Emerging Leaders Prize celebrates outstanding pain researchers

2020’s Emerging Leaders Prize awards £200,000 to outstanding scientists from University College London, the University of Oxford, and King’s College London, who are all working in the field of pain research.

Pain affects around 28 million people in the UK, which is around two-fifths of the UK population. The most common types of chronic pain include musculoskeletal pain such as arthritis and back pain, with women more likely to experience chronic pain than men.

Pain is not simply a symptom of disease, but has a biology that is important to understand due to its wide-ranging effects on quality of life; impacting on the daily activities of vast numbers of people.

Chronic pain is not only expensive at an individual level, but it also carries a large societal and economic burden by putting extra strain on healthcare systems, as well as contributing to unemployment and work absence due to sickness. Chronic pain costs the UK economy billions of pounds every year, with back pain alone estimated to cost £10 billion.

Despite the personal, societal and economic burden imposed by pain, there is still a significant gap in our understanding - in particular, anticipatory care of pain, understanding of pain in children and adolescents, managing co-morbidities in patients with pain (those who may have more than one condition) and public health strategies to deal with pain.

We also need a better understanding of molecular mechanisms involved in the experience of both acute and chronic pain, which means studying both the body’s biological pathways leading to pain but also developing new treatment options.

The 2020 Emerging Leaders Prize-winners are as follows:

1st place, £100,000 prize

Dr Lorenzo Fabrizi, University College London (UCL)

Many infants need invasive neonatal care at birth, either because they have been born prematurely or because they are unwell. Pain is inevitable, the burden is immense, and the consequences can last for many years.

Dr Fabrizi’s work aims to understand how the neonatal brain processes pain, and the longer-term impact of pain. Using advanced brain imaging techniques, he has shown that the way the preterm brain processes pain dramatically changes with age and is different from the way that we process it as adults. This means that infants may not feel pain in the same way as adults, and that we cannot use common behaviours, like crying, to predict pain intensity.

Discoveries made by Dr Fabrizi, a Principal Research Fellow at UCL, have paved the way for a ‘brain-led’ approach to studying pain in babies, and opened new avenues of research to his own trainees and other groups in the UK and around the world.

Using mice as an experimental model, Dr Fabrizi will study early development of networks in the brain that are responsible for processing pain, which is important for understanding when the neuronal architecture that allows babies to feel pain is fully developed. It is not possible to study this in humans, and insights from Dr Fabrizi’s research in animals could have vast clinical benefits – including the development of targeted treatments aimed at alleviating pain, especially in premature babies.

Dr Fabrizi said: “When the Foundation called me, to tell me I’d won first prize, I almost fell off my chair! This award is a true turning point in my career. I had hit a wall in the interpretation of brain imaging of human preterm neonatal pain, as we had concurrent results that did not clearly fit together. This project will allow me to start a new line of models of preterm pain in order to understand the developmental biology underpinning my observations in humans.”

2nd place, £80,000 prize

Dr Annina Schmid, University of Oxford

Patients with nerve injuries often develop persistent nerve-related pain. A staggering 10 per cent of the general population experience such nerve-related symptoms, yet we do not understand why some patients recover whereas others continue to have symptoms for many years.

Dr Schmid is a Specialist Physiotherapist and an Associate Professor at the University of Oxford. Her research examines why some patients with nerve injuries recover whereas others develop persistent pain. To achieve this, she uses an exciting mix of methodologies, ranging from advanced neuroimaging to sensory profiling and analyses of human bio-samples.

The prize funding will allow Dr Schmid to build on her recent discoveries in patients with whiplash injury. She will examine whether injury to small nerve fibres in the skin explains why up to 50 per cent of people develop persistent pain after whiplash injury, and will also explore whether there are differences in skin gene expression between patients who have and have not recovered.

Dr Schmid said: “I am honoured to be the first allied health professional to receive this prestigious prize. It will not only allow me to answer an innovative and potentially game-changing research question, but it will also put physiotherapy pain research in the international spotlight.

“Funding from the Emerging Leaders Prize will allow me to investigate whether an injury to small nerve fibres explains why some patients develop persistent pain after whiplash injury. Importantly, I will examine whether low-cost bedside sensory tests that I have developed can identify such small fibre damage. This will enable early targeted intervention to prevent pain persistence.”

Highly Commended, £10,000 prize

Dr Philip Holland, King’s College London

Migraine is one of the most common, disabling conditions in the world, affecting over one billion people.

Patients experience repeated bouts of head pain that worsen due to everyday activities, including exposure to light and movement. Research by Dr Holland, a Senior Lecturer from King’s, aims to understand why the brain of a migraine patient abnormally processes pain signals during an attack and how we can develop new treatments to reduce the impact of migraine on everyday life.

To date, Dr Holland has managed to translate several of his research findings into novel therapies that are in clinical development or already used successfully in patients, including a non-drug approach that delivers small magnetic pulses to the brain to help reduce pain signalling in migraine.

Dr Holland said: “Most recently, my research has identified how our body’s daily rhythms across the sleep-wake cycle increase the likelihood of migraine attacks occurring during specific times of the day. This work has identified the importance of lifestyle factors like sleep patterns and shift work on an individual’s susceptibility, and we have rapidly shared this information with migraine sufferers and clinicians via patient awareness days and international meetings. This ensures our research has maximum impact for those who need it most, people suffering with migraine.”

He added: “I’m absolutely delighted to receive this award for my research, but also on behalf of everyone who suffers from migraine, which is an often under-appreciated condition. Using this prize fund will enable me to expedite the development of state-of-the-art approaches to image neural networks that are altered in people with migraine. I will combine these techniques with my established electrophysiological and chemogenetic approaches to facilitate our ability to track, trace and manipulate these neural networks, to determine their function in encoding and processing head pain.

“This award will be transformative for my research, but it will also increase my visibility and that of migraine, supporting my long-term aim of using innovative technology to explore mechanism-based research that will underpin future clinical translation."

Highly Commended, £10,000 prize

Dr Franziska Denk, King’s College London

Dr Denk’s laboratory at King’s researches the molecular mechanisms of chronic pain. One in five of us will suffer from chronic pain at some point in our lives; that is 1.4 billion people, equivalent to the entire population of China. The nervous system of a pain patient malfunctions at many levels: the sensory neurons in our body, the spinal cord and the brain.

Dr Denk, a Lecturer at King’s, is particularly interested in the sensory neurons, which are the first to report on what happens in our environment. In chronic pain, they are known to be hypersensitive, a state thought to be caused by their exposure to substances released from non-neuronal cell types.

“Much of my work to date has focused on characterising the molecular profile of these non-neuronal cell types in a pain state. I have shared my findings widely on public databases, making it possible for other scientists to use this information to help them predict how peripheral cells influence each other to cause chronic pain.

“With the Foundation’s prize funding, this work can now be taken a step further, actually studying this miscommunication ‘in real time’, using cell culture models that combine human immune cells with stem-cell derived human nerves. This will be a crucial step towards developing better analgesics (i.e. pain-relieving treatments) for the many individuals who have to live with pain every day.”

The Medical Research Foundation’s Emerging Leaders Prize is funded by a gift in Will from Professor Victor Louis Ménage and Mrs Johanna Alicia Ménage.