PICH2GO is an exciting new series of educational and networking events co-hosted by Pain in Child Health (PICH) and local children’s hospitals. This year, PICH2GO was held in Toronto and Calgary in November, 2016. I attended PICH2GO Calgary, which was organized by PICH and the Alberta Children’s Hospital on November 24th and 25th (See Figure 1).
On the morning of 24th November, there was a P
ain Management Coping Circus (See Figure 2). It was intended to connect patients and families with local Pain Champions to promote awareness and education about what researchers and clinicians are doing to help kids in pain. My role as a volunteer was to introduce the role of Clinical Scientist to the patients and families. I saw Bruce Dick, who was the visiting scientist to Ottawa Pain Hub this year, in the same group and also I met other professors, clinicians, graduate students, patients and families. I was privileged to meet an elderly patient recovering from chronic pain, who was also a volunteer in the circus. He told me his story of how he recovered from chronic pain and how the clinicians and clinical scientists helped him during the 10 years of suffering. During this time, he saw himself as not only a patient but also a partner in his own care. Clinicians or clinical scientists did not only treat his disease but also engaged him into his health care, including educating of the recent research findings, getting him involved in research projects, giving him choice in treatment options. From his story, I learnt much about the role of clinical scientists. Clinical scientists are clinicians. They do not just learn about better ways to work with patients from textbooks, but help create new knowledge to put in textbooks! Furthermore, clinical scientists also have a responsibility to make sure what they learn gets outside their group of scientists and into the hands of people who can use it, such as clinicians, policy makers, patients and families.
The topic of the conference on November 25th was “Unraveling the Puzzle of Pediatric Pain: From Neurons to Narratives” (See Figure 3). I met a lot of research ‘super stars’ who gave great presentations including Dr. Ken Craig and Dr. Maria Fitzgerald.
Dr. Craig introduced the update of the pain definition as published in PAIN in November, 2016. The updated definition is: “Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive, and social components.” The new terms included are “distressing”, “cognition” and “sociality”. I think it is a big improvement in the pain research. However, the update is a topic article. I think the method of the concept analysis could contribute to the definition update significantly, even though it is criticized by some scholars that it is only used in nursing area (Draper, 2014).
Dr. Fitzgerald’s presentation is about “What do we really know about newborn infant pain?” It is so close to my research topic. In her presentation, she deliberated the neural basis for current pain measurement in infants, including cortex, brainstem, thalamus, spinal cord and hypothalamus pituitary adrenal (Fitzgerald & Walker, 2009). But she argued that we really need to study how cortex responses to pain and EEG (cortex level) can be used to assess pain in infants – as other responses (behavioral and physiological) can be triggered by innocuous stimulation in infants. Her idea of pain experience also leads to the biggest discussion in the conference: whether sucrose could reduce pain in infants. She thinks sucrose-induced analgesia acts at the level of the brainstem, but not the cortex, so sucrose does not reduce pain in infants. A few clinicians in the conference don’t agree with this statement and have different insights in this issue. This reminds one paragraph in Commentary published in PAIN in June, 2016 (Pillai Riddell et al., 2016).
“Basic scientists are trying to establish the fundamental pathways by which noxious events are transmitted and processed by the infant central nervous system, whereas behavioural scientists address how this process plays out in the behavior and social interactions of the infant. Both approaches build on an underlying framework of academic neuroscience and psychology. The clinician who works with infants, however, is necessarily focused on the problem of inadequately treated pain and seeks a safe and practical solution. Which group (basic scientists or clinicians) is really studying infant pain? The answer is both of them. Although, some would argue that, given the hallmark of pain being a subjective experience, the answer could be none of them because we do not have access to their verbal report.”
I think given the different perspectives from different professions or disciplines, arguments cannot be avoided, however these arguments could bring more insights into the issue and provide more options to solve the problem. I guess this is why PICH2GO wants to get families, trainees, clinicians, researchers, and policy makers together to promote healthy debate. Moreover, the pragmatic and urgent need for infant pain assessment does not allow the luxury of prolonged theoretical debate. Clinicians must still take action and use the evidence based measure and treatment to manage infant pain. And I need to keep working on the potentially validated, reliable and feasible pain measurement: Skin Conductance.
Draper, P. (2014). A critique of concept analysis. J Adv Nurs, 70(6), 1207-1208. doi: 10.1111/jan.12280
Fitzgerald, M., & Walker, S. M. (2009). Infant pain management: a developmental neurobiological approach. Nat Clin Pract Neurol, 5(1), 35-50. doi: 10.1038/ncpneuro0984
Pillai Riddell, R., Fitzgerald, M., Slater, R., Stevens, B., Johnston, C., & Campbell-Yeo, M. (2016). Using only behaviours to assess infant pain: a painful compromise? Pain, 157(8), 1579-1580. doi: 10.1097/j.pain.0000000000000598
I was honored to be supported to participate in a one day knowledge translation (KT) planning workshop as a graduate student of an Ontario Child Healt...