Completed Early Career Practitioner Fellowship:
Steven Miller
Host Organisation: Monash University
TAC Funding: $125,488
Mentor: Associate Professor Stephen Gibson
Fellowship Project:
Investigating a novel therapeutic intervention for chronic pain following neurotrauma
Aims:
The research component of this part-time fellowship aimed to investigate a simple,
inexpensive and non-invasive brain stimulation technique, caloric vestibular
stimulation (CVS), as a potential tool for managing neurotrauma-related persistent
pain. Three persistent pain conditions were to be examined: phantom limb pain (PLP),
spinal cord injury pain (SCIP) and complex regional pain syndrome (CRPS). The
study aimed to collect data on the clinical effectiveness of repeated administration of
CVS in these persistent pain conditions, to determine whether progression to a full
randomised controlled trial (RCT) of the intervention was warranted. The career
component of the fellowship aimed to enable the fellow to combine his clinical
medical career with a research career, and to enable acquisition of clinical research
skills, with a pain medicine focus.
Methods:
CVS involves irrigation of the external ear canal with iced water, thus stimulating the
vestibular system in a simple non-invasive way. This stimulation in turn induces
activation of brain regions that are involved in pain processing. Approximately 800
persistent pain patients were screened for suitability to participate in this exploratory
study. The technique and/or one of two control techniques (an ice-pack administered
to the forehead, or body temperature water irrigation of the external ear canal) was
applied to twenty-five patients from amongst the above three persistent pain condition
groups, and a newly-added group of non-specific persistent pain (e.g. persistent low
back, neck, joint pain). Data collection remains ongoing as part of a newlycommenced PhD project that is being supervised by the fellow.
Results:
Modest pain reductions following CVS were demonstrated in a small number of
patients. However, dramatic reductions in allodynia (pain in response to a usually
non-painful stimulus, such as light touch across the skin) were demonstrated in two
patients with CRPS. Moreover these reductions in allodynia were sustained for over 1
week following a single CVS session, in both cases, and reductions again occurred
following repeat sessions. Most recently, a third clinically-significant allodyniareduction case has been observed. During the course of the fellowship, the fellow
advanced his neuroscience research career substantially, participating in international
conferences, publishing in high-impact journals, acquiring competitive research grant
funding, and establishing his research group (with one NHMRC post-doctoral
researcher, 4 PhD students and a wide network of collaborative research relationships
locally, nationally and internationally).
Conclusions:
CVS data remain too preliminary for firm conclusions to be drawn about the clinical
effectiveness of CVS as a pain management tool, however, the most promising
potential application (based on new data available from this fellowship) concerns
neuropathic pain, in particular, allodynia. Demonstration of a simple, inexpensive,
non-invasive, well-tolerated and effective means of allodynia reduction would be a
substantial contribution to management of this disabling aspect of neuropathic pain
states and may lead to improved function, mood, quality of life, and return-to-work.
Clearly further research is warranted to continue characterising (and to quantify) the
clinical effects of CVS in the context of neurotrauma-related persistent pain. This will
ultimately, if data remain promising, require examination of the technique in formal
RCT conditions.
Feedback on the Fellowship from Steven Miller:
“The fellowship has been of enormous benefit to me in providing a means of
continuing to develop my research career, to establish and grow a thriving research
group and to explore clinical and scientific aspects of a novel brain stimulation
technique with potential relevance to management of persistent pain following
neurotrauma. I have been exposed to the active neurotrauma research community in
Victoria, nationally and internationally, and I continue to have a strong interest in
this field. The growing of my group will ensure the work started during the course of
this fellowship will continue to the point of being able to answer the research
questions originally asked, and will also ensure my research career progress in both
neurotrauama and other neuroscience fields. There is no way that my current
research status would have occurred in the absence of the fellowship and for this
reason, along with the abovementioned exciting preliminary research findings, the
fellowship has been invaluable.”
Publications:
MILLER SM, HANSELL NK, NGO TT, LIU GB, PETTIGREW JD, MARTIN NG, WRIGHT MJ.
Genetic contribution to individual variation in binocular rivalry rate. Proc Natl Acad Sci USA. 2010;
107 (6): 2664–2668.
NGO TT, MITCHELL PB, MARTIN NG, MILLER SM. Psychiatric and genetic studies of binocular
rivalry: An endophenotype for bipolar disorder? Acta Neuropsychiatrica. 2011; 23 (1): 37–42.
Presentations:
NGO TT, BARSDELL WN, CHOU MJ, ARNOLD C, NUNN A, HILL ST, BROWN DJ, GIBSON SJ,
MILLER SM. Effects of a non-invasive vestibulocortical activation technique in persistent pain states.
8th IBRO World Congress of Neuroscience; 2011, July 14–18, Florence, Italy.
MILLER SM, HANSELL NK, NGO TT, Liu GB, Pettigrew JD, Martin NG, Wright MJ. Genetic
contribution to individual variation in binocular rivalry rate, an endophenotype for bipolar disorder.
18th World Congress on Psychiatric Genetics; 2010, October 3–7, Athens, Greece.
MILLER SM, HANSELL NK, NGO TT, LIU GB, PETTIGREW JD, MARTIN NG, WRIGHT MJ.
The genetics of binocular rivalry. 7th FENS Forum of European Neuroscience; 2010, July 3–7,
Amsterdam, The Netherlands.
MILLER SM. Binocular rivalry: Mechanisms, genetics, applications and the scientific study of
consciousness. 14th Annual Meeting of the Association for the Scientific Study of Consciousness;
2010, June 24–27, Toronto, Canada.
MILLER SM. Binocular rivalry: Mechanisms, genetics, applications and clinical applications.
Melbourne Neuroscience Seminar Series (invited speaker); 2010, April 7, Melbourne, Australia.
MILLER SM, HANSELL NK, NGO TT, LIU GB, PETTIGREW JD, MARTIN NG, WRIGHT MJ.
Genetic contribution to individual variation in binocular rivalry rate. Australian Neuroscience Society /
Australian Physiological Society Joint Meeting; 2010, Jan 31–Feb 3, Sydney, Australia.
NGO TT, CHOU MJ, NUNN A, ARNOLD C, BROWN DJ, GIBSON SJ, MILLER SM. Caloric
vestibular stimulation induces sustained reduction of allodynia in complex regional pain syndrome
(CRPS) type II. Australian Neuroscience Society / Australian Physiological Society Joint Meeting;
2010, Jan 31–Feb 3, Sydney, Australia.
PALMER CJ, PATON B, NGO TT, THOMSON RH, HOHWY J, MILLER SM. An association
between inequity-averse moral preference and risk aversion in decision-making. Australian
Neuroscience Society / Australian Physiological Society Joint Meeting; 2010, Jan 31–Feb 3, Sydney,
Australia.
MILLER SM, HOHWY J. Constitution, correlates and states of consciousness. University of
Melbourne Consciousness Workshop (invited speaker); 2009, October 20–21, Melbourne, Australia.
MILLER SM. Caloric vestibular stimulation and neuropathic pain. 29th Annual Scientific Meeting of
the Australian Pain Society (invited symposium presentation); 2009, April 5–8, Sydney, Australia.
MILLER SM. The changing face of perceptual rivalry. Monash University Philosophy Department
Workshop: "Dichotomies of the Visual Brain" (invited speaker); 2008, June 17, Melbourne, Australia.