Unlocking the Reasons For Chronic Pain
Chronic pain is a significant problem worldwide and locally, impacting one in three Australians. It results in enormous suffering and costs to the individual, as well as their loved ones and society in general. Despite the availability of pain medications and other pain therapies, there is still no ideal treatment which benefits the majority of sufferers, and most of the available therapies have significant side effects or risks of serious adverse events. Thus, there is an urgent need to identify, develop, and evaluate new chronic pain therapies.
Dr Sylvia Gustin’s research program addresses this need by developing and evaluating treatments which can provide pain relief via the primary source of pain: the human brain. Her research has identified biochemical, structural and functional alterations within the thalamus which are now known to play a key role in the development and maintenance of chronic neuropathic pain. The thalamus is a small structure within the brain located just above the brain stem and acts as a gateway to and from the cortex. Dr Gustin’s new approach targets these thalamic changes to ultimately treat chronic pain.
In a new study these thalamic changes will be modulated via electroencephalography (EEG) – based neurofeedback which Dr Gustin hopes will lead to significant pain reduction. This teaches individuals to gain control over their brain activity in a way which reduces their pain. An important part of the programme is a nested mechanisms study which applies causal mediation analysis to state-of-the-art brain imaging data so that the precise brain processes which underlie therapeutic change can be identified.
Part of the reason behind our inadequate ability to provide satisfactory pain relief in people with chronic pain is our limited understanding of the pathophysiology underlying chronic pain. Consequently, it is important that we determine the mechanisms underlying the development and maintenance of chronic pain.
Research has identified anatomical changes within the medial prefrontal cortex in chronic pain sufferers. The medial prefrontal cortex is the brain’s major processing centre for emotions. In a new study Dr Gustin will determine the nature of these anatomical changes using state-of-the-art brain imaging techniques. The results from this study will provide evidence that anatomical changes within the medial prefrontal cortex underlie a decrease in GABA which is the major inhibitory chemical messenger in the nervous system.
Establishing a decrease in medial prefrontal GABA is important because it provides new information which is needed to develop pain drugs that specifically target discrete brain regions, e.g. medial prefrontal cortex. Current pain medications are not targeted and therefore have significant side effects or risks for adverse events.