This paper describes the plans for a new trial for the Pain At Work (PAW) toolkit. The toolkit aims to help people manage their own pain and remain active and productive at work. It guides the user to helpful online resources, designed to help people with pain. This trial hopes show how a large-scale study of the PAW toolkit will be feasible. If a large-scale study were successful, the PAW toolkit could be made available to anyone struggling with their work because of chronic pain.
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The central nervous system (brain and spinal cord) plays a hugely important role in pain. The processing of pain signals can worsen the pain from many different body sites, across many different diagnoses, in many different people. Measuring the effects of the central nervous system is challenging, but a series of physical tests can be used that measure pain sensitivity; Quantitative Sensory Testing.
This study tried to find out if different tests can reliably measure pain sensitivity in people with rheumatoid arthritis, people with chronic lower back pain and healthy volunteers.
Osteoarthritis of the hip or knee are major causes of disability, largely due to the pain that they cause. People often use medicines to try to relieve their pain. One of the main aims of management is to improve physical function, such as walking or standing. Several research studies have compared medicines to inactive tablets (placebos) to show that they relieve pain. Some research also looked at physical function, but not all studies gave the same answer. We systematically reviewed all the published clinical trials of pain medicines and physical function. We used the statistical technique of meta-analysis to find out whether, overall, taking pain medicines improves physical function.
Osteoarthritis and chronic low back pain are very common, but it has been uncertain just how much of a financial drain they are on the National Health Service. We analysed information from 2008 to 2019 from two large statistical databases in the UK, the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics (HES). We studied information from people who had received healthcare for mild, moderate or severe chronic pain associated with osteoarthritis or chronic low back pain, and compared them to people without those conditions who were otherwise similar.
Knee pain and knee osteoarthritis are common causes of disability in the UK. They become even more common as people get older. People with knee pain often experience muscle weakness, which can increase disability. Knee pain depends not only on osteoarthritis in the joint, but also on how the central nervous system (CNS: spinal cord and brain) processes nerve signals from the joint. In this study, researchers looked at whether joint disease or changes in the central nervous system cause muscle weakness in people with knee pain.
Frailty refers to being more vulnerable to decline as one gets older, which means that recovering from illnesses or injuries takes longer. Our previous research showed that pain increases the chances of becoming frail in the following year. People who live with frailty or pain often have other health conditions (morbidities). Some of these conditions, like osteoarthritis, can cause pain, while others, such as high blood pressure, do not cause pain. In our study, we explored the link between pain and frailty and having more painful health conditions.
Low back pain (LBP) is a condition that affects a large proportion of the population and is one of the main reasons for people to visit their GP and take time off work. For some people LBP can be long lasting and the focus for management is help people to better self-manage their LBP to enable them to be able to confidently cope with their symptoms and manage their condition. Being able to self-manage the symptoms of LBP is very important as it can impact on a person’s ability to work and undertake the activities they enjoy.
Falls are very common, especially in women and older people, and can lead to serious injuries such as broken bones. We can prevent falls by addressing the factors that lead to falls. We wanted to know if pain is one of these factors.
Both depression and pain are common and reported more frequently by women than men.
It is often thought that pain may lead to depression, while depression may precede and worsen pain. To help disentangle this potential two-way street, we explored whether the presence and intensity of pain may be risk factors for onset of depression in adults without depression.
Knee pain is a common problem across populations. Osteoarthritis or sporting injuries often cause this type of pain. Several treatments are available and more are being developed. There are several questionnaires that measure knee pain and help clinicians or researchers decide whether their proposed treatment works. Although treatments can provide pain relief, such improvement in pain is often not enough to be useful to the person taking the treatment. Despite using treatments, people often continue having unacceptable knee pain.
Low back pain (LBP) is very common, can last for months or years, and can substantially impact on the quality of life of people who experience it, as well as on healthcare services. Why does back pain last so long?
Within the bones of people with osteoarthritis there are often regions called Bone Marrow Lesions (BMLs) which are seen using MRI scanners. They appear to be linked to inflammation and pain. When BMLs are close to the knee joint, they appear to be closely related to osteoarthritis knee pain. Joint tissues are very useful for research aiming to characterise cells and molecules that might be targeted by new drugs in order to relieve pain.
What do people with knee osteoarthritis think is happening when their pain changes (or doesn't change)?
Pain is unfortunately a common experience of people with knee osteoarthritis. Healthcare practitioners consider many things when helping people to manage their pain. They are thinking about what is happening within the affected knee, how the nervous system is translating those changes into pain, what the person with knee pain is thinking, how they cope, and what support they have available to them.
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Different genes may influence how pain from osteoarthritis is felt in areas close to and away from the painful joint
People with neuropathic-like pain or with pain sensitisation can experience constant pain even after having had joints replaced by surgery. So, understanding the causes of pain sensitisation and neuropathic-like pain is essential for developing effective treatments to help these patients.
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Investigating soluble epoxide hydrolase as a target for osteoarthritis pain
Research into the body’s natural anti-inflammation systems may highlight new drug targets for pain relief for people with osteoarthritis. Current treatments for osteoarthritis pain are often not good enough, and pain severely affects the lives of people with osteoarthritis.
Rheumatoid Arthritis (RA) is an autoimmune condition that mostly affects the joints and long-term pain, and fatigue are common problems. We believe the brain, spinal cord and nerves may make pain and fatigue worse by affecting the way the body feels pain - a process called central sensitization.
Further information, including links to the article can be found on the summary page.
Pain is one of the main problems for people with active rheumatoid arthritis (RA), and glucocorticosteroids (GCs) are often used to treat this. The commonest GC is prednisolone, and others include dexamethasone, betamethasone and cortisone. GCs can be used to affect the whole body; which normally means taking a daily tablet, but can also be by intravenous infusion or injection into a muscle (these are known as systemic administration). It is currently believed that GCs relieve pain by reducing inflammation and joint swelling in people with RA.
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One of the enduring problems with osteoarthritis is that many people appear to have osteoarthritic changes in their joints but yet they don’t experience major amounts of pain making research targets difficult to identify.
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Osteoarthritis is a long term joint problem, mostly prevalent among the elderly population. However, any association of osteoarthritis with other long-term conditions has not been studied in detail.
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The development of long-lasting pain involves changes in the strength of connections between the nerve cells that conduct sensory information from the body to the brain. One of the key goals in pain research is to identify how and when these connections are altered, in order to find ways to prevent or reverse this process and thus provide pain relief. A key site where this occurs is the spinal cord, where incoming information from the nerve fibres in the body are received by spinal nerve cells to encode the location and strength of a painful stimulus, before sending it on to the brain.
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Anti-inflammatory tablets (such as ibuprofen) and opioids (such as codeine) are often used to treat the chronic pain of osteoarthritis or low back pain. However, pain relief might not outweigh the risk of side effects from such treatments.
Further details are available on the summary
Ibuprofen gel and capsaicin cream are two commonly used treatments for painful osteoarthritis of the knee. Based on previous studies involving hundreds of people, we know that they provide similar levels of pain relief on average. But does that mean that each person that tries the two treatments finds that they give the same amount of pain relief? Our clinical experience would suggest that it does not, however, no studies had tested this before.
The topmost concern of people with osteoarthritis (OA) is a reduction in joint pain but the mechanisms of OA pain are complex. People with OA experience “flares” of joint pain. Joint inflammation contributes to OA pain. We show that OA joints are more sensitive to damage following painful inflammatory flares and the joint damage persists even after the resolution of joint pain. Preventing inflammatory flares may be particularly important in preventing symptoms and long-term joint damage in OA.
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Key characteristics such as depression, have been suggested to act through the central nervous system to increase knee pain in osteoarthritis (OA).
This study found that in individuals with knee pain, higher scores for 8 different characteristics are linked to processes occurring within the central nervous system, called ‘central mechanisms’.
This research is important because using a simple questionnaire which addresses these 8 characteristics might allow clinicians to identify and effectively target treatment towards central mechanisms, thereby improving knee pain treatment in individuals.
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This study challenged a popular viewpoint, that the inflammation in rheumatoid arthritis (RA) is fully responsible for the symptoms that are experienced.
This study implies that the troublesome symptoms of RA may not be wholly explained by inflammation. It is possible that people with RA might gain added benefits from pain management strategies.
Please visit the published article for further insite into this study.
It appears that osteoarthritis may be common in the hands and feet of people who have newly diagnosed rheumatoid arthritis.
Studying X-rays shows that both rheumatoid arthritis and osteoarthritis progress over the course of 3 years.
We found that people whose rheumatoid arthritis was slightly more “inflammatory” had worse erosions; and those people whose rheumatoid arthritis was more painful had less severe erosions. Further information
Different people with knee osteoarthritis (OA) often have different symptoms and joint structural changes and also respond differently to treatment.
We show that patients with OA can be classified into 3 groups based on differences in changes in the joint.
Subgrouping people with OA may allow for more effective personalised treatments to reduce pain and slow down disease progression. Further information
Changes within the bone are associated with the development of OA as well as knee pain.
Cells that are responsible for breaking down bone, release biological factors to help with this breakdown.
The amount of these cells and related factors were found to be higher in people with painful OA. Further information
Functional brain imaging uses magnetic resonance imaging (MRI) to tell us about brain activity, for example during pain.
The ways of combining and summarizing results from previously published functional imaging studies can now be improved to help to analyse the results with greater certainty; this analysis is called coordinate based meta-analysis. Further information
Causes of pain from osteoarthritis are diverse and poorly understood.
Symptoms which are similar to pain from nerve damage such as burning pain or numbness, are common among patients with severe knee osteoarthritis.
Although these symptoms may be caused by osteoarthritis, in some patients such pain may arise from nerves damaged during surgery to repair the knee. Further information
Knee osteoarthritis is one of the most common types of arthritis, causing pain, disability as well as emotional distress.
However, there is limited research on the daily experience of living with knee osteoarthritis.
Understanding people's beliefs and how they can affect the outcome of treatment recommendations, should help healthcare professionals to provide information and education that will assist people in managing osteoarthritis.
Further details relating to this publication and the article are available here.
Inflammation is known to be a key contributor to osteoarthritic joint pain.
Nerve growth factor (NGF), a naturally occurring molecule in our body, is essential for the maintenance and development of nerves, but NGF levels also increase in many painful conditions, especially those associated with inflammation.
Sensitivity to NGF is increased in osteoarthritic knees and treatments that reduce this sensitivity, have the potential to improve osteoarthritic pain. Further information
It is not understood why osteoarthritis causes pain which, for many people, can be one of the most debilitating symptoms.
During the early stages of osteoarthritis, cells called osteoclasts break down bone in the joint.
Preventing the activity of these osteoclasts decreases pain and joint damage later in the disease, suggesting that bone is important in the generation of arthritis pain. Further information
Risk factors for painful rheumatoid arthritis
Medication can often control inflammation in rheumatoid arthritis (RA), but the effects on pain are less certain.
By looking at the Early Rheumatoid Arthritis Network (ERAN) cohort study, it was possible to estimate which people were prone to experience more pain and feel worse at diagnosis.
This information will help further research into the causes of rheumatoid arthritis pain. Further information
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