PhD: Neural Mechanisms of Pain Relief: Comparing Cognitive Training and Neurostimulation Interventions

This project is one of several in competition for funding from the United Kingdom MRC Doctoral Training Partnership (DTP). This project brings together the Universities of Bath, Bristol, Cardiff and Exeter to develop the next generation of biomedical researchers. Students will have access to the combined research strengths, training expertise and resources of the four research-intensive universities.

*Supervisory Team:*
Dr Ali Khatibi (University of Bath), Dr Julian Basanovic (University of Exeter), Dr David McGonigle (Cardiff University), Dr George Tackley (Cardiff University)

*Key Research Question*
Which intervention—interpretation-bias modification or focal neurostimulation—yields greater analgesia, and through what brain–brainstem–spinal mechanisms?

*The Project:*
Pain arises from a dialogue between incoming nociceptive signals and higher-order cognitive processing. People who habitually interpret ambiguous bodily sensations as threatening report more intense and disabling pain. Experimental work shows these interpretation biases can be shifted with short computer-based cognitive bias modification for interpretation (CBM-I); altered bias predicts reduced pain during cold-pressor and contact-heat tasks. A second, mechanistically distinct route to analgesia is non-invasive neurostimulation. Transcranial electrical stimulation (tES) applied to the primary motor cortex (M1) consistently elevates thermal pain thresholds in healthy volunteers. Although both M1-tES and CBM-I reduce experimental or clinical pain, they have never been tested head-to-head, nor has anyone mapped whether they recruit shared or distinct nodes within the cortical–brainstem–spinal pain-control network. This blind spot constrains optimisation: without mechanistic insight, we cannot decide which therapy to deploy, combine, or tailor. Simultaneous brain–cervical–spinal fMRI now enables such mapping by capturing task-dependent coupling between periaqueductal grey, brainstem nuclei and dorsal-horn neurons in real time. Addressing this is clinically pressing: despite modern protocols, 10–50% of surgical patients develop persistent post-surgical pain, underscoring the need for scalable, non-drug preventives with known mechanisms and efficacy.