Clinical Pain Research

Chronic pain is one of the leading causes of disability worldwide. Persistent pain following severe illness including sepsis, acute respiratory distress syndrome (ARDS) and major trauma is common, but little is known about the prevalence, risk factors and mechanisms that lead to chronic pain in these populations. Many of these patients will be managed in the intensive care, a unique environment within the hospital where patients have high healthcare professional input yet acute pain is frequent and management can be poor. Survivors of critical illness are known to have a constellation of longstanding symptoms including pain and currently there is limited evidence for interventions to improve these symptoms.

It is not understood which patients benefit most from which analgesic interventions therefore determining underlying pain generating mechanisms in the individual could lead to a more personalised approach. Persistent pain is a complex interplay of biopsychosocial factors.

Longitudinal deep profiling of patients to include biological, psychological and functional variables allows for the capture of large datasets to explore clusters of contributing mechanisms and the potential to develop novel methods of clinical stratification and treatment. There is currently a knowledge gap of such mechanisms in the unique populations of the critically ill and those who experience major trauma.

We aim to better understand the mechanisms and features of pain in these unique, under-researched populations to target improved pain management in the acute setting within the intensive care and trauma centres, to better determine those at high risk of developing persistent pain and to enable the development of future interventions to prevent and treat chronic pain after severe illness. As a clinical research group we aim to combine our first-hand knowledge of healthcare systems to understand and study the challenges in improving pain management in real world settings.

Through a validated clinical deep profiling testing protocol, developed by collaborators in the Pain Research Group at Imperial College and the Nuffield Department of Neurosciences at Oxford University, we are exploring the mechanisms and clinical features associated with the development of chronic pain following critical illness. Using quantitative sensory testing, skin biopsy and patient reported outcome measures, we are conducting longitudinal clinical observational studies of patients during and following sepsis, acute lung injury and major trauma. This work is conducted in collaboration with the Imperial Pain Research Group and MSK Lab.

In parallel we are performing systematic review and meta-analytic projects to understand the prevalence, impact and clinical factors associated with the development of pain in these unique cohorts.

One factor identified that is associated with the development of chronic pain in these cohorts is the severity of acute pain reported by patients during hospital admission. Previous work conducted by the London Anaesthetic Trainee Research and Audit Network (PLAN) identified a knowledge translation gap in the management of acute pain in the critically ill. We are conducting qualitative and quantitative studies to further the understanding of barriers to implementation of validated pain assessment techniques and ways to improve delivery of analgesic interventions in the critical care environment.