Pain, the Brain and Analgesia
| Module title | Pain, the Brain and Analgesia |
|---|---|
| Module code | NEU3029 |
| Academic year | 2023/4 |
| Credits | 15 |
| Module staff | Dr Sam Hughes (Convenor) |
| Duration: Term | 1 | 2 | 3 |
|---|---|---|---|
| Duration: Weeks | 11 | 0 | 0 |
| Number students taking module (anticipated) | 60 |
|---|
Module description
The unique experience of pain is driven by a complex interaction between networks in the brain, brainstem and spinal cord. Normal, physiological or ‘acute’ pain forms part of a survival mechanism, whereby our bodies are protecting us against actual or potential tissue damage. However, following an injury or disease it is possible that pain can persist beyond an initial healing period which is often associated with significant distress and suffering with no benefit to the patient. In order to effectively treat persistent or ‘chronic’ pain, we need to first understand how dysfunction in pain pathways can be targeted with new or existing pain therapies.
In this module you will focus on the peripheral and central mechanisms that underpin acute pain perception and explore our current understanding of the pathological changes that occur during chronic pain. There will be a focus on understanding how chronic pain should be treated using pharmacological and non-pharmacological (e.g. virtual reality) approaches. You will also get the chance to learn how to use specialist techniques used in pain research.
This module is optional for students studying BSc Neuroscience. Students on the BSc Medical Sciences (Neuroscience pathway) may also take this module subject to capacity. NEU1006 Introduction to Neuroscience is a pre-requisite for this module. NEU2004 Neuroanatomy, NEU2018 Neural Circuits and NEU2019 Neuropharmacology are recommended. However, you may have covered similar material elsewhere. If you have not studied the preliminary content, you should be able to successfully complete this module by undertaking some additional study but should discuss this further with your Academic Tutor and the Module Conveners.
Module aims - intentions of the module
The overall aim of the module is to develop an understanding of the peripheral and central mechanisms of acute and chronic pain conditions, and how this information can be used to develop new pain therapies.
Through lectures, journal clubs, interactive seminars, workshops and written assignments you will have opportunities to understand how noxious signals are transmitted from peripheral nerve endings to specific cortical regions, where the unique experience of pain is perceived. Critically, you will begin to recognise how dysfunction in these pathways can result in the development of chronic pain, and how new or existing pain therapies should aim to target these pathological mechanisms in specific patient groups.
Overall, this module will enhance your transferrable skills by helping to develop your strengths in:
1. Applied Research Techniques
You will become familiar with the specialist sensory and pain testing techniques widely used in pain neuroscience. Specific examples will include how to determine sensory detection and pain thresholds, psychophysical assessment of endogenous pain modulation, using pain rating scales to assess different dimensions of the pain experience and how virtual reality can be used to modulate pain processing. You will also have the opportunity to apply some of these techniques through interactive seminar sessions with leading research scientists in the field of Pain.
2. Critical Appraisal.
Through formative and summative assessments, you will develop your ability to identify, review and appraise scientific literature whilst working as part of the group.
3. Scientific writing
You will learn how to effectively write a research proposal, whereby you will get the opportunity to apply your new knowledge of pain research techniques in the development of a new research idea.
Intended Learning Outcomes (ILOs)
ILO: Module-specific skills
On successfully completing the module you will be able to...
- 1. Outline the anatomy and functional role of peripheral nociceptors, the spinal cord, ascending pathways to the brain and descending control systems.
- 2. Identify the mechanisms that underpin different chronic pain conditions.
- 3. Analyse the role of cognitive and affective influences on acute and chronic pain.
- 4. Examine the different methods used to assess pain mechanisms in human pain models and chronic pain patients.
- 5. Evaluate the pharmacological and non-pharmacological approaches to pain management.
ILO: Discipline-specific skills
On successfully completing the module you will be able to...
- 6. Critically evaluate the latest primary research on pain, demonstrating an appropriate knowledge of the underlying research methodology.
- 7. Explain why new or existing therapies should target dysfunctional pain mechanisms.
- 8. Decide which method(s) should be used to answer specific pain related research questions.
ILO: Personal and key skills
On successfully completing the module you will be able to...
- 9. Carry out targeted literature searches and produce clear scientific writing using bibliographic databases.
- 10. Apply skills of critical thinking, problem-formulation and problem-solving to clinical science practice.
Syllabus plan
The module’s precise content will vary from year to year, but the following information describes its typical structure.
Lectures
An introductory lecture (week 1) will outline the broad aims of the module, its weekly structure, assessment processes and other practicalities. You will also have a workshop which will focus on the module’s assessment: writing a research project proposal.
For each of the next 10-weeks, there will be a series of lecture sessions, incorporating different pain themes. Each week will consist of a one-hour lecture, followed by a 2-hour facilitated interactive journal club session.
Lectures may broadly cover the following subjects:
- Peripheral mechanisms of cutaneous nociception
- Neuroanatomical substrates of spinal nociception
- Ascending projection systems
- Central nervous system mechanisms of pain modulation
- Peripheral and central sensitisation
- Chronic pain conditions
- Cognitive and affective influences on pain
- Methods of experimental pain stimulation
- Pharmacological management of pain
- Non-pharmacological management of pain
In the final week of the module there will be a one-hour session providing you with details on the exam and preparation support.
Interactive workshop sessions will take place live, in person or online via a streaming platform e.g. Microsoft Teams.
Journal club sessions
There will be ten journal club sessions where you will explore the latest research techniques used in the field of pain and chronic pain by discussing a research paper relating to topics linked to the lecture materials. These two-hour sessions will incorporate an introduction to the paper and methods used at the beginning of each session, followed by a Q&A discussion. In these you will cover the past, present and future research techniques used in more detail. You will learn how research projects are designed, carried out and interpreted, which will help you to prepare for your research proposal assessment and written exam.
Seminars and workshops
There will be three seminars (1.5 hour each) and one workshop (2 hour), which will help you to prepare for your summative research proposal assessment. These interactive sessions will help you to develop a deeper understanding of the methods used to assess pain in humans and how these can be used in the development of new pain therapies.
During the first seminar you will work in groups to discuss the different pain assessment research methods and identify how these could be used in the development of new analgesics.
This will be followed by a two-hour research methods workshop, where you will get the chance to try out some of the sensory testing equipment used for assessing pain perception.
In the second seminar, you will work in your groups to establish a research question based on your new research methods experience and start to plan your 500-word research proposal outline.
During the final seminar, you will be given feedback on the 500-word page research proposal outline you will have individually prepared as part of your formative assessment. You will also work in your groups to discuss how to turn a 500-word proposal outline into a full 2000 word research proposal which will form your summative individual coursework assessment. You will have access to the sensory equipment again if you would like to further test any new ideas based on the feedback you have been given so far. During this session you will also have an opportunity to clarify any questions related to the assignment.
Learning activities and teaching methods (given in hours of study time)
| Scheduled Learning and Teaching Activities | Guided independent study | Placement / study abroad |
|---|---|---|
| 38.5 | 111.5 |
Details of learning activities and teaching methods
| Category | Hours of study time | Description |
|---|---|---|
| Scheduled Learning & Teaching | 2 | Introductory and wrap lecture (2 x 1hr) |
| Scheduled Learning & Teaching | 20 | Interactive journal club sessions (10 x 2hrs) |
| Scheduled Learning & Teaching | 4.5 | Research methods seminars (3 x 1.5hrs) |
| Scheduled Learning & Teaching | 2 | Research Proposal workshop (1 x 2 hrs) |
| Scheduled Learning & Teaching | 10 | Lectures (10 x 1hr) |
| Guided Independent Study | 9 | Lecture preparation |
| Guided Independent Study | 9 | Lecture review and reflection |
| Guided Independent Study | 20 | Write-up of 1 page proposal |
| Guided Independent Study | 20 | Seminar preparation |
| Guided Independent Study | 10 | Seminar sessions review and reflection |
| Guided Independent Study | 20 | Revision |
| Guided Independent Study | 23.5 | Wider reading & preparation of written assessment |
Formative assessment
| Form of assessment | Size of the assessment (eg length / duration) | ILOs assessed | Feedback method |
|---|---|---|---|
| Research proposal outline | 500 words | 6-10 | Written |
| Online multiple-choice questions progression test (MCQs) | 3-5 questions/lecture | 1-7 | Online model answers |
| Online practice short-answer (SAQs) questions | 5 SAQs online per theme | 1-7, 10 | Online model answers |
Summative assessment (% of credit)
| Coursework | Written exams | Practical exams |
|---|---|---|
| 40 | 60 | 0 |
Details of summative assessment
| Form of assessment | % of credit | Size of the assessment (eg length / duration) | ILOs assessed | Feedback method |
|---|---|---|---|---|
| Short-answer questions (SAQ) | 60 | 2 hours | 1-7, 10 | Written (on request) |
| Research proposal | 40 | 2000 words | 6-10 | Written |
| 0 |
Details of re-assessment (where required by referral or deferral)
| Original form of assessment | Form of re-assessment | ILOs re-assessed | Timescale for re-assessment |
|---|---|---|---|
| Short-answer questions SAQs (60%), 2 hour | SAQs (2-hours) | 1-7, 10 | Ref/Def period |
| Research proposal (40%), 2000 words | Research proposal (2000 words) | 6-10 | Ref/Def period |
Re-assessment notes
Please also refer to the TQA section on Referral/Deferral: http://as.exeter.ac.uk/academic-policy-standards/tqa-manual/aph/consequenceoffailure/
Indicative learning resources - Basic reading
Basic reading
1. Purves, D., et al. (2018) Neuroscience. 6th Edition, Sinauer Associates, New York. (Chapters 9 and 10 on the somatosensory system and pain)
2. Bear, M. F., Connors, B. W., & Paradiso, M. A. (2016). Neuroscience: Exploring the brain. 4th Edition, Wolters Kluwer, Philadelphia. (Chapters 5 – 8 on synaptic transmission, structure of the nervous system and human neuroanatomy and chapter 12 on the somatosensory system).
Module specific reading
3. McMahon, S & Koltzenburg, M, Tracey I, Turk D (2005). Wall and Melzack's Textbook of Pain. 6th Edition, Churchill Livingstone, Elsevier Health Sciences. (Chapters 1, 5 – 8, 12, 18 – 21, 24, 25, 27, 28, 30 – 36, 38, 41, 42, 44 – 50, 61, 63, 65, 70).
4. Bannister K, Hughes S. One size doesn't fit all: towards optimising the therapeutic potential of endogenous pain modulatory systems. Pain. 2022 May 20. doi: 10.1097/j.pain.0000000000002697. PMID: 35594517.
5. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. London: National Institute for Health and Care Excellence (NICE); 2021 Apr 7. (NICE Guideline, No. 193.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK569960/
6. Trost Z, France C, Anam M, Shum C. Virtual reality approaches to pain: toward a state of the science. Pain. 2021 Feb 1;162(2):325-331. doi: 10.1097/j.pain.0000000000002060. PMID: 32868750.
All the recommended books and journal articles are available as an e-resource at the University of Exeter Library. Other resources on specific topics might be recommended by the lecturers and will be added to ELE webpage and included as recommended reading material at the end of each lecture.
| Credit value | 15 |
|---|---|
| Module ECTS | 7.5 |
| Module pre-requisites | NEU1006 |
| Module co-requisites | None |
| NQF level (module) | 6 |
| Available as distance learning? | No |
| Origin date | 01/12/2022 |
| Last revision date | 21/02/2023 |
