Focus on Pain Day

I recently attended a one-day conference in Holborn at the Royal College of Anaesthetists, hosted jointly by the British Pain Foundation and Arthritis UK, which I thought I’d give a brief synopsis of. As these events are hosted by charities with very limited budgets, the places available are equally limited. The upside of this is that it’s great to see that this societies are giving a platform for researchers and patients to come together and share ideas and perspectives on a problem which requires both camps to truly tackle. The downside of this is that the limited spaces mean this information doesn’t reach very far outside of the room. Therefore, although I suspect my reach is quite short, I felt if I gave a brief recap of the bits that had the biggest impact on me from the Focus on Pain day, perhaps a few extra people may gain the benefit!

My personal highlight was quite easy to decide on. One of the first talks of the day was given by Louise Trewern, an expert patient who is keenly involved in the development of research and someone who, not only was incredibly articulate, but someone who had a unique perspective of what it’s like to live with pain, and how our research can benefit from this perspective. Louise suffers from fibromyalgia, and in her words, has “lived her whole life in pain”. She shared her life story with us, which I find quite a trusting concept to a room full of strangers. She covered her issues with opiate medication, associative side-effects including weight gain and dependency and how she was the first patient in the UK to be given a rapid tapering of opiates, and what this was like. She also shared her views on alternative (non-pharmacological) treatment, namely exercise and being among nature. My personal views on mindfulness and exercise meld with this perfectly. While Louise still identifies as a chronic pain patient, she is more content now than ever before and has taken an active position in managing her own pain, and removing the dependency of powerful opioidergic painkillers, which presented more side-effects than benefits in the end. Louise perfectly demonstrated the benefits of researchers integrating better with patients, and the importance of people and humanity in pain research and management.

I will not cover all of the talks that I heard on the day, but I can confirm they were all of an excellent standard. Especially given a quite surprising number of no-shows from speakers, and late replacements (the shadow of coronavirus perhaps…?). In particular, Amanda Williams presenting some early sneak-peeks of her upcoming meta-analysis on the efficacy of psychological interventions for chronic pain was very useful. Despite the wealth of review material from Amanda’s lab over recent years, it appears the field is never content and publications age faster than Apple products. Can say I’m grateful for the time taken to compile these reviews, even if it does appear that the end result of the reviews do not change… I was also very interested to hear from Fiona Watt (pictured above) at Oxford University who gave some excellent examples of the benefits of involving patients in the development of research. The clearest example was the use of average pain ratings as outcome measures. It is commonplace for studies to ask our participants and patients to average their pain over the last few days/week/2 weeks etc. It is only when you step outside of the academic bubble and actually consider how hard this would be to do. I do remember I stubbed my toe over the weekend, that hurt quite a bit for 2 minutes (4/10?). I also scraped my knuckles drilling a birdhouse to a tree (yes, I am noticing I should perhaps pay more attention to my surroundings), that also hurt (2/10?). I don’t have a chronic pain condition though, so happily I live my life free from pain. Is my average 3.5? 0.01? 4? 2? Who knows? And even if they did, what can we discern from this analytically? Fiona turned to the use of smart phone technology to get frequent daily ratings, which the patients insisted they did not mind doing. This is one tiny step that will make a massive difference to Oxford’s research projects, and made me think how many silly decisions have I made that may be similarly easy to fix..

I’d also give honourable mentions to Nikita Gamper from Leeds, who presented some really compelling evidence for the use of GABA as in inhibitor that has a degree of specificity to signals between the dorsal horn and brainstem (he also gave me a fresh appreciation for how excellent a model Gate Theory of Control is…). Tony Pickering from Bristol gave an incredibly composed talk summarising the excellent work from Bristol, expanding on the use of PPI to unpack pain modulation across the cortex, subcortex, brainstem and spinal cord (one day I’d love to learn how they do this). I also found Michael Bennet’s talk about treating pain in palliative care to be surprisingly impactful. My own Nan recently passed away after suffering from terminal bowel cancer, and pain was the biggest obstacle to her peacefulness in the last few weeks. This is an incredibly important area for pain research that is often overlooked, and I’m very pleased for the dedication of labs like Michael’s at Leeds who are leading to fight and blowing the trumpet loudly for this important cause.

I really enjoyed the Focus on Pain Day, as I did last time I attended too. I’m very grateful to Versus Arthritis and BPS for supporting this meeting, and for all the organisers involved in actually making it happen. I look forward to attending again next year, and “stay tuned” for a similar recount on British Pain Society’s AGM at the end of the month. I’ll be presenting some important work on our findings from daycase hysteroscopy, which I hope will be of interest to clinicians and researchers alike!

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