quite common to experience pain after a physical trauma
whether it be an accident or a medical intervention such as surgery
while in most people this pain goes away there is a significant portion of the
population for which this pain becomes chronic now
chronic pain is formally defined as pain
after an event that continues for more than 12 weeks despite
medication i'm Ali Mazaheria senior lecturer at
the school of psychology university of birmingham and part of my
research is investigating ways which we can identify individuals
that are vulnerable to developing chronic pain
there are currently no curative treatments for chronic pain
in fact in august of this year the national institute for health
and care excellence nice drafted a guideline suggesting that
painkillers are likely to do more harm to the patient that benefit
what is actually endorsed in the guideline are things such as cognitive
behavioral therapy and antidepressants well what does this mean
well this could very well be interpreted such that
it might not be possible to treat directly treat the pain
experienced by the chronic patients but rather instead help the patients
live with their pain so as it stands now
the most effective way to deal with chronic pain is to prevent it
to prevent it from developing in the first place
how can this be done well the biggest single predictor of an individual
developing chronic pain is the degree of pain they experience in
the period immediately after the pain
inducing event now mechanistically this is thought to
occur by the fact that this intense experience
of pain changes the brain's architecture and it's in
such a way that it becomes really really hypersensitive to the
sensation of pain now this would mean that if
somehow you could reduce the pain experienced by
by a patient immediately after the traumatic event and then it is
possible for you to prevent from the pain
actually becoming chronic now there is
a hurdle to this and the hurdle of that
is that there is extreme variability in our experience of pain from
person to person some people are extremely
tolerant to pain others are extremely sensitive to pain
now if you could identify individuals that are extremely sensitive
to pain before they develop pain then you can actually then take pre-emptive
steps to actually ensure that they're not
in a lot of pain after a traumatic event particularly when the traumatic event
here is a medical intervention such as surgery or chemotherapy or
radiotherapy medical interventions which end up with
a significant portion of the patient's being in
sorry developing chronic pain now what me and my
collaborators in baltimore maryland have been working on over the last few years
is a biological marker that can predict if an individual will develop
chronic pain or not in particular i should be careful it's an individual
it's a marker that can predict if an individual is
highly sensitive to pain or not now this biomarker
can be measured relatively easily using the electroencephalogram now
the electroencephalogram EEG in short what it does is that it records your
brain activity and you can record your brain activity
at rest and everyone's brain activity
has one particular dominant rhythm of between
14 hertz and that's called the alpha rhythm
now in some individuals the alpha rhythm is higher
give me 12 hertz and some individuals the alpha of them is lower
now the alpha rhythm is highly stable as in an individual
but it varies from person to person what we've identified in our research
and is that individuals that have a lower alpha frequency
they tend to be more sensitive to pain than individuals
that are that are less sensitive or in fact more resilient to the
sensation of pain and the way we've done this was to
actually experimentally induce pain in the laboratory
by to this procedure of rubbing capsaicin on an individual and heating
it up now if you do that it creates this
sensation that is very very similar to the pain
that chronic pain patients
experience and what our research has shown now across multiple studies
is that individuals that have a lower alpha frequency
they are far more likely to report a really really high level of pain
after this capsaicin administration than individuals that have a high alpha
frequency now what we've done here in birmingham
is actually directly take this into the clinic and looked at
individuals that are undergoing lung surgery for lung cancer
and here we chose lung surgery for lung cancer because it's
considered one of the most painful surgeries out there
with a high portion of individuals going on and develop pain
and what we what we did here was we looked at
we measured a patient's EEG before they had the operation and then we
looked at how much pain they were in after the operation and what we found
was quite remarkable what we found was that
we could actually use a patient's alpha frequency to predict
if they were going to experience a lot of pain
after the surgery or actually not a lot of pain after the
surgery now at the end of the day one might ask
what's all this good for well as i said earlier if you can
identify individuals that are at a high that are
really high sensitive to pain you can already pre-emptively
take steps you take steps by increasing their painkillers
dosage you can do all sorts of stuff behind the scenes in terms of their
anesthesia basically doing whatever you can to make
sure that this the pain immediately after the surgery
is actually reduced also what you're going
to do is offer alternatives to the medical intervention if you know
someone's really highly pain sensitive for example in terms of chemotherapy
it's possible to change the chemotherapy dosage it's also
possible to prescribe other stuff that alongside the
chemotherapy that although might make the
chemotherapy less effective it might make it also that the patient
is experiences less pain and as such is likely is less likely to be
less likely to develop chronic pain now what we're hoping to do in the
future is to test this alpha frequency
biomarker in a larger much larger sample of
of patients going into lung surgery undergoing lung surgery
and if our results could continue to hold what we hope
to do what will happen is that we can take the next steps and make it a
routine in terms of someone's clinical assessment
thank you very much