Chronic pain is a leading cause of morbidity, common to patients with gastrointestinal diseases such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Most pain killers are largely ineffective against this type of pain or restricted for use in these patients due to gut related complications and risk of addition. A significant unmet clinical need therefore exists to develop novel non-opioid based visceral analgesics.

Pain has both a sensory and emotional component and is driven by activation of sensory neurones called nociceptors that are tuned to detect noxious stimuli in a process called nociception. Although nociception functions as a detect and protect mechanism. and is found in many organisms, this system becomes dysregulated in a number of conditions where chronic pain presents as a key symptom, for example osteoarthritis. Nociceptors do not innervate empty space though and do not act alone. Going beyond the neurone, other cell types, such as fibroblast-like synoviocytes interact with and modify the function of nociceptors, which is likely a key contributor to the chronification of pain. In this talk, I will look at how combining pre-clinical mouse work with human tissue and genetics might provide a way to accelerate new analgesics from bench to bedside, giving examples from our work in joint pain, bowel pain and labour pain.

In this talk, Dr. Schweinhardt will discuss top-down (i.e. cerebral) modulation of the perception and processing of nociceptive stimuli using selected examples in chronic pain patients as well as healthy subjects. Data on activity-dependent central sensitization will be presented as a case of bottom-up pain modulation. Finally, Dr. Schweinhardt will present a new line of research with which she aims at studying the interaction of top-down and bottom-up pain modulation.

Pain is a major clinical problem affecting 1 in 5 people in the world. There are unresolved questions that urgently require answers to treat pain effectively, a crucial one being how the feeling of pain arises from brain activity. Computational models of pain consider how the brain processes noxious information and allow mapping neural circuits and networks to cognition and behaviour. To date, they have generally have assumed two largely independent processes: perceptual and/or predictive inference, typically modelled as an approximate Bayesian process, and action control, typically modelled as a reinforcement learning process. However, inference and control are intertwined in complex ways, challenging the clarity of this distinction. I will discuss how they may comprise a parallel hierarchical architecture that combines pain inference, information-seeking, and adaptive value-based control. Finally, I will discuss whether and how these learning processes might contribute to chronic pain.

The ability to experience pain is old in evolutionary terms. It is an experience shared across species. Acute pain is the body’s alarm system, and as such it is a good thing. Pain that persists beyond normal tissue healing time (3-4 months) is defined as chronic – it is the system gone wrong and it is not a good thing. Chronic pain has recently been classified as both a symptom and disease in its own right. It is one of the largest medical health problems worldwide with one in five adults diagnosed with the condition. The brain is key to the experience of pain and pain relief. This is the place where pain emerges as a perception. So, relating specific brain measures using advanced neuroimaging to the change patients describe in their pain perception induced by peripheral or central sensitization (i.e. amplification), psychological or pharmacological mechanisms has tremendous value. Identifying where amplification or attenuation processes occur along the journey from injury to the brain (i.e. peripheral nerves, spinal cord, brainstem and brain) for an individual and relating these neural mechanisms to specific pain experiences, measures of pain relief, persistence of pain states, degree of injury and the subject's underlying genetics, has neuroscientific and potential diagnostic relevance. This is what neuroimaging has afforded – a better understanding and explanation of why someone’s pain is the way it is. We can go ‘behind the scenes’ of the subjective report to find out what key changes and mechanisms make up an individual’s particular pain experience. A key area of development has been pharmacological imaging where objective evidence of drugs reaching the target and working can be obtained. We even now understand the mechanisms of placebo analgesia – a powerful phenomenon known about for millennia. More recently, researchers have been investigating through brain imaging whether there is a pre-disposing vulnerability in brain networks towards developing chronic pain. So, advanced neuroimaging studies can powerfully aid explanation of a subject’s multidimensional pain experience, pain relief (analgesia) and even what makes them vulnerable to developing chronic pain. The application of this goes beyond the clinic and has relevance in courts of law, and other areas of society, such as in veterinary care. Relatively far less work has been directed at understanding what changes in the brain occur during altered states of consciousness induced either endogenously (e.g. sleep) or exogenously (e.g. anaesthesia). However, that situation is changing rapidly. Our recent multimodal neuroimaging work explores how anaesthetic agents produce altered states of consciousness such that perceptual experiences of pain and awareness are degraded. This is bringing us fascinating insights into the complex phenomenon of anaesthesia, consciousness and even the concept of self-hood. These topics will be discussed in my talk alongside my ‘side-story’ of life as a scientist combining academic leadership roles with doing science and raising a family.

Candy will provide an overview of Bristol Health Partners' Chronic Pain Health Integration Team which brings together clinicians, academics, patients and carers to focus on improving the lives of those with chronic pain and supporting those who provide chronic pain services or care. Tony will describe recent and ongoing studies that have been forward and reverse translating pain neuroscience from animal to human including functional imaging in patients, microneurography, industrial partnerships and trials of novel preventative approaches that are benefitting from the people, expertise and facilities available in Bristol and GW4.

What happens when the nervous system fails to adapt? Our perception of the world relies on a nervous system that learns and adapts to sensory information. Based on our experience we can predict what a wooden surface will feel like, that fire is hot, and that a gentle caress from a partner can be soothing. But our sensory experience of the world is not static – warm water can feel like fire on sunburned skin and the gentle brush of our clothes can be excruciating after an injury. In pathological conditions such as chronic pain, changes in nervous system function can cause normally innocuous sensory stimuli to be perceived as aversive or painful long after the initial injury has happened. These changes can sometimes be similar to the formation of a pain ‘memory’ that can modulate and distort our perception of sensory information. Our research program seeks to understand how fundamental processes that govern the formation and maintenance of plastic changes in the nervous system can lead to pathological conditions and how we can reverse engineer these changes to treat chronic conditions.