The Irish Pain Research Network (IPRN) Aim • To bring together all active pain researchers on the island of Ireland (North and South) for the purposes of sharing research results and ideas and facilitating cross-institutional collaboration in the area of pain research
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The Irish Pain Research Network (IPRN)irishpainsociety.ie/.../IPRNDataBlitz-Symposium2015.pdfUCD School of Public Health, Physiotherapy and Population Science UCD Health Science Centre
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The Irish Pain Research Network (IPRN)
Aim
• To bring together all active pain researchers on the island of Ireland (North and South) for the purposes of sharing research results and ideas and facilitating cross-institutional collaboration in the area of pain research
Origins of IPRN
• Discussions in late 2014 between NUI Galway pain researchers (Prof. David Finn and Dr. Brian McGuire) and UCD researchers (Dr. Brona Fullen, Dr. Catherine Doody and Dr. Catherine Blake)
• Idea advanced with the IPS Committee
• IPRN is a Special Interest Group (SIG) of the IPS
• Launched formally at the 15th Annual Scientific Meeting of the Irish Pain Society, 26th Sept 2015
Anticipated benefits of IPRN• Facilitate greater collaboration• Forum for presenting research results, sharing ideas,
networking• Multidisciplinary
– Neuroscience, Psychology, Physiotherapy, Nursing, Pain Medicine etc
• Easier access to expertise and methodologies– Training, lab visits, student exchanges– Website: repository of expertise
• Opportunities for junior researchers to present and network
• IPRN members better positioned to apply successfully for research grants (HRB, SFI etc)– Particularly multi-institute grant applications
• Raise the profile of pain and pain research in Ireland
Membership of IPRN• If you are active in pain research within Ireland (or would like to
become research active) then we would like to extend a very warm invitation to you to join IPRN
• Pain researchers at any level of seniority are welcome to join, and we particularly welcome students and early-career researchers.
• There is no fee to join IPRN but you must be a member of the IPS in good standing (to join the society see http://www.irishpainsociety.com/ ; all registered delegates at the Annual Scientific Meeting on Saturday 26th September 2015 will automatically become members of the IPS and are therefore eligible to join IPRN if they wish).
• If you wish to join IPRN, please complete the short application form enclosed and give to David Finn at end of today’s session or submit at registration desk. Alternatively submit by email to Orla Doran ([email protected]). Please put “IPRN” in the subject field of your e-mail.
– Analgesic and anti-inflammatory potential of novel drugs and associated neurochemical/molecular mechanisms of action• Cannabinoids, TRPV1, opioids, monoamines, antidepressants, GABA, glutamateimidazolines, Ca2+ channels,
– Exploring the relationship between negative affect and pain: the role of the endogenous cannabinoid and opioid receptor systems:• Fear-induced analgesia• Anxiety/depression-related hyperalgesia (rodents and humans)
– Assessment of the effects of neuropathic pain and its treatment on cognitive function (in rodents and humans)
– Novel drug delivery systems for analgesics, including cannabinoids
– Neuroimmune mechanisms and chronic pain• Cannabinoid regulation of neuroimmune function
– Development of new animal models • post-operative pain following inguinal hernia repair• Depression-Pain comorbidity
• The endocannabinoid system mediates fear-induced analgesia (Finn et al., 2004, Eur J Neurosci; Butler et al., 2008, Pain; Ford et al., 2010, Pain; Olango et al., 2013, Br J Pharmacol)
• Dysfunction of the endocannabinoid system in PAG/RVM circuitry may contribute to hyperalgesia associated with negative affect (Rea et al., 2014, Pain)
• Developed a novel rat model of postoperative pain associated with inguinal hernia repair (Bree et al., 2015, J Pain)
• Monoaminergic and neuroimmune alterations underpin altered nociceptive processing in animal models of depression (Burke et al., 2015, Behav Brain Res; 2014, Brain Behav Immun, 2013, Genes Brain Behav, 2013, J Pain)
• The endocannabinoid system modulates neuroinflammatoryprocesses (Roche et al., 2006 J Neuroimmunol; Kerr et al., 2012, Neuroscience; 2013, Br J Pharmacol; Henry et al., 2014, J Neuroimmunol)
Methodologies
Behavioural models/tests
Pain/Stress/
depression
Proteomics
Elisa, Mass spec, western blotting,
Molecular techniques
qRT-PCR, gene delivery,
radioligandbinding, GTPyS
Lipidomics
EC assay, AA, PGE2
NeurochemistryHPLC, LC-MS-MSIn vivo microdialysisELISA, IHC
In vitro screening assays
iPSc
Human and animal
Clinical Neuroimaging
Facility
Research Skillsets/Technical Expertise
Animal models/methodologies
• Behavioural models /tests Pain
• Acute: Hot Plate, Tail Flick, Hargreaves test, Acetone Drop Test, Von Frey test • Chronic/Persistent: Formalin test, Complete Freunds' Adjuvant induced arthritis/pain (CFA), Spinal
• Surgery techniques i.c.v., i.c., IV cannulae Olfactory bulbectomy, spinal nerve ligation bioradiotelemetry
Psychological Aspects of Pain and Population Health Research in Pain
Dr. Brian McGuire
Dr. Line Caes
Dr. Jonathan Egan
HRB Interdisciplinary Capacity Enhancement (ICE) Award
• HRB funding call description/ focus: ‘Developing interdisciplinary research capacity at post-doctoral level’
• Application title: Chronic Pain in Ireland: Prevalence, Management and Professional Education
• PostDocs- Dr. Siobhan O’Higgins, Dr. Chris Dwyer– Psychology, Physiotherapy, Health economics
• Projects and focus of award:
WP1: Prevelance of CP in 5-12 year olds
WP2: Online ACT
Three main areas of output
WP3: Clinical Judgment
Annual Sciific
HRB Research Leaders Award
• HRB funding call description/ focus: ‘Investing in leadership capability in population health and health services research’
• Application title: Psychological therapies for chronic pain and adjustment difficulties in multimorbid health conditions: Development and delivery of eHealthsolutions.
• PostDoc- Dr. Brian Slattery, RA- Ms. Laura O’Connor
• RA- Health Science/Epidemiology RA- Health Economics
• Projects and focus of award:
WP1: Prevelance of MM WP2: eHealth interventions
Three main areas of output
Dissemination & Collaboration
Annual Scientific meeting
eHealth course
Research Programme
• Prevalence, Impact and Cost of Chronic Pain– PRIME 33% prevalence, cost: €4.8bn 2.8% GDP– PRIME-C 10% 5-12 year olds– PRIME-6
• Pain-ID • Pain in children and interactions with parents• Online pain treatments
– Online MBCT for chronic back pain in adults– Online MBCT for chronic headache in adults– Online hypnotherapy-based intervention for migraine in adults– Online MBCT for wellbeing in MS– Online CBT for cancer-related fatigue– Online ACT for adults with chronic pain– Online “Feeling Better” for children and parents
– Mechanical, heat and cold sensitivity – von Frey, Hargreaves and acetone application tests– Weight bearing - pain induced incapacitation– Pressure administration method - for arthritic scoring
• Multi-photon in vivo Ca2+ imaging of Pirt-GCaMP3 mice
• Expertise in recombinant technologies
• GMP facility for production of toxin-based therapeutics
ICNT collaborators:
• Prof. Oliver Dolly, Dr. Jianghui Meng, Dr. Jiafu Wang, Dr. Omprakash Edupuganti, Dr. Laura Casals-Diaz, Dr. Tom Zurawski, Dr. Charles Metais, Dr. Gary Lawrence, Marc Nugent
External collaborators:
• Prof. D. Julius (UCSF), Dr. F.G. Scholl (Inst. de Biomed., Seville), Dr. M. Dong (Harvard Med. Sch.)
Musculoskeletal Pain ResearchUniversity of Limerick
Dept of Clinical Therapies
Dr Kieran O’Sullivan
Dr Karen McCreesh
Dr Katie Robinson
Key research questions
• Does providing a biopsychosocial, individualised treatment for LBP improve clinical outcomes? And if so, is it worth the extra costs?
• Musculoskeletal pain: is it what you do or the way that you do it? A study of therapeutic alliance in physiotherapy
• What factors are changed after an exercise programme for Achilles tendinopathy? – is it pain, tendon structure, muscle strength, fear, confidence?
• What is the role of spinal posture in shoulder pain?
• The Working with Arthritis program: Can an
occupational therapy-led vocational intervention support
people with musculoskeletal disorders to remain in,
or return to, work?
Recent research findings
• Group exercise for MSK pain is more effective than individual exercise (sys review)
• A mix of interpersonal, clinical and organisational factors influence the patient-therapist interaction (systematic review)
• Major predictors of injury in professional dancers are systemic factors (poor sleep and general health complaints), rather than physical or biomechanical factors (prospective study)
Research skill sets
• Methods: Systematic reviews and meta-analyses, Qualitative research
Ability to Sleep 50% (n=12) 59% (n=14) 62.5% (n=15)
Social Functioning 46% (n=11) 67% (n=16) 79% (n=19)
Improved Quality of Life following Capsaicin 8% treatment
•Capsaicin 8% is a beneficial addition to the medication armamentarium for the treatment of Neuropathic Pain (NP). •With 62.5% of patients experiencing at least a 30% reduction in pain at rest and 54% of patients on movement at 3 months, treatment with Capsaicin 8% should be considered to patients suffering NP as a first line treatment.•The results demonstrated that treatment of NP with Capsaicin 8% can be managed in a nurse led clinic, positive results are achieved and patients are happy with the treatment received.
Research Skillsets/Technical Expertise
Novice Researcher
Practice based research
REACH project (Research Excellence Across Clinical Healthcare Project)
The IPRN will provide the support and expertise to expand research ideas and practices.
Supporting work participation through early intervention in
Aims1. Profile levels of work related disability/instability in patients
in paid employment referred with RMSKP in Ireland;
2. Specify the content and delivery of an early integrated care intervention to improve work retention/participation, decrease distress, improve functional status, and increase health related quality of life among RMSKP patients;
3. Feasibility test, pilot and evaluate the intervention in terms of efficacy and economic impact.
Design• Phase 1:
– (a) Systematic review to collate the evidence on interventions to prevent work disability/instability in RMSKP
– (b) Quantitative study to document levels of work related disability/instability in patients referred for RMSKP in Ireland.
• Phase 2: Needs analysis of specific patient requirements to inform the intervention content.
• Phase 3:– (a) Specification of the content, components, mode and timing of the
intervention;– (b) Comprehensive feasibility and pilot testing with evaluation of
patient outcomes and economic impact.
specific core set of patient requirements that will comprise the early integrated care intervention;
identify key barriers and facilitators of work participation, associated support needs, and service expectations and priorities amongst patients with RMSKP
examine potential challenges in intervention delivery
identify optimal timing for delivery of the intervention
Research Management Team•Dr Andy Cochrane & Dr Niamh Higgins (MU)•Dr Oliver FitzGerald (DCU/St. Vincent’s)•Prof. Pamela Gallagher (Dublin City University)• Ms Roisin Breen (RCPI)• Ms Oriel Corcoran (Waterford Regional) • Ms Jennifer Ashton (Beaumont)• Ms Aisling Brennan (AMNCH)
Acknowledgement
HRB/Research Collaborative for Quality and Patient Safety (RCQPS) Award 2014-2016
• The EASI-FIT Study: Exercise for fatigue and sleep dysfunction
in fibromyalgia: a feasibility study (ARUK, £356K)
• Exercise management of subacromial impingement syndrome
• Impact and extent of shoulder dysfunction post breast
reconstruction using LD
• Effectiveness of working wrist splinting in patients with RA
• CHaRT @Ulster
• Non-pharm interventions in long term conditions
• (LBP, Resp disease, Neuro conditions)
Key research Questions/Projects
The effectiveness of exercise in the management of fatigue and sleep dysfunction in fibromyalgia syndrome: a systematic review and meta-analysis (33 RCTs, n=2328)
Russell D, Álvarez Gallardo IC, Hughes CM, Davison GW, Sañudo B, McVeigh JG
Fatigue: Exercise vs control Sleep: Exercise vs control
23 RCTs
10 RCTs
Perceptions of fatigue, pain, sleep dysfunction and barriers to exercise in people with FMS: A focus group study
Russell D, Álvarez Gallardo IC, Wilson I, Hughes CM, Davison GW, Sañudo B, McVeigh JG
Fatigue / sleeplessness / pain / cognitive dysfunction: “I think the fatigue is worse than the pain, the pain you know what to do and what not to do…”
Exercise is a major challenge for patients: Household chores, ADLs exercise in themselves
“exercise to me is a scary word … “
“my exercise consists of getting out of bed…”
Lack of understanding:‘Doctors need to realize, we wouldn’t chose to live like this…”
Loss of self / role / function: “Life has been stolen.”
“Sometimes you just don’t go out at all, the person you were before this illness has totally changed.”