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Tacking the ‘untapped frontier’ of chronic pain

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Dr Deepak Ravindran

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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Royal Rehab opens Australia’s largest technology centre

The centre caters for people living with disabilities across the country

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Royal Rehab, Australia’s not-for-profit provider of rehabilitation and disability support services, opens the country’s largest technology centre, providing Australians with access to a comprehensive range of technology.

Royal Rehab’s Advanced Technology Centre is a purpose-built hub designed to improve the rehabilitation outcomes of people impacted by life changing illnesses or injuries. The centre also caters for people living with disabilities, by providing expert support and access to technologies that aim to improve function, strength and wellbeing and is the largest of its kind in Australia.

The C-Mill VR+ technology combines a treadmill with body weight supports and virtual and augmented reality to improve balance, gait, and gait adaptability in a controlled environment. The device provides a safe and comfortable training environment that mimics the challenges of real-life, helping users to navigate situations like walking in crowded areas and avoiding obstacles.

The centre is also home to a Zero G Gait and Balance System, which has the longest walking track in the country. This device is a robotic body weight support that is designed to assist those affected by spinal cord injuries, brain injuries, neurological conditions and degenerative conditions to walk.

It allows falls prevention training to minimise patient risk, so they can focus on regaining their confidence in walking, balancing, climbing stairs and manoeuvring from sitting to standing positions.

Matt Mackay, CEO of Royal Rehab, believes technology can play a significant role in unlocking better patient outcomes and that the opening of Royal Rehab’s Advanced Technology Centre will make innovative technology more accessible.

“We know that the use of technology in combination with traditional therapies has the potential to drive better outcomes,” he says. “This will revolutionise the rehabilitation pathway for many patients, which in turn can lead to dramatic changes in a person’s quality of life.

“Our Advanced Technology Centre provides Australians with the opportunity to access potentially life-changing devices, many of which have never been accessible in Australia until now. We are delighted to be able to provide patients access to emerging advanced technologies that has the potential to accelerate rehabilitation progress and help people to improve their function, mobility and strength, the CEO adds.

“We want to provide people living with a long-term disability access to these technologies, so they too can benefit from improved strength and fitness, and maintain or even improve their functional independence.”

Jason Redhead, senior physiotherapist and technology lead at Royal Rehab, says that the centre offers Australian patients exclusive access to advanced technologies that will provide greater opportunities to achieve their rehabilitation goals, adding: “We have seen that advanced technology is starting to play a leading role in rehabilitation programs in many other countries.

“We want to ensure Australians too can access the best technology, like robotic exoskeletons, body weight support systems, upper limb robotics and virtual reality technologies. This means we will see more patients achieve more in their rehabilitation goals.”

The centre operates under the Royal Rehab LifeWorks banner, which provides Australians with access to a multidisciplinary team of allied health clinicians who work together with patients and clients on their individualised goals to develop integrated therapy and wellness programmes.

Royal Rehab’s Advanced Technology Centre is located at their Ryde location and will open its doors on July 1. Access to the centre is covered under a range of funding options, including NDIS, iCare, and self-funding.

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Neuro Convention returns next week

The event brings together neuro-rehab professionals and leading organisations from across the UK

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Neuro-rehab professionals and organisations will be attending one of the key dates in the sector calendar next week – Neuro Convention 2022. 

The event showcases the latest technology and innovations in the neurological sector, with the goal of improving patient outcomes. 

Neuro Convention, held on Wednesday and Thursday at the NEC Birmingham, will focus on four key areas – rehabilitation, mental health, diagnostics and brain and spinal injury. 

The free event includes a programme of more than 50 free CPD-accredited seminars, hosted by leading experts from across neuro-rehab, as well as interactive workshops hosted by the specialist neuro-rehab team at the University of Plymouth. 

Technology will also be showcased, with a programme of live demonstrations, to show how the latest innovation can benefit people’s lives. 

More than 50 exhibitors will also be in attendance, including the team from NR Times, who can be found on stand N-G3. 

Neuro Convention will be co-located with Naidex and UK Care Week within the NEC, highlighting the shared dedication of all three events to improve mobility and the technology introduced to support independent living.

Deborah Johnson, editor of NR Times, who will be attending Neuro Convention, said: “Neuro Convention is known as being one of the must-attend events in the neuro-rehab calendar, and 2022 looks to be another excellent event, with a packed programme of speakers and workshops and an array of leading exhibitors. 

“It’s absolutely fantastic that the opportunities for the neuro-rehab sector to come together again in person are returning, and I’m personally looking forward to meeting as many people as possible – those who are new to NR Times, others who are old friends, and those who to date we have only met via Zoom!” 

Tickets are free and to register, visit here. 

SHOW INFO 

Dates & Times 

Wednesday 6th July 2022 | 09:30 – 16:30

Thursday 7th July 2022 | 09:30 – 16:00 

Venue Address 

Hall 19

National Exhibition Centre (NEC)

Birmingham

B40 1NT, UK

Social links #NeuroCon

https://www.facebook.com/neuroconvention

https://twitter.com/NeuroConvention

https://www.linkedin.com/company/european-neuro-convention/

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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

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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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