SY1.7. Rewiring pain through non-invasive brain stimulation

Abstract

Chronic pain occurs when pain in an injured tissue persists beyond the normal recovery time. This crippling condition causes significant burden to the individual and to society. Despite years of research, treatments for chronic pain are largely ineffective, which may in part be due to a lack of understanding of the mechanisms that underpin chronic pain. There is increasing evidence that chronic musculoskeletal pain is associated with sensorimotor dysfunction, and that targeting the mechanisms associated with this dysfunction using non-invasive brain stimulation may alleviate symptoms of pain. This presentation will highlight studies investigating the manifestation of sensorimotor neuroplasticity in a range of musculoskeletal pain conditions such as low back pain, persistent elbow pain and persistent patellofemoral pain. These studies have used transcranial magnetic stimulation and electromyography methodologies and have shown that the organisation of the sensorimotor cortical representation of the pain afflicted muscle is altered. Novel treatment studies will then be reviewed. These studies have attempted to “rewire” pain by targeting sensorimotor cortical organisation using ‘top-down’ (non-invasive brain stimulation) and “bottom-up” approaches (trans-spinal stimulation, peripheral electrical stimulation and exercise). The potential limitations of these approaches will then be discussed including the large variation in responsiveness to treatment, and the need for individualized treatment. Indeed, our work using transitional pain models in healthy human subjects has shown that inter-individual differences in sensorimotor function in a pain free state and during persistent pain, can predict the severity of pain. It will be argued that tailoring treatment in accordance with an individual’s sensorimotor function in the early stages of pain may facilitate the diagnosis, prevention and treatment of pain. A planned project will be presented which will focus on modulating pain in accordance with these individual differences using non-invasive brain stimulation.