Forum in Valencia

By Agnes Kittel

This year Valencia (Spain)  was the host city of the present conference of a biennial series organized by the European Pain Association (EFIC).  The conference was held in the FIRA Center between  September 4-7, 2019 and visited by 3500 participants .

This series of conferences is a special one. The audience could listen to not only the results presented by researchers, but also to the experiences of clinicians. This year as a new initiative,  a group of invited patients also could enjoy the lectures presented by renowned plenary speakers.

Some form of pain, this very complex sensation is familiar to all people.  However, while we have a theory for the development of acute or short-term pain, and in most cases we can alleviate it, the situation is different in the case of  chronic pain. Chronic pain lasts for more than six weeks, often for the whole life of the patient, and affects one fifth of humanity!

Even if we can discover the cause of chronic pain, its alleviation  is one of the greatest challenges in medicine. Due to the aging societies the number of patients in need is increasing however, it is not the only thing to make the task more difficult.

Pain experience is fundamentally influenced by the patient’s past experience and current emotional state, so the treatment should be personalized and has to select a painkiller for long-term use without serious side effects. It is a huge task. Unfortunately, the opium derivatives, which have been used for thousands of years by mankind and have been used in medical practice for so many years for pain management, are not only effective pain relievers but also cause addiction. Nowadays, especially in the case of the United States, we can read a lot about the opioid crisis. We know about cases  where the death can be attributed to the dependence or overdose of synthetic opiates prescribed by doctors. At this conference we also learnt about the side effects of these medications which can make the everyday life a misery. It was heartbreaking to read the patients’ statements that they would have never started taking these type of painkillers, or rather reduced the dose and endured the pain, just to get rid of the side effects. / Perhaps the most troublesome side effect of opiates, is chronic constipation.

And what else could we learn? Actually, a lot.

Let’s see only two examples!

“Neuromodulation – Where Are We Going To?” It was the title of a lecture presented by Belgian neurosurgeon Dirk De Ridder, which introduced the initial steps of (brain-nerve) stimulation therapies and led us to an amazing future.

Dirk de Ridder, who is professor of neurosurgery at the Neurological Foundation at the University of Otago in Dunedin, New Zealand, shares his time between New Zeeland and Belgium, where he is working on setting up a neuromodulation clinic and collect patients for his research. He investigates a variety of diseases and disorders such as phantom perceptions – e.g. understanding and treating common mechanisms of phantom pain, tinnitus – Parkinson’s disease, depression, slow-wave epilepsy, addiction, obsessive-compulsive disorder, different personality disorders – and tries to find their common root.

As treatment he  uses non-invasive neuromodulation (for experts in the field: TMS, tDCS, tACS, tRNA, tPNA, neurofeedback) and invasive neuromodulation techniques such as brain implants.

According to Professor Dirk De Ridder, combining brain stimulation and artificial intelligence (AI) can open up new avenues for treating not only pain but also many other illnesses. By means of a variety of software, treatments can be truly patient-specific, perfectly adapting to the given condition.

“Initially, we sent a single pulse to the brain during neurostimulation. The new device we are developing already sends pulse sequences that the brain has to “respond to.” So today we can treat conditions like phantom sounds (tinnitus) or phantom pain, depression, OCD, Parkinson’s and various addictions. It is still quite primitive, but our goal is to follow the way in which the human brain communicates with itself. The different brain circuits,  just like radio,  use different frequencies. Today,  we are already able to create this by non-invasive techniques.

As a further step, we want to incorporate AI, which is constantly being used on our smart phones, into the nervous system stimulators. In fact, the neurostimulation hardware is already in place, but the software is not yet available. And artificial intelligence can be this software. If this is accomplished in 10 to 20 years, AI software itself will act as a “small brain” that first recognizes abnormal patterns in the brain – e.g. when a person experiences a certain amount of pain or stress – AI automatically adjusts the stimulation at the right time and under the right conditions to modulate brain signals to relieve discomfort while also triggering a deep learning process. ”

Professor Ridder added, that while pharmaceutical companies are not interested in the method, many organizations have already invested huge sums of money in research of neurostimulation, including opportunities such as electronic interfaces between the human brain and the Internet. It was almost a terrifying experience to hear that “we are already able to read the memories of some animals and to pass on those memories to other animals. The next big thing is when such a connection can be made over the Internet. E.g. a  husband or wife would be able to send good-night kiss to the other from thousands of miles away so that the other can feel it.The realization of this is not so far off. ”

The audience was wondering how much we wanted this “brave new world” . . .

Professor Lorimer Moseley’s presentation focused more on the tasks to be accomplished today. The purpose of his presentation was to convince everyone, that if someone has been succeeded in understanding how pain actually works, this one  can achieve fantastic pain relief.

About two-thirds of the 3,500 conference attendees listened to the presentation, which certainly changed their views on chronic pain. According to Professor Moseley, this change would also be needed by many clinicians because, even if they know how dynamically our pain sensitivity can change, and, that long-term pain can increase its sensitivity is a well-known fact for them, many clinicians are sceptical  that the patients can be taught to take control of their lives. Many of physicians cannot belive that their patients would cope with difficulties  and they would not be trapped by catastrophic thinking.

“All patients need to be aware that pain is not bad in itself, that it has a protective function, and that your body, your entire sensory system, is not working against you but for you … if people learn how pain works and how the body and brain do, then you can achieve great results in reducing pain, ”said the professor.

With his books and lectures, he does his best to make this opportunity to be known to all sufferers. He suggested that health care professionals should be provided with modern pain science education so that patients can have the knowledge that can effectively improve their quality of life.

Hopefully  this conference, where also decision-makers were invited, was the best place for his proposal to be not only listened but accepted, too.

Agnes Kittel thanks for the support of EFIC and EUSJA and for the great work of  Dennis Landsbert-Noon to help science journalists.

Photos: credit Agnes Kittel.

Agnes Kittel is science journalist and researcher based in Budapest.






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