Chronic pain, typically defined as pain lasting more than three months, is a public health issue that impacts the lives of millions of people across the world. It is a particularly prominent concern in Chile, with a 2018 study reporting that one-third of the adult population has some form of chronic pain (Vargas et al., 2018).
Having such a high proportion of individuals with pain-related issues presents several challenges for the healthcare system in this South American country. One challenge is the lack of pain-educated healthcare professionals, according to PRF Editorial Board member Margarita Calvo, Pontifica Universidad Católica de Chile, Santiago (see recent PRF interview here).
“There are very few hospitals with pain units or clinics, so most patients end up being managed by a general practitioner [GP], but most GPs have not been trained on how to properly treat patients with chronic pain. Consequently, many people end up on the wrong medication, or not being treated at all,” said Calvo.
Treating chronic pain in Chile is also associated with a high financial cost. With few pain specialists throughout the country, patients often turn to private doctors to find relief. However, the most significant costs related to these people in pain is their need to take time off from work.
Now, a new consortium led by Calvo has been established to address these challenges.
The Millennium Nucleus for the Study of Pain (MiNuSPain) consortium brings together a broad range of researchers and clinicians from five Chilean universities: Pontifica Universidad Católica, Universidad de Chile, Universidad de Santiago, Universidad Católica del Norte, and Universidad de Concepción.
“These five universities are strategically located at different institutions throughout the country,” Calvo explained. “This allows us to incorporate different programs and approaches to our research.”
The consortium hopes to find new targets for the treatment of pain and train the next generation of pain scientists in Chile.
“Each of the principal investigators [in the consortium] works on a different aspect of targeting pain, such as different ion channels or kinases, and we are trying to put all of our knowledge together, share our expertise, and learn from each other’s work,” said Calvo.
PhD students associated with the consortium can undertake rotations in the various labs to learn new skills. As such, these skills can then be taken back to their “home” lab to increase knowledge and capabilities throughout the country.
A key part of the consortium’s funding has been devoted to communicating its research to the public. They are approaching this in a variety of ways, including extensive liaison work with patient groups, pushing to have pain added to medical school curricula in Chile, and creating a series of educational videos for the consortium’s website. There are even plans to implement a national awareness day for chronic pain.
One educational initiative Calvo is particularly proud of is a card game designed to teach school-aged children about sensory neurons and pain biology. The game, which is accompanied by a video, will be distributed to schools across the country.
“I was a bit skeptical about the game at first, but it turned out really well,” Calvo shared. “It’s quite fun and makes learning about pain biology simple. My kids played it and learned about sensory neurons in a second. It’s great!”
The research program of MiNuSPain takes a “bench-to-bedside and back” approach. Having a translational mindset to research is important, according to Calvo.
“It can be frustrating at times as a clinician, because there are a lot of patients with pain. The treatments we currently have are not very effective and can have aggressive side effects. Most clinicians aren’t aware of the work scientists are doing, and sometimes the scientists [who don’t always get to see patients] aren’t aware of what the real problems are, and what matters most to patients.”
“As both a clinician and a scientist, it’s nice to bring both groups together. The ‘bench-to-bedside and back’ approach aims to identify new targets in human samples, test them in cell cultures and in our animal models, and then bring them back to patients to see if what we learned can be used clinically.”
A potential target the consortium is currently investigating is voltage-gated potassium ion channels. Potassium ion channels play a key role in neuronal activity throughout the nervous system, and have been implicated in maladaptive pain signaling in peripheral sensitization and neuropathic pain (Tsantoulas and McMahon, 2014).
“We published a paper a few years ago where we used an animal nerve injury model to show they began overexpressing Kv1.6 channels after injury, which wasn’t expressed before (Calvo et al., 2016). Then, when we looked at nerves from [human] neuroma patients undergoing surgery or chronic pain patients, they also expressed this receptor,” said Calvo.
“Since then, we have started doing electrophysiology and molecular biology research to characterize this ion channel. Additionally, one of my co-investigators, Rodolfo Madrid from the Universidad de Santiago, is exploring the role of Kv1 channels in cold hypersensitivity in the corneal cells. We work together and look at the whole body, as well as develop novel animal models to explore this area further.”
Calvo takes pride in being named the inaugural director of the consortium.
“It’s a nice recognition. Unfortunately, Chile can still be a very sexist country. When we were applying for funding for the consortium, I saw that only 5% of directors were female. I hope I can use this role to open a path for the next generation and help empower younger female researchers about the career possibilities available to them.”
The international pain community will keep a keen eye on the MiNuSPain consortium and its achievements over the coming years. The consortium's success may help to inspire the formation of similar groups in countries around the world.
Lincoln Tracy is a researcher and freelance writer based in Melbourne, Australia. You can follow him on Twitter @lincolntracy.