Chronic pain is a common and debilitating condition. One in five people in the Australian community have been found to experience chronic pain at any one time. Although there is no evidence of a consistent increase in rates of chronic pain, the rate of permanent disability has increased dramatically in recent decades. This has contributed to the growing cost of chronic pain. For example, back pain is the most common reason for filing workers' compensation claims and leads to loss of 101.8 millio ....Chronic pain is a common and debilitating condition. One in five people in the Australian community have been found to experience chronic pain at any one time. Although there is no evidence of a consistent increase in rates of chronic pain, the rate of permanent disability has increased dramatically in recent decades. This has contributed to the growing cost of chronic pain. For example, back pain is the most common reason for filing workers' compensation claims and leads to loss of 101.8 million workdays annually. The annual costs of medical care for back pain alone have been estimated at $AUD50 billion in the US and $10 billion in Australia. Not only is chronic pain a considerable economic burden, it is also a considerable personal burden to patients. Pain is one of the strongest predictors of poor quality of life and has consistently been found to be associated with high rates of depression. Although there is a large body of research that investigates what factors are associated with chronic pain, there is surprisingly little research that investigates the mechanisms that cause chronicity. Theories of chronic pain suggest that psychological characteristics increase the propensity for people to develop chronic pain. Specifically, theories argue that those people who tend to be fearful of pain will over-attend to painful sensations and avoid pain-provoking activities and as a result are at risk of developing chronic pain. This study will test those theories. If it is found that over-attending to pain does predispose patients to develop chronic pain, this will have important implications for preventing the development of chronic pain. These findings could help to devise early interventions to prevent chronicity and thereby reduce the economic burden to health services and the emotional burden to patients in terms of reduced quality of life.Read moreRead less
Whiplash Injury: Mechanisms, Prediction And Directives For Improved Management Strategies.
Funder
National Health and Medical Research Council
Funding Amount
$772,359.00
Summary
Whiplash is a costly condition with many people developing chronic symptoms. This research aims to improve the understating of involved mechanisms, diagnosis and classification of the condition from the time of injury until either recovery or the development of persistent pain. This will facilitate the early identification of those at risk of poor recovery and will lay the foundations for the development of improved early management, particularly in primary care.
Pain And Trunk Muscle Control: Effects, Mechanisms And Consequences
Funder
National Health and Medical Research Council
Funding Amount
$296,452.00
Summary
Twenty-one percent of Australians report long-term back problems. This makes back pain the most common chronic pain in Australia and most prevalent disorder among the National Health Priority Areas. For the majority with recurrent and chronic problems, the cause is unknown but changes in control of the spine are thought to be important. It is well accepted that pain and injury to the low back affect the way that we control the back muscles and this leads to changes in spinal function. However, d ....Twenty-one percent of Australians report long-term back problems. This makes back pain the most common chronic pain in Australia and most prevalent disorder among the National Health Priority Areas. For the majority with recurrent and chronic problems, the cause is unknown but changes in control of the spine are thought to be important. It is well accepted that pain and injury to the low back affect the way that we control the back muscles and this leads to changes in spinal function. However, despite considerable investigation of this problem, there is a distinct lack of consensus for how the control of movement is changed during pain, why it changes, and whether these changes lead to further problems in the long term. The objective of this series of studies is to determine how the adaptation to pain changes the control of the spine. We will use a range of techniques that include tests of the strategies used by the brain to control the spine and mathematical models to estimate the effect that these changes have on the spine when people are given back pain by injecting sterile salty water into the back muscles. These studies will be backed up by measures of mechanical properties of the spine and by comparison to people with clinical pain. This combination of methods has not been used previously and is likely to help resolve the problem of how muscle control is chaged in back pain. We will also test a range of hypotheses regarding how pain has its effect on muscle activity. A final series of studies aims to determine whether the failure of these changes in muscle control to resolve after an epiosde of back pain leads to increased recurrence of pain in the long-term. The importance of this project is highlighted by the significance of back pain as a major health issue, the lack of consensus regarding the effect and mechanisms of pain on trunk muscle control (despite extensive investigation), and the potential for the findings to guide rehabilitation and management.Read moreRead less
Closing The Gap: Implementing Effective Treatments To Improve Post-operative Nausea And Vomiting
Funder
National Health and Medical Research Council
Funding Amount
$175,303.00
Summary
Nausea and vomiting are common after surgery, concern 80% people undergoing surgery, and are managed by drugs with unwanted side effects. High quality evidence supports acupuncture being a safe and effective non-drug therapy for this complaint. This study will examine if and how acupuncture can be delivered by doctors and nurses around operation time. In future, people may have the choice of using acupuncture or drugs, or both, for preventing or treating nausea and vomiting after surgery.
TIR Signalling Pathway Pharmacogenomics And Opioid Response: Beyond The Mu Opioid Receptor
Funder
National Health and Medical Research Council
Funding Amount
$246,396.00
Summary
This project will identify why some people respond poorly and others have toxic side effects to the major group of pain relieving medications, the opioids. The basis will be the genetics of the immune system and both acute postoperative and chronic cancer pain patients will be studied in this international pharmacogenetics project.
Low back pain (LBP) is highly prevalent and enormously expensive to society: total payments made by Workcover for injuries to the low back were in excess of $530 million in NSW in 1996. Chronic LBP (pain lasting more than 3 months) accounts for up to 90% of these costs. Prevention of a large part of this costly problem could be achieved by effective treatment at the earlier sub-acute phase of LBP (6 weeks to 3 months duration). Exercise and advice are two widely-used treatments for sub-acute LBP ....Low back pain (LBP) is highly prevalent and enormously expensive to society: total payments made by Workcover for injuries to the low back were in excess of $530 million in NSW in 1996. Chronic LBP (pain lasting more than 3 months) accounts for up to 90% of these costs. Prevention of a large part of this costly problem could be achieved by effective treatment at the earlier sub-acute phase of LBP (6 weeks to 3 months duration). Exercise and advice are two widely-used treatments for sub-acute LBP, yet remarkably, their efficacy is unknown. For the first time, this study will rigorously evaluate the effectiveness of both a supervised exercise program and advice to return to normal activity for sub-acute LBP. When this study is completed, Australian practitioners will be able to adopt evidence based practice when managing sub-acute LBP. In addition, the study's results will enable practitioners to select the most effective treatment for each individual patient. The results of this study should lead to a large reduction in the incidence of chronic LBP, therefore the results should lead to significant savings in terms of social and economic costs.Read moreRead less
The First Randomised Placebo Controlled Trial Of Paracetamol For Acute Low Back Pain
Funder
National Health and Medical Research Council
Funding Amount
$73,852.00
Summary
Low back pain is a considerable burden for individuals and society. While clinical guidelines recommend simple treatments such as paracetamol for new low back pain, most people receive costly and potentially harmful treatments. This may be due to limited direct evidence supporting the recommended treatments. A placebo controlled clinical trial of 1650 patients with recent onset low back pain will be conducted to determine the effect that paracetamol has on improving the time to recovery.
New Methods Of Pain Assessment In Demented Older Persons
Funder
National Health and Medical Research Council
Funding Amount
$306,000.00
Summary
There are substantial risks of inadequate pain assessment and management in persons with cognitive impairment and particularly in those with communication problems. Undetected or under-treated pain can have serious adverse effects on frail older adults including poorer cognitive performance, increased levels of depression, anxiety and disruptive behaviours, a reduced quality of life and higher levels of functional disability. These adverse effects contribute to greater demands for daily nursing ....There are substantial risks of inadequate pain assessment and management in persons with cognitive impairment and particularly in those with communication problems. Undetected or under-treated pain can have serious adverse effects on frail older adults including poorer cognitive performance, increased levels of depression, anxiety and disruptive behaviours, a reduced quality of life and higher levels of functional disability. These adverse effects contribute to greater demands for daily nursing care and a corresponding increase in health care costs. The present proposal aims to develop more sensitive, reliable and valid questionnaire and non-verbal measures of pain in older adults with cognitive impairment and particularly in those with verbal communication problems. By completion, the present studies should provide much needed information on the reliability and validity of several different types of verbal and non-verbal indicators of possible pain. This research should lead to improved pain assessment and management for the growing segment of the population who suffer from pain and impaired cognitive function.Read moreRead less
The Efficacy Of Manipulation For Recent Onset Neck Pain
Funder
National Health and Medical Research Council
Funding Amount
$393,974.00
Summary
Neck pain is extremely common, with a point prevalence of 46% in the general community. Neck pain can cause significant disability, and is the second most common injury causing people to take time off work. Neck pain and its associated disability clearly poses a substantial social and economic burden. Neck manipulation (high velocity thrust of the joints, often associated with a click) is widely used by physiotherapists for the management of recent onset neck pain, but there is no clear evidence ....Neck pain is extremely common, with a point prevalence of 46% in the general community. Neck pain can cause significant disability, and is the second most common injury causing people to take time off work. Neck pain and its associated disability clearly poses a substantial social and economic burden. Neck manipulation (high velocity thrust of the joints, often associated with a click) is widely used by physiotherapists for the management of recent onset neck pain, but there is no clear evidence for its efficacy. In addition, the use of manipulation is associated with serious, although rare, adverse events such as stroke or even death. The risk-benefit analysis, therefore, does not clearly favour manipulation because efficacy has not been established, while the risks are serious, but infrequent. The findings of the proposed study will clearly and precisely determine the efficacy of manipulation compared with the safer treatment technique of mobilisation (gentle oscillatory pressure applied to the joints), information that is currently unavailable. This information is of vital importance to many different disciplines, including health professionals, insurance companies, and to administrators for development of health policy. Our findings will thus provide evidence-based guidelines for the use of manipulation, and will ultimately lead to safer practice of physiotherapy for neck pain.Read moreRead less