Churack Chair of Chronic Pain Education and Research

  • Education and Research

    HDR Student Supervision

    Dr Natalie Morellini

    Post-doctoral study

    Thesis: Examination of the cellular and neurobiological features of alpha adrenergic receptors in skin (keratinocytes) and tissue samples of patients with chronic pain.

    Overview: To identify possible therapeutic and diagnostic targets for adrenoreceptors in tissues of patients with chronic pain, in particular neuropathic pain.

    Eamon McDonnell    

    Masters of Science (Medicine)

    Thesis: Effects on Migraine frequency of using Combined Anti-Oxidant Therapy: N-Acetylcysteine, Vitamin E and Vitamin C (NEC): The MIGRANT study.

    Overview: Migraine affects 15% of Australians and is leading cause of suffering and disability in our community. Research suggests that inflammation of the brain’s coverings (meninges) by nerve cell inflammation and the release of ‘free radicals’, is a cause of migraine. N-acetylcysteine, Vitamin E and Vitamin C are powerful anti-oxidants (free-radical scavengers) that reduce brain inflammation and nerve activity. It is therefore possible these anti-oxidants could reduce the number and severity of migraines. We are currently studying  90 subjects to see if a combination of N-acetylcysteine 600 mg, Vitamin E 250 IU and vitamin C 500 mg (NEC) taken twice daily for 12 weeks, will reduce migraine attacks. This safe vitamin-based therapy has never been studied and if effective, will play an important role in migraine prevention.

    Andrew Jan

    PhD

    Thesis: Is Battlefield Acupuncture (BFA) effective for managing acute pain in the emergency setting?

    Overview: This research project aims to evaluate the efficacy, feasibility and appropriateness of BFA (a form of ear or auricular acupuncture) for acute pain management in the emergency care setting as an adjunct to current therapies, through a randomized controlled trial.

    Elspeth Shipton

    PhD

    Thesis: An examination of pain education, knowledge and attitudes of medical students in Australia and New Zealand.

    Overview: This study was undertaken to identify and describe the delivery of pain medicine education at medical schools in Australia and New Zealand.

    Potential HDR Projects

    Please contact Prof Eric Visser eric.visser@health.com.au if you are interested in undertaking one of the following HDR projects.

    • Review of lateral cutaneous branches of dorsal rami of T9-T12 as pain generators in low back pain: An anatomical, clinical and therapeutic study.

    Provisional PhD candidate appointed; January 2018.

    Sub project: suitable for Honours or MSc interested in gross anatomy; examination of lateral branch nerves by dissection.

    • The role of checklists as a learning tool for pain medicine education in health care students.

    Provisional PhD candidate appointed; January 2018.

    Suitable for Honours student in health care or education. Sub-projects.

    • The role of cranial TENS for acute migraine treatment in the emergency department.

    Expression of interest offered: 2017

    Suitable for Masters student

  • Research Hub

    Featured Research Projects

    Adrenergic nervous system in the modulation of chronic pain

    Post-doctoral Fellowship, Dr Natalie Morellini. In association with Professor Peter Drummond, Centre for Research on Chronic Neuropathic Pain and Inflammatory Diseases, Murdoch University, WA.

    Examination of the cellular and neurobiological features of alpha adrenergic receptors in skin (keratinocytes) and tissue samples of patients with chronic pain.

    The project’s aim is to identify possible therapeutic and diagnostic targets for adrenoreceptors in tissues of patients with chronic pain, in particular neuropathic pain.

    Effects on Migraine frequency of using Combined Anti-Oxidant Therapy: N-Acetylcysteine, Vitamin E and Vitamin C (NEC): The MIGRANT study

    Eamon McDonnell (MSc candidate), Eric Visser, Monica Lacey, Peter Drummond, Max Bulsara.

    Media: https://thewest.com.au/news/medicine/beating-the-migraine-bc-5330862371001

    Migraine affects 15% of Australians and is leading cause of suffering and disability in our community. Research suggests that inflammation of the brain’s coverings (meninges) by nerve cell inflammation and the release of ‘free radicals’, is a cause of migraine. N-acetylcysteine, Vitamin E and Vitamin C are powerful anti-oxidants (free-radical scavengers) that may reduce brain inflammation and nerve activity. It is therefore possible these anti-oxidants could reduce the number and severity of migraines. We are currently  studying  90 subjects to see if a combination of N-acetylcysteine 600 mg, Vitamin E 250 IU and vitamin C 500 mg (NEC) taken twice daily for 12 weeks, will reduce migraine attacks. This safe vitamin-based therapy has never been studied and if effective, will play an important role in migraine prevention.

    Is Battlefield Acupuncture (BFA) effective for managing acute pain in the emergency setting?

    Andrew Jan (PhD candidate), Ian Rogers, Emogene Aldridge, Eric Visser, Max Bulsara, Richard Niemtzow.

    The ideal acute pain management strategy should be: easy to deliver, rapidly-effective, safe and have minimal adverse effects such as sedation and cardiorespiratory depression. Most current acute pain strategies, and in particularly opioid analgesia, do not meet these criteria. Acupuncture is an effective holistic treatment for chronic pain which allows patients to maintain their normal activities with minimal side effects.

    This research project aims to evaluate the efficacy, feasibility and appropriateness of BFA (a form of ear acupuncture) for acute pain management in the emergency care setting as an adjunct to current therapies, through a randomized controlled trial.

    Our recent systematic review and meta-analysis demonstrated a significant reduction in acute pain scores when with all forms of acupuncture and with BFA, applied either alone or as adjuvant analgesia in emergency situations.

    An RCT is currently planned to test BFA for acute pain in emergency settings.

    An examination of pain education, knowledge and attitudes of medical students in Australia and New Zealand

    Elspeth Shipton (PhD candidate), Eric Visser, Carole Steketee, Raymond Garrick, Frank Bate.

    Pain medicine content, teaching and assessment in medical school curricula

    Part II. Pain medicine education in Australia and New Zealand.

    The objective of pain medicine education is to provide medical students with opportunities to develop their knowledge, skills and professional attitudes that will lead to their becoming safe, capable, and compassionate medical practitioners who are able to meet the healthcare needs of persons in pain.

    This study was undertaken to identify and describe the delivery of pain medicine education at medical schools in Australia and New Zealand.

    All 23 medical schools in Australia and New Zealand in 2016 were included in this study. A structured audit tool was used to obtain information on pain medicine curricula including its composition, delivery and assessment. Nineteen medical schools (83%) completed the survey. Neurophysiology, clinical assessment, analgesia use and multidimensional aspects of pain medicine were covered by most medical schools. Specific learning objectives for pain medicine were not identified by 42% of medical schools. Pain medicine teaching was delivered at all schools by a number of different departments throughout the curriculum. The mean time allocated for pain medicine teaching during the entire medical course was just under 20 hours.  16% of schools were unsure of whether any assessment of pain medicine education took place.

    This study was undertaken to identify and describe the delivery of pain medicine education at medical schools in Australia and New Zealand.

    This descriptive study provides important baseline information for pain medicine education at medical schools in Australia and New Zealand. Medical schools do not have well-documented or comprehensive pain curricula that are taught and evaluated using pedagogically-sound approaches considering the complexity of the topic, the prevalence and public health burden of pain.

    An examination of pain education, knowledge and attitudes of medical students in Australia and New Zealand

    Elspeth Shipton (PhD candidate), Eric Visser, Carole Steketee, Raymond Garrick, Frank Bate.

    Pain medicine in medical school curricula. Part 1: Systematic review of pain medicine education internationally.

    This systematic review updates the literature on the current focus of pain medicine education at medical schools internationally with particular attention to the documentation of a defined pain medicine curriculum in terms of dedicated modules, compulsory teaching, learning objectives and elective opportunities; hours allocated to the teaching of pain medicine within the entire medical curriculum; core pain medicine topics, and teaching and

    13 articles met the inclusion criteria. Evaluation of pain medicine curricula has been undertaken of 368 medical schools in the United Kingdom (UK), United States of America (USA), Canada and Europe. Pain medicine was mostly incorporated into other medical courses such as anaesthesia or pharmacology, rather than presented as a dedicated pain medicine module.  96% of medical schools in the UK and USA, and nearly 80% of medical schools in Europe had no compulsory dedicated teaching in pain medicine. Learning objectives were not specified in articles describing the pain medicine curriculum of 364/368 medical schools (99%).  On average, the mean number of hours of pain content in the entire curriculum was 28 in Canada (2009), 13 in the UK (2011), 12 in Europe (2012/2013), and 11 in the USA (2009).  Neurophysiology and pharmacology pain topics were given priority by medical schools in all countries. The medical schools in Europe mostly assessed pain learning using written examinations (93%), and assignments (24%).

    This systematic review aims to update the literature on the current focus of pain medicine education at medical schools internationally.

    This systematic review revealed the low priority given to pain medicine in the medical curriculum at medical schools internationally, as evidenced by lack of dedicated course structure, minimal learning time, limited breadth of course content compared to conventional curricula, and low emphasis on assessment of pain knowledge and clinical competence. This study was undertaken to identify and describe the delivery of pain medicine education at medical schools in Australia and New Zealand.

    Prospective audit of opioid analgesia use, pain scores and adverse clinical events during the first seven days following day-case surgery. ODDS study

    Nisha Sikotra, Jill Kelly, Eric Visser

    With decreased length of hospital stays and complex procedures now being performed as day-cases, increasingly, patients are discharged home with prescribed opioids to manage acute postoperative pain. However, there has been minimal research into the patterns of opioid prescribing and consumption for day-case surgery patients in Australia. This is concerning as opioid analgesia is not without risks such as overdose, addiction, unintentional initiation of long- term use, falls and driving risks and concerns regarding disposal of unused opioids in the community and their potential diversion for substance abuse. In order to explore these issues.

    We will perform a prospective clinical audit of opioid analgesia prescribing and consumption, pain scores, adverse events and patient satisfaction in 300 patients, for the first seven days following day-case surgery in an Australian private hospital; also disposal of leftover analgesics by day 10-14 post-discharge and plans for their disposal.

    Collaborations

    Adrenergic nervous system in the modulation of chronic pain

    Centre for Research on Chronic Neuropathic Pain and Inflammatory Diseases, Murdoch University, WA

    Dr Natalie Morellini

    Post-doctoral Fellow

    Is Battlefield Acupuncture (BFA) effective for managing acute pain in the emergency setting?  

    St John of God Hospital Health Care, Murdoch WA

    Dr Andrew Jan

    Consultant, PhD Candidate

    Prospective audit of opioid analgesia use, pain scores and adverse clinical events during the first seven days following day-case surgery. ODDS study.

    St John of God Hospital Health Care, Subiaco WA

    Mrs Jill Kelly

    Nurse Practitioner

    Review of lateral cutaneous branches of dorsal rami of T9-T12 as pain generators in low back pain: An anatomical, clinical and therapeutic study

    UWA Anatomy and physiology

    Prof Nick Milne

    Anatomist