Improving Outcomes In Low Back Pain: Targeting Specific Therapies To Patient Subgroups
Funder
National Health and Medical Research Council
Funding Amount
$435,061.00
Summary
Low back pain is a major health problem worldwide. There is a lack of effective treatments and a “one size fits all” approach to treatment is being used. This innovative research program aims to change the way back pain is treated, by identifying specific types of back pain, determining the effectiveness of treatments for these types of back pain, and translating a targeted approach to management into clinical practice to improve the health of individuals with back pain.
Brain Training In Osteoarthritis - Does It Decrease Pain?
Funder
National Health and Medical Research Council
Funding Amount
$299,564.00
Summary
In people with osteoarthritis (OA), the amount of pain is often not related to the amount of joint damage seen on x-ray. This suggests that there are other processes contributing to their pain. Recently, the role of the brain in contributing to chronic pain has been investigated. This project aims to determine what parts of the brain are affected in people with OA. It also aims to develop new treatments that target these brain areas and determine if these brain-training treatments decrease pain.
Controlled Clinical Trial Of Desensitization To Chronic Pain
Funder
National Health and Medical Research Council
Funding Amount
$349,149.00
Summary
An estimated 17.1% of males and 20.0% of females in NSW report having chronic pain. Chronic pain sufferers are major users of health services, with frequent medical consultations and high pharmacological consumption. A recent NSW population-based study found that 78% of pain sufferers had consulted at least one healthcare practitioner in the previous 6 months about their pain, and 71% of those sampled were taking regular oral analgesic medications. Disability due to chronic pain is often associa ....An estimated 17.1% of males and 20.0% of females in NSW report having chronic pain. Chronic pain sufferers are major users of health services, with frequent medical consultations and high pharmacological consumption. A recent NSW population-based study found that 78% of pain sufferers had consulted at least one healthcare practitioner in the previous 6 months about their pain, and 71% of those sampled were taking regular oral analgesic medications. Disability due to chronic pain is often associated with higher levels of distress and use of healthcare services. Unfortunately, at present there are no lasting curative treatments for most chronic pain conditions and most people with these conditions are told they have to learn to live with their ongoing pain. One of the most effective ways of teaching chronic pain sufferers to live with their pain are known as cognitive behavioural therapy (CBT) interventions. But even though many find these methods helpful, a significant proportion of cases remain distressed by their pain. This places them at higher risk of relapse and further treatment seeking. If this group of pain sufferers could be taught more effective ways of minimising their pain-related distress, their overall functional and long-term quality of life goals could be maximised. The study has the potential to achieve a major improvement in outcomes for distressed patients with disabling chronic pain, traditionally a very intractable group. The study would also have important implications for the prevention of disability associated with persisting pain. If successful, it could alter the ways in which many health professionals advise patients to cope with their chronic pain, especially in relation to the use of the common modalities of relaxation and distraction techniques, as well as the use of pain reducing interventions. The study represents the first major clinical test of an alternative to these traditional modalities.Read moreRead less
Physiological Mechanisms Of Efficacy Of Cervical Flexor Muscle Retraining
Funder
National Health and Medical Research Council
Funding Amount
$264,750.00
Summary
Neck pain is a significant problem in society and its frequency is beginning to match the proportions of back pain, probably reflecting our increasingly sedentary lifestyles. Several problems have been identified in the muscle system in persons who suffer from neck pain. Therapeutic exercise has been found to have benefit in preventing and relieving pain and improving the neck function. Currently there are several, quite different methods of exercise and there is controversy regarding how therap ....Neck pain is a significant problem in society and its frequency is beginning to match the proportions of back pain, probably reflecting our increasingly sedentary lifestyles. Several problems have been identified in the muscle system in persons who suffer from neck pain. Therapeutic exercise has been found to have benefit in preventing and relieving pain and improving the neck function. Currently there are several, quite different methods of exercise and there is controversy regarding how therapeutic exercise works. It has been argued that parameters such as changes in muscle strength, endurance, joint position sense or muscle coordination may be responsible for the clinical efficacy. It is difficult to disentangle the effective component of exercise strategies and thus prescribe the most effective exercise strategies. This series of experiments will evaluate the physiological factors that change with a specific exercise intervention and to compare different exercise modalities in order to identify the most effective means to induce these changes. Cervical muscle training, using a proven exercise intervention strategy for chronic neck pain and headache, has been chosen as the model to investigate these questions. This exercise strategy has been chosen not only because it has been shown to be effective, but also because it does not conform to contemporary rationales for strength or endurance training. Thus while effective in relieving pain, it is unlikely to produce changes in these parameters. Thus other mechanisms are likely to be responsible for the clinical change. This research stands to make a significant contribution to exercise therapeutics by identifying the effective components of different exercise methods and investigating the pain relieving effects of the specific exercise. This knowledge will lead to the construction of a research based exercise program for neck pain patients, rather than have the current situation of often arbitrary choice of exercise.Read moreRead less
Current treatments for chronic pain are limited in their success. This emphasises the need for new insights into the basic mechanisms and nervous system circuitry underlying altered or chronic pain states. Work in animals and patients with chronic pain shows that certain brainstem centres communicate, via descending spinal cord pathways, with small nerve cells in the superficial dorsal horn (SDH) of the spinal cord. These SDH neurones receive and process pain-signalling information from the skin ....Current treatments for chronic pain are limited in their success. This emphasises the need for new insights into the basic mechanisms and nervous system circuitry underlying altered or chronic pain states. Work in animals and patients with chronic pain shows that certain brainstem centres communicate, via descending spinal cord pathways, with small nerve cells in the superficial dorsal horn (SDH) of the spinal cord. These SDH neurones receive and process pain-signalling information from the skin and internal organs, and receive inputs from descending pathways. This descending input can either inhibit or enhance the activity of SDH neurones and subsequent pain perception. Till now it has been difficult to directly examine how descending pain pathways influence the small SDH neurones in the spinal cord. A new approach, which has been developed in our laboratory, now allows us to record from these very small SDH neurones in the spinal cord of an intact deeply anaesthetized mouse. In addition, our technique allows us to examine the recorded SDH neurone s responses to functionally relevant stimuli (brushing or pinching the hindpaw) as well as its physiology and anatomy. This project will use our new techniques to examine the effects of activating descending brainstem pathways that alter the way painful stimuli are processed in the spinal cord. The effects of altered levels of inhibition in the spinal cord will also be studied by using mice with naturally occurring mutations in their inhibitory glycine receptors. We believe a more complete understanding of pain processing mechanisms will be achieved by examining the role of descending pathways in an intact animal preparation. Such data are essential for the development of drug therapies that can successfully target pain syndromes.Read moreRead less
Increasing The Capacity Of Community Pharmacy For Screening, Brief Intervention And Referral For Treatment Of Pharmaceutical Opioid Use Disorders
Funder
National Health and Medical Research Council
Funding Amount
$177,197.00
Summary
Pharmaceutical opioid dependence is a growing problem. There are effective treatments available, yet few people who need treatment receive it. Currently, pharmacists receive little training on substance use disorders, yet are in contact with almost every person likely to develop problems with pharmaceutical opioids. This project will take an innovative approach to involve pharmacists in identifying those developing problems with pharmaceutical opioids and referring them to treatment.
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.
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.
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