Adapting to a worklife of academia

I’m not sure which is the optimal way forward. Either, I can tolerate that my freetime dwindles more and more each year and just hope readers are sympathetic to this and don’t write me off as lazy/uninterested. Alternatively, I can delete the “date submitted” information under each of my posts, and then no-one needs to know that this is the first time I’ve written in two years. Sadly, I’m a victim to my pursuit for transparency, so I’ll go with the latter. What a two years it has been. The end of lockdown was met with an urgent need to finish data collection on our MRC-funded project (examining neural mechanisms of pain sensitisation, and individual differences in response to cognitive behavioural interventions for pain management). I seem to recall we finish data collection 10 days before my contract expired, which is too often the way. This meant I transitioned to a new post-doc position (below), while trying to archive, analyse and write-up findings. Hence blog posts fell by the wayside. We have had many achievements in this time. We were shortlisted for our University’s submission to the UKRI Expanding Excellence scheme, have been in and out of the media spotlight, have won a large grant to expand our lab and buy new equipment and I’ve been appointed co-lead of pain research in the School alongside my long-suffering colleague and friend Wiebke Gandhi. Even if no-one reads these, it is quite nice to reflect on the few things that went right, as (in my world) we spend far too much time agonising on the things that did not…

One thing that does seem to be the case, is that this habitual ‘plate-spinning’ appears to be a core feature of academia, which only increases in intensity the longer you stay. If you are a curious sort of person, research could stand to be the perfect job. It is for me. But, the downsides are considerable, and should always be reviewed. When studying in a field like pain, if you are paying attention, you will be struck on all sides by the suffering of others. In acute pain, we encounter those who have congenital sensitivities (and even insensitivities!) to pain, or women who encounter traumatic levels of pain when attending routine procedures such as hysteroscopy or coil fitting. We find participants who are, perhaps, victims to their own neural mechanisms of pain modulation, who readily sensitise to ongoing pain, or finding the idea of controlling pain to be an impossibility. In chronic pain, we encounter patients whose lives have been transformed for the worse due to the impact of pain. Treatments that don’t go to plan, work that is now unsustainable, hobbies that are forcibly retired. We also encounter fellow scientists and clinicians, wringing their hands trying to figure out why or how to help. There is always a sheer wall of questions to tackle, but a desire to smash the wall to pieces. If you are a curious sort of person, research could be the perfect job, just be aware of biting off more than you can chew..

To finish off this post, I’d like to just describe my new post-doc position, and the project that I’m a part of. Over the next few years, I’ll be working colleagues in the Royal Berkshire Hospital (led by Professor Mark Little, described on my collaborators page), working on phase 2 of the GENESIS trial. We are being funded by Varian Medical Systems to investigate the utility of knee embolisation for the treatment of mild-to-moderate knee osteoarthritis. This is being evaluated with a double-blinded RCT design, wherein half of our patients will receive sham surgery, whereas the other half will be in the active experimental group. Before undergoing the procedure, they will visit me at the University of Reading, where I will be complete a presurgical assessment, including psychometrics, sensory pain testing, as well as functional and structural MR imaging. I will aim to identify predictive biomarkers for treatment response trajectories, so that we can optimise presurgical assessments, alongside the hopeful adoption of embolisation as a potential interventional technique for osteoarthritis.

To provide a bit of detail, embolisation is what’s known as an “interventional radiology” technique, rather than a traditional surgical one. It is a procedure that is completed without the requirement for general anaesthetic and with minimal post-surgical recovery time. A tiny catheter is inserted into the genicular artery, roughly in line with the hip. This is passed down the artery towards the synovial capsule within the affected knee. Osteoarthritis is associated with chronic inflammation. While inflammation in the short-term is a critical and useful immune/defence mechanism, when it becomes a prolonged chronic condition, it can cause damage to the body, swelling, stiffness and pain. Over time, this inflammation becomes supported by new blood vessels, and sensory nerves grow alongside (further increasing pain). Embolisation is a process where small microbeads are fired from the end of the catheter, to block these abhorrent blood vessels, kill them off, taking the nerves with them, reduce pain, increase function and help treat the negative consequences of knee osteoarthritis. From previous datasets, we know that this procedure is effective for a majority of patients. It reduces pain, increases function, and represents an effective intervention technique (although, this still needs confirming alongside placebo…). However, a subset of patients will not improve, despite successful embolisation. Our theories are that this may be a feature of central, neurological and psychological variables. If we can predict those via presurgical intervention, we can (in the first instance), prevent these patients undergoing unnecessary surgery or make this known to the patient and clinician beforehand. But, my primary aim, would be to intervene presurgically, enhance whichever characteristic is likely to be problematic via psychological or pharmacological intervention, and then allow a patient to gain the benefit of a procedure that may stand to enhance their life. This last step, sadly, is likely for GENESIS Phase 3.

We are currently recruiting for the trial, and if you are in the Berkshire area, please feel free to get in touch with me or your GP to discuss whether you are suitable. We have published on the protocol, and I’m working on publishing data from the Phase 1 trial at the moment. This is a project I am very passionate about, and it would be an amazing achievement to help develop a medical intervention that could stand to help thousands of people. But for now, all that is to be done, is hardwork and rigorous science. While doing so, I’ll try to keep the blog posts coming. There is always so much to discuss, and so little time to do so. I’ve uploaded a few new pieces of media engagement to my site, which may be worth a read if you are interested in pain in women’s health or the use of marijuana for pain management. Thank you for reading!

Little, M.W., Gibson, M., Briggs, J., Speirs, A., Yoong, P., Davies, N., Tayton, E., Tavares, S., MacGill, S., McLaren, C., Harrison, R. (2021). Genicular artEry embolisatioN in patiEnts with oSteoarthrItiS of the knee (GENESIS) using permanent microspheres: Interim Analysis. Cardiovascular and Interventional Radiology. Doi: 10.1007/s00270-020-02764-3

Little, M.W., Gibson, M., Briggs, J., Speirs, A., Yoong, P., Davies, N., Tayton, E., Tavares, S., MacGill, S., McLaren, C., Harrison, R. “Genicular artEry embolisatioN in patiEnts with oSteoarthrItiS of the knee II (GENESIS II): Protocol for a double-blind randomised sham-controlled trial” [in press, DOI will be provided soon]

Clinical trial identifier NCT05423587: