Using virtual reality (VR) to treat pain has delivered exciting results, thanks to research conducted by Dr. Sam Sharar. A professor of anesthesiology and pain medicine at the University of Washington, Sam explains how “pain is all in our heads”: our physical, cognitive, and emotional reactions in the brain combine to tell us we are experiencing pain. The reality of pain is entirely variable, unpredictable, and different for each person, making it hard to manage. Hearing the success of VR in other fields, Sam is now exploring the impact of applying VR to burn patients in an effort to alleviate the excruciating pain of their necessary treatments.

The results of his studies are compelling. Getting relief from pain could come from leveraging the brain’s ability to leave the reality of pain for another reality that encourages healing—a promising concept across the field of medicine. Sam Sharar, MD, refers to himself as “an academic anesthesiologist.” He is a board-certified anesthesiologist and cares for seriously injured children and adults at Harborview Medical Center. He is also a Professor of Anesthesiology and Pain Medicine at The University of Washington. Dr. Sharar teaches and advises medical students as a College Faculty Mentor and is Vice Chair for Faculty Affairs and Development of Anesthesiology and Pain Medicine. Additionally, he is the Associate Medical Director for King County Medic 1, where he provides training to paramedics.

Kate Nicholson was working as a civil rights attorney for the Justice Department when a surgical error left her unable to sit or stand, largely bedridden, and in severe pain for almost 20 years. Using opioids as an appropriate pain management tool, she continued to function as a high-level federal prosecutor. In this talk, Kate pivots from her inspiring and excruciating story to examine the under-treatment of pain, showing how our approach to opioid abuse by 2.5 million Americans is hurting 50 million people in severe or persistent pain.

Curtin researchers will develop a system that uses artificial intelligence to provide fast and personalised care for young people living with chronic musculoskeletal pain, as part of a new Curtin-led project that has been supported by the Federal Government.

Chief Investigator Professor Helen Slater, from the Curtin School of Allied Health, said the aim was to support young Australians aged 16-21 years with chronic musculoskeletal pain to take their health into their own hands and improve their health and wellbeing.

“Despite the significant burden of chronic musculoskeletal pain in young Australians, an enduring service gap remains,” Professor Slater said.

“While primary care services are available to young people with chronic conditions, age-appropriate, accessible, affordable and effective resources to support high-value musculoskeletal pain care across Australia are lacking.”

Professor Slater said an interdisciplinary team of researchers from Curtin, Flinders University and the Department of Health WA in collaboration with international researchers from New Zealand, Canada and USA would develop, implement and evaluate myPATH.

“MyPATH will function as a ‘virtual clinician and coach’ care model to provide personalised pain care directly to young people,” Professor Slater said.

“This dynamic, interactive system will rapidly learn from young people what pain care they need, when they need it and what works best for them, helping them to understand and better manage their individual care needs by supporting them and prompting healthy habits.”

Using anti-inflammatory drugs and steroids to relieve pain could increase the chances of developing chronic pain, according to researchers from McGill University and colleagues in Italy. Their research puts into question conventional practices used to alleviate pain. Normal recovery from a painful injury involves inflammation and blocking that inflammation with drugs could lead to harder-to-treat pain.

“For many decades it’s been standard medical practice to treat pain with anti-inflammatory drugs. But we found that this short-term fix could lead to longer-term problems,” says Jeffrey Mogil, a Professor in the Department of Psychology at McGill University and E. P. Taylor Chair in Pain Studies.

The difference between people who get better and don’t

In the study published in Science Translational Medicine, the researchers examined the mechanisms of pain in both humans and mice. They found that neutrophils – a type of white blood cell that helps the body fight infection – play a key role in resolving pain.

“In analyzing the genes of people suffering from lower back pain, we observed active changes in genes over time in people whose pain went away. Changes in the blood cells and their activity seemed to be the most important factor, especially in cells called neutrophils,” says Luda Diatchenko a Professor in the Faculty of Medicine, Faculty of Dentistry, and Canada Excellence Research Chair in Human Pain Genetics.

Inflammation plays a key role in resolving pain

“Neutrophils dominate the early stages of inflammation and set the stage for repair of tissue damage. Inflammation occurs for a reason, and it looks like it’s dangerous to interfere with it,” says Professor Mogil, who is also a member of the Alan Edwards Centre for Research on Pain along with Professor Diatchenko.

Experimentally blocking neutrophils in mice prolonged the pain up to ten times the normal duration. Treating the pain with anti-inflammatory drugs and steroids like dexamethasone and diclofenac also produced the same result, although they were effective against pain early on.

Thesefindings are also supported by a separate analysis of 500,000 people in the United Kingdom that showed that those taking anti-inflammatory drugs to treat their pain were more likely to have pain two to ten years later, an effect not seen in people taking acetaminophen or anti-depressants.

Reconsidering standard medical treatment of acute pain

“Our findings suggest it may be time to reconsider the way we treat acute pain. Luckily pain can be killed in other ways that don’t involve interfering with inflammation,” says Massimo Allegri, a Physician at the Policlinico of Monza Hospital in Italy and Ensemble Hospitalier de la Cote in Switzerland.

“We discovered that pain resolution is actually an active biological process,” says Professor Diatchenko. These findings should be followed up by clinical trials directly comparing anti-inflammatory drugs to other pain killers that relieve aches and pains but don’t disrupt inflammation.”

A new study is the first to investigate brain connectivity patterns at rest in veterans with both chronic pain and trauma, finding three unique brain subtypes potentially indicating high, medium, and low susceptibility to pain and trauma symptoms. The findings provide an objective measurement of pain and trauma susceptibility and could pave the way for personalized treatments and new therapies based on neural connectivity patterns.  

Chronic pain and trauma often co-occur. However, most previous research investigated them in isolation and using subjective measures such as surveys, leading to an incomplete picture. A new study in Frontiers in Pain Research has filled in some of the blanks. It found three unique brain connectivity signatures that appear to indicate veteran susceptibility or resilience to pain and trauma, regardless of their diagnostic or combat history. The study could pave the way for more objective measurements of pain and trauma, leading to targeted and personalized treatments.

Chronic pain and trauma are linked but not studied together

“Chronic pain is a major public health concern, especially among veterans,” said first author Prof Irina Strigo of the San Francisco Veterans Affairs Health Care Center. “Moreover, chronic pain sufferers almost never present with a single disorder but often with multiple co-morbidities, such as trauma, posttraumatic stress, and depression.”

Researchers already understand that both pain and trauma can affect connections in our brains, but no-one had studied this in the context of co-occurring trauma and pain. Much pain and trauma research also relies on subjective measurements, such as questionnaires, rather than objective measurements, such as brain scans.

Identifying brain connectivity signatures of pain and trauma

Taking a different approach, the researchers behind this new research studied a group of 57 veterans with both chronic back pain and trauma. The group had quite varied symptoms in terms of pain and trauma severity. By scanning the veterans’ brains using functional magnetic resonance imaging, the researchers identified the strength of connections between brain regions involved in pain and trauma. They then used a statistical technique to automatically group the veterans based on their brain connection signatures, regardless of their self-reported pain and trauma levels.

Based on the veterans’ brain activity, the computer automatically divided them into three groups. Strikingly, these divisions were comparable to the severity of the veterans’ symptoms, and they fell into a low, medium, or high symptom group.

The researchers hypothesized that the pattern of brain connections found in the low symptom group allowed veterans to avoid some of the emotional fallout from pain and trauma, and also included natural pain reduction capabilities. Conversely, the high symptom group demonstrated brain connection patterns that may have increased their chances of anxiety and catastrophizing when experiencing pain.

Interestingly, based on self-reported pain and trauma symptoms, the medium symptom group was largely similar to the low symptom group. However, the medium symptom group showed differences in their brain connectivity signature, which suggested that they were better at focusing on other things when experiencing pain, reducing its impact.  

Putting the findings into future practice

“Despite the fact that the majority of subjects within each subgroup had a co-morbid diagnosis of pain and trauma, their brain connections differed,” said Strigo.

“In other words, despite demographic and diagnostic similarities, we found neurobiologically distinct groups with different mechanisms for managing pain and trauma. Neurobiological-based subgroups can provide insights into how these individuals will respond to brain stimulation and psychopharmacological treatments.”

So far, the researchers don’t know whether the neural hallmarks they found represent a vulnerability to trauma and pain or a consequence of these conditions. However, the technique is interesting, as it provides an objective and unbiased hallmark of pain and trauma susceptibility or resilience. It does not rely on subjective measures such as the surveys. In fact, subjective measurements of pain in this study would not differentiate between the low and medium groups.

Techniques that use objective measures, such as brain connectivity, appear more sensitive and could provide a clearer overall picture of someone’s resilience or susceptibility to pain and trauma, thereby guiding personalized treatment and paving the way for new treatments.