Posted on Leave a comment

A Must listener – Stephen McMahon at PRF

Musings on the Progress of Pain Research: A Podcast with Stephen McMahon

 

You could spend 45 minutes in a whole bunch of worse ways…
“McMahon discusses his early days in the pain research field, what it was like to train with Patrick Wall, the gate control theory of pain, central sensitization, and much more”

“Not the smartness of people but the smartness of nature, I still think that there are many thinks to be discovered from the natural world that would greatly help in our efforts to develop analgesics”

 

Stephen McMahon

 

Go to Podcast here

About Stephen McMahon

In this third IASP podcast features pioneering pain researcher Stephen McMahon, PhD. Dr. McMahon is Sherrington Professor of Physiology at King’s College London, UK, where he leads a research group in clinical neuroscience. He also directs the Wellcome Trust Pain Consortium, an international network of leading pain researchers. He trained under Patrick Wall at University College London before moving to King’s College London in 1985 to run his own lab. His major research interest is pain mechanisms, and he has been working to identify and understand pain mediators. More recently, he has focused on neuroimmune interactions and the role of genetics and epigenetics in pain.

Posted on Leave a comment

Pain Medicine in Medical Curricula

Pain in medical school

Synopsis

“Ninety-six percent of medical schools in the UK and USA, and nearly 80% of medical schools in Europe had no compulsory dedicated teaching in pain medicine”
“On average, the median number of hours of pain content in the entire curriculum was 20 in Canada (2009), 20 in Australia and New Zealand (2018), 13 in the UK (2011), 12 in Europe (2012/2013), and 11 in the USA (2009). Neurophysiology and pharmacology pain topics were given priority by medical schools in all countries.”
Stop and consider, just for a moment, how many hours in total an entire medical school curriculum may consist of… and the vanishingly small % that 11-20 hours may represent…
 

Link to the paper

Check out the open access article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251835/

Posted on Leave a comment

Meet Dr. Kirsty Bannister

Kirsty Bannister

Biography

I lead the Bannister lab group, where we focus on the biological, pharmacological and anatomical basis of pain pathways and their plasticity in chronic pain states. Chronic pain affects up to 20% of the adult population and can occur in the presence or absence of any past injury or evidence of body damage. Modules that I teach on include Physiology and Pharmacology of the Central Nervous System, Pharmacology of Neurological and Psychiatric Disorders, Core Year One Fundamentals of Pharmacology, and Neuroscience. My lab’s research is funded by the Academy of Medical Sciences and the NC3Rs.

Please see my Research Staff Profile for more detail

Posted on Leave a comment

Why Pain Experience is not a Controlled Hallucination of the Body

Synopsis

This is where a Le Pub Scientifique can lead to. Professor Mick Thacker and Dr. Julian Kieverstein just published this paper. A must read!

 

This paper aims to provide an account of the subjective character of pain experience in terms of predictive processing. The PP theory is often taken to support a view of perceptual experience as a controlled hallucination of the external world. Transposed to pain this would have the consequence that pain is a controlled hallucination of the body. The PP theory would have the consequence that the body that is in pain is just another hidden cause of sensory input that stands in need of inference and control by the brain. We argue that pain experience cannot be a controlled hallucination of the body since the predictive machinery that constitutes pain experience is not brain bound. The subject’s pain experience is physically realised in a system that is spread
across the body as a whole. This system comprises the immune system, the endocrine system, and the autonomic system in continuous causal interaction with pathways spread across the whole neural axis. We will argue that these systems function in a coordinated and coherent manner as a single complex adaptive system to maintain homeostasis. This system, which we refer to as the neural-endocrine-immune (NEI) system maintains homeostasis through the process of prediction error minimisation. We go on to propose a view of the NEI system as a multiscale nesting of Markov blankets that integrates the smallest scale of the cell to the largest scale of the embodied person in pain. The NEI system is the embodied subject’s first-person perspective on the world. The PP theory, we will argue, can therefore make sense of how a living body that acts to minimise prediction error can also be a lived body, the subject’s embodied point of view on their surrounding world.

Key Points

We have shown how the predictive processing theory of pain is best understood against a backdrop of a view of the whole NEI ensemble as working predictively. Pain experience cannot be reduced to nociception or decomposed into sensory-discriminatory, affective-motivational and cognitive-evaluative elements. Instead we have argued pain is the outcome of predictive processing that takes place in the whole neural axis in continuous reciprocal interaction with the immune system, the neuroendocrine and the autonomic system. All of these systems are working together as an integrated whole. Pain occurs when all of these systems together conclude that the prediction of body integrity is likely to be disconfirmed. Body integrity here means the states of the body the organism should return to under a wide variety of different conditions that are necessary if it is to continue to exist. Pain is an allostatic process that aims to maintain the body in these states under conditions of constant change, providing the organism with feedback that it is diverging in potentially dangerous ways from these (adjustable) setpoints.  

 

We have argued that the predictive processing theory of pain does not support a conception of pain as controlled hallucination of the body. Proponents of the PP theory often present the body as just another hidden cause of sensory input no different from anything else in the environment external to the body. We have argued this is a mistake. Predictive processing takes place in all of the systems that maintain the homeostasis of the body. What travels up the neural axis to the brain is prediction error from these systems, not a sensory signal originating from an external hidden cause.

 

In place of a view of the brain separated from the body by an evidentiary boundary we have proposed to think of the predictive processing that takes place within each of the systems that makes up the nervous system as producing and maintaining a nesting of Markov blankets. At the smallest scale to the largest scale processes of prediction error minimisation play out that separates but also connects and integrates these systems. This nesting of Markov blankets makes sense of how the body is presented in pain not as an object but as the subject’s point of view on the world. Pain is not only in the brain. Pain is a state of the whole body that prioritises the actions the organism needs to undertake to return the body to the state of healthy flourishing that is expected.

Research papers

Posted on Leave a comment

Central Nervous System Targets: Supraspinal Mechanisms of Analgesia

Central Nervous System Targets: Supraspinal Mechanisms of Analgesia

In the run up to Dr Kirsty Bannister’s Home Brew we will be sharing her work with you!

Pain care needs to understand and be able to integrate current discoveries in lab-based science.

Check out this article and drop your thoughts in the comments!
“Central Nervous System Targets: Supraspinal Mechanisms of Analgesia”

https://lnkd.in/etmcssz

Posted on Leave a comment

Pain and Exercise

What does exercise do for pain?

Exercise is recommended to help prevent the development of pain and as a treatment for those with chronic pain. However, the act of exercising can be extremely painful for some. So why should we do it?  

Professor Kathleen Sluka is joining us on Thursday 18th February to discuss how physical activity can increase and decrease pain, revealing the underlying neurobiology. She will also discuss how we can integrate exercise into the bigger healthcare picture. 

Joining us on our panel are Adam Meakins (The Sports Physio & the Better Clinician Project) and Pete Moore (Paintoolkit). Come and join in the discussion and find out how we can implement exercise for chronic pain and what effects exercise will have on the individual.

Posted on Leave a comment

Discovering novel & effective pain treatments

About the event

We are SO excited to welcome Dr. Kirsty Bannister to Le Pub

Kirsty will be talking about the reality of discovering novel and effective pain-relieving treatments through performing bench to beside translational research.

Chronic pain affects up to 20% of the adult population and can occur in the presence or absence of any past injury or evidence of body damage. ‘Nothing is more unique than our experience of pain and the idea that the same stimulus could evoke a different pain sensation in different individuals has always fascinated me’.

‘There have been great improvements in our understanding of pain physiology and pathophysiology over the years, but why hasn’t this translated to a met clinical analgesic need? By discussing the ways in which we currently assess nociception and pain in non-human and human experimental models, we will slowly unravel the intricacies and challenges of treating persistent pain in varied patient groups’.

This is going to be an incredible Le Pub Homebrew!

World Event Times

London, Thursday, 18 March 2021, 20:00 GMT

Amsterdam, Thursday, 18 March 2021, 21:00 CET

New York, Thursday, 18 March 2021, 16:00 EDT

Dr. Kirsty Bannister

Kirsty Bannister is a Lecturer in the Institute of Psychiatry, Psychology and Neuroscience at Guy’s campus, King’s College London. Kirsty does research in neuropharmacology.

Kirsty leads the Bannister lab group, where she focuses on the biological, pharmacological and anatomical basis of pain pathways and their plasticity in chronic pain states. Modules that she teaches on include Physiology and Pharmacology of the Central Nervous System, Pharmacology of Neurological and Psychiatric Disorders, Core Year One Fundamentals of Pharmacology, and Neuroscience.

Cancellation Terms

Places can be cancelled and refunded up to 48 hours before the start of the event. Within 48 hours of start time no refund.

Recordings

Please note that Le Pub Home Brew is a LIVE EVENT. We are looking at options for giving access to recordings in the future, but right now, we are doing what we are best at – bringing you awesome live and interactive learning events!

Kirsty Bannister Efic interview with Morten Hoegh

Posted on Leave a comment

Why opioids are overrated for pleasure and pain

About the event

Opium, morphine and other opioids are famous for their ability to relieve pain and cause pleasure. These mythical effects may however be just that: mythical.

In recent years, systematic, well-controlled studies of opioid analgesics suggest little benefit from opioid treatment of chronic pain or even of acute musculoskeletal pain. In addition to reducing pain, opioid drugs change a cascade of other feelings, such as increased nausea, constipation and sedation that limit their clinical utility. The numerous unpleasant opioid effects are also thought to substantially dampen any opioid-induced pleasure.

In healthy people who do not regularly use opioids, the sum total is frequently a disliking of opioid drug effects. Healthy people will sometimes even pay money to *avoid* getting another opioid! I will discuss the evidence on how opioids change how people feel, and discuss how some of these opioid-related myths have become so persistent in science and society.

World Event Times

London – Tuesday 11 May 2021, 19:00 GMT

Oslo – Tuesday 11 May 2021, 20:00 CET

Amsterdam – Tuesday 11 May 2021, 20:00 CET

New York – Tuesday, 11 May 2021, 14:00 EDT

Adelaide – Wednesday, 12 May 2021, 03:30 ACST

Prof. Siri Leknes

Siri Leknes is a Professor of Social and Affective Neuroscience at the University of Oslo, Norway and Senior Researcher at Oslo University Hospital. She completed her D.Phil. at Oxford and postdoctoral research at Gothenburg University. Her lab in Oslo, the Leknes Affective Brain lab (LAB lab), studies how the brain and body give rise to pleasurable and painful feelings. One interdisciplinary project centred on benefits of acute pain and was awarded The Daniel M. Wegner Theoretical Innovation Prize in social/personality psychology. Currently, LAB lab specialises in drug studies. Through psychopharmacology in healthy humans, Leknes’ team charts how the brain’s neurochemical systems shape hedonic feelings, decisions and behaviour. LAB lab also conducts studies in drug-treated clinical populations. Leknes is currently funded by an ERC grant to study state-dependent effects of opioids and their relation to social support, stress and dopamine, as well as by the Regional Health Authority to study mood, stress and pain in clinical groups treated with opioid agonists and antagonists.

Get your tickets here!

Posted on Leave a comment

Call for an Urgent Action on Forced Opioid Tapering

Call for an Urgent Action on Forced Opioid Tapering

Synopsis

Opioid tapering guidelines were created, in part, to decrease harm to patients resulting from high-dose opioid therapy for chronic pain. However, countless “legacy patients” with chronic pain who were progressively escalated to high opioid doses, often over many years, now face additional and very serious risks resulting from rapid tapering or related policies that mandate extreme dose reductions that are aggressive and unrealistic.

Key Points

There are major concerns:

  • rapid, forced opioid tapering among outpatients;

  • mandated opioid tapers that require aggressive opioid dose reductions over a defined period, even when that period is an extended one.

Research papers

You can read a full text here

Posted on Leave a comment

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

Synopsis

Recognition is growing that to create patient‐centred care, health‐care organizations need to more directly engage patients across the spectrum of health‐care design and quality improvement. We highlight two papers that emphasize the necessity of implementing models and frameworks for research and  the clinical setting. From: Abstract

Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems..

From: Abstract

Key Points

This study demonstrated the feasibility and benefits of including a roughly equal number of patients and clinical providers/staff in design events and ensuring that the patients represent diverse perspectives.

The evidence is clear that the development, implementation and evaluation of MoCs must rely more on the involvement of those with the lived experience. Their involvement must be in collaboration with those who provide care, their managers and funders.