Chronic pain is a common and debilitating condition. One in five people in the Australian community have been found to experience chronic pain at any one time. Although there is no evidence of a consistent increase in rates of chronic pain, the rate of permanent disability has increased dramatically in recent decades. This has contributed to the growing cost of chronic pain. For example, back pain is the most common reason for filing workers' compensation claims and leads to loss of 101.8 millio ....Chronic pain is a common and debilitating condition. One in five people in the Australian community have been found to experience chronic pain at any one time. Although there is no evidence of a consistent increase in rates of chronic pain, the rate of permanent disability has increased dramatically in recent decades. This has contributed to the growing cost of chronic pain. For example, back pain is the most common reason for filing workers' compensation claims and leads to loss of 101.8 million workdays annually. The annual costs of medical care for back pain alone have been estimated at $AUD50 billion in the US and $10 billion in Australia. Not only is chronic pain a considerable economic burden, it is also a considerable personal burden to patients. Pain is one of the strongest predictors of poor quality of life and has consistently been found to be associated with high rates of depression. Although there is a large body of research that investigates what factors are associated with chronic pain, there is surprisingly little research that investigates the mechanisms that cause chronicity. Theories of chronic pain suggest that psychological characteristics increase the propensity for people to develop chronic pain. Specifically, theories argue that those people who tend to be fearful of pain will over-attend to painful sensations and avoid pain-provoking activities and as a result are at risk of developing chronic pain. This study will test those theories. If it is found that over-attending to pain does predispose patients to develop chronic pain, this will have important implications for preventing the development of chronic pain. These findings could help to devise early interventions to prevent chronicity and thereby reduce the economic burden to health services and the emotional burden to patients in terms of reduced quality of life.Read moreRead less
Selective Attention And Fear Avoidance In The Maintenance And Management Of Pain Associated With Rheumatoid Arthritis
Funder
National Health and Medical Research Council
Funding Amount
$195,660.00
Summary
Despite advances in the treatment of RA, the condition continues to have a chronic course for the majority of patients. Research has established that the way in which people think about pain and illness influences their responses to symptoms. In turn, these factors can impinge on quality of life and disability. For people with chronic pain problems, those who are fearful of pain and concentrate on symptoms have a poorer outcome in the long-term. In RA, striking a balance between rest and exercis ....Despite advances in the treatment of RA, the condition continues to have a chronic course for the majority of patients. Research has established that the way in which people think about pain and illness influences their responses to symptoms. In turn, these factors can impinge on quality of life and disability. For people with chronic pain problems, those who are fearful of pain and concentrate on symptoms have a poorer outcome in the long-term. In RA, striking a balance between rest and exercise is thought to be crucial. As such, ignoring the pain can lead to overactivity and subsequent joint damage and may be as unhelpful as underactivity. This project aims to investigate the relationship between people's fear of pain and the degree to which they attend to pain. It is suggested that those with very high or very low levels of fear towards the pain will either over-attend or under-attend to pain in comparison to healthy controls and patients with a moderate level of fear. Optimum levels of fear avoidance are expected to be associated with less disability and improved joint function. These findings have implications for the management of RA. Psychological treatments for patients with RA have been found to be effective in reducing pain, disability and improving mood. Treatments usually focus on a combination of changing people's attitudes and behaviours. However, whether strategies that aim to change attitudes or those targeting behaviour are more successful or have specific treatment effects is unknown. The present project will compare a treatment targeting behaviours associated with RA and encouraging a balanace between rest and exercise, with a treatment targeting patient's beliefs about the illness. It is expected that the treatments will have specific effects, which may better allow tailoring of psychological management to patient's individual needs.Read moreRead less
Disorders of fear and anxiety impose significant burdens on individual sufferers, their families, and communities. This project studies the brain mechanisms of fear and anxiety, with special focus on the role of the prefrontal cortex. It tests the novel hypothesis that prefrontal cortex is part of a neural pathway critical for regulating fear learning and ensuring that fear learning is adaptively guided by past experience. In the absence of this pathway, fear learning is maladaptive and excessiv ....Disorders of fear and anxiety impose significant burdens on individual sufferers, their families, and communities. This project studies the brain mechanisms of fear and anxiety, with special focus on the role of the prefrontal cortex. It tests the novel hypothesis that prefrontal cortex is part of a neural pathway critical for regulating fear learning and ensuring that fear learning is adaptively guided by past experience. In the absence of this pathway, fear learning is maladaptive and excessive relative to the danger posed by a situation.Read moreRead less
The Extinction Of Conditioned Fear And Its Implications For Cue Exposure Therapy
Funder
National Health and Medical Research Council
Funding Amount
$322,430.00
Summary
This project studies extinction of Pavlovian conditioned fear reactions in rats. Extinction of these reactions is an animal model for exposure therapy used in the treatment of anxiety disorders in people. In exposure therapy, the patient, aided by the clinician, confronts trauma-related cues in the absence of any overt danger. The intention of this therapy is to reduce the ability of the trauma-related cues to provoke the fear reactions that are undermining the patient's quality of life. In Pavl ....This project studies extinction of Pavlovian conditioned fear reactions in rats. Extinction of these reactions is an animal model for exposure therapy used in the treatment of anxiety disorders in people. In exposure therapy, the patient, aided by the clinician, confronts trauma-related cues in the absence of any overt danger. The intention of this therapy is to reduce the ability of the trauma-related cues to provoke the fear reactions that are undermining the patient's quality of life. In Pavlovian conditioning, subjects (typically rats) are exposed to a signaling relation between an initially neutral stimulus (e.g., a noise) and a feared outcome (e.g., foot shock). When later repeatedly exposed to the initially neutral but now feared stimulus (the noise) in the absence of the feared outcome, the fear reactions it acquired progressively decline until eventually it fails to elicit any such reactions. The fear reactions are said to have been extinguished. There has been significant progress in understanding the psychological processes and neural mechanisms underlying the acquisition of fear reactions, but much less is known about the processes and mechanisms underlying the extinction of these reactions. The project has two general objectives. The first is to determine the conditions of extinction training that promote long-term loss of fear reactions. The second objective is to determine how the brain controls this extinction of learned fear. Achieving these aims will be significant for two reasons. First, it will contribute to understanding the mechanisms by which animals (including people) learn to adjust their behaviour to bring it into line with the current relations that exist between events in the world. Second, it will provide important information about how such adjustment is facilitated or impaired across extinction training and, thereby, contribute towards understanding both the successes and failures of cue exposure therapy for fear-related disorders.Read moreRead less
D-Cycloserine And Conditioning: Increasing The Effectiveness Of Exposure Therapy For Fear And Anxiety
Funder
National Health and Medical Research Council
Funding Amount
$400,750.00
Summary
The psychological, social, and financial costs of anxiety problems are among the highest burden-of-disease costs to the community. The most effective long-term psychological treatment for anxiety disorders is cognitive behaviour therapy (CBT), in particular exposure therapy. However only a small minority of individuals receive comprehensive treatment, and a portion of these individuals re-experience symptoms in the long-term. These difficulties are partially due to the cost of treatment and diff ....The psychological, social, and financial costs of anxiety problems are among the highest burden-of-disease costs to the community. The most effective long-term psychological treatment for anxiety disorders is cognitive behaviour therapy (CBT), in particular exposure therapy. However only a small minority of individuals receive comprehensive treatment, and a portion of these individuals re-experience symptoms in the long-term. These difficulties are partially due to the cost of treatment and difficulties with relapse. Recent research has shown that D-Cycloserine (DCS) facilitates extinction in animals and possibly in humans. DCS has the potential to offer a simple, brief, and cost-effective intervention that enhances treatment effects. In the United States the new NIMH director has set research into DCS and exposure to fear as a high priority that is likely to have a significant public health impact. This proposal provides an opportunity for Australian researchers to become involved in a rapidly expanding research field. The research team at UNSW have already established an international reputation in DCS applications, fear conditioning in humans, and clinical trials in humans. They are in a unique position internationally to investigate the means by which DCS exerts its effects and to conduct randomised clinical trials of DCS in recovery from fear in humans.The goal is to test DCS in facilitating exposure and extinction of fear. The research will directly lead to recommendations for clinical application and demonstrate whether the drug has the capability of significantly increasing the success of exposure therapy by reducing the time required for treatment, the rate of relapse, the financial cost of treatment, and the overall burden of anxiety to the community. The fear-conditioning studies will also inform our theoretical understanding of emotion processing and fear conditioning in humans, which in turn will allow clinical applications to be optimised.Read moreRead less
Early Regular Egg Exposure During Infancy To Prevent Egg Allergy: A Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$2,304,911.00
Summary
Food allergies are common and result in a significant burden to families and the health care system. One approach to prevent food allergies may be to introduce specific foods earlier than currently recommended. The study will compare early regular introduction of egg from 4-6 months compared to the more common practice of egg avoidance until 10 months of age. If successful at reducing egg allergy, this approach will have a significant impact on reducing the burden of allergic disease.
Analysis Of Low Radiation Dose Outside Of The Treatment Field Received By Cancer Patients Undergoing Radiotherapy
Funder
National Health and Medical Research Council
Funding Amount
$332,384.00
Summary
Every medical intervention is associated with risk. The present proposal aims to quantify the dose from radiation that is delivered outside the actual target region in radiotherapy of breast cancer patients. This information can help the development of better irradiation techniques as well as inform patients and their carers about possible long term side effects. Finally, the research can be used to finetune radiobiological models by comparing clinical outcomes and accurately calculated doses.