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Tacking the ‘untapped frontier’ of chronic pain
By writing a book on how to deal with chronic pain, Dr Deepak Ravindran aims to help medical professionals and patients alike to better understand the issue.
A consultant is building on his experience of supporting people with pain by writing a book which will help others to develop a mindset to understand and overcome the issue.
Dr Deepak Ravindran has written The Pain Free Mindset, which brings together the experience and expertise of his 20 years working in the specialist field to increase understanding of chronic pain among patients and medical professionals alike.
Through developing a new mindset, says Dr Ravindran – which can help form a new perception and response to pain – a revised approach can be adopted which can potentially remove the need for medication or surgery.
Using the mindset acronym, Dr Ravindran demonstrates a range of areas in which positive change can be effected:
- Medication – how to use it safely
- Interventions – how to discuss with your doctor or surgeon
- Neuroscience – how to better manage stress
- Diet – what can be included in an anti-inflammatory diet
- Sleep – the relationship between sleep and pain
- Exercise – its impact on the brain and role in pain control
- Therapies – what mind/body therapies are available.
Statistics help to show the impact of chronic pain in the UK, with up to 40 per cent of the population – around 28 million people – experiencing pain from conditions including fibromyalgia, nerve damage, arthritis and headache and migraine. It is also a symptom of Long COVID, more recent developments have established.
But rather than continual medical interventions, supporting people to take control of their chronic pain can secure better and longer-lasting outcomes, says Dr Ravindran.
“Pain is not always the indication or harm we have been led to believe. Pain is our body recognising the need to protect us, but there are options on other ways to react to it other than becoming over-medical and over-anxious,” says Dr Ravindran, a consultant in pain, anaesthesia, musculoskeletal and lifestyle medicine at the Royal Berkshire NHS Foundation Trust.
“Nociception occurs when chemicals are produced through injury, but when that is not present, then it could be that medical intervention is not useful. That’s when we see the overuse of surgery and overuse of drugs.
“Through this book, I wanted to bring out the complexity of pain but at the same time show that there is hope. There are so many ways of managing it, but it remains an untapped frontier for so many people.”
As well as the self-help aspect of the book, Dr Ravindran – who is lead for the Berkshire Long covid Integrated Service (BLIS) – also wants to tackle the gap in knowledge of medical professionals when it comes to chronic pain.
“In the five or six years doctors spend training, pain teaching can account for about 10 hours of that,” says Dr Ravindran, who completed a pain Fellowship at University College London.
“Both pain and nutrition are not taught well in medical schools, and I would suspect it is the same with other medical professions. There are a whole host of medical professionals who still have the same thinking and beliefs as in the 1980s and 90s.
“I’m an anaesthetist and I’d say 99 per cent of pain consultants come from that background. We do a lot of pain relief through epidurals in labour, nerve blocks in surgery, so it forms a big part of our work and interest. Beyond that, there are not many.
“I continue to see people coming to my pain clinic who have been sent by their GP or surgeon, and have been given advice or medication because they don’t know any better. Before I began my work in pain, I may have been in the same situation.
“But from my book, I want to help to change this. A new approach and mindset can be so important for people who have pain, as well as the medical professionals. This is a complex area, but one in which we can all benefit from greater understanding.”
- The Pain Free Mindset is published on March 4. It is available for pre-order now at Amazon.
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Role of sleep in memory and learning uncovered
Research findings could aid development of assistive tools for people with neurological injury or disease
New research into sleep may help explain how memories are formed and how learning is consolidated, and could aid the development of assistive tools for people affected by neurological injury or disease.
Scientists previously studying laboratory animals discovered a phenomenon known as ‘replay’ that occurs during sleep – a strategy the brain uses to remember new information.
Scientists believe that this replay of neuronal firing during sleep is how the brain practices newly-learned information, which allows a memory to be consolidated, and converted from a short-term memory to a long-term one.
However, replay has only been convincingly shown in lab animals.
Now, a new study has investigated whether replay occurs in the human motor cortex — the brain region that governs movement — focusing on a 36-year-old man with tetraplegia who cannot move his upper and lower limbs due to a spinal cord injury.
The man, identified in the study as T11, is a participant in a clinical trial of a brain-computer interface device that allows him to use a computer cursor and keyboard on a screen.
The investigational device being developed by the BrainGate consortium, a collaborative effort involving clinicians, neuroscientists and engineers at several institutions with the goal of creating technologies to restore communication, mobility, and independence for people with neurologic disease, injury, or limb loss.
In the study, T11 was asked to perform a memory task similar to the electronic game Simon, in which a player observes a pattern of flashing coloured lights, then has to recall and reproduce that sequence.
He controlled the cursor on the computer screen simply by thinking about the movement of his own hand. Sensors implanted in T11’s motor cortex measured patterns of neuronal firing, which reflected his intended hand movement, allowing him to move the cursor around on the screen and click it at his desired locations.
These brain signals were recorded and wirelessly transmitted to a computer.
That night, while T11 slept at home, activity in his motor cortex was recorded and wirelessly transmitted to a computer.
“What we found was pretty incredible,” said Dr Daniel Rubin, lead author and a neurologist at the MGH Center for Neurotechnology and Neurorecovery.
“He was basically playing the game overnight in his sleep.
“This is the most direct evidence of replay from motor cortex that’s ever been seen during sleep in humans.”
Most of the replay detected in the study occurred during slow-wave sleep, a phase of deep slumber.
Interestingly, replay was much less likely to be detected while T11 was in REM sleep, the phase most commonly associated with dreaming.
The researchers see this work as a foundation for learning more about replay and its role in learning and memory in humans.
“Our hope is that we can leverage this information to help build better brain-computer interfaces and come up with paradigms that help people learn more quickly and efficiently in order to regain control after an injury,” said neurologist Dr Sydney S. Cash, co-director of the Center for Neurotechnology and Neurorecovery at MGH.
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