Overview
This is a talk about two clinical trials of pain: one when a Laser beam was shone on the arms of volunteers and one that measured the moods of patients who had chronic arthritis of their knees. The trials found that moods like anxiety and anger have a large part to play and it is essential not to ignore them … and yes, your liquid paracetamol really does work faster than a tablet.
Lynn’s Review
Dr Sutton, being naturally inquisitive, decided not to work in general practice. He was interested to know whether an intravenous anaesthetic was analgesic (pain relieving) and hypnotic (induces a state of unconsciousness). He therefore followed the path of medical research.
His thoughts on the measurement of pain led to innovation. He designed a clinical trial model to evaluate pain relief medication. His model was deemed a success as it limited the coefficient of variation to just 2%.
Dr Sutton’s study involved a laser, because the beam power can be precisely controlled and will remain at skin level. He also introduced a switch so that the volunteer had control over the laser. It could be turned off if the volunteer chose to stop. This reduced anxiety in the volunteer.
The trial: a randomised, double-blind, placebo controlled cross over study, was to test whether 1g of liquid paracetamol had a faster onset of action in pain relief than the equivalent dose in a tablet form.
The arm of the volunteer was painted black. This was to ensure that each of the volunteers would absorb the same amount of thermal energy, so standardising the baseline, because skin pigmentation varies. Black also eliminated the skin reflectance variability.
In the first trial some volunteers had a local anaesthetic applied (Emla) and others a placebo cream (E45). Those with Emla displayed a greater threshold for pain. This demonstrated that the use of a laser was effective.
Refinements to the study were now made:
The volunteers would have a button to press which would increase power of the laser until the pain threshold was reached and the button released by the volunteer.
Tests would happen at the same time each day.
Participants should not drink alcohol and should be free from any substance which could inhibit the results obtained during the trial.
No rugby players
Trial participants were a mix of men and women and no difference in pain threshold was noted between men and women.
Pain is a complex sensation and pain severity brings mood disturbance, so Dr Sutton devised a questionnaire requiring answers to 17 questions. These would measure how people felt physically and emotionally, so identifying the impact of pain.
The answers to the questions would track how a patient felt before and after using an analgesic during the pain test.
This test successfully demonstrated that the liquid formulation of paracetamol outperformed standard tablets in early pain management.
Dr Sutton also noted that people suffering from osteoarthritis of the knee would feel anxious, tired, angry or irritable when experiencing pain, but the use of an analgesic such as a Voltarol spray would reduce those feelings, so changing the mood of the sufferer.
Dr Sutton’s talk evoked many questions as, his audience being mainly retired people, meant that, having lived longer, they had probably experienced pain.
An interesting point made, was that although there had been some concern that analgesics could cause heart attacks, anger was also a factor to be considered as it causes a restriction in blood vessels.
The members of Science at Fishbourne were dismayed to hear of the difficulties encountered in our country when seeking funding for medical research, and attempted to offer solutions, as they were keen to support such work, particularly Andrew’s research.
Dr Sutton described his other areas of interest and achievement in medical research which he felt could be of great benefit to health and to the NHS. He declared his frustration with bureaucracy in Britain, comparing it with the ease of achieving funding and making progress elsewhere. Here there is a lack of support, resources, funding and focus on innovation, making every step in research a struggle and often, a waste of time.