Studying the brain to relieve pain By Jane Elliott 'I had to give up my job' Doctors hope they will soon be able to assess exactly how much pain their patients are suffering. As many as one in four people suffer from chronic pain - people like Malcolm Pankhurst who was plagued for years by chronic back pain. Until now, doctors have had to rely on patients' descriptions of their pain. But now researchers at the Pain Clinical Research Hub, based at King's College Hospital (KCH) and the Institute of Psychiatry, London, are using the latest imaging techniques to measure the brain activity of people in pain to get an objective measurement of its intensity. They hope that knowing how much pain the patient is really suffering will teach them whether the treatments they are prescribing are doing enough to help. Excruciating Malcolm says anything that can help others escape the years of suffering he endured can only be welcomed. He first noticed a problem with his back nearly 10 years ago. I can think of at least a dozen occasions when I would have needed to attend an accident and emergency department at my local hospital due to acute debilitating pain Malcolm Pankhurst Years of sitting hunched over a desk in his job in the banking industry had taken its toll. One New Year, his back started to ache. Within hours he was in excruciating pain unable to sit, and he was rapidly referred for surgery. He suffered three prolapsed discs and severe pains in his leg and foot. The problem became so bad he had to have discs removed. But the pain continued and Malcolm, aged 53, decided to quit his high profile job and set up his own business selling specialised chairs to back pain sufferers like himself. "I could no longer work the demanding hours in banking, and indeed the surgeon suggested a 'change in lifestyle' might help." Relief Now he is virtually pain-free and credits a pain clinic run by Dr Magdi Hanna, who is KCH Consultant in Pain Relief and is involved in the new research hub, for his miraculous improvements. "I was referred for pain control and whilst the initial doses of medication were fairly high the relief from the pain was almost immediate," Malcolm said. Over the next couple of years, he had a number of procedures to help relieve the pain. Eight years later he sees Dr Hanna every three or four months, and his medication is regularly adjusted. He said: "The doses of medication allow me to carry on with a fairly normal life. "The tablets I take are anti-convulsants and tricyclic anti-depressants that block the brain's neurotransmitters. "I have since suffered many episodes of acute pain as further problems have arisen in my back, but I always have sufficient 'back-up' medication to tolerate these instances. "Had I not received such excellent pain management from Dr Hanna, overseen by my GP, I can think of at least a dozen occasions when I would have needed to attend A&E due to acute debilitating pain. "But thankfully it has only been once in eight years due to the education I have received." Management And the researchers hope it will not be too long before they can get other patients' pain managed as well as Malcolm's. Initially, the researchers will use functional magnetic resonance imaging to study patients in pain from back problems, diabetes and other causes of neuropathic pain such as traumatic nerve injury and the pain after shingles. By getting information from the neural pathways they hope to identify new methods of pain measurement. Professor Steve Williams, Head of Imaging Sciences at the Institute of Psychiatry, said: "Recent developments in functional imaging have allowed us for the first time to visualise the brain pathways involved in processing pain. "This technology will undoubtedly lead to new ways of measuring and treating pain." Dr Hanna agreed: "Our delivery of pain relief is still pretty limited. We hope to we will be able to give individually targeted and tailored regimes to patients." Professor Sally Davies, Head of NHS Research and Development said: "The Pain Clinic Research Hub is a vital step forward in developing our understanding of pain, what triggers it, how it is felt physically, and the impact it has on the lives of sufferers and their families. "The research will result in better pain prevention, treatment and management for the hundreds of thousands of people who live with constant and unremitting pain."