About pain - what is being done
There has been an explosion of knowledge about pain and its treatment over the past 10 years, but much remains to be done for the many patients who continue to suffer persistent pain. The people who currently cannot be helped are in desperate need of the advances that current and future research can deliver.
PMRI is conducting a multi-disciplinary basic and clinical research program involving over 40 scientists and clinicians, which targets understanding the mechanisms of persistent pain as a disease. The research program aims to develop new treatments that specifically attack underlying abnormalities causing persistent pain to become a disease in itself, rather than a symptom.
New treatments for persistent pain will target the underlying problems rather than using pain medication, such as morphine, that purely provides symptomatic relief. This has an important advantage in restoring people to a normal range of everyday activities, without the troublesome side effects of current pain medications.
PMRI has a major research program investigating causes and treatments of spinal cord injury pain. A significant advance has been made in the development and clinical testing of a new drug (pregabalin) that acts on the calcium channels in the spinal cord.
These play a key role in the abnormal firing of spinal cord nerve cells, for example unpredictable episodes of shooting electricity-like excruciating pain. PMRI led a multi-centre research trial that proved that pregabalin is effective and safe, resulting in a major publication in the prestigious journal ‘Neurology.’
Other PMRI programs include studies of the mechanisms of tolerance to morphine-like drugs, which become ineffective with long-term treatment; studies of pelvic pain, such as bladder pain; and studies of orofacial pain.
PMRI clinical research includes development of new drugs taken by tablet or injection but also by a range of other routes including via the lungs (inhaled), via the skin (transdermal), and via the spinal route.
A major focus of clinical research is on psychological and environmental factors in persistent pain with the aim of developing non-drug treatments that can help a patient to resume work, family, recreational and social activities. More information on this work can be found in our book "Manage Your Pain" by Nicholas et al. (ABC Books) which is available as a printed and electronic book.
Our epidemiological research has been investigating the prevalence of various types of severe pain, their effects on patients and costs to the community. This group also examines population level factors associated with persistent pain and their implications for management at the state and federal levels. These include occupational and socio-economic status, co-morbidities, developmental and age factors.
Persistent pain has such profound effects on every aspect of a person’s life that a team of experts is needed to unravel this complex situation. Expert diagnosis frequently reveals problems to be addressed in multiple areas, including the physical, psychological and environmental (eg home, work etc).
An international consensus is emerging. Initiated by PMRI Director Professor Michael Cousins, a meeting was held in Montreal, Canada in 2010 following the World Congress on Pain. This meeting was organised by the International Association for the Study of Pain (IASP) and attended by conference delegates from around the world. They agreed on what has become known as the 'Declaration of Montreal'. This has been endorsed by the council of the IASP and states:
Recognising the intrinsic dignity of all persons and that witholding of pain treatment is profoundly wrong, leading to unnecessary suffering which is harmful; we declare that the following human rights must be recognized throughout the world:
Article 1. The right of all people to have access to pain management without discrimination (Footnotes 1-4).
Article 2. The right of people in pain to acknowledgement of their pain and to be informed about how it can be assessed and managed (Footnote 5).
Article 3. The right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained health care professionals (Footnotes 6-8).