Registration, coffee and networking  

Welcome and Introduction to the Scottish Pain Research Community (SPaRC) 14^th Annual Scientific Meeting

Lesley Colvin, Chair of SPaRC and Clinical Lead of the NHS Research Scotland Pain Network

Update on the National Framework for Chronic Pain

Nicola Rhind, National Clinical Lead for Chronic Pain, Scottish Government

Session One

Keynote Presentation One

The Contribution of Twin Studies to the Study of Chronic Pain

Professor Frances Williams, Kings College, London

Analysing the Impact of Gabapentinoid Reclassification on Prescribing Rates in the UK

Natalia Dygas

An Audit of Neurodiversity in Children with Chronic Pain

Ewan Wallace, Hadassah Buechner, Ginevra Bubani, Taufiq Hashim

Datablitz

Chaired by Professor Tim Hales and Dr Kathryn Martin  

Morning coffee break and networking

Oral Presentations and Question and Answer

Chaired by Dr. Carole Torsney

11:50 — 12:05

Predictors of Neuropathic Pain Medication Prescribing, Adherence, and Discontinuation: A systematic review and meta-analysis 

Mia Koponen

12:05 — 12:20

Affective Pain in a Rat Model of SYNGAP1 Haploinsufficiency 

Ying Sze

12:20 — 12:35

Cassandra MacGregor

12:35 — 12:50

Factors Associated with Fibromyalgia Diagnosis in People Meeting Criteria: Results from the UK 

Marcus Beasley, Sung-A Kim

12:50 — 13:00

Enhancing Patient and Public Involvement in Pain Research across Scotland 

Line Caes, Kathryn Martin, Carrie Stewart and Heather Wallace

13:00 — 14:00

Lunch and poster viewing (poster vote using the QR Code)

Session Three

Keynote Presentation, Oral Presentations and Question and Answer

Chaired by Associate Professor Line Caes

14:00 — 14:30

Keynote Presentation Two

Pain Through a New Lens: Evolution and Future of the Biopsychosocial Model

Professor Geert Crombez, Ghent University, Belgium

14:30 — 14:45

Using the Storytelling Approach to Better Understand ACEs and Chronic Pain

Aikaterini Christogianni

14:45 — 15:00

Characterization of the Anterolateral System Class 1 (ALS1) Projection Neurons

Mai Abu Hajer 

15:00 — 15:15

Investigating Pain Related Medication Use and Contribution to Polypharmacy in Adults with Intellectual Disabilities: A systematic review 

Christine Pacitti 

15:15 — 15:35

Mid-afternoon coffee break

Session Four

Oral Presentations and Question and Answer

Chaired by Professor Blair Smith

15:35 — 15:50

Multimorbidity and Analgesic-related Harms: A systematic review

Christopher H Grant

15:50 — 16:05

Supporting Employees with Chronic Primary Pain to be in Work: Experiences of support among employees and employers in small-to-medium-sized enterprises 

Ronald O’Kane

16:05 — 16:20

Evidence for Detrimental Effects of Early Life Adversity on Later Life Responses to Morphine 

Alice Bakina

Closing Session

16:20 — 16:30

Prizes for Oral and Poster Presentations and Closing Remarks

Professor Lesley Colvin, Chair of SPaRC and Clinical Lead of the NHS Research Scotland Pain Network

Lead Author (including title):  Professor Sonia Cottom

Job Title of Lead Author: CEO

Organisation of Lead Author: Pain Association Scotland

Title: Outcomes and benefits of supported self-management for those living with chronic pain within ethnic minorities and the added value learning experience within multi-disciplinary working for students.

Background: This paper explores the benefits of a self-management intervention for those living with chronic pain in the community of Bradford. This project, in collaboration with Bradford University pioneered a new approach in the self-management of chronic pain, providing a community-based group within a university environment. As far as we are aware, this is a world first.

Objective(s): The project had the following aims:

• To help people in the community (including university staff) with chronic pain and long-term conditions including long covid, by providing professionally led, supported self-management sessions
• To provide students with a practical experience of therapeutic group work combined with a reflective seminar. This was a theory in to practice experience

Methods: The project consisted of a two hour professionally-led group session which would be observed by students.  The group sessions examined classic self-management topics including: Understanding pain, stress, anxiety, emotions, pacing, acceptance, flare up, confidence, problem solving, changing habits, communication. These were delivered in a lively interactive co-creative way. 

Results: Student feedback was that it facilitated the following:

• Enhanced learning experience
• Enabled real-world participation

Patient feedback included:

• Improved skills in managing their chronic pain
• Provided valuable source of support and education

Conclusions: The project was successful in delivering a community group allied to a powerful student experience. Members from the community gained support and improved their health and well- being. Students gained valuable practical insights and understanding and able to experience real- life scenarios. In addition to this, they were able to learn the practical elements of the theory.

The University benefitted by giving back to the community as well as providing students with the extra - curricular practical based learning and development.

Relevance for patient care and involvement of people with lived experience in the project: Those patients of ethnic minority were able to come together to share their experiences and learn from each other in a comfortable, non-judgmental environment. 

Authors’ Names: Dhaneesha N.S. Senaratne, Mia Koponen, Karen N. Barnett, Blair H. Smith, Tim G. Hales, Louise Marryat, Lesley A. Colvin

Lead Author (including title): Dr Dhaneesha Senaratne

Job Title of Lead Author: Clinical PhD Fellow

Organisation of Lead Author: University of Dundee

Title: The impact of adverse childhood experiences on analgesia-related outcomes: a systematic review

Background: Adverse childhood experiences (ACEs) are any potentially stressful events or environments that occur before the age of 18. Previous research demonstrated a dose-dependent relationship between ACEs and adult chronic pain. However, it is unclear if ACE history should affect chronic pain management.

Objective(s): Do people with a history of ACEs have different responses to pain-relieving medications (“analgesia related outcomes”)?

Methods: We searched seven databases from inception to 26/09/2023. Two reviewers independently performed title/abstract screening, full text review, data extraction, and risk of bias assessment.

Results: 7,531 records, 66 met inclusion criteria (137,395 participants). Compared to no/low ACE exposure, high ACE exposure was associated with opioid misuse (21/27 studies), severity of opioid misuse (4/4 studies), younger age at opioid initiation (7/8 studies), opioid relapse (1/1 study), and sedative misuse (4/5 studies). High ACE exposure was associated with any analgesic prescription (3/4 studies) and over-the-counter analgesia (1/1 study), partially associated with opioid prescription (3/7 studies), but not associated with sedative use (0/1 study). Higher ACE exposure was also associated with medication side-effects (5/5 studies), endogenous pain signalling (2/4 studies), lifetime overdose (2/2 studies), and attempted suicide (1/1 study).

Conclusions: High ACE exposure leads to poor analgesia-related outcomes. No studies assessed whether prior ACE exposure influenced analgesic effectiveness. Opioids were extensively investigated, but other high-risk analgesics were notably absent (e.g. gabapentinoids). The findings reinforce the need to adopt trauma-informed approaches to healthcare, especially in specialties like chronic pain where the prevalence of ACEs is high.

Relevance for patient care and involvement of people with lived experience in the project: Many people with chronic pain have a history of ACEs. This study shows that people with a history of ACEs may experience greater harms from analgesic medication than those without ACEs.

Authors’ Names: Haruno McCartney, Ashleigh Main, Natalie McFayden Weir, Harleen Kaur Rai and Roma Maguire

Lead Author (including title): Haruno McCartney

Job Title of Lead Author: PhD student

Organisation of Lead Author: University of Strathclyde, Glasgow

Title: Professional-facing digital health technology (DHT) solutions for care of patients with chronic pain: a systematic scoping review

Background: Chronic pain is a highly prevalent condition that is considered a public health concern. There is a need for more innovative solutions, and Digital Health Technology (DHT) may be a way to address this challenge (Puntillo et al, 2020). DHT for healthcare professionals (HCPs) could be used to support evidence-based practice. 

Objective(s): It is unknown what DHT exist to support HCPs to manage chronic pain care. This scoping review aimed to identify professional-facing DHT (any digital applications) designed for chronic pain management. The objectives were to investigate the DHT user features, development, outcomes and HCP perspectives on DHT for chronic pain care.

Methods: Five databases were searched using comprehensive search strategies. Two independent reviewers screened titles/abstracts, then full texts. Data extraction and quality assessment was completed using the TiDIER checklist and QuADS. Qualitative analysis involved inductive content analysis (of user features) and thematic synthesis (of HCP perspectives).  

Results: Fifty-two studies were identified, reporting on 44 professional-facing DHTs. The most common target user population was multidisciplinary care teams; the most common setting was primary care. Analysis of user features produced four themes: guiding initial consultation, supporting chronic pain management, facilitating ongoing patient management and supporting routine clinical duties. Thematic synthesis of HCP perspectives produced four themes reflecting factors affecting DHT use: additional value, integration into clinical workflow, ease of navigation, and trust in the DHT. Most studies did not adequately report appropriate stakeholder involvement in thorough co-design.

Conclusions: There are various professional-facing DHT for chronic pain management, but few appeared to be developed with adequate stakeholder involvement. Future research should focus on thorough co-design of professional-facing DHT.

Relevance for patient care and involvement of people with lived experience in the project: There is still unmet potential in DHT for HCPs to support chronic pain care. This review is the first step of a project to co-design DHT for chronic pain management for both HCPs and patients in NHS Scotland.

Authors’ Names:  Emma Scott-Smith, Line Caes, and Vivien Swanson

Lead Author (including title): Ms. Emma Scott-Smith

Job Title of Lead Author: Lecturer and PhD student

Organisation of Lead Author: The University of Stirling

Title: Clinicians working with emerging adults with chronic pain for at least 1-year.

Background: The impact of chronic pain as a multidimensional condition, causes disadvantage to young people’s physical, emotional, educational, and social wellbeing and peer relationships.  Young adults (aged 18-30) are vulnerable due to key transitions occurring. Understanding another's pain has traditionally been one of the greatest hurdles for high quality healthcare. Internationally recognised pain assessment tools demonstrate elements to understand pain and monitoring pain progression but fall short of nuanced pictorial imagery of chronic pain. Creative tools use digital media as inventive visual platforms to communicate a person’s pain experience from iPad drawing, painting, mixed media, reflective visual story telling. Such creative methods could aid in overcoming the communication challenges.

Objective(s): This study aimed to understand clinicians’ perspective on the role of creative tools in the support they provide to young adults with chronic pain.

Methods: A Qualtrics quantitative online survey (21 questions) was disseminated, via social media and the Scottish Pain Research Community (SPaRC), to healthcare professionals working with emerging adults in chronic pain to understand what current creative tools are used in practice. Healthcare professionals were eligible to participate if they worked with young adults for a period of 1 year or more.

Results: Twenty-six clinicians, a mean of 8 years’ experience, completed the online survey. The results found 52.63% of these clinicians used creative tools to aid communication, such as mobile visual Apps, drawing, imagery in letter writing to self. Reasons for not using creative tools were no training available (41.67%), accessibility to materials (25%), and either not on offer to staff or not requested (either 8.33%). Despite this large variety in usage, most clinicians (60%) reported being very interested in using creative tools.

Conclusions: The results show strong interest in using creative practices, what tools are currently in use, and the need to provide better accessibility and training in using creative tools.

Patient Relevance: Increasing the use of creative tool use can help to overcome communication challenges by making the pain visible, build trust and validation in aid patient care and hence allow for more personalised care pathways.

Authors’ Names: Lars Williams, Heather Harrison

Lead Author (including title): Dr Lars Williams

Job Title of Lead Author:  Consultant in Anaesthesia and Pain Medicine

Organisation of Lead Author:  NHS Greater Glasgow and Clyde

Title: Pain clinic letters sent directly to patients – a GP perspective

Background: The Academy of Medical Royal Colleges (AMRC) recommends sending outpatient clinic letters directly to patients, with a copy sent to their GP, to support collaborative patient care(1). Patients attending the Glasgow Pain Service who received such letters reported high levels of satisfaction (2). We wanted to know what GPs and other primary care clinicians thought about this practice. 

Objective(s): To understand any concerns our primary care colleagues might have about direct-to-patient letters in place of doctor-to-doctor letters.

Methods:

1. An online survey using MS Forms, emailed to GP practices across NHS GGC. Participants viewed a sample clinic letter to a patient, which included a clinical summary and treatment plan at the top of the letter. Respondents rated the letter for clarity, ease of retrieval of key information such as medication changes, and overall utility to the primary care clinician.
2. A follow-up transcribed discussion with a panel including two GPs, two primary care prescribing pharmacists, a consultant MSK physiotherapist and a primary care development lead.

Results:  

Online survey: 15 responses (14 GPs, 1 pharmacist). Respondents overwhelmingly rated the letter as clear, informative and safe. Most felt that the letter contained the right amount of detail for both clinician and patient.

Panel discussion: All felt this was a positive development, likely to enhance collaborative patient care. The prominent clinical summary in the sample letter was felt to be an effective and safe way of communicating key clinical information.

Conclusions: GPs and other primary care clinicians reported high levels of satisfaction and no concerns with pain clinic letters written in layman’s language and addressed directly to patients, as the main method of communication between secondary and primary care.

Relevance for patient care and involvement of people with lived experience in the project: Previous work established patient satisfaction with pain clinic letters addressed directly to them rather than to their GP (2). This follow-up survey suggests that GPs and other primary care clinicians are also satisfied. Spreading and scaling adoption of direct to patient letters would improve patient care and satisfaction.

Authors’ Names: Dr Rosemary J Hollick, Dr Martin J Stevens, Dr LaKrista Morton, Mr R Stuart Anderson,  Dr Elaine Wainwright, Prof Suzanne Verstappen, Dr Nicola Goodson, Prof Nicola Fear, Prof Paul McNamee, Prof Karen Walker-Bone, Prof Ira Madan, Prof Gary J Macfarlane

Lead Author: Dr Rosemary J Hollick

Job Title of Lead Author: Senior Clinical Lecturer and Honorary Consultant Rheumatologist

Organisation of Lead Author: Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (University of Aberdeen), Aberdeen, UK

Title: Update from the QUICK study - the new questionnaire to measure the impact of chronic pain on work

Background: Chronic pain impacts people’s work in a variety of ways. Our previous systematic review found that existing questionnaires do not capture this broad range of impacts and tend to focus on productivity measures. A questionnaire is needed which can quantify, at a population level, the broader range of impacts of chronic pain on work to inform development and access to relevant support-to-work services.

Objective(s): To create a new questionnaire which can capture the wider impacts which are important to people working with chronic pain.

Methods: We conducted focus groups with people with chronic pain and other stakeholders, identifying key domains relating to impacts of chronic pain on work which then informed items to include in a new questionnaire. Items were refined through a multi-stage Delphi process. The questionnaire was tested in general population, clinical, and occupational settings by a cohort of people who working with chronic pain. We evaluated item comprehension concurrently via a Think Aloud process.

Results: 50 focus group participants identified key domains to include in our questionnaire, which was then drafted including items relating to financial consequences, cognitive impacts, and degree of support for job modifications. 14 items were taken forward for final testing.  919 people provided data on the questionnaire, which is now being evaluated for validity and reliability.

Conclusions: Our questionnaire has been developed incorporating feedback from a wide range of stakeholders, to comprehensively quantify the impacts of chronic pain on work.

Relevance for patient care and involvement of people with lived experience in the project: We have developed a questionnaire to quantify impacts of chronic pain on work, which will be available for use from late 2024. The questionnaire has been developed with input from over 100 people with lived experience of working with chronic pain. Identifying the broad impacts of chronic pain on work will enable us to better support people living with chronic pain who wish to work.

Authors’ Names: Franziska Mosler, Aikaterini Christogianni, Sam Singleton, Tim G. Hales, Janine Rennie, Lesley A. Colvin, Line Caes

Lead Author (including title): Line Caes, PhD

Job Title of Lead Author: Associate Professor

Organisation of Lead Author: University of Stirling

Title: Assessing exposure to childhood adversity in adults: A systematic review of the psychometrical quality of validated childhood adversity questionnaires

Background: Children exposed to adverse experiences (ACEs) are more likely to develop severe chronic health problems throughout their lifespan. However, methods of assessing ACEs are highly heterogeneous, compromising reproducibility.

Objective(s): This systematic review aimed to identify all validated, self-report ACE questionnaires to compare their quality, with input from people with lived experiences (PWLE).

Methods: The review (PROSPERO: CRD42022299435) followed PRISMA guidelines to systematically search 8 databases (e.g., MEDLINE) for validated measures assessing at least two ACEs through self-reported by adults (aged 16+). The screening process identified 31 ACE questionnaires (112 studies). Psychometric properties were evaluated using 1) Cohen’s criteria, 2) the COSMIN checklist, and 3) a content validity form co-designed with PWLE. 

Results: Cohen’s criteria classified 9 questionnaires as “well-established” and 2 as “approaching well-established”. No questionnaire was rated “sufficient” for all COSMIN measurement properties. The ACE-questionnaire, Childhood Experiences Survey (CES) and ACE-International Questionnaire (ACE-IQ) receiving the best ratings for measurement quality. The Childhood Trauma Questionnaire-Short Form (CTQ-SF) was most frequently evaluated but received an “insufficient” rating across all properties. PWLE scored content validity highest for the CES.

Conclusions: Measurement properties varied widely with no existing ACE questionnaire receiving good ratings across all psychometric properties. The most widely used questionnaire, CTQ-SF, did not perform well with implications for analyses using this as an ACE measure.

Relevance for patient care and involvement of people with lived experience in the project: PWLE were actively involved throughout the review, e.g., selecting search terms, evaluating content validity. This review provides a comprehensive overview of existing ACE questionnaires, which will inform trauma-informed care. A clear need was identified for co-development, with PWLE, of validated trauma-informed questionnaires to assess ACEs for both future research and clinical settings.

Authors’ Names: Bhushan Thakkar, Aikaterini Christogianni, Merin George, Lesley Colvin

Lead Author (including title): Aikaterini Christogianni

Job Title of Lead Author: Postdoctoral Research Fellow

Organisation of Lead Author: Chronic Pain Research Group, Division of Population Health and Genomics, School of Medicine, University of Dundee

Title: Ongoing Clinical Trials & Unpublished Studies to Prevent Chemotherapy Induced Peripheral Neuropathy

Background: Chemotherapy induced peripheral neuropathy (CIPN) is a prevalent (30%-68%) and serious side effect of neurotoxic chemotherapy potentially impacting patient survival, and adversely affecting quality of life (1,2). Although CIPN is widely acknowledged as a serious clinical problem, there are still no therapeutic options available to prevent CIPN (3).

Objective(s): The aim of this study is to appraise available therapies from clinical trial registries using a systematic review approach to prevent CIPN in adult patients undergoing chemotherapy for the treatment of cancer.

Methods: More details about the study can be found on PROSPERO, ID: CRD42023429136.  BT, AC and MG screened the titles and abstracts of the identified records on Covidence, and any conflicts were resolved by LC. BT and AC independently assessed the risk of bias using a modified NIH quality assessment item tool.

Results: 100 ongoing clinical trials (n=21 currently recruiting and n=17 not recruiting), unpublished studies (n=42 completed recruiting, n=7 terminated/suspended) and three studies with their status being unknown were identified. These studies were registered on 10 different clinical trial registries including ClinicalTrials.gov, and EU Clinical Trials Register.

Conclusions: This is the first study that included data from ongoing clinical trials and unpublished studies as part of a SR to evaluate therapeutic options to prevent CIPN in patients undergoing neurotoxic chemotherapy to treat cancer. Typically, only clinical trials with positive results, large effect sizes get published and data from unpublished studies is omitted from SRs which contributes to research bias.

Relevance for patient care and involvement of people with lived experience in the project: Currently, there are no treatment options to manage or prevent CIPN. The purpose of this study is to provide guidance on available therapies to prevent the development of CIPN. This information may assist clinicians in enhancing their follow-up care by monitoring people undergoing chemotherapy more effectively during and after treatment, in optimizing available therapeutic treatment targets to manage and prevent CIPN.

Authors’ Names: Cassandra MacGregor, Dee McAndrew, Christopher Seenan

Lead Author (including title): Ms. Cassandra Macgregor

Job Title of Lead Author: PhD student and Physiotherapist

Organisation of Lead Author: Glasgow Caledonian University and NHS Lanarkshire

Title: Improving connections in the pain care journey: a quality improvement project

Background: Chronic pain is socially patterned, experienced with higher prevalence and severity in areas of deprivation. Recommended management includes pain education and rehabilitation, including exercise. Prior to the Covid-19 pandemic, NHSL delivered six-week pain groups for patients attending either Musculoskeletal or chronic pain physiotherapy. The group facilitated exercise participation and condition management skills for those who attended, however, initial uptake was only 70% of those referred.

Patients present with a variety of needs, capacities and preferences – when we revised the service post-pandemic, we aimed to develop ways of facilitating choice, and improving the connection between services to support long-term management.

Objective(s):

• To improve initial uptake of a group information session
• To collect data on preferences and attendance outcomes across demographics to inform service development

Methods: For the first six months of the project, we delivered pain training to our referrer pool of 70 Physiotherapists. We made initial contact with referred patients via telephone call to provide information, establish preferences, attendance arrangements, and conduct poverty screening. We recorded demographic details, group preference and attendance outcomes from July 2022 to June 2023.

Results: We delivered five pain training sessions to staff between July and December 2022. Following the training and development period, initial uptake of the pain group was 87% between January and June 2023.

Preferences for the initial group were: 86% for in-person, and 14% for a video call group.

Full referral numbers and attendance outcomes across demographics will be presented in the poster.

Conclusions and relevance for patient care: An initial telephone call, staff training and offering choice may improve navigation through pain care. Improving health literacy and connections between services are important to improving equitable pain care, and services should foster ways of doing so.

Authors’ Names: Ashleigh Main, Haruno McCartney, Maryam Ibrar Dr Harleen Kaur Rai, Dr Fiona Muirhead, Dr Alexandra Mavroeidi, Prof Roma Maguire

Lead Author (including title): Miss Ashleigh Main

Job Title of Lead Author: PhD student

Organisation of Lead Author: University of Strathclyde

Title: Patients’ Experiences of Digital Health Interventions for the Self-Management of Chronic Pain: A Systematic Review

Background: Digital health interventions (DHIs) have the potential to enable patients to self-manage their chronic pain. However, the impact these interventions have on the lives of people living with chronic pain is not fully understood. To gain a comprehensive understanding of the influence DHIs have on chronic pain patients’ lives, qualitative evidence on their experience of engaging with DHIs should be examined.

Objective: This qualitative systematic review aims to synthesise the available qualitative evidence on patients’ experiences of engaging with DHIs for the self-management of chronic pain to identify which features of DHIs have the biggest impact on the lives of chronic pain patients.

Methods: A systematic literature search was conducted on MEDLINE, PubMed, Embase, CINAHL, PsycINFO, and Scopus. Inclusion criteria were adult patients aged 18 years or older, a chronic pain diagnosis (>12 weeks), experience of engaging with a DHI for the self-management of chronic pain, and the reporting of qualitative data. Analytical themes were developed through an iterative process, by continually examining and interpreting the descriptive themes.

Results: Three overarching themes encompassing five sub-themes emerged: (1) personal growth, including “gaining new insights” and “renewed mindset”, (2) active involvement including “motivation”, “improved access”, and “healthcare decision making” and (3) connectedness and support.

Conclusions: DHIs promote knowledge, self-awareness, motivation, and confidence, whilst fostering a sense of ongoing support. To ensure that DHIs meet the needs and preferences of people living with chronic pain, patients and healthcare professionals should be involved in the entire development process.

Relevance: These findings will inform the future development and implementation of DHIs that have the potential to empower chronic pain patients to effectively self-manage their symptoms. In turn, this could improve pain outcomes and overall quality of life.

Authors’ Names: Miss Mehak Chandanani, Dr. Saravana Kumar Kanakarajan

Lead Author (including title): Miss Mehak Chandanani

Job Title of Lead Author: Medical Student (MBChB Year 4)

Organisation of Lead Author: School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill Rd, Aberdeen AB25 2ZD, Scotland

Title: Spinal Cord Stimulation for Chronic Pain: Data from A Single Centre

Background: Spinal cord stimulation (SCS) is a neuromodulation technique that has emerged as a promising treatment option for refractory chronic pain. By selectively activating large, rapidly conducting fibres, SCS modulates pain signals, offering relief for patients with debilitating pain.

Objective(s): This study aimed to retrospectively evaluate the effectiveness and safety of SCS in patients within NHS Grampian.

Methods: Data from patients with SCS implants within NHS Grampian was collected and analysed via RedCAP. Patients with inadequate baseline and follow-up data were excluded from analysis. Hospital Anxiety and Depression Scale (HADS), EuroQol (EQ) 5D-5L, and medication intake was analysed.

Results: Data from 72 patient records (age at implant: 50.2 ± 11.8 years) was included for formal analysis. The most common causes for SCS implantation were failed back surgery syndrome (63.8%) and complex regional pain syndrome (11.1%). At a mean follow-up of 10.4 ± 41.8 months, patients reported 59.1 ± 32.1% of pain relief from the SCS. The HADS reported significant improvement in all subscales with an improvement of 2.8 ± 2.3 in the average pain intensity (p < 0.05). The EQ-5D-5L showed statistically significant improvement in the mobility (0.8 ± 1.08, p = 0.0001), usual activities (0.8 ± 1.27, p = 0.0009), and pain and discomfort (0.5 ± 1.14, p = 0.01) subscales. Strong opioid use decreased from 65.2% to 49.2% after SCS implantation.

Conclusions: SCS offers a potential treatment option for refractory chronic pain, providing significant pain relief and improved quality of life. However, further research is needed to refine patient selection criteria and address potential complications.

Relevance for patient care and involvement of people with lived experience in the project: SCS offers promise for treatment of refractory chronic pain, improving quality of life and reducing pain.

Authors’ Names: Philip Appleby, Erum Masood, Gordon Milligan, Armando Mendez Villalon, Esmond Urwin, Philip Quinlan, Christian Cole

Lead Author (including title): Dr Phil Appleby

Job Title of Lead Author: Senior Research Software Engineer

Organisation of Lead Author: Health Informatics Centre, University of Dundee

Title: The Alleviate Project. Providing Federated Discovery Queries for Pain Data Sets

Background: Pain data is currently held by a number of organisations in the UK collected for specific pain studies or as part of wider studies. The principle problem is that such data tends to be stored in silos and is difficult to discover and access from outside the owning organisations.

Objective(s): In accordance with FAIR principles (Findable, Accessible, Interoperable and Reusable), the aim of the Alleviate Pain Data Hub project, established in 2021, is to break down pain data silos in the UK and, through mapping to a common data standard, make UK pain data more accessible for researchers.

Methods: The project has engaged various organisations who hold data on chronic pain, referred to as Data Partners, to standardise their pain data sets for discovery and federated querying for content via the Health Data Research UK (HDR-UK) innovation gateway.

The data is converted using in-house open-source Carrot Tools. Observational Medical Outcomes Partnership (OMOP) CDM from the Observational Health Data Science and Informatics Programme (OHDSI) is chosen as a common data model.

Results: Currently there are >10 pain related datasets (>300,000 individuals) which have been converted to OMOP and ~6 made discoverable on the HDR Cohort Discovery Tool. Pain data such as Pain Tests, Pain Scales, Pain Severity, Conditions, QoL data has been mapped to standard vocabularies.

Conclusions: The Alleviate project is continuing to transform pain data and will eventually prove to be a valuable resource in pain research.

Relevance for patient care and involvement of people with lived experience in the project: The Alleviate project has engaged patients experiencing chronic pain as project participants throughout.

Authors’ Names: Georgia Antoniou, Blair H. Smith, Timothy Hales, J. Douglas Steele, Lesley A. Colvin

Lead Author (including title): Georgia Antoniou (PhD)

Job Title of Lead Author: Postdoctoral Research Assistant         

Organisation of Lead Author: University of Dundee

Title: Nucleus accumbens grey matter associations with Chronic Pain and Adverse Childhood Experiences

Background: Adverse childhood experiences (ACEs) have been associated with persistent brain changes, altered behaviour and stress reactivity, and an increased risk of physical and mental health morbidities, including chronic pain and depression. However, the underlying structural brain alterations remain poorly understood.

Objective(s): We know that ACEs can increase the risk of someone having chronic pain in adulthood, but not why. We also know that there can be long-term changes in brain function arising from ACEs. The particular brain areas affected are similar to those that change in chronic pain.

We aimed to better understand how ACEs and/ or chronic pain affect brain volume, by analysing scans of brain structure.  We explored the relationship in brain regions involved in pain perception and reward processing.

Methods: The Generation Scotland Scottish Family Health Study (GS:SFHS) dataset contains socio-demographic and clinical data collected at study entry (2006-2011), including the Chronic Pain Grade questionnaire.  We analysed a subset of the GS:SFHS participants who participated in the Stratifying Resilience and Depression Longitudinally study whose assessments included structural Magnetic Resonance Imaging. Voxel-based morphometry (VBM) and Region of Interest (ROI) analyses were performed on brain regions associated with pain perception and reward.  ROI analysis was utilised to perform a more detailed examination of the impact and interaction between chronic pain and ACEs.

Results: The dataset included a total of 847 participants, with a mean (SD) age of 59.03 (10.33); 525/847 were females; of these, 368 reported experiencing chronic pain (158/368 had reported at least one ACE). In the VBM analysis, reduction of the grey matter of the nucleus accumbens (part of the reward circuitry) in participants who had reported chronic pain was observed compared to those without. Moreover, the same pattern emerged in those who had reported ACEs, as well as with the combination of chronic pain and ACEs. In the ROI analysis, brain volumes for the same regions as in the VBM analysis were further compared, confirming the results from the VBM analysis.

Conclusions:This study provides new insights into the neural substrates underlying the co-occurrence of chronic pain and ACEs by demonstrating significant structural alterations in brain regions associated with reward processing.

Relevance for patient care and involvement of people with lived experience in the project: To understand who is the most vulnerable (or resilient), and why, we need to examine and understand the structural and functional brain changes in people suffering from these long-term comorbid conditions. By understanding these we may be able to develop targeted interventions for those at most risk of developing chronic pain.

Authors’ Names: Nouf Abutheraa, Blair H Smith, Cassie Higgins, Gary J Macfarlane, Hussien Patwa, Michael Cutter, Paul Cameron, Peter Donnan, Lesley Colvin

Lead Author (including title):  Dr Nouf Abutheraa

Job Title of Lead Author: Postdoctoral Research Assistant

Organisation of Lead Author: University of Dundee

Title: Chronic Pain Identification Through Using Electronic Records (C-PICTURE). The development of a pilot algorithm to identify people with chronic pain

Background: The estimated prevalence of chronic pain (CP) varies from 35% to 51%, with up to 14% of people having moderate-to-severely disabling CP ¹. Currently, we cannot identify who has CP by searching electronic health records (EHRs). Standard survey approaches are open to bias (non-response, sampling or selection bias) and around 50% of people with CP do not take regular prescribed analgesics ². This poses a challenge for research, health and social care service planning.

Objective(s): Whilst there is a specific Read code for CP (1M52), it is not widely used. Therefore, we aimed to identify the optimal combination of Read codes needed to construct an algorithm that accurately identifies people with CP from their EHRs.

Methods: The research team identified diagnostic codes, prescribing data, and secondary care referral codes that might be associated with CP to develop a CP rules-based algorithm, tested by Public Health Scotland in six GP practices across Scotland.

Results: We identified 1,725 codes for inclusion in the algorithm. If the only code used was the specific CP code, 767(2.4%) patients were identified as potentially having CP. Using the algorithm (with multiple codes) to search EHRs an additional 11,915 (36.7%) people were identified as potentially having CP.

Conclusions: The use of the CP code to identify people with CP is inadequate. By using the algorithm, the number of people identified as potentially having CP is similar to prevalence’s reported in the current literature, but further validation is needed to confirm accuracy.

Relevance for patient care and involvement of people with lived experience in the project: People living with CP have been, and remain, an integral part of the research team. Accurate identification of CP will improve research and inform policy / service planning.

Authors’ Names: Wenhui Ma, Erika Polgár,  Allen C. Dickie, Mai Abu Hajer, Raphaëlle Quillet, Maria Gutierrez-Mecinas, Mansi Yadav, Junichi Hachisuka, Andrew J Todd, Andrew M. Bell

Lead Author (including title): Miss Wenhui Ma

Job Title of Lead Author: PhD student

Organisation of Lead Author: Spinal Cord Group, College of Medical, Veterinary and Life Sciences, University of Glasgow.

Title: Anatomical characterisation of somatostatin-expressing neurons belonging to the anterolateral system

Background: Sensory information perceived as pain is conveyed from spinal cord to brain through projection neurons of the anterolateral system (ALS). We recently identified five transcriptomic classes among ALS cells, and showed that one of these (ALS4) is characterised by expression of somatostatin (Sst). This population consists of cells in the lateral reticulated part of lamina V. Here we determined the number of cells in ALS4, demonstrated ways of selectively targeting them and revealed their axonal projections.

Objective(s): To identify and quantify Sst projection neurons, and reveal their axonal targets.​

Methods: Combined retrograde tracing with fluorescence in situ hybridisation to identify and quantify Sst projection neurons in lateral lamina V. Axons of Sst projection neurons were traced using a viral targeting strategy in Sst-Cre mice.

Results: We found that ~75% of projection neurons in lateral lamina V were Sst-positive. Axons of these cells ascended mainly through the ipsilateral white matter, and projected mainly to the nucleus tractus solitarius, various medullary reticular nuclei, and the internal lateral parabrachial nucleus. Within the thalamus, they projected to the posterior triangular nucleus and to medial thalamic nuclei, but not to the ventral-posterolateral nucleus (VPL), which connects to somatosensory cortex.

Conclusions: Somatostatin-expressing projection neurons account for the majority of ALS cells in lateral lamina V. Surprisingly, their axons ascend on the ipsilateral side of the cord. Based on their projections, we anticipate that they underlie affective-motivational, rather than sensory-discriminative dimensions of pain.

Relevance for patient care and involvement of people with lived experience in the project: The ipsilateral projection pattern suggests that anterolateral cordotomy will differentially affect this component of the ALS. This could contribute to the return of pain seen in some patients.

Authors’ Names: Aimi Razlan, Raphaelle Quillet, Allen Dickie, Andrew Bell, Andrew Todd

Lead Author (including title): Aimi N.B. Razlan

Job Title of Lead Author: PhD Student

Organisation of Lead Author: Spinal Cord Group, Centre for Neuroscience, School of Psychology and Neuroscience, University of Glasgow

Title: Characterisation of the projection neurons innervated by Trpm8-expressing afferents in lamina I of the mouse spinal dorsal horn

Background: Anterolateral system (ALS projection neurons are vital for transmitting somatosensory information to the brain, and many of these cells are located in lamina I of the spinal cord. While most lamina I ALS neurons respond to noxious stimuli, a distinct population is selectively activated by skin cooling.

Objective(s): This study aims to understand how the nervous system processes cold stimuli by characterising innervation of ALS projection neurons by primary afferents that express the cold-sensing channel, Trpm8.

Methods: Many ALS neurons express the transcription factor Phox2a, and we therefore used a mouse cross (Phox2a::Cre;Ai9;Trpm8Flp;RCE:FRT) to label Phox2a-derived ALS cells with tdTomato and cold-sensing afferents with GFP.

Results: We found that Trpm8-positive afferents predominantly target lamina I of the dorsal horn, forming a dense network around specific Phox2a-derived projection neurons. This suggests a role for these projection neurons in cold perception. Immunostaining for the postsynaptic density protein Homer revealed numerous excitatory synapses between Trpm8 afferents and these neurons. Approximately 20% of retrogradely labelled lamina I neurons were densely innervated by Trpm8 afferents, likely corresponding to cold-selective cells identified in physiological studies. Single-nucleus RNA sequencing revealed that these neurons corresponded to a specific transcriptomic class, ALS3.

Conclusions: These findings contribute to our understanding of the sensory processing of thermal stimuli in the somatosensory system, by showing a direct synaptic input between Trpm8-expressing afferents and a distinct subset of lamina I cold-selective projection neurons.

Relevance for patient care and involvement of people with lived experience in the project: Understanding thermal sensory processing could lead to improved therapies for conditions like cold allodynia, where cold stimuli cause pain. Identifying the specific neurons and pathways involved in cold detection may provide targeted treatments for neuropathic pain, ultimately improving pain management approaches.

Authors’ Names: Harry L. Hébert, Imran K. Jallaldeen, Fatima Farida, Bhushan Thakkar, Abirami Veluchamy, Lesley A. Colvin, Blair H. Smith

Lead Author (including title): Harry L. Hébert

Job Title of Lead Author: Principal Investigator (Tenure Track)

Organisation of Lead Author: University of Dundee

Title: A systematic review of genetic risk factors for neuropathic pain in adults with diabetes mellitus

Background: Neuropathic pain (NP) affects around 25% of people with diabetes, commonly manifesting as painful diabetic peripheral neuropathy (pDPN). Additionally, diabetes can also increase the risk of other NP aetiologies, such as carpal tunnel syndrome. However, there is large interindividual variation in the onset of NP in diabetes and understanding the mechanisms that contribute to its development is vital for informing its prevention and treatment.

Objective(s): To conduct a systematic review to identify genetic risk factors for NP in adults with diabetes mellitus and to summarise the results through narrative synthesis. 

Methods: Cochrane, Embase, PubMed, Web of Science and Scopus were searched for articles published up to June 2023, using a predefined protocol (PROSPERO ID: CRD42022335554). We included all studies investigating genetic risk factors for any NP condition in adults (18 years or over) with any type of diabetes.

Results: 21,311 articles retrieved, six met the inclusion criteria, including five targeted sequencing studies on pDPN and one genome-wide association study (GWAS) on general NP. These revealed rare, potentially pathogenic, variants in sodium (SCN3A, SCN7A-SCN11A, SCN1B-3B) chloride (ANO1 and ANO3), potassium (KCNK18, KCNQ3 and HCN1) and cation channel (TRPA1, TRPM8, TRPV1 and TRPV4) genes. Meta-analysis was not conducted due to insufficient replication of genetic markers.

Conclusions: These findings demonstrate a potential role for genetic factors in the development of NP in people with diabetes. However, further studies are required, particularly GWAS, with larger sample sizes, a consistent case definition and in specific NP types other than pDPN, to properly elucidate the genetic mechanisms underpinning NP in diabetes.

Relevance for patient care and involvement of people with lived experience in the project: Although the findings reported in this systematic review will need replicating, identifying genetic factors for NP in people with diabetes has the potential to inform the development of new therapies as well as enable patient stratification that can help inform personalised prevention and treatment.