Efficacy And Cost-effectiveness Of Physiotherapy For Chronic Rotator Cuff Pathology
Funder
National Health and Medical Research Council
Funding Amount
$384,675.00
Summary
Shoulder disorders are common, being third only to back and neck complaints as musculoskeletal reasons for medical consultation and accounting for 10% of all physiotherapy referrals. The painful shoulder affects up to 2-5% of the general population, being more common in middle to older age. One of the most common shoulder disorders is chronic rotator cuff pathology. This causes significant pain and disability that restricts activities of daily living as well as work, sleep and leisure. Forty per ....Shoulder disorders are common, being third only to back and neck complaints as musculoskeletal reasons for medical consultation and accounting for 10% of all physiotherapy referrals. The painful shoulder affects up to 2-5% of the general population, being more common in middle to older age. One of the most common shoulder disorders is chronic rotator cuff pathology. This causes significant pain and disability that restricts activities of daily living as well as work, sleep and leisure. Forty percent of sufferers will continue to have symptoms beyond 3 years and 15% will have persistent disability which may require surgical intervention. Because this disorder is prevalent, it imposes a considerable burden on the Australian health care system. Physiotherapy is a common conservative treatment option but its efficacy has not been well established. A recent Cochrane review of the literature revealed several problems with many of the existing studies: (i) the populations have included a mix of shoulder diagnostic categories; (ii) the research designs have major flaws and (iii) a single physiotherapy modality has been evaluated rather than a combined program as is current clinical practice. Thus, this novel research project involving 200 participants will answer important questions about the efficacy of a physiotherapy program for chronic rotator cuff pathology and whether benefits can be maintained. In addition it will determine whether the costs of physiotherapy represent good value for money which is important in today's economic climate. The results of this project can be easily and immediately translated into clinical practice as recommendations can be made about the usefulness of physiotherapy for this patient population. The results will be of major benefit not just to the physiotherapy profession but to the medical profession who must justify patient referral to physiotherapy and to funding and compensable bodies.Read moreRead less
Efficacy Of Physiotherapy After Hydrodilatation For The Painful Stiff Shoulder: A Randomised Placebo-controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$269,020.00
Summary
Shoulder disorders are common, being third only to back and neck complaints as musculoskeletal reasons for medical consultation and they account for 10% of all physiotherapy referrals. The stiff painful shoulder affects up to 2-5% of the general population, being more common in middle age and diabetes. It causes significant pain and disability that restricts activities of daily living as well as work and leisure. Forty percent of sufferers will continue to have symptoms and restricted movements ....Shoulder disorders are common, being third only to back and neck complaints as musculoskeletal reasons for medical consultation and they account for 10% of all physiotherapy referrals. The stiff painful shoulder affects up to 2-5% of the general population, being more common in middle age and diabetes. It causes significant pain and disability that restricts activities of daily living as well as work and leisure. Forty percent of sufferers will continue to have symptoms and restricted movements beyond 3 years and 15% will have persistent disability. Because this disease is prevalent, it imposes a considerable burden on the Australian health care system. Shoulder hydrodilatation is a common conservative treatment option that has been shown by our research group to have short-term but not long-term benefits. Physiotherapy may be prescribed following hydrodilatation on the basis that it may maintain the initial benefits seen with hydrodilatation. However, there are no studies to either support or refute this hypothesis. Thus, this novel research project will answer important questions about the efficacy of a physiotherapy program in addition to hydrodilatation for the stiff painful shoulder. We will determine whether physiotherapy offers a benefit over hydrodilatation alone and if so, whether this benefit is sustained. In addition we will determine whether the additional costs of physiotherapy represent good value for money. The results of this project can then be easily and immediately translated into clinical practice as recommendations can be made about the usefulness of physiotherapy for this patient population. The results will be of major benefit not just to the physiotherapy profession but to the medical profession who must justify patient referral to physiotherapy.Read moreRead less
I am a clinical scientist translating basic science findings into clinical science questions and answers that impart better understanding and management of pain and painful disease.
Adouble-blind Placebo Contorolled Study Of Subcutaneous Ketamine In The Management Of Cancer Pain
Funder
National Health and Medical Research Council
Funding Amount
$50,000.00
Summary
Palliative care teams are studying an anaesthetic, ketamine, used at low doses for cancer pain which is not responsive to opioid drugs. Clinical experience suggests ketamine may help in neuropathic pain, which is due to nerve damage and is common in cancer. The study involves five days of treatment at three doses of ketamine, to see how well pain is controlled on each dose. The highest dose given will be that which gives good pain control. The study compares ketamine with a placebo, and patients ....Palliative care teams are studying an anaesthetic, ketamine, used at low doses for cancer pain which is not responsive to opioid drugs. Clinical experience suggests ketamine may help in neuropathic pain, which is due to nerve damage and is common in cancer. The study involves five days of treatment at three doses of ketamine, to see how well pain is controlled on each dose. The highest dose given will be that which gives good pain control. The study compares ketamine with a placebo, and patients keep on their usual pain medicines. Participants are randomised to have ketamine or the placebo. The study looks at pain control, quality of life, ketamine side effects, and change in need for usual pain medicines. This is the first national clinical study of a new palliative care research network, the Palliative Care Clinical Trials Collaborative (PaCCSC). It is hoped that if ketamine is proven safe and effective in difficult cancer pain, it will be more easily available for cancer patients.Read moreRead less
Disorders of pain sensation due to nerve damage are common, debilitating and difficult to treat. Nerve damage often results in increased sensitivity to painful stimuli and the perception of innocuous stimuli as painful; it may also result in spontaneous pain. Pain is one of the commonest clinical problems, and yet it is often accepted or taken for granted. The outcome of this work will be an increased understanding of the way in which nerve injury leads to spontaneous pain and increased sensitiv ....Disorders of pain sensation due to nerve damage are common, debilitating and difficult to treat. Nerve damage often results in increased sensitivity to painful stimuli and the perception of innocuous stimuli as painful; it may also result in spontaneous pain. Pain is one of the commonest clinical problems, and yet it is often accepted or taken for granted. The outcome of this work will be an increased understanding of the way in which nerve injury leads to spontaneous pain and increased sensitivity to painful stimuli. This will lead in turn to the development of more effective treatments for neuropathic pain.Read moreRead less
The Analgesic Evaluation Of Novel Natural Products From The Australian Plant Barringtonia Acutangula
Funder
National Health and Medical Research Council
Funding Amount
$174,500.00
Summary
This project aims to evaluate the analgesic activity of several novel natural products that have been isolated from the Australian plant Barringtonia acutangula. An Australian Aboriginal tribe have been known to use B. acutangula aqueous bark extracts for its analgesic properties. Griffith University researchers have confirmed this biological activity in the crude aqueous bark extract. A large scale extraction and isolation process will obtain the novel compounds in sufficient quantities that wi ....This project aims to evaluate the analgesic activity of several novel natural products that have been isolated from the Australian plant Barringtonia acutangula. An Australian Aboriginal tribe have been known to use B. acutangula aqueous bark extracts for its analgesic properties. Griffith University researchers have confirmed this biological activity in the crude aqueous bark extract. A large scale extraction and isolation process will obtain the novel compounds in sufficient quantities that will allow for their pharmacological evaluation as potential analgesic drugs.Read moreRead less
Mechanisms Of Endogenous Cannabinoid Mediated Analgesia Within The Midbrain
Funder
National Health and Medical Research Council
Funding Amount
$518,820.00
Summary
While opioid analgesics such as morphine are the most important drugs used to treat moderate to severe pain, their usefulness is limited by side effects such as tolerance and respiratory depression. In addition, clinically relevant neuropathic chronic pain syndromes (caused by nervous system damage) are relatively resistant to opioids. Animal studies have shown that the active ingredient of the plant Cannabis sativa, THC, and a number of synthetic cannabinoids are analgesic in acute pain models, ....While opioid analgesics such as morphine are the most important drugs used to treat moderate to severe pain, their usefulness is limited by side effects such as tolerance and respiratory depression. In addition, clinically relevant neuropathic chronic pain syndromes (caused by nervous system damage) are relatively resistant to opioids. Animal studies have shown that the active ingredient of the plant Cannabis sativa, THC, and a number of synthetic cannabinoids are analgesic in acute pain models, and interestingly, in chronic neuropathic pain models. Unfortunately, cannabinoid also produce a spectrum of adverse side-effects. Administered cannabinoids such as THC produce their physiological effects by mimicking the actions of the body's own cannabinoids (endocannabinoids) by activating cell-surface proteins, called cannabinoid receptors. The endocannabinoid neurotransmitter system is emerging as a potential therapeutic target. For example, it has recently been shown that analgesia induced by physiological stressors is partly mediated by endocannabinoids within the brain. In addition, novel endocannabinoid breakdown inhibitors have some efficacy in animal models of anxiety and chronic pain. Several brain regions are known to play a pivotal role in the analgesic actions of exogenous and endogenous cannabinoids. In previous studies I have identified the cellular mechanisms by which exogenously applied opioids and cannabinoids produce their analgesic effects in single brain cells. However, the mechanisms of endocannabinoid actions within these brain regions are unknown. The proposed study will determine the cellular actions of endogenously released cannabinoids in normal animals and in chronic pain states. Parallel studies will examine the effect of modulation of the endocannabinoid system in animal models of pain. These techniques have the potential to identify novel endocannabinoid analgesic pharmacotherapies with enhanced efficacy and reduced side effects.Read moreRead less
What Triggers Complex Regional Pain Syndrome After Minor Injury?
Funder
National Health and Medical Research Council
Funding Amount
$958,898.00
Summary
Most people recover from minor trauma but some develop very disabling, difficult to treat, costly pain syndromes. We can identify those at high risk of developing such a syndrome after wrist fracture. By comparing inflammation, immune system function, stress, brain function and behaviour between high and low risk patients, we will take a major step towards understanding, preventing and treating these syndromes.
Targeted Ablation Of Sensory Neurons And Glial Cells With A View To Relieving Neuropathic Pain.
Funder
National Health and Medical Research Council
Funding Amount
$280,910.00
Summary
In Australia more than half of chronic pain patients are diagnosed with neuropathic pain resulting from nerve injury. This type of pain persists long after injury has healed and is associated with spontaneous bursts of excruciating pain and altered sensory processing symptoms which can make even the light touch of clothing intolerable. Neuropathic pain is highly resistant to even the most intense and drastic pain treatments. Much research has been devoted to understanding neuropathic pain in ter ....In Australia more than half of chronic pain patients are diagnosed with neuropathic pain resulting from nerve injury. This type of pain persists long after injury has healed and is associated with spontaneous bursts of excruciating pain and altered sensory processing symptoms which can make even the light touch of clothing intolerable. Neuropathic pain is highly resistant to even the most intense and drastic pain treatments. Much research has been devoted to understanding neuropathic pain in terms of changes in nerve cell (neuron) structure, function and chemistry. Whilst we have learned a lot about how neurons contribute to neuropathic pain, it has since become clear that cells other than neurons (namely neuronal support cells called glia) also play a significant role in the production and continuation of pain after nerve injury. Thus, it may be that pain therapies which currently focus on stopping or minimising the changes in neurons after nerve injury are only doing half the job when it comes to relieving such pain. Targeted therapies aim to affect or kill particular groups of cells with the hope of further understanding their role in the disease progression or eliminating their contribution to the disease state to produce relief. This can be done using a toxin linked to a vehicle that only binds to a particular cell type and which, upon uptake, causes the cell to suicide. Targeting neurons and glia responsible for neuropathic pain may hold a key to relieving this pain state. This project aims to further understand the contributions of neurons and glia to the production of neuropathic pain and aims to determine the effectiveness of synergistic targeted therapies that kill both the neurons and glia responsible for neuropathic pain production. It is hoped that killing these cells will effectively remove their input to the production and continuation of neuropathic pain and may offer a new avenue for neuropathic pain treatment in the future.Read moreRead less