Vishvarani Wanigasekera
MRCP, FRCA, D.Phil
Clinical Research Fellow
My research focus is on understanding how analgesics modulate neural activity that underlies nociception and pain perception to ultimately optimize pain relief in chronic pain patients.
Chronic pain is poorly managed, lack of effective analgesics being a key reason. Even opioids, one of the most powerful analgesics that are available for treating moderate to severe pain, has a mixed success rates in treating chronic pain. The amount of analgesia patients experience is variable and inconsistent with some patients developing tolerance, heightened pain sensitivity and even dependence and misuse.
Inherent variability in subjective pain reports and the expectation driven effects on pain reports make assessment of analgesics efficacy challenging especially during analgesic drug development.
Using functional neuroimaging I study the analgesic modulation of neural mechanisms that underpin nociception, central sensitisation and pain processing. I work with a range of analgesics including the intravenous opioid remifentanil. My work is targeted at improving early analgesic drug development processes by using mechanism based disease models to demonstrate analgesic modulation of the pain and nociception related neural activity. This work aims to validate neuroimaging as a biomarker for early analgesic drug development. Within this frame work this research also aims to understand the neurological basis of expectation related effects in a double-blind randomised clinical trial setting.
My interest in chronic pain focusses on exploring the neurobiological basis of chronic pain that can shed light into identifying methods for patient stratification for appropriate treatment/ intervention. I collaborate with Dr Anushka Soni for this body of work.
Key publications
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The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil.
Journal article
Bingel U. et al, (2011), Sci Transl Med, 3
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Baseline reward circuitry activity and trait reward responsiveness predict expression of opioid analgesia in healthy subjects.
Journal article
Wanigasekera V. et al, (2012), Proc Natl Acad Sci U S A, 109, 17705 - 17710
Recent publications
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The effects of lacosamide, pregabalin, and tapentadol on peripheral nerve excitability: A randomized, double-blind, placebo-controlled, crossover, multi-center trial in healthy subjects.
Journal article
Nochi Z. et al, (2025), Anesthesiology
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What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus.
Journal article
Evers AWM. et al, (2020), Psychother Psychosom, 1 - 8
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Opioids for breathlessness: psychological and neural factors influencing response variability.
Journal article
Abdallah SJ. et al, (2019), Eur Respir J, 54
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Inclusion of patient functional neuroimaging metrics in early analgesic drug development. Reply to Br J Anaesth 2018; 121: 969-71.
Journal article
Wanigasekera V. et al, (2019), Br J Anaesth
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Central Sensitization in Knee Osteoarthritis: Relating Presurgical Brainstem Neuroimaging and PainDETECT-Based Patient Stratification to Arthroplasty Outcome.
Journal article
Soni A. et al, (2019), Arthritis Rheumatol, 71, 550 - 560
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Sertraline or placebo in chronic breathlessness? Lessons from placebo research.
Journal article
Pattinson K. and Wanigasekera V., (2019), Eur Respir J, 53
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Disambiguating pharmacological mechanisms from placebo in neuropathic pain using functional neuroimaging.
Journal article
Wanigasekera V. et al, (2018), Br J Anaesth, 120, 299 - 307
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Opioids decrease the unpleasantness of dyspnoea via actions in the medial prefrontal cortex
Conference paper
Hayen A. et al, (2017), BIOLOGICAL PSYCHOLOGY, 129, 375 - 376
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Opioid suppression of conditioned anticipatory brain responses to breathlessness.
Journal article
Hayen A. et al, (2017), Neuroimage, 150, 383 - 394
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OUP accepted manuscript
Journal article
(2017), British Journal Of Anaesthesia
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NEUROIMAGING EVIDENCE OF CENTRAL SENSITIZATION IN PATIENTS WITH KNEE OSTEOARTHRITIS
Journal article
Soni A. et al, (2016), OSTEOARTHRITIS AND CARTILAGE, 24, S443 - S443
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Disambiguating Pharmacodynamic Efficacy from Behavior with Neuroimaging: Implications for Analgesic Drug Development.
Journal article
Wanigasekera V. et al, (2016), Anesthesiology, 124, 159 - 168
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Learning to identify CNS drug action and efficacy using multistudy fMRI data.
Journal article
Duff EP. et al, (2015), Sci Transl Med, 7
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Imaging opioid analgesia in the human brain and its potential relevance for understanding opioid use in chronic pain
Journal article
Lee MC. et al, (2014), Neuropharmacology, 84, 123 - 130
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Amygdala activity contributes to the dissociative effect of cannabis on pain perception.
Journal article
Lee MC. et al, (2013), Pain, 154, 124 - 134