Next Open Dialogue Live explores the complexities of pain at all stages of life

Pain is the body’s way of telling us that something’s wrong. It may be a universal phenomenon, but everyone experiences pain differently. What causes moderate pain for one person may cause no pain for somebody else.

There are also different types of pain. There’s acute pain, the kind that happens suddenly at the time of an injury and tapers off as healing occurs. Then there’s chronic pain, which remains after recovery of an injury (or more mysteriously, the origin might even be unknown).

Pain is a complex phenomenon and there’s no one-size-fits-all approach to diagnosing and treating it. Dalhousie is at the forefront of pain research, with interdisciplinary research teams working to better understand and treat pain in people of all ages.

As part of Dal Alumni Days next week, the Faculty of Medicine and the Dalhousie Medical Research Foundation will host a special Open Dialogue Live panel discussion on May 26th from 12:00 to 1:00 PM ADT. Everybody Hurts: Understanding Pain from Start to End of Life will feature three Dalhousie researchers who are exploring the complexities of assessing, treating, and managing pain across the lifespan.

The moderator of this discussion is Joanne Bath, the CEO of the Dalhousie Medical Research Foundation.

Panelists include:

• Dr. Christine Chambers (BSc’96) – clinical psychologist, Canada Research Chair (Tier I) in Children’s Pain, Scientific Director of SKIP: Solutions for Kids in Pain, and Killam Professor in the Departments of Psychology & Neuroscience and Pediatrics at Dalhousie.
• Dr. Natalie Rosen – clinical psychologist and associate professor in the Departments of Psychology and Neuroscience and Obstetrics and Gynaecology at Dalhousie.
• Dr. Shanna Trenaman (BScPh’08, MAHSR’14, PhD’20) – postdoctoral fellow with Geriatric Medicine Research at Dalhousie and clinical pharmacist at the Dartmouth General Hospital.

Children’s pain

Pain can be experienced as early as the day somebody is born. But until the 1980s, it was widely assumed that babies couldn’t yet feel pain. Christine Chambers, a leading expert in the area of children’s pain, will spend time discussing the evolution of our understanding of pain in children before digging deeper into the current research that informs how to assess, treat and manage pain in kids.

“Pain is common in kids — it’s not just an adult problem,” says Dr. Chambers. “One in five children experience chronic pain.”

She says there are three categories of pain management interventions: physical, psychological, and pharmacological. As a clinical psychologist, her research program covers psychological interventions to improve pain, such as relaxation and distraction — both of which have been shown to be very effective in managing pain. But Dr. Chambers’ research also explores the role that parents can play in pain management, including what they can say or do in response to their children’s pain.

Dr. Chambers has worked tirelessly to make sure the results of her research mobilize beyond scientific journal publications and conference proceedings. She wants families and clinicians to be aware of the latest evidence-based pain treatments as quickly and as easily as possible. Her efforts helped formed SKIP: Solutions for Kids in Pain in 2019. It’s a national knowledge mobilization network dedicated to addressing the knowledge gap that she now leads as their scientific director. Dr. Chambers will also spend some time during the panel discussing SKIP’s work and the importance of knowledge mobilization.

Pain in older adults

Shanna Trenaman’s research dives into the pharmacological interventions for pain management in patients at the other end of the lifespan. As a clinical pharmacist, she draws on her experience caring for hospital patients to inform her research.

“Older adults are at a higher risk of having adverse drug events because they’re on many different types of drugs,” explains Dr. Trenaman. “Those drug interactions can sometimes unintentionally increase the risk of adverse side effects even further.”

Because of this, Dr. Trenaman has a special interest in deprescribing work for older adults, especially those with dementia. She found that in Nova Scotia alone, 20 per cent of dementia patients were prescribed a common class of pain medication called a nonsteroidal anti-inflammatory drug (NSAID). About five per cent of those patients were prescribed at least two different NSAIDs. But research has shown that combining two drugs in the same class doesn’t result in better pain management. Rather, it increases the risk of that patient experiencing troublesome side effects.

“All of a sudden we see that pain in these patients is perhaps not being adequately treated,” says Dr. Trenaman, adding that it takes a lot of trial and error to treat pain in people who may no longer have the expressive language skills to describe how they’re feeling.

Dr. Trenaman will talk about the importance of optimizing medications in older age, monitoring the effectiveness of medications, and how to navigate over-the-counter pain medication purchases. Plus, she’ll briefly discuss what to consider, and with whom, when deciding on what end-of-life pain management approach is best for you or your loved one.

Painful intercourse

For young and middle-aged adults who are sexually active, pain during intercourse is a lot more common than you’d expect. In fact, 20 per cent of women between the ages of 18-30 experience chronic vulvar pain during sex. In post-menopausal women, around 35 per cent. There are many different reasons for genito-pelvic pain during sex: infections, injury, hormonal changes, a history of abuse or trauma. But eight per cent of women are diagnosed with vulvodynia, which is genito-pelvic pain with no obvious origin.

Natalie Rosen, a clinical psychologist and sexual health researcher, specializes in psychological interventions for women with vulvodynia.

“There’s still a lack of knowledge about this problem,” says Dr. Rosen. “With vulvodynia, there aren’t necessarily any physical indicators of pain… so many women are likely to go through some invalidating experiences of being told there’s no sign of a problem before receiving a diagnosis.”

Conventional treatment for vulvodynia falls in the pharmacological category of pain management. Lidocaine, a local anaesthetic, can be applied topically to desensitize the painful parts of the genital area. It may be effective at treating the physical pain, but it doesn’t address other problems that arise with vulvodynia. Dr. Rosen says genito-pelvic pain hurts “more than your sex life” because women suffering from pain during sex report more feelings of psychological distress, such as anxiety and depression, a lot of guilt and shame, and feelings of isolation. It also takes a toll on their relationship because their partners suffer negative impacts, too.

That’s why Dr. Rosen’s latest research study looked at managing vulvodynia pain through the use of cognitive behavioural couple therapy (CBCT). The results from that study — the very first randomized clinical trial comparing the medical intervention of lidocaine with the psychological intervention of CBCT — will be published any day now. Dr. Rosen will discuss those band-new findings in next week’s panel discussion.

Join the conversation during Dal Alumni Days on May 26 to learn more about these topics. Register for Everybody Hurts: Understanding Pain from Start to End of Life today.