Learn More About Pain Clinical Trials
What Are Pain Clinical Trials?
Researchers have struggled to define pain because the experience is a subjective one with a large interindividual variability. All experts agree that pain may be perceived as an unpleasant sensory experience due to tissue damage. Pain can be broadly classified into two areas: physiological pain and pathological pain. Physiological pain states can be further divided into nociceptive and inflammatory pains because they are adaptive and protective, whereas pathological pain is maladaptive and non-protective.
Nociception occurs after the suprathreshold stimulation of peripheral nociceptors. Inflammatory pain occurs after the release of various chemical mediators following a tissue injury. The neurobiological apparatus that stimulates nociceptive pain is believed to have evolved from the ability of nervous systems to warn that tissue damage may be occurring or about to occur.
It requires immediate action and attention, which may occur by a quick reflex. Because pain is entirely a subjective experience, it is hard to correctly measure it quantitatively in a standardized manner. More pain research studies are focused on developing novel pain measurement methods using several scales.
Why Is Pain Being Studied Through Clinical Trials?
Researchers are investigating mechanisms through which pain is experienced. A recent finding suggests that many brain systems involved in generating basic emotions overlap with pain. This means that the brain systems responsible for undesirable emotions, such as fear and anxiety, are also responsible for pain. Certain systems in the brain may also mitigate or accentuate the pain. For example, pain descending pathways from the brain to the spinal cord can block the intensity of incoming nociceptive signals and reduce the overall pain experience.
Researchers have found that the design signals reduce pain by releasing molecules (such as self-produced opioids) into the spinal cord to prevent the transmission of pain signals to the brain from the spinal cord. Studies also investigate how to implement individual treatments for chronic pain and promote pain treatment programs to improve the patient's quality of life. This will require several clinical trials to identify the key barriers to implementing therapies. In addition, more pain research is needed to discover self-management approaches to pain for individuals, such as exercising.
Experts also agree that improvements in the execution of clinical trials for pain treatment are needed, including more accurate tests for measuring pain, patient selection, analytical approaches, and study design. It has also become clear that comparative effectiveness research examining evidence of benefits, harms, and effectiveness can provide a more informed decision-making process for both the patients and clinicians. Further research is needed to identify patient characteristics in their responsiveness to specific treatments that would allow for better matching between treatments and patients.
What Are The Types of Treatments Available For Pain?
Treatment plans for pain depend on the patient’s symptoms, disease, age, and other factors. Doctors may prescribe over-the-counter drugs or prescription medicine to help alleviate pain. It is common for health practitioners to prescribe acupuncture and other mind/body techniques to manage pain. Treatment for chronic pain is slightly more complicated because no single technique can provide complete pain relief. Instead, doctors prescribe a combination of treatment options to provide relief.
Over-the-counter medications such as Tylenol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin are often prescribed for mild forms of main. These drugs relieve muscle stiffness and ache. The use of NSAIDs reduces inflammation. Creams and lotions can also be applied to the skin to relieve pain and inflammation from arthritis and sore muscles. Doctors may prescribe stronger medications such as anti-anxiety drugs and muscle relaxants if OTC medications fail to relieve the patient.
It is also common to use stronger painkillers such as codeine and fentanyl for a short period of time. In the worst case, steroid injections may be administered to reduce inflammation and swelling. Another method is to block the group of nerves that are deemed to cause pain to a specific organ or body using a nerve block. This treatment method may not always be used because it is too dangerous.
What Are Some Recent Breakthrough Clinical Trials For Pain?
2012: Deep and Slow Breathing on Pain Perception - Researchers investigated different deep and shallow breathing (DSB) techniques at the same depths and respiration rates on autonomic activity, mood, and pain perception in 16 participants. The DSB group was asked to breathe using a respiratory feedback task that requires constant attention and a lot of concentration. In the relaxing DSB intervention, subjects relaxed during the breathing training.
Their skin conductance levels were measured during the breathing techniques. Pain thresholds for hot and cold stimuli were examined before and after the breathing exercises were performed. There was a significant increase in mean detection and pain thresholds from the relaxing DSB. No major changes were observed in the group with attentive DSB. The results indicate that breathing decisively may influence pain processing, thereby modulating pain perception and sympathetic arousal.
2014: Yoga vs. Physical Therapy vs. Education for Chronic Low Back Pain - This randomized controlled trial compared the effectiveness of yoga and physical therapy for managing chronic low back pain. 320 participants from low-income minority backgrounds were randomized in a 2:2:1 ratio into i) a standardized weekly yoga class, ii) standardized evidence-based exercise therapy protocol, and iii) education delivered through a self-care book.
The primary outcome measures were a 12-week pain intensity and back-specific function measured using the Roland Morris Disability Questionnaire. It was found that the yoga group was not superior to education for either outcome. Yoga and physical therapy showed similar results for secondary outcomes. Moreover, the frequency of adverse events did not differ between the yoga and PT groups.
2017: Moxibustion for Pain Relief in Patients with Dysmenorrhea - Although moxibustion has been used to treat dysmenorrhea in China, there is very little evidence to support its effectiveness. This clinical trial randomized 152 patients to receive two treatment plans: moxibustion and conventional drugs.
Menstrual pain intensity in both groups was found to be reduced with no significant differences. It was found that the effectiveness of moxibustion was superior and sustained for a longer time than conventional drugs’ use. A limitation of this study was that participants were not blinded in the study and, therefore, could not rule out the effect of psychological factors.
2018: Pain Neuroscience Education with Cognition-Targeted Motor Control - This randomized controlled trial compared the effectiveness of pain neuroscience education with cognition-targeted motor control training for improving functionality and reducing pain. 120 participants with nonspecific pain in the spinal region were allocated to an experimental group and a control group. Primary outcomes are pain and function.
There were 38 women and 22 men in the experimental group and 25 women and 25 men in the control group. Researchers observed fewer lower pain thresholds and CSI scores at the primary test site in the experimental group. Participants in this group experienced better function with a clinically significant reduction of disability. It was found that pain neuroscience education combined with cognition-targeted exercise effectively improved pain.
2019: Using Virtual Reality to Reduce Chronic Low Back Pain - This clinical trial provided neurorehabilitation treatment to patients for six weeks using virtual reality systems. The treatment consisted of teaching correct movements to patients with painful body parts to regain a correct body image based on multisensory feedback. The results showed a significant reduction in all pain rating scale scores with significant improvements in quality of life scores in physical role functioning, bodily pain, and vitality, among others.
2019: Effectiveness of Cognitive Functional Treatment and Lumbar Stabilization Treatment - 52 patients were allocated into various groups: functional cognitive treatment (CFT), lumbar stabilization treatment (LST), and control. Lumbar movement control and pain were measured before and after the intervention with Luomajoki LMC battery tests and a visual analog scale.
It was found that LMC and pain were reduced significantly in both groups after 8 weeks of intervention with no major changes in variables. Both LST and CFT groups improved LMC and reduced pain intensity. There was no difference between both experimental groups on LMC test results and pain.
2020: Manual Therapy Versus Therapeutic Exercise for Chronic Pain - This study compared the effects of two experimental treatments based on therapeutic exercise and manual therapy for treating non specific chronic neck pain. Participants were randomized into three groups: therapeutic exercise, placebo, and manual therapy. The researchers studied pain based on the visual analog scale and the pressure pain threshold.
Outcomes were registered at various intervals. Although no clinically significant differences were obtained between the groups, it was found that manual therapy improved perceived pain before therapeutic exercise.
2021: Taping Method Combined with Manual Therapy for Treating Chronic Low Back Pain - This randomized controlled trial investigated the efficacy of Medi-Taping, a novel treatment method for treating pelvic obliquity using a combination of manual treatment of trigger points and Kinesio taping. 110 patients were randomized at two study centers to a Medi taping or standard treatment consisting of patient education physiotherapy as control.
The duration of treatment was 3 weeks. The primary outcomes were the Chronic Pain Grade Scale, Oswestry Low Back Pain Disability Questionnaire, and VAS. Patients in both groups benefited from the treatment with a low variation. The Medi-Taping groups showed slightly better results with no significant differences in the primary endpoints. It was concluded that Medi-taping is similar in effectiveness to complex physiotherapy and patient education.
2022: Pain Reprocessing Therapy vs Placebo - This randomized controlled trial investigated the use of psychological treatment that provided significant pain relief from chronic back pain and also looked for various treatment mechanics. The randomized controlled trial with fMRI was conducted in a university setting and compared PRT with an placebo treatment and with usual care.
The treatment designed to help participants differentiate their pain from non threatening psychological and real tissue damage by combining somatic, cognitive, and exposure therapy. Psychological treatment was found to provide substantial and durable pain relief for patients with chronic back pain.
Who Are Some Of The Key Institutions Conducting Pain Clinical Trial Research?
Neurosurgery Pain Research Institute at Johns Hopkins Medicine is a leading center for investigating, controlling, and preventing neurologically related pain. The center performs scientific and clinical research into the mechanisms of chronic pain with a focus on neurological diseases that trigger pain. The team is led by Michael Jerry Caterina, M.D., and Allan Joel Belzberg, M.D., both are the foremost authority in pain research.