Churack Chair Newsletter #9, September 2021

Welcome to the ninth edition of the Churack Chair of Chronic Pain Education and Research Newsletter, which provides supporters with the latest updates on how the Chair is reducing the impact of chronic pain in our community, through pain research and healthcare education.

The last few months have seen the graduation of our first PhD, Dr Elspeth Shipton, who completed her thesis on best-practice pain education of medical students. This is a milestone for us all and something to be celebrated!  Our main goal this year is to seek sponsorship to re-establish our post-doctoral research Fellowship position, so we can continue to investigate the basic cellular causes of chronic pain.  As always, we express our gratitude for your ongoing support and interest in these endeavours.

We look forward to sharing ongoing updates and the Chair’s next milestones.

Cooperative research projects

The current flagship project for Professor Eric Visser is the MEMOIR study of memantine (a ketamine-like oral pain medication) and graded motor imagery (physiotherapy-based brain retraining programme, including ‘mirror therapy’), for the treatment of Complex Regional Pain Syndrome (CRPS). This study has established strong research cooperation with Professor James McAuley and his world-class team at Neuro Science Research Australia (NeuRA) and the University of New South Wales, and received a NHMRC special grant for approximately one million dollars.

Professor Visser is currently the clinical investigator in this study, screening all patients who are going to participate. This is the largest study worldwide for any treatment of CRPS and for the first time, we are screening patients virtually via videolink, which is a totally new approach and very timely in the current Covid climate.

As a spin-off, we have developed a simple new technique where patients can ‘test themselves’ for nerve pain (with help from the onscreen professional), using simple tools they can find at home, such as tissue paper, toothpicks and a cold metal spoon! We hope to develop this idea further and use it in real life telehealth consultations, thus reducing the need for face-to-face pain clinic visits.

With NeuRA, we are also starting a high-impact Cochrane review of memantine in the treatment of chronic pain, and re submitting an NHMRC grant application to study a new medication for the treatment of acute back pain.

In association with Dr Lucy Gilkes and A/Prof Diane Arnold-Reed (UNDA general practice division) and Professor Caroline Bulsara (Nursing and Midwifery, Health Sciences), we have just interviewed a new PhD candidate who will embark on a study next year of how GPs identify patients at risk of developing chronic pain after an injury, such as a low back strain or whiplash.

The title of the study is: Clinical gestalt in acute to chronic pain transition in general practice, and will for the first time, investigate the role of  ‘gut feelings’ or ‘clinical intuition’ in identifying patients at risk of pain. This is important because GPs are the first port-of-call for such patients, so if they can intervene at an early stage, chronic pain might be prevented. We will update you in coming months regarding details of this intriguing study, which has attracted a special UNDA research scholarship of ninety thousand dollars over three years.

We are also helping in the early stages of a new study investigating the effects of blood vessel dilating vitamins and supplements in preventing migraine (directed by Professor John Mamo and his team at Curtin University’s Health Innovation Research Institute).

Read more >>

Post-doctoral Pain Research Fellowship at Murdoch University has concluded.

Dr Natalie Morellini’s funding for research into the cellular mechanisms of neuropathic pain with Professor Peter Drummond at Murdoch University’s Centre for Research on Chronic Pain and Inflammatory Diseases, has come to an end. We hope to secure further funding so that this Fellowship might be reestablished. We sincere thank Natalie for all her excellent work over the past four years and wish her the very best for the future.

Read more >>

PhD graduation

In a first for the Churack Chair, Dr Elspeth Shipton graduated at UNDA last month after completing her PhD titled: An examination of pain education, knowledge and attitudes of medical students in Australia and New Zealand, which was very well received. Dr Shipton’s work will form the basis for pain medicine curriculum development at medical schools and provides guidelines for key pain teaching topics and assessments (including newly developed assessment and examination questions). In this way we can effectively teach up-and-coming doctors about pain medicine, early in their training. Congratulations to Elspeth on this outstanding five year achievement.

Dr Andrew Jan’s PhD thesis on the role of acupuncture for acute pain in the emergency setting is currently under examination and we anticipate completion soon.

Battlefield acupuncture added no benefit as an adjunct analgesic in emergency department for abdominal, low back or limb trauma pain >>

Lessons Learned in Teaching Battlefield (Ear) Acupuncture to Emergency Medicine Clinicians >>

Teaching and education

Professor Visser continues to tutor students in research methods as part of the MEDI 6302 course and is a member for the medical school research committee. The Churack Chair website is under constant revision and serves as a valuable teaching and learning resource for students regarding ‘all things to do with pain.’

Professor Visser is frequently invited to speak at pain education events, recently the Australian Pain Society, Australian and New Zealand College of Anaesthetists, rehabilitation medicine and GP symposia.

Eric conducts face-to-face small groups teaching with UNDA and UWA medical students at St John of God Subiaco Hospital and Joondalup Health Campus, and recently held a successful GP back pain symposium for 3^rd year medical students at UNDA with Dr Lucy Gilkes. Pain medicine has been introduced in medical school examinations over the past two years which reflect its increasing profile in the UNDA curriculum. Final year students continue to submit high quality essays on various pain topics to compete for the Faculty of Pain Medicine Undergraduate Prize, arranged by Drs Steve Lamb and Max Majedi from anaesthesia.

Future plans

Over the next six months we will continue to develop research ties with other centers, particularly with NeuRA, the division of general practice and the Sydney Campus of Notre Dame. We are also currently advertising for post-graduates (including anaesthesia and pain medicine specialists) to join us at the UNDA School of Medicine, to complete a PhD or Masters in pain, to launch their research career.

• Research papers

  Key research papers generated via the Churack Chair:

  Shipton EE, Bate F, Garrick R, Steketee C, Visser EJ. Pain medicine content, teaching and assessment in medical school curricula in Australia and New Zealand. BMC medical education. 2018 Dec;18(1):110.

  Shipton EE. Oral Presentation at the annual Australian Pain Society Scientific meeting held in Sydney, Australia in April 2018.

  Shipton EE. Poster presentation of review of pain medicine education internationally at the IASP 17^th World Congress on Pain held in Boston, USA in September 2018.  Submitted a paper on a review of published literature on tools to assess knowledge, attitudes and skills of medical students with regard to pain medicine to Pain Reports.

  Morellini N, Finch PM, Goebel A, Drummond PD. Dermal nerve fibre and mast cell density, and proximity of mast cells to nerve fibres in the skin of patients with complex regional pain syndrome. Pain. 2018 Jun 12. PubMed PMID: 29905655.

  Drummond PD, Morellini N, Finch PM, Birklein F, Knudsen LF. Complex regional pain syndrome: intradermal injection of phenylephrine evokes pain and hyperalgesia in a subgroup of patients with upregulated alpha1-adrenoceptors on dermal nerves. Pain. 2018 Jul 2. PubMed PMID: 29994991.

  Jan AL, Rogers I, Visser EJ. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. The Medical Journal of Australia. 2018 Mar 5;208(4):188-9.

  Jan AL, Aldridge ES, Rogers IR, Visser EJ, Bulsara MK, Niemtzow RC. Does ear acupuncture have a role for pain relief in the emergency setting? A systematic review and meta-analysis. Medical acupuncture. 2017 Oct 1;29(5):276-89.

  Jan AL, Aldridge ES, Rogers IR, Visser EJ, Bulsara MK, Niemtzow RC. Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta‐analysis. Emergency Medicine Australasia. 2017 Oct;29(5):490-8.

Support the Churack Chair – Make a Gift to the Post-Doctoral Fellowship in Pain Sciences Research

We wish to re-establish this position by attracting a high-quality post-doctoral (PhD) researcher for a minimum three years (0.5 FTE contract), to continue vital research on disease-based mechanisms of chronic pain, such as nerve pain and inflammation, low back pain, headaches and complex regional pain syndrome. The Fellowship would require funding of $50,000.00 per year, over a three year period. Funding the Fellowship directly from donations or by sponsorships, is needed.

There are few if any dedicated pain research Fellowships in Australia. Dr Natalie Morellini's position at UNDA / Murdoch University was unique in this regard, and produced a number of high impact research papers, which discovered new cellular, inflammatory, hormonal and molecular causes of chronic pain. It is therefore vital to re-establish this Fellowship so we can continue this cutting edge research into the fundamental causes of chronic pain.