Join Tasha Stanton discussing the One Thing she wants people challenged by pain to know about. Explore the current state of pain science research and clinical practice in this straight-to-the-point interview with Tasha Stanton.
About A/Prof Tasha Stanton
Tasha Stanton leads the Osteoarthritis Research Theme within IIMPACT in Health at the University of South Australia, Adelaide. She completed her PhD at the University of Sydney in 2010 and is currently a National Health & Medical Research Council (NHMRC) Career Development Fellow (2019-2021). Here is her research profile.
Tasha encouraged viewers of this video to look into resources from Noigroup, as well as checking out https://www.painrevolution.org
Transcript
So Tash, what’s the one thing you want people challenged by pain to know about?
I think it’s the remarkable changeability and adaptability that systems have, because I think we almost fall into this mindset of thinking that ‘once pain has been there for a while, that means nothing else of me can change’. And I think what the research shows quite strongly is that our systems are dynamic – they’re always updating based on the available information for that person in that environment, in the society that they’re in. Often those updates can be largely driven by things that you do, things that you have control over, and things that I think we might not always consider are related to something like pain.
I guess where I get really excited is when we start to understand that pain is a really complex phenomenon. I think it’s really tempting to think in terms of simplicity, such as “I’ve got this chronic knee pain, and all I need to do is cut out the wrecked or damaged areas of my knee and I’d be totally fine”.
But problematically, we often see that it’s not that simple. We have cases where people who have osteoarthritis have had a knee replacement and they still have quite severe pain. Luckily that’s not too many people, but the fact that that’s still occurring helps give and build this evidence base that things are more complex. That might sound like a bad thing, like “Wait, what it’s not simple, it’s more complex!”, but I think it’s a really good thing.
If we embrace this complexity of an experience, what it means is that there’s so many different things contributing to it. And if there are so many different things contributing to it, [then] that’s so many different targets. That’s so many different things that we can do and we can try that may well make a real impact – certainly upon our function, but also on I think pain in itself.
Where I see this as being really relevant is in order for things to update and to change, it needs to have a stimulus. There has to be something there that is enabling and pushing and promoting that adaptation. That’s where I think some of the things that we already have are really powerful.
Things like knowledge and education, our thoughts and nerve impulses. When we have these thoughts and these beliefs, as we learn, and as we start to understand more, I think not only can it sometimes help people explain why they might have really weird symptoms. Why something hurts way more today than yesterday when I didn’t even do anything different. That might be explained by some of these biological processes that we understand. But it’s also just that having that understanding can also then help us move forward and shape what we do.
I’m always intrigued by visual illusions, how our system works, and how we create the perceptions that we have. One of the coolest things right now is a video on Tiktok; it gives this sound and if you read the words ‘green light’, you hear ‘green light’ being said. Similarly, if you read ‘brainstorm’, you hear ‘brainstorm’ being said. What I think is so powerful about that is that it’s giving us an overt example that what we perceive is actually shaped by our expectations and the things that have occurred to us, our experiences, right before we’ve experienced that.
So, it raises the possibility that our strong beliefs can very much shape what we experience. To me, that’s just fascinating because it means that: the more I think we understand about how pain works, the ability for us to engage with the environment and also for that to shape our experiences, is really large. That’s where I get excited.
If all these different potential stimuli are there, how do we find the right ones to start to change the way people perceive their pain experience?
It’s a good question. I think it comes down to working with a trusted health professional to work through some of those things. I would argue that we really do need to do nuanced assessments, both talking to people and working with them objectively, to see how they move how or how they approach different problems. It’s not a one-size-fits-all [approach], and what might be really contributing to [pain] for some people might not matter as much for others.
I think we see this particularly in people that feel quite anxious or fearful of different movements. It’s often a very valid emotion – it’s exactly how they should feel based on an understanding of seeing a scan of their back and seeing a big bulging disc. I’m pretty much picturing when I’m bending over lifting something heavy, that’s a lot of pressure on that big bulging disc.
I think then understanding, for that specific person, what needs to be reviewed or what needs to be discussed – that allows it to become a lot more nuanced. I think some of the things that generally tend to have support are things like exercise, where specific to that person, helping to get them moving not only has excellent heart health, lung health, general health effects, but it also can really promote self-confidence and ability to move. It can help get habits or patterns back into place and even improve function, just by getting people back into doing things.
I think it does require nuance, but it does mean that it can be trial and error. It can be seeing ‘does this have a meaningful impact for me?’ And if it doesn’t, then we can work with health professionals as pain coaches to help take us to that next level.
It seems like you could almost use some of these illusions of perception as a way to find some of those nuanced things. How do you use illusions as a way to shift perceptions?
We have to be careful with how we present illusions, because the very last thing we want people to come away with, or to feel, is that we’re saying their experience isn’t real, [or] it’s all in their head. I would maybe argue [that] it kind of might be – that’s how we experience any emotion or perception or feeling. But that’s not what we’re saying.
What we’re saying is it’s a very real experience. The brain is a constant learning machine. Our systems are constantly learning. What they’re trying to do is as we give different available information, that allows things to shift and inherently allows systems to learn. So, thinking about what sort of information we put in can also then dictate on how that system learns over time.
In the rubber hand illusion, for example, you stroke a fake hand and someone’s real hidden hand at the same time so it feels like it’s theirs. But using a rubber hand illusion shows that sometimes when you get sensory information that’s coming at the same time, your brain adapts to that right away. It starts to then make it feel like that’s your hand, and you’re feeling touch on that. If something was to come and attack that hand, you would defend it. You’d try to pull back. That’s direct evidence of your system learning. So if we can use that, that’s cool if we can use that in the realm of pain.
Yeah and it’s actually real, right? Even though it’s an illusion. It’s still real to the person.
Right, it is differentiating between the fact that what you’re doing is a trick, but the experience itself is an ‘update’; it’s real.