to promote or restore touch perception among those with discomplete SCI. The proposed study will address this need by developing and testing a novel intervention that can provide touch restoration via the primary source of sensory perception: the brain.Complete spinal cord injury (SCI) is associated with a complete loss of function such as mobility or sensation. In a recent discovery we revealed that 50% of people with complete SCI still have surviving somatosensory nerve fibres at the level of the spine. For those with complete SCI this is hopeful news as it means — contrary to previous belief that communication to the brain had been severed by injury — that the brain is still receiving messages. This new SCI type is labelled “discomplete SCI” — a SCI person who cannot feel touch, but touch information is still forwarded from the foot to the brain.

The project will use virtual reality (VR) in a way it has never been used before. We will develop the first immersive VR interface that simultaneously enhances surviving spinal somatosensory nerve fibres and touch signals in the brain in an effort to restore touch perception in people with discomplete SCI. In other words, immersive VR is being used to re-train the brain to identify the distorted signals from toe to head as sensation (touch). For example, participants will receive touch simulation in the real world (e.g., their toe) while at the same time receiving corresponding multisensory touch stimuli in the virtual world (e.g., experiencing walking up to kick a ball).

This project is the first effort worldwide to restore touch sensation in 50% of individuals with complete injuries. The outcomes to be achieved from the current study will represent a cultural and scientific paradigmatic shift in terms of what can be expected from life with a spinal cord injury. In addition, the project allows potential identification of brain mechanisms that may ultimately represent direct targets for acute discomplete SCI rehabilitation, including efforts to preserve rather than restore touch perception following SCI.

RESTORE consolidates the expertise of scientists, clinicians, VR developers and stakeholders from NeuRA and UNSW School of Psychology (A/Prof Sylvia Gustin, Dr Negin Hesam-Shariati), John Walsh Centre for Rehabilitation Research, Kolling Institute and University of Sydney (Prof James Middleton, Prof Ashley Craig and Prof Jim Elliott), Virginia Commonwealth University (A/Prof Zina Trost), Immersive Experience Laboratories LLC (Director Corey Shum) and James Stanley.

If you are interested in being contacted about the RESTORE trial, please email A/Prof Sylvia Gustin (s.gustin@unsw.edu.au) and include your name, phone number, address, type of SCI (e.g., complete or incomplete), level of injury (e.g., T12) and duration of SCI (e.g., 5 years).

The No Worries Trial

ASSOCIATE PROFESSOR SYLVIA GUSTIN, NELL NORMAN-NOTT, DR NEGIN HESAM-SHARIATI

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.

A Multi-Site Randomized Clinical Trial to Examine the Efficacy and Mechanisms of Immersive Virtual W

ASSOCIATE PROFESSOR SYLVIA GUSTIN, DR NEGIN HESAM-SHARIATI

Chronic neuropathic pain (NP) can be a debilitating secondary condition for persons with spinal cord injury (SCI) and effective pharmacological and non-pharmacological treatments remain elusive. This project brings together international experts in basic science and clinical approaches to SCI NP for a rigorous multisite randomized clinical trial to examine the efficacy and mechanisms of an advanced interactive virtual reality (VR) walking intervention (VRWalk).