Reflections from the Annual Scientific Meeting
Brian Pulling presenting his PhD research at the Australian Pain Society meeting in Hobart Tasmania, April 2022
The first Australian Pain Society Annual Scientific Meeting to be held face to face in 3 years was finally able to take place this year (back in April) in glorious Hobart, Tasmania. With many brilliant guest speakers including guests all the way from London and Alabama the event was one not to be missed. We asked our Revolutionaries to reflect on their experiences. Enjoy their reflections over the next few pages!
PhD Candidate, IIMPACT in Health, UniSA
One conversation seems to come up among pain researchers and clinicians more and more these days – what do we do for people who can’t tell us about their pain? As the global population ages, we’re starting to hear more about the experience of pain from older adults, and finding new ways to understand the complex experience of pain among older adults. While visiting Hobart for the 2022 Australian Pain Society annual meeting, I had the distinct pleasure of hearing about how other researchers and clinicians are facing
Prof Mark Hutchinson is doing some incredibly beautiful work, whereby fluorescent light is associated with nerve injuries (the images are quite striking - he calls this “the colour of pain”). Dr. Flavia Di Pietro is looking at how the brainstem functions differently when a person experiences pain. In the clinical space, Dr Frederick Graham talked about efforts at the Princess Alexandra Hospital in Queensland to treat people who experience pain and have dementia. Dr Dan Harvey uses virtual reality to study how our perceptions can be impacted by changes to our environment. These (and many other) researchers and clinicians are finding creative and exciting new ways to integrate what happens at the cellular level with how we perceive pain, to find new ways of treating pain.
This complexity leaves me struck by the depth and breadth of pain science – from the laboratory to the clinic, we all seek to understand pain better, and to bring that understanding directly to people with pain. I’m left to reflect on my own work, and further consider that we need to evaluate how we ask people about their pain experience if we are to have any hope of helping them manage
You can find out more about how we’re working on developing new methods for assessing people’s conceptualisations of their pain condition here.
Research Fellow, IIMPACT in Health
Something that struck me from one of the Australian Pain Society workshops last week, was that we should think and be mindful of how we behave and talk about pain and injury with our kids. Kids are always learning, observing, and adapting. Dr Dianne Crellin from the Royal Children’s Hospital in Victoria gave a really thought-provoking presentation about procedural pain in children – procedural pain encompasses things from the common immunisation injection, inserting an IV line, to insertion/changing a nasogastric tube. And although aspects of this might be less relevant to many of you Pain Rev folk, you might be astounded to hear that the guidelines for managing pain and distress for these procedures has not changed in 30 YEARS!
Children are often held down and many have horrendous experiences with these types of procedures. And they remember these experiences. In fact, research shows that not only do kids remember these experiences, often these negative experiences become exaggerated in their memory, and these negative memories are more predictive of future pain experiences, than the actual event. Just wow!
I also presented in this workshop where I talked about ‘everyday’ pains in young kids. So here I’m referring to everyday cuts, scratches and bruises in children aged 2-7 years. In a nutshell, we know that these everyday pain experiences are golden opportunities to teach and empower kids, so that they can grow and develop with the knowledge and toolkit for recovery and resilience into the future. These opportunities might include how we respond or react to a child’s pain or injury, the language we use, influences of the people around them (i.e. siblings, friends), or other socio-cultural experiences (i.e. like what they see on TV). And don’t forget – they are always watching – so we need to be mindful of our position as
a role model.
The importance of these younger years in shaping fundamental life-long beliefs and behaviours surrounding pain and injury is becoming clearer. But I will leave it at that and hopefully this will give you some
food for thought.
Pain is a complex condition, with complexity at the cellular, single organ, body system, individual and society levels. Pioneers in pain research and clinical practice, now dating back over fifty years have proposed a framework for managing pain which includes biological, psychological and social factors.
We now know that a wide variety of treatment types may be used to treat pain. Many of these different treatments only have small effect sizes. However, a trusted clinician can deliver these treatments in the context of listening to the individual’s story, validating their experience, and providing support, empathy and empowerment. This approach can lead to lasting change thanks to the adaptability of our amazingly complex biology when facilitated by a trusted and empathic clinician.
We have learned much from the researchers and professors who spoke at the recent Australian Pain Society Conference. As I mentioned, we have been learning of the biopsychosocial approach to managing pain from these experts for fifty years or so. What is emerging, and what I hope to learn more of in the coming years, is the knowledge and expertise owned by people with lived experience of pain. Recent research involving people with complex regional pain syndrome (CRPS) have identified themes that have helped them manage their condition. Important and meaningful themes that they shared with us included :
understanding that pain can fluctuate,
not everyone with CRPS have the same symptoms,
the importance of a paced approach to movement and exercise, and
facilitating social and community supports to empower and improve their ability to live well with this potentially disabling pain condition.
I believe that the inclusion of people with lived experience of pain in future research and education will further improve our understanding of pain, and will also further improve our ability to help others with persistent pain conditions. Maybe in the future there will be a new type of health professional. That of a lived experience clinician who could directly share their knowledge, understanding and experience to empower other people with persistent pain.
At APS, two things stood out to me over and over again; people in pain deserve individualised and multidisciplinary care. And when you hear that over and over again, aside from furiously nodding in agreement, you hear that omnipresent cash register sound.
No person in pain nicely fits in a one-size-fits-all box (not comfortably at least). That is, pain looks different for everyone when we remove the biomedical lens. We also know that chronic pain doesn’t just respond to one method of care. It takes a multidisciplinary team - one that crosses the same complex domains
that pain does.
Now none of this information is new to those researching, experiencing, or caring for someone in pain. Yet, we continue to witness one-size fits all, ‘guaranteed to work for you’, garden-path answers, often with a
biomedical focus. As individualised and multifaceted chronic pain is, why is the care for those suffering rarely of the same shape?
It seems the first step to the answer lies in collaboration - a multidisciplinary team committed to interrogating every angle of the human experience that pain touches and recognising this doesn’t look the same for two people. Again, that dollar sound - you can hear it louder. But this is an upwards of 73.2 billion dollar problem (Deloitte, 2019) - and each narrowly individual line of inquiry comes at their own cost.
I felt the low-humming sense of consensus at APS - bits and pieces across plenary talks, papers, posters, and standing in line for tiny croissants (they really were a novel figurine-like size.) Perhaps the most exciting recognition of axing silo thinking when it comes to chronic pain came from the inimitable Prof Mark Hutchinson. And despite being the rookie in the room, I didn’t feel for a second that other young researchers like myself weren’t a part of this collaborative approach. And these weren’t just words that Mark was promising - in May I’ll be tuning in to Mark’s open discussion of transforming an idea into something that has an impact on people’s lives.
Dr Dianne Wilson
Research Associate, IIMPACT in Health - UniSA
Along with other colleagues, I was inspired by many of the presentations at the APS conference. Overall, the recognition by researchers and clinicians of the value of the uniqueness of each person’s persistent pain story was gratifying. As clinicians, we have been trained to listen to, assess and manage each person’s presentation in a biopsychosocial (BPS) model, using sound clinical reasoning to treat the variability of their signs and symptoms (using the evidence when possible). We are often derailed in this approach by funding models, socio-economic factors, poor health literacy and limited knowledge of neuroscience amongst health providers. However, hearing experts reinforce the value of the patient’s perspective, the need for variability of approaches and integration of multi-disciplinary management, reassured me that perhaps we have been on the right track all along!
The physiotherapy pre-conference workshop on the ‘Interdisciplinary approach to managing persistent pain’ set the scene for individualised, evidence-based management within a BPS model. It was an interactive workshop with a panel consisting of a physiotherapist, a general practitioner and a psychologist identifying communication issues that can adversely impact outcomes of an interdisciplinary approach. The highlight of the afternoon was a group exercise where we all managed the same case study, but from the perspective of another discipline. For example, physiotherapists discussed the case from the perspective of a psychologist, identifying what relevant information the psychologist might need from the GP and physio to address any psycho-social issues. The results were surprising but led us to a better understanding of the type of information that may assist a true interdisciplinary approach.
For many of us, the conference was a wonderful opportunity to catch up with old friends and colleagues – unfortunately for some, the Coronavirus was shared as well!
It was a privilege to attend the 2022 meeting of the APS in Hobart in these times. Listening to the speakers a few themes stood out for me. First, the importance of considering the person in pain as a part of all research projects. Second, the emphasis on social determinants of health and the various health inequities that exist in our society. And last but not the least, closing the gap in terms of best practise pain and health care amongst our indigenous brothers and sisters.
I have been a part of Pain Revolution for almost 3 years now. Reflecting back on the amazing work that PR has done, I am aware as to how the team has been working in these areas for quite some time. What stands out is the extensive clinical consultation with people living with pain and their input on the essential pain facts. Lastly, catching with up my fellow pain revolutionaries and listening to some of the leading clinicians, researchers and advocates and their work in the pain space left me energised and inspired. The only other times I have felt like that have been my two previous tours with Pain Revolution, first as a cyclist and then as an educator!
Physiotherapist , Royal Hobart Hospital, Local Pain Educator
Despite now being in iso with Covid, I don't regret attending my first APS conference in my home town of Hobart. My motivation for attending was to get inspiration for a research project I'm working on with Jane Chalmers on Pain Education Co-design for Tasmanian Women with Pelvic Pain. The highlights were reconnecting with Pain Revolution friends and being inspired by the diversity and quality of presenters from around the country. Shout out to Fran Black, Lance House and Jan and Phil Millner for their support with the Cygnet reunion ride logistics.
Masters by research candidate, IIMPACT in Health, UniSA
The simplest language, messaging and concepts work to help people understand and manage their pain regardless of educational attainment, according to Professor Emerita Beverley Thorne at the APS 2022 Scientific meeting. From my pilot study we've discovered that people who develop persistent pain after total knee replacement (TKR) can be identified at earlier time points (1 month after surgery) than they are commonly reviewed in the post-op clinic (usually around 6 weeks). So, as clinicians we also need to listen to the simple messages from our patients. When they tell us (in questionnaires or verbally) at early stages (1 month) after TKR that they're having persistent pain, we need to provide simple information and clear messages about the normal trajectory of post-op recovery and also consider interventions that may steer them away from the persistent pain trajectory. What are these interventions? At the moment we can only do our best with the knowledge we have, but watch this space!
PhD Candidate, IIMPACT in Health, UniSA
Harnessing diversity in pain research
What stood out to me most at the recent Australian Pain Society Conference was the everpresent theme of diversity - not only in research topics, but presenters and audience members, all coming together with the overarching goal of improving the lives of those with pain. To highlight this diversity, I presented one of my PhD studies, “Treatment recommendations for the management of persistent pelvic pain in clinical guidelines: a review of clinical guidelines”, in the opioid-themed session. Whilst others presented great insights into the pros and cons of painkillers I took the session on a slight detour discussing periods, pain, and the pelvis. Slightly daunting, but also exciting was the potential to broaden the horizons of people who may not necessarily have attended the session to learn about pelvic pain (although my bias says this should be something EVERYONE should learn about). Diversity is a wonderful thing when we think about pain - it allows us to expand our mind, challenge our thoughts, and engage with people and topics we might not have planned. I definitely achieved this by attending the APS conference and I challenge you to do the same.