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Research by Maria Fitzgerald's group in the Department of Neuroscience, Physiology & Pharmacology has provided fundamental biological knowledge of the development of pain pathways in the human fetus that is recognised all over the world. As a direct result of her published research, she co-authored a report from the Royal College of Obstetrics and Gynaecology on clinical recommendations for practice in fetal medicine and fetal termination. Published in March 2010, this report provides authoritative, evidence-based recommendations for medical practitioners, abortion advisory groups and patients, and consequently determines clinical practice throughout the UK. The recommendations impact upon a large number of women; in 2011 there were 196,082 abortions in England and Wales.
The Glasgow Composite Measure Pain Scale (CMPS) has provided the first validated pain questionnaire for the rapid assessment of acute pain in dogs in surgical and clinical settings. Developed by the University of Glasgow School of Veterinary Medicine, the scale aids clinical decisions on appropriate pain relief intervention and has been freely downloaded by over 3,000 clinical users since its launch in 2008. In addition, it has been used extensively by veterinary healthcare companies to successfully obtain regulatory approval for analgesic drugs and in marketing support materials. The University of Glasgow researchers have been instrumental in developing international pain guidelines with the World Small Animal Veterinary Association, which represent more than 180,000 veterinarians worldwide, and has thereby promoted awareness of pain management in companion animals.
More than three million people are in pain at any one time in the UK, with inadequate analgesic treatment because of side-effects or lack of drug efficacy. By identifying roles for the voltage-gated sodium channel subtypes Nav1.7 and Nav1.8 in peripheral pain, our research has had a significant impact on the clinical understanding of human pain disorders and on the commercial development of selective analgesics with fewer side-effects. We have developed and disseminated several transgenic mouse lines which are widely used by the pharmaceutical industry. Through media appearances, we have also increased public awareness of the physiological basis of pain.
A high quality clinical trial, systematic reviews and meta-analyses performed by a team at Brunel University have directly informed key international clinical practice guidelines, policies and on the management of low back pain and neuropathic pain and have been cited by users (NHS Trusts: Addenbrookes) in response to such guidelines. In this way our research is directly informing clinical practice.
Adolescents (and their families) in the UK and around the world are now better able to cope with chronic pain because of the unique work carried out at the University of Bath Centre for Pain Research (BCPR), directed by Professor Christopher Eccleston.
The BCPR produced the first multidimensional `one-stop' tool to assess the impact of pain on children's lives, which has now been adopted in at least 12 countries. Pioneering treatments from Bath have influenced therapeutic approaches worldwide.
The Bath team also manage the evidence base for chronic pain, giving access through the Cochrane Library, advising internationally on clinical service development and improvement.
Newcastle University research has changed policy and practice relating to the provision of pain relief to rodents and rabbits. This has impacted on up to 35 million animals worldwide during the REF period. Having established the under-use of analgesics in laboratory rodents, Newcastle researchers developed objective pain scoring systems. These established that analgesics should be administered to rodents and rabbits, and that the efficacy of this treatment should be assessed objectively. The research resulted in changes to policy statements, institutional policies (both academic and industrial) and individual research worker practices in the USA, Canada, Australia, Europe and the UK. This has produced clear benefits to the welfare of animals used in biomedical research, helps to satisfy public concerns that animals used in research should experience the minimum pain and distress, and improves scientific outcomes of research, since pain is an uncontrolled experimental variable, that can adversely affect study results.
The Pain Research Group (PRG) is a research team within the Centre for Health and Social Care Research (CHSCR). The PRG's research programme in chronic pain management encompasses a range of robust methodological approaches to achieve better patient outcomes with local, national and international impact. The PRG has adopted a dual approach to investigating the treatment of chronic pain, incorporating psychological factors with the application of neuromodulation techniques. This has led to significant improvements in patient outcomes and patient satisfaction surveys demonstrate excellent, positive results. The research has had significant influence on clinical practice at national level, underpinning recommendations for best practice issued by the British Pain Society in relation to spinal cord stimulation and intrathecal drug therapy. It has also contributed to NICE's clinical guidelines on the implementation of spinal cord stimulation and influenced clinical decision making through the NHS evidence database. At an international level, our research has contributed to three sets of guidelines issued by the Polyanalgesic Consensus Conference: inflammatory mass, intrathecal drug therapy for chronic pain and recommendations for reducing mortality and morbidity of intrathecal drug therapy. The reduction of morbidity and mortality in intrathecal drug therapy is of particular significance as the reduction of harm and unnecessary complications in healthcare is of high concern to healthcare organisations worldwide.
As a result of our discoveries of a new splice variant (ASIC1b) and a new member (ASIC4) of the ASIC family, and elucidation of their roles in pain caused by tissue acidity, several pharmaceutical companies are now working on ASIC-targeted analgesics and one company has been set up specifically to focus on this work. ASIC-related therapies for a wide variety of conditions are now in clinical trials, with substantial patient involvement. Our work has allowed new therapeutic applications to be conceived for already existing prescribed compounds, and for naturally-occurring compounds, that act on ASICs. Thus, our research on ASICs has had clinical and commercial impact.
Having recognised the relative under-use of analgesics (painkillers) in animal research and veterinary practice, a programme of research at Newcastle led to the development of a behaviour-based pain scoring system. This system provided an objective way of establishing effective doses of analgesics to reduce post-operative pain and discomfort in animals. This work led to changes to a range of policy statements, institutional policies (both academic and industrial) and individual research worker practices. It is now established that analgesics should be administered to rodents and rabbits, and that the efficacy of this treatment should be assessed objectively, in both the laboratory and in veterinary practice.
Statistical research has played a leading role in the creation of two pain measurement tools for dogs and a welfare tool for farm animals. The Glasgow Composite Measure Pain Scale (CMPS) was the first validated, multidimensional tool for assessing acute pain in domestic animals in surgical and clinical settings, leading to improved treatment. The tool is based on a statistical model and is unique in providing an intervention threshold for pain relief. Since its launch in 2008, it has been downloaded by over 3,000 users from both veterinary practice and industry and it has been used by several companies for regulatory approval of novel analgesics. A second pain measurement tool (GUVQuest) was developed for chronic pain in dogs, enabling its impact on quality of life to be assessed. This tool is suitable for animal owners and is being exploited commercially in web-based form. A welfare tool for pigs has also been developed using the same statistical principles and work is underway on the development of similar tools for cows and cats.