New chronic pain spinal fluid study may hold key to better treatment

The spinal fluid of patients with chronic pain will be examined by a team of Australian researchers in a new pilot study that could lead to the development of a test for chronic pain and more effective treatment for the condition.
With one in five Australians under 65 now living with chronic pain the project involves testing the spinal fluid of patients with the condition to determine whether a test for chronic pain and complex pain syndromes is feasible and likely to be clinically useful.
The two year study is being led by Director of Innovation at the University of Adelaide Professor Paul Rolan, Professor Rainer Haberberger, convenor of the Centre for Neuroscience at Flinders University and Dr Porhan Kang, Director of Flinders Medical Centre, Pain Management Unit..
Professor Rolan said the study would focus on examining the tiny “bubbles” called exosomes that are shed from brain cells. These exosomes, which are present in spinal fluid, contain markers of brain activity that will help the project’s research team to identify pain types and better understand pain in individual patients. 
“We can do scans of people’s brains but we can’t understand what is happening inside that brain at a chemical level. We are hoping that the markers, which are also known as “microRNAs”, are messenger chemicals which may reveal specific patterns for pain and possibly give us clues as to how to treat pain. Blood tests could then be developed and this could help in the diagnosis and management of patients with chronic pain,” he explained.

“Objective tests of pain have many potential applications to improve outcomes for patients with pain. Pain is of course a subjective experience. However an objective test which reflects a chronic pain state could help in the diagnosis and management of pain in patients with complex medical problems of which pain may be a part. This would benefit children, patients with cognitive impairment or those with specific communication difficulties.”
The project is being funded by the Australian and New Zealand College of Anaesthetists (ANZCA) Research Foundation through a $32,500 grant awarded under the College’s 2018 grant scheme and is a collaboration between the University of Adelaide, Flinders University and Flinders Medical Centre's Pain Management Unit (Department of Anaesthesia). A total of $1.74 million has been awarded by the ANZCA Research Foundation for 2018. The Foundation supports research projects across the fields of anaesthesia, perioperative and pain medicine.
The study will draw on a group of 30 current chronic pain patients whose pain is so severe that they require catheters for pain relief medication.

The fluid will be taken from the catheters.

Professor Rolan said one of the challenges faced by pain medicine specialists is the variation in how patients respond to treatment.
“Currently many treatments for chronic pain only work in a proportion such as 25 to 50 per cent of patients, necessitating multiple trials of drug therapy which may be ineffective yet expose patients to unwanted effects. A suitable test has the potential to select therapy more effectively,” he explained.
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