Placebo pain-relief is reproducible in patients with chronic pain compared to healthy volunteers according to a unique University of Manchester study.

In a research first, patients with high levels of psychological distress such as depression and anxiety experienced pain relief in a placebo experiment with inert cream they thought might help them.

And that, say the research team, could encourage clinicians to think about using alternative strategies other than pain medication. It could also, they say, manage pain better and reduce dependence on pain medication which can have unwanted side-effects.

Pain is experienced as a result of particular brain processes in the brain which are sometimes not fine-tuned as well as they might be. Placebo is a powerful way of positively harnessing the brains ability to take control of how we feel pain.

The study, funded by Versus Arthritis is published in Pain – the world’s leading journal in the field.

The cream was applied to the forearm of 60 osteoarthritis and 79 fibromyalgia patients as well as and 98 Healthy Individuals.

The placebo group was told this may or may not be a local anaesthetic cream, while the control group was told the cream was inactive.

They were then given laser pain and asked to rank the intensity of the pain before, during and after cream application, along with expectation of pain relief and anxiety.

The procedure was repeated after two weeks and the results were found to be the same.

The findings complement the team’s work on enhancing natural pain control, using ‘Alpha brain-wave entrainment’, a light therapy which tunes the brain to a particular frequency of 10 cycles per second – known as alpha frequency.

Alpha brain-wave entrainment was previously shown by the team to be associated with the expectation of pain relief in health volunteers and patients with chronic pain.

Professor Anthony Jones from The University of Manchester is the Director of the Human Pain Research Group (HPRG), which is based at Salford Royal NHS Foundation Trust, part of the Northern Care Alliance NHS Group.

He said “Chronic pain carries a huge socioeconomic burden and substantially impacts the quality of life of affected individuals.

“It is often difficult to treat- and many of these patients have to live with its effects - and resultant impacts on their mental health- day in day out.

“But this study shows for the first time that people with osteoarthritis and fibromyalgia can modulate their responses to experimental pain as efficiently as healthy individuals.

"There might be a way to treat these patients - and that’s exciting.”

Dr Manoj Sivan is an Associate Professor in the Leeds Institute of Rheumatology and Musculoskeletal Medicine at the University of Leeds and honorary senior lecturer at The University of Manchester.

He said: “What was previously considered to be a nuisance variable has now been shown to have substantial potential to improve patient outcomes in chronic pain.

“Understanding the neural mechanisms of placebo response enables us to tap in to this more to modulate pain perception and enhance the analgesic effect of other novel step-change treatments, such as our Smart Neurotherapies Platform.”

He added: “With the current crisis of overuse of opioids a concern for all clinicians, this research strengthens the evidence for using non-drug approaches to manage chronic pain and encourages an important cultural change in managing our patients”

Dr Andrea Power, Honorary Research Associate at the University of Manchester said: “Pain normally increases negative emotions, which in turn increases the subjective experience of pain.

“Conversely, analgesic administration induces the expectation of reduced unpleasant symptoms, which reduces anxiety and, consequently, actual symptoms of unpleasantness.

“That is why chronic pain patients have psychological co-morbidities such as anxiety, depression, pain catastrophizing and cognitive impairments.

“For this reason, the role of expectancy and anxiety in modulation of pain by placebo has a role in treating these patients.”

Val Derbyshire, who has Osteo Arthritis and Fibromyalgia and works with the Salford Fibromyalgia Support Group

She said: “Currently people are offered different treatments - including opioids- with varying levels of success. Some people despair of ever finding resolution for their pain, and will try almost anything however weird and wonderful it may seem, whilst others are suggestible to any option offered.

“Anything which can reduce the use of Opioids and the concomitant side effects has to be welcomed. Placebo has been shown to work for many individuals without any harmful side effects. Therefore I believe that it could be used more widely in the treatment of chronic widespread pain.”

The abstract is available  

A new mass study of people living with chronic pain in the UK has demonstrated the links between pain and certain atmospheric weather conditions.

Weather systems in the UK could cause chronic pain suffers to experience more or less pain on certain days as a result of certain pressure patterns and accompanying rain, humidity, and temperature caused by movements in the jet stream, according to new research published in the .

To better characterise which weather conditions most affect pain, a group of University of Manchester–based researchers and their collaborators, funded by Versus Arthritis, conducted a 15-month long study with over 13,000 UK residents living with chronic-pain conditions.

In this study called , the participants recorded their daily pain intensity within an app on their smartphones. The GPS location of the phone would then link to the weather data. The team’s previous work used a statistical approach to examining the difference in local weather between days where individuals had an increase in pain over the previous day versus days they did not have such a pain event.

In this new study, the team analysed the data across all of the UK as a meteorologist would do. The researchers ranked all days in the study by the percentage of people responding who recorded a pain event. The most painful days had 23% of participants reporting an increase in pain, and the least painful days had 10% of participants reporting an increase in pain.

The researchers took the 45 days at the top of the ranking (the top 10% of all study days) and averaged the weather conditions on those days to determine the weather patterns present when the most number of people were in pain. They did the same for the 45 days where the least number of people reported pain (bottom 10%).

These research results show for the first time the weather patterns on days with a large number of people reporting pain, compared to days with a low number of people reporting pain. On the most painful days, the jet stream was aimed right at the UK, with below-normal (or low) pressure over the UK. The humidity and precipitation rate were both above normal, and winds were stronger. In contrast, on the least painful days, the jet stream tended to blow north of the UK, bringing above-normal (or high) pressure to the UK. The humidity and precipitation rate were both below normal, and winds were weaker.

The new research was led by Professor David Schultz, , The University of Manchester, and is a collaboration with the Cloudy With a Chance of Pain team led by Professor Will Dixon. Prof Schultz has now been awarded the 2020 European Meteorological Society S. W. Tromp Foundation award for “Outstanding Achievement in Biometeorology” for this research paper.

“Over 2400 years ago, Hippocrates wrote that different wind directions could bring better or worse health to individuals. said Prof Dixon. “The belief by people living with long-term pain conditions, such as arthritis, that their pain is affected by the weather remains prevalent today, with about 75% of people with chronic pain believing this to be true. Yet, there is disagreement over what weather condition makes their pain worse.”

Prof. Schultz added, “Part of the reason for this lack of consensus is that previous researchers have treated the different measures of the weather such as pressure, temperature, humidity separately, which assumes that one could vary the temperature while holding all of the other weather measures fixed. Of course, the real atmosphere does not behave like this, as all the variables are changing simultaneously. A simple analysis clearly won't do to get at understanding how weather affects pain.”

This research confirms and expands on previous research from the 91Ö±²¥ researchers. Because this study is the largest in terms of both duration and number of participants, it allows greater confidence in the results. Although not everyone believes in the link between weather and pain, the results of this project should give comfort and support to those who have claimed that the weather affects their pain, but have been dismissed. Finally, this research also begins to shed light on the environmental conditions that modulate pain, insight that might be explored further for improving the treatment, management, and forecasting of pain.

The study, 'Weather patterns associated with pain in chronic-pain sufferers' can be accessed in the .

Scientists at The University of Manchester are developing a smart connected to goggles which flash light at a special frequency to tune patients’ brains in a ground-breaking treatment for chronic pain.

The being developed by the team will eventually allow patients to choose between light, audio, or ‘neurofeedback’ treatments for pain.

The team are on the hunt for volunteers with any chronic pain condition - except cancer - to test the three revolutionary technologies in a clinical setting.

The light therapy makes use of the team’s research demonstrating that pain can be alleviated by tuning the brain to a particular frequency of 10 cycles per second – known as alpha frequency.

The audio therapy uses two ‘binaural’ tones - close in pitch but not identical - which the user can use to focus on to tune their brain to the alpha frequency.

The team are also testing a ‘neurofeedback’ system which measures the user’s brain activity in real-time with an EEG cap, teaching him or her to increase activity in relevant brain regions.

Neurofeedback aims to gain control over brain activity in brain regions associated with increased pain resilience, enabling patients to manage their own chronic pain better.

The user’s increased pain resilience levels will be tested by asking them to submerge their hand in cold water, known as the Cold Pressor Test.

The group’s study, published in 2016, examined pain-free volunteers, giving them short bursts of pain. The volunteers reported feeling less pain when they were exposed to light pulses or sounds at alpha frequency.

Professor Anthony Jones from The University of Manchester is the Director of the Human Pain Research Group (HPRG), which is based at Salford Royal NHS Foundation Trust, part of the Northern Care Alliance NHS Group.

He said: “We hope this work will be good news for up to 40 % of the UK’s population - rising to 62% in the over 75s – who suffer from chronic pain.

“These exciting technologies are a simple, safe and harmless and have exciting potential to allow patients with chronic pain to treat themselves in the comfort of their own homes.

“For many, it will for the first time they are given control of their condition. We think these technologies could be used either in addition or instead of their current pain therapies.

“But to allow us to move on to the next stage, we need volunteers who are willing to work with us to try the technology so we can develop it further.”

Dr Manoj Sivan is a consultant in NW CATS and senior lecturer at The University of Manchester.

He said: “This treatment not only helps reduce pain but could influence other associated symptoms such as sleep problems, fatigue and mood.

“Our ongoing studies could not only help chronic pain patients with their symptoms but also contribute to develop this research idea that could benefit millions of chronic pain sufferers worldwide”

Dr James Henshaw from The University of Manchester said: “We are very excited about this work and about how much control the Smart Neuro-therapies Platform can give back to the patient.

“We are currently looking for volunteers aged 40 or over to test the neurofeedback system and volunteers aged 18 or over to test the visual and auditory app, so if you are interested please get in touch.”

Heather Wallace, General Manager of Pain Concern said: “Chronic pain affects so many people in the UK and makes it difficult for them to function.

“There is no one-size fits all approach to managing pain. That’s why it is vital that we look at new ways of helping people living with pain to understand and manage their own condition.

“We welcome the new University of Manchester research into this exciting technology and the potential it offers as an additional or replacement way of managing pain.”

A Podcast made by the charity  featuring Professor Jones is available

If you want to take part in the neurofeedback trial, email James Henshaw (james.henshaw-2@manchester.ac.uk) or Tim Rainey on 0161 206 0205

If you want to take part in the visual and auditory trial email Helen Locke (helen.locke@manchester.ac.uk) or Sarah Martin (sarah.martin-2@manchester.ac.uk).