Director: Professor Anthony Jones
1. Use of functional brain imaging to understand brain mechanisms of pain perception and therapy
The Human Pain Research group is a multidisciplinary team focused on using different functional brain imaging techniques to understand human pain perception. Over the last thirty years we have defined the matrix of structures in the brain that is responsible for pain perception and what the division of function is within that matrix.
All kinds of pain are processed within this Human Pain Matrix. So, as far as the brain is concerned - pain is pain, is pain, is pain. The pattern of response within the pain matrix may vary from one type of pain to another, but the main determinant of this is the psychological context of the pain.
We have found that the brain has powerful ways of controlling information about pain that can be enhanced during placebo analgesia and a procedure known as brain entrainment.
More recently we have identified some candidate brain mechanisms for chronic pain and pain therapy. This allows us to work towards developing new brain-based treatments and practical ways of monitoring the effects of treatment for pain.
These methods also provide the possibility of characterising individual patients better so that we can work towards implementing individualised or customised therapies based on individual responses to pain.
2. Development of new pain therapies
On the basis of some of our recent discoveries we are developing a ‘smart neuro-therapies platform’ for providing brain-based therapies for pain. The concept of this is that patients with chronic pain, in the comfort of their own home, will be able to put a smart EEG (electroencephalography) cap on their head and watch their brain-waves on their phone. In addition, they will be able to record their symptoms on the phone and decide if they want to try a number of options for therapy. At the moment there two main options: 1/ brain-entrainment where the brain is tuned to one particular frequency (alpha or 10 Hz) which has been found to have pain killing effects. 2/. the other is a longer-term technique called neurofeedback. This involves monitoring brain responses in real-time and training the brain to respond differently usually over a period of weeks. The idea is that patients will use these therapies either in addition or instead of their current pain therapies. Recent funding has facilitated the development of some of the key components of this platform and to commence some small pilot trials.
3. Getting the positive message out
Public engagement has become a major part of our activities in recent years. This has included a collaboration with Knaive Theatre called ‘Pain, the brain and a little bit of magic’ which has toured the North West and various arts and science festivals. It is an empowering show about pain, enabling patients, relatives, health-care professionals and the general public to understand how the brain perceives pain and how it can take better control over these feelings (http://research.bmh.manchester.ac.uk/pain/events/PainTheBrainandabitofMagic/). We have also featured in a number of programmes on radio and television including a recent Horizon programme with Michael Mosely on Placebo (‘The Power of placebo’) and various international press releases about our research including an article in ‘Time’ magazine. (https://www.manchester.ac.uk/discover/news/people-can-raise-pain-threshold-by-altering-brain-chemistry-arthritis-patients-study-shows/)
We have discovered common candidate brain mechanisms for chronic pain (osteoarthiritis and fibromyalgia-a type of non-damage-related widespread pain) related to abnormal anticipation of pain that are related to the extent of pain symptoms. There is a failure of regulation of coping within the forebrain and amplification of processing within the insula cortex. The insula cortex is a part of the brain involved in processing our sense of self, emotions and pain. We have also discovered that some of these mechanisms are partially reversed by talking therapies such as mindfulness-based cognitive therapy.
More recently we have discovered that entraining the brain to express more alpha-waves using pulses of light or sound has a pain-killing effect. (https://www.manchester.ac.uk/discover/news/scientists-successfully-tune-the-brain-to-alleviate-pain/)
We are studying potentially similar mechanisms existing in neuropathic (nerve damage-related pain) e.g. Parkinsonian [Silverdale], Dental [Aggarwal] and cancer pain [Briggs] in Salford, Greater Manchester and with our colleagues in Liverpool (Chris Brown & Andrei Stancack) and Leeds (Sivan and O’Connor).
We have also discovered that the brain has its own natural resilience to pain. In patients with chronic arthritis pain we have found that there is a change in the natural opiate system in the brain that increases the resilience to pain. This works by increasing the numbers of opiate (morphine-like) cell surface docking stations (receptors) within brain in response to recent pain.
With encouragement and support from our two previous academic leads, we have formed the Greater Manchester Pain Consortium to bring together the main academic and clinical groups who are focused on Pain within Greater Manchester. This will allow us to extend our activities beyond our own group.