An expert network of doctors and research scientists is forming the world's first national centre for research into understanding pain in arthritis. Backed by medical research charity the Arthritis Research Campaign and The University of Nottingham, it will aim to improve treatments for arthritis — the most common cause of chronic pain — which affects more than ten million people in the UK.
The charity has awarded funding of £2.5m over five years and the University itself has pledged a further £3m to support the Nottingham-based Arthritis Research Campaign National Pain Centre investigating mechanisms of pain in arthritis. Key partnerships with local NHS Trusts will further strengthen the new venture.
The new centre represents an ambitious bid to tackle chronic pain involving clinicians and scientists from different research fields including rheumatology, neuro-imaging and psychology. These experts will come together in a multi-disciplinary, integrated approach to research better treatments for the painful symptoms of arthritis.
The researchers' aims over the next five years will be to gain a better understanding of how people experience pain, to use that knowledge to fully understand the biological basis of pain in osteoarthritis, to develop new drugs to treat pain more effectively and to target existing drugs more effectively at individual patients.
The Director of the new centre Dr David Walsh from the School of Clinical Science's Division of Academic Rheumatology said the centre offered a "wonderful opportunity" to produce more effective pain treatments. "There is a huge unmet meet for better pain relief for people with arthritis."
"Current treatment can help some people, but the future holds huge potential for developing new and better treatments for the millions who suffer from chronic pain. Bringing together a team like this, of world experts in their fields, to look at the problem from completely different angles presents us with a wonderful opportunity."
Professor Alan Silman, Medical Director of the Arthritis Research Campaign, said: "Pain is the number one concern for all patients with arthritis, and there have been too few recent advances in how to manage it. Several million people suffer both day and night, with only conventional painkillers helping to keep the pain at bay.
"Our new centre is charged with a truly innovative approach; covering the basic pathways of pain perception and the changes in the tissues caused by arthritis to identify completely new targets for developing effective, safe and acceptable treatments."
Professor David Greenaway, Vice-Chancellor of The University of Nottingham, said: "This significant research award will harness the considerable expertise of researchers in The University of Nottingham's Department of Academic Rheumatology within our School of Clinical Sciences.
"Working across the University and with our partner NHS Trusts as an Arthritis Research Campaign centre of excellence, this innovative research team has the prospect of finding vital solutions to the terrible pain caused by osteoarthritis for many millions of people in the UK and worldwide," said Professor Greenaway. "The University has committed additional funding to supporting this research centre's success."
Osteoarthritis is the most common type of arthritis. It affects several million older people in the UK. There is currently no cure for it, so the emphasis is on effective treatment. A major cause of disability, it occurs when cartilage — the lubricating substance between joints — is diseased, leading to stiffness and pain.
Current drug treatments to relieve the pain of osteoarthritis are unsatisfactory, and although exercise, weight loss and self-management help some sufferers, many more people struggle to find adequate, side-effect-free pain relief. Joint replacement surgery is available for people with severe, unremitting pain, but even this is not a solution for everyone. Many osteoarthritis sufferers turn to unproven supplements, but few have been shown to work.
Dr Walsh and his team will use osteoarthritis of the knee as an initial model for their research, although it is expected that their work will help other people with arthritis pain over time.
Osteoarthritis is a complicated condition, and the level of pain experienced by sufferers does not correlate closely to the level of cartilage damage or deterioration as measured by x-ray. Some people whose joints appear to be completely worn away can suffer little pain, while others with no obvious x-ray evidence of disease are in constant severe pain.
Dr Walsh said: "It is well recognised that the experience of osteoarthritic pain involves the interplay between the way that the nerves present in the joint (the peripheral nerves) detect changes in the joint tissues that occur in osteoarthritis, how these nerve signals from the joint are processed by the spinal cord and brain and translated into feelings of pain, and how this is influenced by the way a patient thinks and feels about their pain.
"However, our understanding of the relative contributions of each of these factors to the final experience of pain is incomplete — which is our great challenge."
To find out more about the way patients experience pain, people with osteoarthritis in the Nottingham area are being recruited as participants in the team's research. They will be interviewed and asked to complete questionnaires to identify the most important factors that must be targeted to provide the best treatments for pain relief.
Using MRI scans and other imaging techniques the team also hopes to find out how an individual's way of processing pain signals may explain why their experiences of pain do not necessarily match the severity of x-ray changes, and to measure the effects of various drugs on the nerves of the joint and the pain-processing activity of the brain.
The researchers also plan to test, through clinical trials, ways of improving the effectiveness of analgesic pain-relief drugs that are currently available, and to develop new drugs for the future.
This work aims to provide the basis for developing new drugs that will target pain peripherally (targeting nerves in the joint itself) or centrally (targeting the brain's processing of pain signals from the joint), as well as understanding and tracking the response to existing treatments.