Research in Chronic Overlapping Pain Conditions (COPCs) is in its infancy but holds many exciting opportunities for scientists. This page highlights interviews with scientists who are working to improve the lives of those with COPCs, through advancing research on the co-relationship of these disorders.
Q&A with Dr. Emeran Mayer
Emeran Mayer, M.D., is a Professor in the Departments of Medicine, Physiology and Psychiatry & Biobehavioral Sciences at UCLA, and has more than 15 years of experience in the study of clinical and neurobiological aspects of brain gut interactions in health and disease
What spurred your interest in researching Chronic Overlapping Pain Conditions (COPCs)?
The Oppenheimer Center for Neurobiology of Stress at UCLA is an interdisciplinary research and clinical center focused on advancing and disseminating knowledge, and on the treatment of several chronic medical conditions. The Center’s goal is to ‘Bring the Brain Back into Medicine’. The Center began with a primary focus on visceral pain and functional gastrointestinal disorders, such as Irritable Bowel Syndrome (IBS) and functional dyspepsia, but our research and clinical experience led to the recognition that there are important common mechanisms, as well as differences involved in many pain chronic pain conditions. We hypothesized that studying various chronic pain conditions comparatively would facilitate a better understanding of the pathophysiology of chronic pain, and accelerate the development of effective treatments.
What is your COPCs research focus (e.g., genetics, epidemiology, basic science)?
Our Center’s research is interdisciplinary, multilevel and translational. Our approach is to use advanced methodologies in order to examine integrated hypotheses regarding important brain-body interactions for chronic pain. For example we have projects that integrate multiple types of brain imaging data with patient clinical characteristics and biological measures such as genetics, immune cell biology, and the gut microbiome. We also do more basic molecular and animal models research addressing hypotheses based on results from the human studies (reverse translation).
What are the major goals of your COPCs research?
Example current initiatives include:
- Examining the role of the gut microbiome in health and disease, specifically related to chronic visceral pain and affective responses.
- Hosting and expanding the first international, standardized repository for pain related brain neuroimaging and associated clinical data (painrepository.org). This initiative is key to enabling the analysis of large datasets that include multiple COPCs, an important research strategy that is not possible at present.
- Elucidating common brain mechanisms across various inflammatory, neuropathic and functional pain conditions including IBS, Inflammatory Bowel Disease, Chronic Urologic Pelvic Pain, Headache, TMJD and low back pain.
- Identifying brain signatures associated with positive treatment response to pharmacological and nonpharmacological interventions for pain including mindfulness meditation, and CBT.
- Study of sex differences in chronic pain.
Major findings of your COPCs research?
Example recent findings:
- First of its kind study showing changes in brain responses following use of a probiotic vs placebo - Tillisch, et al., Consumption of fermented milk product with probiotic modulates brain activity. Gastroenterology. 2013 Jun;144(7):1394-401.
- Establishment of the first structured repository for brain imaging and clinical data from COPCs. - Labus JS, et al., Pain and Interoception Imaging Network (PAIN): A multimodal, multisite, brain-imaging repository for chronic somatic and visceral pain disorders. Neuroimage. 2015 Apr 19.
- Studies showing disease related differences in brain networks activated during rest for multiple COPCs. - e.g. Gupta A. et al., Disease-related differences in resting-state networks: a comparison between localized provoked vulvodynia, irritable bowel syndrome, and healthy control subjects. Pain. 2015 May;156(5):809-19.
- Studies showing sex differences in brain responses for COPCs. - e.g. Gupta, et al., Early adverse life events and resting state neural networks in patients with chronic abdominal pain: evidence for sex differences. Psychosomatic Medicine. 2014 Jul-Aug;76(6):404-12.
- Review of brain imaging findings in several chronic visceral pain conditions. Mayer et al. Imaging brain mechanisms in chronic visceral pain 156:S50-S63, 2015.
- Review of the interaction between central and peripheral disease components in IBS. Mayer et al. A systems biological view of IBS. Nature Reviews Gastroenterology and Hepatology, 2015, in press
How do you hope your line of research will benefit patients with COPCs in the future?
Our group expects that in the near future studies identifying structural and functional ‘brain signatures’ related to COPCs will enable clinicians to better diagnose and target available treatments to individuals. In addition this brain data taken together with other potentially important biological information (for example the content and metabolite production of the microbiome) will suggest new treatment targets and better classification of pain disorders. We also believe that collaboration among scientists and advocacy groups is key to advancing knowledge in COPCs and that initiatives like our PAIN repositories will be critical for moving the field forward.
To learn more about his research, you can view Dr. Mayer's recent TEDx talk on brain gut microbiome interactions by clicking here.