Living with chronic pain can be tough, and many people rely on social support to cope with having pain and feeling distressed. We recognised that informal social support is important for people who live with both HIV and chronic pain, and we wanted to know who they lead into, what kinds of support they benefit from, and where the system could strengthen these informal social support networks. This paper describes what we learned from in-depth interviews with people who had chronic or recurrent pain and virally suppressed HIV. It has been submitted for peer review. In the meantime, here is the preprint.

A person's chronic pain can change over time, yet few research studies directly study how pain fluctuates or changes locations over time. We wanted to know how much the location of pain (in the body) changes over time in people living with HIV and pain. We also wanted to find a way to quantify that variation - because that will help us study what this variation is influenced by, and what influences it. We wrote up our approach and we have submitted it for peer review. Here is the preprint.

Many people in hospital have pain, but does pain change how they fare? This multicenter study found that patients in African hospitals who had severe pain were more likely to have critical illness or die within 7 days than patients who did not have severe pain.

We have submitted it for peer review; in the meantime, here is the preprint!

Psychological distress is associated with persistent pain severity, but how? With this work, we wanted to find out whether subtle changes in inflammatory responses could be responsible. We hypothesised that distress may prime the inflammatory system, thus increasing likelihood of pain persistence.

This study took the first steps to investigating this, in people with virally suppressed HIV. Our results were surprising, even to us!

People who have experienced a particularly difficult childhood are more likely to develop persistent pain – but why? Some evidence suggests that these people also commonly have hypersensitivity in immune responses. Other evidence suggests that persistent pain is linked to hypersensitivity in the nervous system. And we know that the immune and nervous systems interact.

We wondered whether a hypersensitive immune system in people with childhood adversity contributes to hypersensitivity in the nervous system, increasing risk of persistent pain. This study tested this idea, and had unexpected results that highlight the importance of conducting more research in diverse settings, especially in Africa.

Our nervous systems protect us, but they can become overprotective or 'hypersensitive'. We wanted to understand the processes that cause this hypersensitivity. Because we know how certain medicines work, and because we can induce a shortlived (experimental) version of this hypersensitivity, we can test which medicines interfere with the hypersensitivity to work out which processes cause it.

In this review, we collated all the published evidence on this question, in an effort to clarify the physiology underlying secondary hypersensitivity (also called 'secondary hyperalgesia') in humans.

Is pain really an experience with many parts? Is it possible to separate the sensation from the emotional feeling of pain? This review pulled together all the experimental studies that have tried to tease pain into these components to find out what the scientific evidence says about whether pain can be separated into components. This is a complex but accessible discussion with important implications for what we understand pain to be.

Many pain researchers use averages and group patterns to describe the information they collect from people who participate in pain experiments. But when we look at group patterns, we miss the patterns within each person’s reports of pain. Those patterns might be important, considering that people who seek treatment for pain don’t want treatment that works for a group; they want treatment that will work for themselves - for an individual. We wrote this commentary to remind other pain researchers to think about this when we report the data we gather in experiments.

Many people who live with HIV report chronic pain that limits their daily life - but why is pain so common and so problematic for these people? This review briefly summarises what we do and don’t know about HIV-related pain.

Threat influences pain - but how? Our group is developing ways to ask this question with strong science. This study tested whether threat changes the sensitivity of neural signalling about potentially dangerous events - and encountered some significant hurdles along the way.

Neural signals are constantly being adjusted inside our bodies; our systems can turn the volume of signalling up or down. Some research suggests that an impaired ability to suppress danger signals can contribute to problematic pain. In this work, we reviewed studies that had used a particular lab-based technique to induce excessive danger signalling - experimentally induced secondary hypersensitivity - and tested a non-drug intervention’s ability to control that signalling.   We wanted to understand which non-drug interventions have the potential to improve a person’s ability to suppress excessive danger signals.