BJA/RCoA Project Grants

University of Aberdeen

Title
Double blind randomised controlled trial of exogenous administration of melatonin in chronic pain (DREAM - CP)

Amount
£96,010

Scientific Abstract

Background:
Chronic pain affects ~20% of adults. Pain and sleep are inextricably linked: individuals with persistent pain experience poor sleep quality, which worsens as pain intensity increases. Improvements in sleep can also improve pain. Endogenous pineal melatonin is regulated by light and regulates sleep. Exogenous melatonin also has analgesic and anxiolytic effects; however, the effect of melatonin on sleep/chronic pain is unclear.

Aim:
To investigate the efficacy of exogenous melatonin on sleep and pain in patients with severe chronic pain.

Design:
A double blind, randomised, placebo controlled, cross-over trial.

Setting:
Tertiary referral pain management clinic.

Procedure:
Patients (n=60) with an average pain rating of ≥7 (brief pain inventory, BPI) will be randomised to 4mg melatonin or placebo, then crossover to the opposite treatment, 6 weeks each arm.

Outcomes:
Primary outcomes measures are sleep disturbance and average pain intensity. Secondary outcome measures will include melatonin/6-hydroxymelatonin levels, psychomotor vigilance, objective sleep measures and real time pain/fatigue scores.

Analysis:
Self reported sleep quality and pain scores, and objective sleep measures, with contemporaneous real time pain/fatigue scoring will be compared between melatonin or
placebo and over time.

Potential implications:
Melatonin may provide an inexpensive and safe therapy for chronic pain related sleep problems and pain.

University of Dundee

Title
Does cadaver simulation training offer best clinical performance behaviour during ultrasound guided regional anaesthesia?

Amount
£69,970

Scientific Abstract
Anaesthetists still perform their first regional nerve blocks on patients and not on a simulator. As a result, performance is variable and exposes patients to repeated attempts, pain and harm. Only a limited number of anaesthetists in the UK have sufficient expertise to provide reliable, high quality nerve block. Mastery learning is an educational technique that ensures all doctors gain skills and provides better clinical outcomes. We hypothesise that simulation based training using cadavers, mastery learning and feedback translates to improved clinical regional anaesthesia performance compared to standard training (lectures, volunteer scanning and needle alignment practice on a phantom). We wish to conduct three studies. First, we will train raters to reliably recognise step and error performance metrics that 16 UK experts have developed. Second, we will investigate whether the combination of cadaver training and standard training translates to better clinical interscalene block performance, and thirdly we will determine whether mastery learning on the soft embalmed cadaver translates to better clinical interscalene block performance. Our primary outcome measure will be step and error metrics. Secondary outcomes will be eye tracking metrics (measure of cognitive intention and visual perception), quality of anaesthesia, trainee self-efficacy, patient experience and health economics.