Editor’s note: The 2021 Australian Pain Society 41st Annual Scientific Meeting was held virtually April 19-20. This report summarizes a session at the meeting that argued for outside-of-the-box thinking when communicating with others about pain and about science more broadly.
At the 2021 Australian Pain Society 41st Annual Scientific Meeting, held as a virtual conference, a “Thinking outside of the box” topical session featured three expert communicators discussing what the pain community does right, what it does wrong, and how it could do better with respect to communication about pain science as well as human interaction. The session was chaired by Tasha Stanton from the University of South Australia in Adelaide.
The best of both worlds
Kicking off the session was Fiona Kerr, founder and director of The NeuroTech Institute in Adelaide. The NeuroTech Institute brings together academic and industry interests with a focus on creating and translating leading-edge research into end-user products and consulting services.
Drawing upon her expertise in systems engineering, cognitive neuroscience, psychology, and anthropology to discuss key features of human interaction, Kerr said that, when thinking about how artificial intelligence and other technological advances can be incorporated into future treatments for pain, it's important not to forget the things that humans do right in clinical practice– these are things that add value as only human thought and interaction can.
Kerr said that, because of the complex nature of pain, technology and machine learning can be very useful for identifying and treating certain aspects of pain experience. But, at the same time, because pain is a complicated mix of sensory and emotional components, there are many aspects of treating and managing pain where the outcome from human interaction and intermediation is more effective and efficient compared to what machines can accomplish. Further, the partnership of the two often gives the best results, as human interaction creates electrochemical changes that alter the neurophysiology of pain events, and targeted technology can work in concert with this.
Kerr then pointed to important recent advances in the systems used to deliver pain management in recent years. For example, in 2017 researchers at Boston Children’s Hospital reported a novel drug delivery system where tetrodotoxin-containing liposomes are injected under the skin (see related PRF news story). Ultrasound can then be used to trigger the release of tetrodotoxin from the liposomes to allow for instant, non-invasive pain relief via blockade of sodium channels. The development of small and portable ultrasound devices could mean that patients can receive the liposome injection at the hospital, and then take the device home and use it to trigger the nerve-blocking agent at will.
Similarly, in 2009, researchers from the University of Michigan developed nanoparticles that can deliver morphine to soldiers sustaining severe injuries in combat. The nanoparticles can also monitor blood oxygen levels and release naloxone when oxygenation levels fall below a certain level, to counter the respiratory depression associated with large doses of morphine.
In addition, there has been a huge increase in the use of machine learning in medical diagnosis. Kerr pointed to one particular example where researchers put machine learning to use to examine the association between gut microbiome composition and fibromyalgia (see related PRF Virtual Correspondent blog). After the study established that people with fibromyalgia have an altered gut microbiome compared to pain-free controls, a machine learning algorithm could then differentiate between individuals with fibromyalgia and pain-free controls based solely on individual microbiome features.
While these are wonderful advances in technology design, there are some things that humans excel in, compared to technology and machines, with regard to pain management. For example, looking other humans in the eye sets off a cascade of internal activity and changes starting with activation of oxytocin and opiate receptors in the eyes, leading to further changes in chemical, immune system, and brain activity. Kerr also said that touch (even just taking a pulse), too, has a profound chemical impact through C-fiber attenuation, and a warm, respectful voice sets up calming brainwave activity. All of these interactions alter hippocampal and hypothalamic-pituitary-adrenal axis activity. Ultimately, the activity changes the way humans perceive and react to painful stimuli.
However, the “neurophysiological sonar” of live human interaction is not engaged in the same way when locking eyes or holding hands with a robot. This means we do not get the same benefits from interacting with robots as we do from interacting with fellow humans.
In closing, Kerr emphasized the importance of continuing to consider how the field can combine the best of technology with good old-fashioned human interaction for novel and effective approaches to pain management.
You’ve got to learn to learn before learning
The next speaker was David Butler, a physiotherapist, educator, researcher, and founder of the Noigroup, who aim to develop “healthy notions of self through neuroscience knowledge.” Recently, Butler has been thinking about ways people can communicate to enhance learning. But, as he said at the start of his talk, “what is learning?”
Butler alluded to the complex nature of this question, proposing that asking “what is learning?” is like asking “what is love?”
For Butler, learning is best defined as the outputs a person is seeking at a particular time, be that in research or in the clinic. He proposed that learning, like relationships, is something a person needs to learn to be good at. After reflecting over his career, Butler felt that he hasn’t done his own brain any favors by not getting the most out of his learning potential. Three considerations led him to this conclusion.
First, as part of his reading into the learning behaviors of university students, Butler came across three papers that asked veterinary students if anyone had taught them how to learn. Eighty percent of students indicated no – no one had taught them how to learn. He reflected on his own learning experiences, where he had been trained to repeat answers back like a parrot.
Second, Butler realized that despite taking countless flights and repeatedly hearing safety demonstrations, he was still unsure whether he would be able to properly put a lifejacket on in case of emergency, which embarrassed him. To rectify this, Butler took a life jacket with him off the plane after a recent flight and took the time to learn and feel comfortable in his abilities. Flight attendants use the safety demonstration to teach – they do not help you to learn how to put the lifejacket on yourself.
Third, Butler spoke about the feedback he and Lorimer Moseley received about Explain Pain, their book discussing how pain experiences are constructed in response to danger and threat. While some people gave positive feedback, others were less enthusiastic – “It’s not for me,” and the like. This feedback made Butler realize that, like the flight attendants, he and Moseley had been teaching, but not helping people to learn. Nor had they tried to help people learn to learn before learning.
Now, Butler is keen to implement these learn to learn strategies wherever possible – in the clinic, in research methodology, and with his neighbor’s children when they are having difficulties at school. A key component of this is andragogy, which are the methods and principles used in adult education.
Butler called for the pain field to consider the field of educational psychology and the need to focus on self-regulated learning. He highlighted the three key elements of self-regulated learning (before learning, during learning, and after learning) and three evidence-based strategies that can be used throughout each element (motivational, metacognitive, and cognitive).
As an example, cognitive strategies refer to the tactics we use to help us learn. Butler emphasized the need to connect, relate, and interpret what a person is trying to learn. Rather than trying to write everything down, jot down important aspects or areas to come back to at a later point for further discussion, which allows for better connection with the content. Other strategies to consider include avoiding simply looking things up on Google (a lot of information existed before Google; you just have to think about it more); avoiding highlighters (these may make a paper look pretty, but they don’t help with learning), and never letting an abbreviation go by without understanding what it means (otherwise it remains as a “brainworm” and attracts too much attention).
In closing, Butler encouraged attendees to give the “forgotten branch” of educational psychology a go and to tap into the minds of the billions of people on the planet, as learning is the most renewable energy of all.
Words are everything
Last but certainly not least was Hannah Brown, Science Strategy and Operations Manager from the Victorian Heart Institute in Melbourne. Brown is an expert research communicator who promotes the use of storytelling to communicate complex scientific concepts. Outside of work, Brown is a keen golfer and makes “Fairly Ugly” earrings. As part of her talk, Brown shared 10 top tips for telling stories that matter – valuable points to consider that can be used for any kind of communication with any stakeholder.
To begin, Brown said that “words are everything” – although this sounds simple, it's also undeniably true. When communicating, words are vital to set the scene, to engage and maintain the attention of others, and to have a positive interaction with them. Consequently, the words people choose when they communicate are incredibly important. This is particularly true when researchers talk about science and their research.
Brown said that when scientists use complicated jargon to talk about their work, it's like sitting next to someone on the train who is speaking a foreign language you don’t understand. Scientists learn how to speak to other scientists but forget that not everyone, particularly those in other fields, speaks the same tongue. So it is important to choose words carefully when communicating science so as to not actively exclude individuals who don’t understand the language.
The second key point was that “authenticity breeds trust.” Most people pick up the subtle changes in verbal and nonverbal behaviors that occur when someone is being dishonest with them. Being more honest and authentic about what you have to say helps a person engage with the audience, regardless of who the audience might be.
A great example of being authentic is to use real people, names, and experiences when the situation allows. This relates to, let's call it the “nonsense radar” (though Brown used more colorful language for the word “nonsense”) we all have that goes off when we feel we are being lied to. Being as real as one possibly can when communicating with others helps build trust, similar to the benefits of eye contact and warm touch discussed by Kerr earlier in the session.
Another example of bringing one's true self to the table is not being afraid to try being funny. While others may discourage attempting to bring humor into science communication, Brown strongly argues for the opposite. The science behind laughing forms a key plank to this rationale. With laughter comes a cascade of neurological and physiological responses that help a person become more relaxed, and those responses are also associated with memory formation. These changes explain why we can often remember the punchline to a joke – the thing that made us laugh – rather than the setup. Of course, there may be situations where being funny is not appropriate. But Brown strongly believes that incorporating humor into communication, when possible, certainly makes a difference.
Finally, Brown reminded attendees that rules are made to be broken, and that the tips she provided are only guidelines. Just like science, communication is a matter of trial and error. Therefore, Brown encouraged attendees to try the tips covered during the session and see what works best for them. Getting feedback from colleagues on presentations will help a person figure out which of these tips work best with one's individual style.
Together, Kerr, Butler, and Brown covered unique and thought-provoking aspects and approaches to improving how people – including pain researchers – interact and communicate with others. Hopefully these “outside-of-the-box” talks will help pain investigators learn to learn how to do exactly that!
Lincoln Tracy is a researcher and freelance writer from Melbourne, Australia. You can follow him on Twitter @lincolntracy.
Image credit: jcsmilly/123RF Stock Photo.