Professor Stanton started her career as a physiotherapist in Canada. Her journey into pain science was sparked by her work with complex clinical cases, leading her to question the traditional biomedical model of pain and query how we can truly embed a biopsychosocial approach to pain management. She has since delved into researching the complexity of chronic pain, aiming to understand the various sensory and cognitive contributors to pain. Her broad scope of research includes using technologies like virtual and mediated reality to manipulate sensory cues and exploring the use of illusions to modify bodily experiences, including pain perception.
Your experiments use illusions as tools and involve sensory manipulation, such as virtual reality. Could you explain this interesting part of your work and its clinical relevance?
Of course. We explore innovative treatments that involve sensory manipulation. For instance, we use virtual reality to create sensory illusions, where what you see doesn’t match what you are doing, and it ultimately changes the way you feel. For example, we manipulate what you see during a virtual bike ride such that we unpair expected and actual effort. Specifically, we show uphill slopes in the virtual environment - this makes you expect that you should have to work harder. Yet, we don’t have resistance increase as it should. This creates an odd sensation that you are being carried or lifted up the hill. That is, you feel as though you are working less hard than when you are cycling with the exact same resistance but you see a flat road. We call this "sensory trickery." This approach aims to take advantage of how our brain makes predictions based on incoming sensory input (in this case, vision of a hill), and thus how altering sensory input can influence bodily perceptions, like perceived exertion or even pain.
We’ve been exploring the use of sensory trickery to help people overcome barriers to engaging in exercise. And there are a lot of barriers! Exercise can hurt, it can be boring, or people can be fearful of certain exercises to name but a few. In our clinical approach, we start by trying different virtual or mediated reality strategies to help an individual overcome their unique initial barriers to exercise. This may involve using virtual reality to promote graded activity, using sensory tricks to make cycling feel easier, using body morphing illusions to reduce pain. Over time, we remove these sensory manipulations as the patient becomes more fit. In all cases, we are working hand in hand with the person who has pain: it's crucial to remember that our goal is to help patients regain control over their lives and reduce pain.
What do you hope to see in the future regarding this kind of experiential learning and research?
I hope to see more thoroughly tested innovations in clinical trials with larger sample sizes. We also must consider the transition from lab environments to clinical settings. In a lab environment, a person might expect to receive a treatment that is a little weird, such as mediated reality that changes the visual appearance of their limbs. However, in the clinical setting, you wouldn’t expect to get something like this, so it is important that we make these new approaches less intimidating for patients. Thus, how we communicate and frame information about new technology is essential: we need to entice people to have an open mind and try new treatments. Expectations can affect a person’s willingness to try something new and their experiences with that new treatment; this can be especially powerful if they have experienced numerous past failed treatments. We need to be transparent about potential benefits of new technology. While we need to ensure we don’t oversell benefits, there is relevance in placing new treatments in context of what we know of existing treatments - e.g., highlighting lack of side effects relative to many common medications for pain.
As healthcare practitioners, it is our job to meet our patients where they're at, and understand their unique life experiences. Then we can use our knowledge to help frame treatments in a way that aligns with a patient’s experiences and expectations. It is not over-promising: we're not saying this is going to cure you, because if we promise too much and the person experiences less benefit than expected, we just reinforce negative expectations. But we need to take responsibility. The onus is on us to understand people and meet them where they are currently at.
If I think about my hopes for the future, I reckon, let's stay curious. Because the more questions we ask, and the more we aim to understand, the more powerful and wide-reaching our research becomes. Embracing the complexity in this field is so much more fruitful, and so much more interesting than trying to fit things into predefined boxes of presumed knowledge.
What do you wish people understood better about pain?
I wish people better understood that everyone’s pain can be influenced by many factors other than physical injury. Stress, thoughts, and beliefs can hold equal or greater weight in shaping a person's pain experience, and not just in people who are anxious or fearful. In all of us! But in the absence of changing what people understand about pain, I think it is important that we change the way we talk about it. The way we communicate with patients is essential. Our words can strongly influence their acute experience, prognosis, and overall pain trajectory. But more importantly, our words can provide validation that this pain experience is real. Chronic pain is typically invisible, creating misunderstandings or even presumptions of good health, so respect and empathy are crucial when we communicate about pain.
Why do you believe it's important to highlight this topic on the IASP site?
Pain science is a constantly evolving field. By featuring this topic on the IASP site, we can ensure that both healthcare professionals and the public stay informed about the latest research and treatment options. It's crucial to emphasize that we're not promoting a new fad treatment but rather deepening our understanding of pain contributors that may be relevant treatment targets for an individual. Topics like pain science education or cognitive behavior therapy need to be discussed and most importantly, how we then might apply such research in everyday life should be explored.
What is the most rewarding part of your work in the field of clinical pain neuroscience?
The most rewarding part of my work isn't actually the science itself but rather the opportunity to train the next generation of scientists. Witnessing students ask nuanced questions and begin to explore new horizons is incredibly fulfilling. I also find that collaborating with patient partners and learning from their experiences is just so inspiring. They are the experts in their own pain; our job is to listen.
