At the IASP 2022 World Congress on Pain, taking place 19-23 September in Toronto, Canada, the International Association for the Study of Pain will present awards to honor the achievements of up-and-coming and further established investigators. Here, we chat with Dr. Aidan Cashin, winner of IASP’s 2022 Ronald Dubner Research Prize.
Cashin is a postdoctoral fellow at the University of New South Wales, Australia, and the Centre for Pain IMPACT at Neuroscience Research Australia (NeuRA). His research focuses on how treatments for musculoskeletal pain work – looking at all aspects and mechanisms, both physical and psychological, that may confer benefits to patients who undertake them.
Here, Cashin speaks with freelance writer Kayt Sukel about his training as an exercise physiologist, the gaps that need to be addressed with regard to current pain treatments, and his advice for students who are looking to pursue a career in pain research. Below is an edited transcript of their conversation.
What first interested you in pursuing a career in pain research?
That’s a great question. I started as a clinician – I was an exercise physiologist, working in a range of private and public practices, mainly treating people with longer-term pain. Seeing patients day to day with chronic pain problems, I became very curious about what worked in terms of treatments. It was something I wanted to explore more. You have to understand, as an exercise physiologist, we would often prescribe movement- or behavioral-based interventions, and after a time, it didn’t seem to me that it was actually the exercises that were making people better. Rather, it was more the act of doing those exercises, or the decision to do them. That really interested me in understanding how our treatments were working. If we could understand that aspect better, then maybe we could do a better job of helping the people living with pain who were in front of us.
How does your training in exercise physiology shape your perspective on improving pain interventions?
I suppose it does bias me a little bit in terms of working from an allied health angle. Through my training, however, I’m very grounded in the biopsychosocial model of pain. I think I may take a wider approach in considering the many contributors that play a role in people’s pain compared to other interventionists who may have a more specific view on the problem and what needs to be fixed. I think, in that way, my training has allowed me to be very open. I’m not sure it gives me better insights compared to others, but it’s been very useful.
What are the gaps in current pain interventions that you hope to improve?
The biggest gap is not understanding how these treatments are working. If we had a better understanding of how they work, we could design treatments to be more effective. That’s what a lot of my research looks at – trying to use different approaches to understand how treatments work in a more quantitative way. We use different analyses, as well as qualitative measures, to understand patients’ experiences and how accepting they are of the treatments we are providing.
Another gap we see is that so many treatments are very unidimensional. They are trying to target one problem and one problem only. The people we see in the clinic are quite complex, and that complexity influences their pain problems. Their pain isn’t usually driven by a single primary cause. Instead, there are many interwoven factors that need to be dealt with so they can feel better. I think we need better multimodal, multidisciplinary treatments so we can really target these different contributors instead of taking a narrower view of treatment.
What are some of the things you’ve learned in your research that can help us optimize pain treatments?
Part of the focus my research is trying to explore are the mechanisms underlying treatments. What we’re starting to see is that psychological constructs or variables like pain self-efficacy – the desire to be active despite having pain – and patients' beliefs about their pain are key things that we need to identify, possibly measure, and then address with our interventions. At the moment, not all treatments take these factors into account. Clinicians may not take the time to listen to someone’s story, explore their beliefs, and then work with them to actively change them. These are the sorts of things we’re learning that seem to be quite important for a range of different treatments – and relevant for a range of different providers to think about when interacting with patients in the clinic. These are key things if we really want to reduce pain and the disability associated with it. They aren’t just nice things to do – they also result in meaningful outcomes for the patient.
What are your goals for your career?
I want to keep doing what I’m doing – trying to understand how we can help people in pain, and then focus on developing and testing new treatments. I’m sure as my research career develops, that may take a different form in terms of the questions I’m asking and the strategies I’m using to answer them, but my goal is really just trying to improve the lives of people in pain. Making sure they have access to the right treatments, at the right time, in the right place for them.
What advice might you have for students or clinicians who are thinking about embarking on a career in pain research?
I’d encourage them to be curious, to always ask questions and explore. That helps with our motivation, of course, but it also helps us better understand the problems we are trying to address. I also think we should seek guidance and help to foster support for that curiosity. Role models hold a real key place for me. I was fortunate to have good clinical and research mentors. If you can find a mentor that you get along with, who has skills they are willing to share, those are key strengths that will help you as you try to get into pain research or any research in general.
How did it feel to win the Ronald Dubner Research Prize?
It was a shock, but it was awesome. After reading through the list of previous recipients, it was a real honor to be among those sort of high-caliber researchers. I was stoked, to be completely honest.
These sorts of awards are pretty special. They don’t come along very often, so it’s important to stand back and appreciate how lucky you are to receive them and how useful they can be as you move forward in your career. I’m very fortunate to be speaking at the IASP World Congress on Pain in Toronto, and to have the opportunity to meet new people and share the research I’m doing across that platform. It’s a huge opportunity – and I’m so grateful that I’ve been awarded this prize.
What do you hope that IASP World Congress on Pain attendees will take away from your talk?
I hope they gain a greater appreciation for understanding why and how we do what we do in terms of treatments. There are so many people doing great research, great trials, and working hard to understand what interventions are most effective, but I think it’s also important to start thinking about how those interventions work in order to provide the best outcome for the patient. Certainly, it is important to know if a treatment will work, many people are working on that, but it is equally important to understand how it works, especially when we are talking about developing more effective treatments for people living with pain.
Kayt Sukel is a freelance writer based outside Houston, Texas.