2020 Global Year: Interview with the Co-Chair

Preventing Pain: A Conversation with Dr. Brona Fullen

Brona Fullen is an Associate Professor in the UCD School of Public Health, Physiotherapy and Sports Science. Her research areas of interest include the assessment and rehabilitation of people with chronic pain in a range of conditions including musculoskeletal dysfunction, obesity, and spinal cord injury. Brona is a founder and Director of the UCD Centre for Translational Pain Research. Here she talks with IASP about pain prevention. 

IASP: How did you get started in pain research? What do you do in your current job?

Fullen: As a clinical physiotherapist I always worked in research-intensive physiotherapy departments, so it seemed a natural progression to undertake a PhD. From there I was appointed to an academic position in University College Dublin (UCD), and am currently an Associate Professor in the School of Public Health, Physiotherapy and Sports Science. I teach across undergraduate, graduate entry and specialist MSc Physiotherapy programmes, with specific focus on pain science. I am also the Director of the UCD Centre for Translational Pain Research (CTPR).

Have your research interests changed throughout your career? What are you currently studying?

My research areas of interest include the multidisciplinary assessment and management of people with pain in a number of conditions (spinal cord injury, musculoskeletal conditions and obestiy).  I am currently focused on the use of e-health technology for health assessment and patient management.

Can you explain what translational pain research is and how it benefits pain patients and the general public?

Translational pain research  or ‘bench-to-bedside’ research bridges the gap between advances in neuroscience through to effective patient care. It can be bidirectional.

As a pain researcher, how do you communicate progress in the field so that those who are living with pain can remain hopeful about the future?

I believe that this is most important and I accept every opportunity to engage with support groups for people living with chronic pain. With regards to the European Pain Federation EFIC Advocacy is one of the core pillars of our organisation’s work and includes a number of initiatives that map to this issue. We also include a dedicated ‘patient track’ at our biannual flagship EFIC Congress.

What are some general strategies for pain prevention for the public?

Being physically activity can lower the risk of developing chronic pain [1]. The World Health Organisation recommends 150 minutes of moderate-intensity aerobic physical activity a week (five fast walks for 30 minutes) or 10,000 steps a day [2]. Daily living habits affect how we feel, and a more physically active lifestyle gives us great benefits. Strategies to be physically active in the long term include: (1) find a form of activity that you like, (ii) pace up your physical activity levels slowly, (iii) set reasonable goals and avoid comparing yourself to others, (iv) create good habits, (v) build physical activity into every day life  - taking the stairs rather than the elevator, cycling or walking rather than using the car. At EFIC, Prof Bart Morlion’s President's campaign ‘On The Move’ raises awareness of the importance of physical activity in the prevention of primary and secondary pain [3].

What can healthcare providers do to help those with acute pain prevent it from becoming chronic?

Effective management of acute pain using best practice guidelines will reduce the chance of a person developing chronic pain. This includes communicating treatment recommendations using language that patients understand (health literacy). At the end of each consultation patients would be clear about (i) what is wrong with them, (ii) what they need to do, and (iii) understand why it is important for them to do so.

How have you seen pain prevention strategies change throughout your career?

The role that behavioural factors play, particularly physical activity, in pain prevention has grown significantly. We now have World Health Organisation recommended guidelines as to frequency, intensity and duration of physical activity. However, the concept of ‘Exercise as Medicine’ is not a new one, it has been known since the 5th century BC when Hippocrates stated that  ‘eating alone will not keep a man well; he must also take exercise' [4]. The relationship has of course been further defined by years of scientific research.

[1] Landmark, T., Romundstad, P., Borchgrevink, P. C., Kaasa, S., Dale, O., 2011 Association between recreational exercise and chronic pain in the general population: Evidence from the HUNT study. Pain 152, 2241-2247

[2] World Health Organisation Global Strategy on Diet, Physical Activity and Health. Recommended levels of physical activity for adults aged 18 - 64 years, WHO website accessed 9/05/19

[3] https://europeanpainfederation.eu/advocacy/current-projects/

[4] Berryman JW. Exercise is medicine: a historical perspective. Curr Sport Med Rep 9: 195-201, 2010