Pain Management Division
Laboratories and their heads
- Brain Behaviour and Society Research Laboratory
- A/Prof Michael Nicholas
- Cellular Physiology of Pain Research Laboratory
- Dr Christopher Vaughan
- Pain Management Human Studies
- Prof Michael Cousins
- Spinal Cord Injury Pain Clinical Research Laboratory
- A/Prof Phillip Siddall
Overview of research program
The Pain Management Research Institute (PMRI) is a global leader in research focused on pain. It comprises basic and translational researchers, and many members directly involved in clinical treatment, research and education programs. The Pain Management Education Program continues to grow, reaching healthcare professionals across Australia and in 20 other countries. Our multidisciplinary research team drives an intensive program investigating mechanisms and treatment of a wide range of severe persistent pain problems that many people suffer. Our research pursues the broad theme that persistent pain is a disease entity with its own symptoms, signs and underlying disorders such as abnormal sensory, spinal cord and brain neuronal physiology, neurochemistry, anatomy, and pathology. PMRI continues to achieve significant scientific breakthroughs that have led to a greater understanding of neurobiological mechanisms that underpin pain, providing important clues to how persistent pain becomes such a devastating disease state. Our goal is to build on this fundamental information to develop new treatments for persistent pain.
The laboratories include the Brain, Behaviour & Society Research Laboratory, Cellular Physiology of Pain Research Laboratory, Pain Management Human Studies Group, Opioids and Neuropathic Pain Laboratory, Peripheral Mechanisms and Injury Laboratory and the Spinal Cord Injury Pain Clinical Research Laboratory.
Major sources of funding
- Australian Health Ministers Advisory Council (AHMAC)
- Australian and New Zealand College of Anaesthetists (ANZCA)
- National Health and Medical Research Council (NHMRC)
- National Institutes of Health (US)
- Ritchie Family Foundation
Who suffers from pain?
How does pain affect individuals and the community? An estimated 1 in 5 Australians suffer persistent pain – pain that continues for more than 3 months. People from all walks of life can suffer from persistent pain including children and the elderly. Pain has obvious human costs to patients, families, and communities. There are also huge costs to the economy – 36.5 million lost workdays each year are attributed to people suffering from persistent pain. The total cost of lost workdays, health care, and associated costs add up to over $34 billion per year. This makes persistent pain one of the nation’s most costly healthcare problems.
Pain can kill. Acute pain can affect the heart, lungs, and other key body systems which can be life threatening. Unfortunately, patients who continue to suffer severe pain contemplate or actually commit suicide. The effective treatment of cancer pain can actually prolong life by improving immune system function.
Pain Relief as a Universal Human Right. An international consensus is emerging, led by PMRI Director Professor Michael Cousins, that pain relief should be a 'Universal Human Right'. This was the theme of a WHO sponsored global 'Day Against Pain' in October 2004. Editorials on this subject by Professor Cousins have appeared in the Medical Journal of Australia (MJA 2000;172:3-4) and in the journal Pain (Pain 2004;112:1-4).
Different types of severe pain
Acute pain: Usually, but not always, of short duration, e.g. after surgery, injury, burns or other short-term episodes. PMRI research aims to improve the treatment of acute pain to prevent life threatening risks, and is developing methods to detect those at risk of progressing from acute pain to severe persistent pain.
Severe persistent pain: Pain becomes persistent when it lasts for more than three months, despite attempts to diagnose and treat an underlying cause. Over 300 conditions may lead to persistent pain, such as ‘shingles’, amputation, severe burns, spinal cord injury, low back or neck injury, surgery of various types, hernia repairs and many other causes.
Cancer pain: Many different problems in patients with cancer can cause severe pain. Some cancer pain is acute and some is persistent. There have been improvements in the treatment of cancer pain, however too many adults and children continue to suffer severe unrelieved cancer pain, especially if nerve damage has occurred.
Persistent pain as a disease
When pain is brief or short-term (acute pain), it acts as a warning for the body to seek help. However, when pain never goes away, becomes severe and persists month after month despite any causes being treated or excluded, it serves no useful purpose.
Evidence from the PMRI and other international groups shows that left unrelieved, this type of pain can go on to cause severe physical and psychological problems. In these cases, pain itself becomes the problem and is called a disease. This is the major theme of PMRI’s basic and clinical research program.
What is being done to help?
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 that 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. Other PMRI programs include studies of the mechanisms of tolerance to morphine-like drugs, which become ineffective with long-term treatment and studies of visceral pain, such as bladder and pelvic 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.
The team approach. 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 (e.g. home, work, etc). A major focus of clinical research is on psychological and environmental factors in persistent pain with the aim of developing non-drug treatment that restore patient’s work, family, recreational and social activities. Another key group conducts epidemiological research to determine the prevalence of various types of severe pain, their effects on patients and costs to the community. This group also examines factors associated with persistent pain.