Seven early-career pain researchers took part in the PRF Correspondents Program during the 7th International Congress on Neuropathic Pain (NeuPSIG 2019), which took place May 9 to 11, 2019, in London, UK. This unique science communications training program provides participants with knowledge and skills needed to communicate science effectively to a wide range of pain researchers and to patients and the broader public. In addition to blogging and writing summaries of scientific sessions, the Correspondents also conducted interviews with plenary speakers. At NeuPSIG, PRF Correspondent Laura Pusey, a third-year undergraduate student at the University of Exeter, UK, spoke with NeuPSIG plenary speaker Nadine Attal, MD, PhD, for an interview.
Attal is a professor of therapeutics and pain at University Versailles Saint Quentin, France, and responsible for the Center of Evaluation and Treatment of Pain at Ambroise Paré Hospital, Boulogne-Billancourt, France. She is also a member of the INSERM U 987 Research Unit on Pain, directed by Didier Bouhassira. Her research activity mainly focuses on neuropathic pain and pain management. She is also a council member of the International Association for the Study of Pain (IASP), and the French Society of Pain, as well as a member of the scientific committee of the European Academy of Neurology. She was appointed knight (Chevalier de la légion d’honneur) in 2016 and received a biology prize from the Science Academy (Académie des Sciences) in 2017.
Here, Attal discusses translational pain research, what it is about pain research that excites her, and much more. Below is an edited transcript of the conversation.
For those who weren’t lucky enough to attend NeuPSIG 2019 in London, what were the main points from your lecture?
The aim of my talk was to show that translational neuropathic pain research has several aspects to it. I discussed how the more conventional approach to this research, from bench to bedside, has had many limitations, and therefore few successful drugs have been discovered by using this strategy thus far. This is often because of safety issues in later stages of drug trials, and also because the animal models we use sometimes do not translate to humans.
This is why the reverse approach, from bedside to bench, has been proposed. You start with the clinical applications and then try to see whether these can be translated into animals to learn about mechanisms of action. During the talk, I gave examples based on our studies of botulinum toxin, and on our work with rTMS [repetitive transcranial magnetic stimulation]. We use rTMS in patients, and we have studies suggesting some efficacy, but we don’t know how it works. So we began to research this in animals—it’s exactly the reverse approach.
I also showed that it’s very difficult to work on psychosocial aspects of neuropathic pain in animals. There have been attempts, but it’s very difficult to mimic those aspects. Cognitive dimensions of pain are also very important; in the past these have been overlooked, but they are becoming more and more significant again. This is why it is important to do in-depth phenotypic assessment in clinical trials, as this is sometimes able to predict the potential effects of a drug.
Finally, I concluded by saying that the best way to conduct translational neuropathic pain research is to combine both approaches, from bench to bedside and bedside to bench. It is also important to use phenotypic assessment combined with the investigation of biomarkers identified through fMRI or genetic testing, for example. The best studies published in good journals are those that combine all of these strategies.
How did you become a pain researcher?
It’s a very long story, so I’ll make it short! It was a matter of chance. Initially, I was only a doctor, and before my residency I didn’t know exactly what I was going to do. At this time, I was in anesthesiology, which I wasn’t interested in as a medical student. I was a little bit bored because I was not very good at intubating patients; I appeared to be a little bit more intellectual in terms of my interests.
So my colleagues said anesthesiology wasn’t for me and asked me if I would like to do work for them on pain. So I began going through the French literature, but it was difficult because I didn’t have any previous education about pain; at that time, it wasn’t a part of medical training. So I looked at the literature, and I saw that the subject of pain was fascinating. That’s how I first became interested in it.
Have you always been passionate about research?
Yes. I had always wanted to be a doctor, but I have always been interested in doing research as well, and so I did my master’s very early in my career; this was not so common for young doctors. After my time spent in anesthesiology, I did a residency in neurology, during which I said I wanted to do a master’s and tried to find a good lab to welcome me. I had already developed an interest in pain, and I wanted to work in the best lab. At that time, this was the lab of Jean-Marie Besson, who was a very important pain researcher and one of the founding members of IASP. So I went to his lab, found it very nice, and decided I wanted to work there.
What is it about pain research that keeps you interested in it?
I’m interested in chronic pain because when you deal with human patients, you begin to see that pain is much more complex than in animals. The biology is important, but there are also interactions among so many factors, including environmental, genetic, psychological, social, and societal factors, all of which have an impact on pain—that is what interests me. This means that pain research is multidisciplinary and pluriprofessional, which we need to have for a better overall picture of pain.
What’s the most exciting thing about translational pain neuroscience at the moment?
What is exciting to me is actually what I’m working on now, which is rTMS. We really need to develop new non-drug therapies, and the good thing about rTMS is that it works not only on pain but also on quality of life and on anxiety. These are the types of things I’d like to go further with.
What new areas of pain research really excite you?
Recently, I have been interested in Nav1.7 blockers because we really need to develop new treatments. We do have many therapies, but they are rarely very effective, and even when they are, there are safety issues, and patients can find them difficult to tolerate. So these sodium channel blockers seem very exciting and, at least for some groups of patients, they seem to be safe. All the literature on these antagonists has captured my attention recently.
In looking at the pain field more broadly, what do you hope to see in the next 10 years?
I hope to see new treatments, including new drugs such as anti-NGF therapies, Nav1.7 antagonists, and others. I also hope there will be advances in techniques such as neurostimulation and neuromodulation. There are many things we can do; we can develop new techniques, and make them more effective.
Also, thinking of something completely different, virtual reality is now being developed for use in many conditions, including Parkinson’s, stroke and also pain—it’s extremely interesting. This is the future, because we need to begin to use technology to help our patients, and this is one way to do so. We are working very closely with a lab that specializes in virtual reality, although not currently for pain. However, they would like to collaborate with us on a pain project, and it could be brilliant. In addition, we should use e-cohorts for more accurate phenotyping of patients based on extremely large databases. There are thousands of applications that the web makes possible. That’s my view of the future.
What is your advice to trainees beginning their research careers?
For trainees interested in the field of pain, my advice would be to work hard. Trainees also need to know where they’re going in their careers. It’s not only about doing what you like, but you will also often need to specialize in something, particularly because the field is so competitive now. It’s not only important to be in a good lab, but it is also about what you plan to do in the future.
Laura Pusey is a third-year undergraduate student, BSc medical sciences (neuroscience) with a professional training year, at the University of Exeter, UK.