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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PainDETECT as a Potential Tool for Personalized Medicine: Predicting Outcome One Year After Knee Arthroplasty.
Journal article
Wall AJW. et al, (2025), Mayo Clin Proc Innov Qual Outcomes, 9
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Brain signatures of nociplastic pain: Fibromyalgia Index and descending modulation at population level.
Journal article
Kelleher EM. et al, (2025), Brain
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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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Correction to 'Systematic review and co-ordinate based meta-analysis to summarize the utilization of functional brain imaging in conjunction with human models of peripheral and central sensitization'.
Journal article
(2025), Eur J Pain, 29
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Systematic review and co-ordinate based meta-analysis to summarize the utilization of functional brain imaging in conjunction with human models of peripheral and central sensitization.
Journal article
Clarke S. et al, (2024), Eur J Pain, 28, 1069 - 1094
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CENTRALISED PAIN IN EARLY RHEUMATOID ARTHRITIS PREDICTS WORSE BODILY PAIN OUTCOMES
Journal article
Kelleher E. et al, (2024), RHEUMATOLOGY, 63, I74 - I74
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THE USE OF ONLINE PLATFORMS IN THE TREATMENT OF CHRONIC MUSCULOSKELETAL DISEASE
Journal article
Wall AJW. et al, (2024), RHEUMATOLOGY, 63, I146 - I146
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IMI2-PainCare-BioPain-RCT2 protocol: a randomized, double-blind, placebo-controlled, crossover, multicenter trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by non-invasive neurophysiological measurements of human spinal cord and brainstem activity.
Journal article
Leone C. et al, (2022), Trials, 23
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Hippocampus mediates nocebo impairment of opioid analgesia through changes in functional connectivity.
Journal article
Bingel U. et al, (2022), Eur J Neurosci, 56, 3967 - 3978
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IMI2-PainCare-BioPain-RCT1: study protocol for a randomized, double-blind, placebo-controlled, crossover, multi-center trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by peripheral nerve excitability testing (NET).
Journal article
Nochi Z. et al, (2022), Trials, 23
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IMI2-PainCare-BioPain-RCT3: a randomized, double-blind, placebo-controlled, crossover, multi-center trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by electroencephalography (EEG).
Journal article
Mouraux A. et al, (2021), Trials, 22
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"Consensus on Placebo and Nocebo Effects Connects Science with Practice:" Reply to "Questioning the Consensus on Placebo and Nocebo Effects".
Journal article
Evers AWM. et al, (2021), Psychother Psychosom, 90, 213 - 214
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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, (2021), Psychother Psychosom, 90, 49 - 56
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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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Response to "Treating patients rather than their functional neuroimages" (Br J Anaesth 2018; 121: 969-71).
Journal article
Wanigasekera V. et al, (2019), Br J Anaesth, 123, e166 - e171
