Clinical pain phenotyping
The pain experience is a complex result of arthritis in the joint, processing of pain signals by nerves and in the central nervous system, and moderation by genetic, psychological and environmental factors. Being better able to describe and measure arthritis pain is essential for understanding its mechanisms, developing new treatments, and determining which treatments are effective.
Better ways of working out what kind of arthritis pain is causing an individual the most difficulty would help them to decide what treatment is likely to be best for them. Preclinical models reflect differences between people with arthritis pain and are enabling us to develop new treatments to relieve pain for different individuals.
Different people describe their pain in a variety of ways and people with arthritis can experience a range of pains at different times. We have refined questionnaires used to define the pain experience and to measure the effects of arthritis and its treatment on that pain. We are now exploring how the pain experience changes over time and what mechanisms underpin those changes so that we can develop new treatments to minimise the impact of pain progression.
We are exploring how changes both in the joint and the nervous system influence the way that people experience arthritis pain. Combinations of imaging, biochemical, histological and genetic techniques are enabling us to identify those aspects of arthritis that drive pain from the joint. Techniques such as quantitative sensory testing (QST) and brain imaging are enabling us to identify activation and modulation of pain processing pathways. The balance between different pain mechanisms changes over time and differs between individuals. Our research is defining risk factors that identify people who might develop worse arthritis pain, who could benefit from earlier or more intensive treatments. We are also identifying people whose pain might be caused more by changes in the joint and also those affected more by changes in the nervous system, these diverse groups might benefit differently from alternative treatments.