BJA/RCoA Project Grant
Metabolic Characterisation of Human Models of Burn Pain
Dr Carsten Bantel
Burn pain is a significant problem for patients in hospitals around the world including the United Kingdom. Since it also carries a high chance to persist for many years, new diagnostic and treatment strategies need to be developed. Improved diagnostic tools are important since we just start to recognize that 'burn pain' possibly is a combination of different pain sub-types with each of them potentially involving different underlying mechanisms. The ability to distinguish between these burn pain sub-types serves two main purposes: a) to predict which patient might develop persistent pain and b) to treat patients specifically according to the mechanisms involved in their pain (personalised treatments). It would be hence very useful to find signs in patients, which would indicate the respective type of pain they are suffering from. Such signs can be anything from the results of certain pain assessment tests to substances produced in blood, urine or body-water. They are called biomarkers and should be very specific for only one condition. At present the development of these screening tools or biomarkers is in its infancy, but with NIAA / BJA Project Grant 2011 (1) this study we hope to discover some to be used in burn pain. Unfortunately, animal models in pain research have been found to be of limited use in this regard. In this study we will therefore focus on three different models of burn and inflammatory pain employed to the skin of healthy human volunteers. We will sample the tissue fluid from the affected skin and analyse it for its contents (metabolite analysis). Through this we hope to identify a) key substances and b) specific profiles of these compounds for each pain sub-type. At the same time as we induce pain in this study, we will test the intensity of the pain elicited and further the changes in pain detection thresholds as well as the development of hypersensitivity in the affected skin with a specific standardized testing kit. The last two steps are important, because although pain in general and burn pain in particular might only generate a very intense painful sensation for a short period of time; the injury nevertheless will make the injured skin become very sensitive (hypersensitive). Skin hypersensitivity as frequently observed for example after sun burn is often very bothersome to burn victims but not very well understood. In correlating the injury induced substance release in the skin with detected sensory changes we hope to successfully discover the first biomarkers important for burn pain.
