Hello, curious people. I'm Dr. Joshua Pate, a pain scientist, physiotherapist, and an academic at UTS. I'm here to answer your curious questions about pain, how it works, how it's treated, and how we can help people to live better lives. This is health Curious.

Our UTS community has sent in some thought provoking questions to tackle. So let's get started. 

Why does pain sometimes continue even after an injury has healed? Pain can last a long time for a whole variety of reasons, and ultimately it comes down to safety and whether or not overall safety is required because pain's a really good feeling for us to be kept safe.

You might think about putting your hand on a hot plate and you would never do that again because it hurts so much. That kind of process happens over and over and again. But in chronic pain, it's really complex because often people are told the tissues are all healed, the body parts are all better. So why do I still have pain and pain's incredibly complex?

We could look and zoom in on peripheral sensitisation of nociceptors at the biological level, or we could zoom right out to all the different social factors that are influencing our day-to-day pain. It is a really, really complex feeling, and there's so much to say about this topic. Why do different people feel pain in different ways?

People feel pain in many different ways, even from the same stimulus, like in in a lab setting. If everyone had the same stimulus, like something hot put on their arm, studies show that some people would feel close to a zero out of 10, and for other people, that's a 10 out of 10, and it's the same temperature, same everything, but different people.

And that's not to say that it's just your genetics or just your expectations or your memories or childhood experiences. I think it's a combination of all of these different factors adding up to contribute to why you feel a certain amount of pain at a certain time. How do emotions like fear or anxiety make pain worse?

This is a big question because anxiety and depression are really, really common. Occurring alongside when someone has chronic pain. And it makes a lot of sense that when you have pain for a long period of time, it's horrible. But do those things actually cause the pain or how does that work? There's a lot of research being conducted in this space, and on one hand it's just like more fear leads to more pain, which leads to more fear, which leads to more pain, and it goes around and around.

But I think this idea of worrying about that is also kind of part of the picture too. So it is a bit of a complex mix, and again, it comes back to everyone feeling pain very differently. And so it's not like there'll ever be a one size fits all magic solution for someone's chronic pain. 

What are some practical things I can do each day to reduce or manage pain?

In the day-to-day, there are a whole range of different strategies that are being tested in the research. And for one person, heat might help someone for a small amount of time, and for other people, ice packs are better. But I think this is a very individualised thing and that whole idea of day-to-day pain, flare up management is very different to long-term strategies that are going to help you get back to doing more of what you love.

And so I think there's this tossup of do I want something to help me now, or do I want to feel better in the long term? 

And, and getting a multidisciplinary assessment from health professionals is a really good starting point because they can tailor the strategies just right for you in today's situation.

So what makes pain in children different from pain in adults? Pain in children is complex because the role of a parent is uniquely different in different age ranges. Like if you think about a, a teenager's response to pain and even response to their parents is very different to how an adult responds compared to those who they live with in their household.

And so the influence of parents is one part of the picture, but a child is developing physically and socially, emotionally all at the same time. And so these different variables can also impact on their experience. Not only previous experience, but what they observe if they see their parents manage pain in a certain way.

What strategies are they going to choose? Most likely they'll see and copy whatever they observe. 

Why is it important for kids to learn about pain early on? 

No, I don't think we want to dwell on a negative topic like this really early in a child's development. We want to focus on them developing and growing and engaging in meaningful activity.

But by learning about pain and even some of the neuroscience behind it, that can give kids the confidence to be able to articulate what's going on in their experiences. And we can see in the research that this helps a family to manage pain a lot better. 

What can a physiotherapist do to help with pain?

A physiotherapist is equipped in many ways to help with both acute pain and chronic pain, and there are a whole range of strategies. And you might be thinking, oh, I don't want to do more exercise, or I don't need to do these sorts of strategies, whatever it is. And I think it just depends on your goals and getting back to the things that you want to do, because that's probably where the physio is best equipped to help.

For someone who wants to run a marathon, that's very different than someone who wants to just walk out to the mailbox, for instance. And so your goals factor into the strategies that are used. What's really exciting about the latest neuroscience though, is that our bodies are much more resilient and adaptable than we used to think.

And so 50 years ago, people were told to lay down and rest, whereas now the evidence is much more in favour of things like motion is lotion and, and getting moving again. And so I'd encourage people listening to go and get an assessment by a physiotherapist to assess what is possible at this stage of your pain journey.

Can talking to a psychologist or counsellor help with pain? 

I reckon a decade ago I would've been sceptical to say yes, whereas now I have this overwhelming sense of how helpful a psychologist or a counsellor can be. And I think that's because I now understand the neuroscience of pain a lot more, and that pain is affected by biological and structural physical factors, but psychological factors as well as social factors, and having a support network around you makes such a difference.

The really exciting thing that a psychologist and a counsellor can do is provide really practical strategy. From things like breathing strategies through to anxiety management, through goal setting, problem solving. I've worked in multidisciplinary pain programs and honestly, the psychologist has so much to offer and I just wish everyone accessed them earlier.

What are the treatment options available for people dealing with chronic pain? 

A lot of our health system is kind of set up for chronic pain management to be a siloed approach. And what I mean by that is if you have a car accident, you'll go down this pathway and have workers' compensation, and you'll do these strategies.

And if that doesn't work, then you'll go to the next thing. And some of that is really fixated on the body part that's hurting. And I don't want to say that that's not the problem, but often the problem becomes much more complex than that over time. And so in the short term, there are some really helpful strategies and systems for someone.

But once we call it chronic pain, that means the pain's lasting longer than the healing time. And that's where these complex web of factors needs to be addressed. And so I think seeing what we call multidisciplinary care, which is a pain specialist, a physiotherapist, a clinical psychologist, and often others too, like an OT, social worker, nurse, and there's a lot of people in these teams now in public hospitals.

It's a freely available service in Australia, and I think it's really worth considering if you want to get back to doing the stuff that you love doing. 

How can a better understanding of pain improve care from future health professionals? 

I think ultimately some of the research now is showing that the latest neuroscience has given us more reasons to be optimistic than we've ever had before.

Because if someone understands what's going on in the biology and psychology and social parts of their pain experience, they can be more confident to try different strategies. And I think that links with empathy, that links with that ability to kind of care better. 

So for health professionals in training, by learning the latest neuroscience they can be better at caring because they understand confidently what's going on inside. 

Rather than it being this black box mystery of what is pain and what's going on here. We are now equipped so that we can confidently say this strategy will help, and there's data to back that up. 

What challenges do health professionals and patients face when communicating about health?

For me, I think the big one I've observed is misunderstanding. Because everyone has slightly different understandings of what pain is and how we deal with it. What happens for a patient is that the health professionals might be using jargon, and the spouse or the siblings or the kids or the adults or whoever it is, is using a different understanding.

And so if one person around the patient is telling them to behave in a certain way, it can really cause a lot of conflict. And so I think the challenge is having a common understanding and the latest neuroscience can allow for that. And I think that's a really exciting finding of recent studies. 

How might emerging technologies like AI or virtual reality improve our understanding and treatment of pain in terms of understanding?

I think these technologies could help, particularly with AI, a lot of discoveries and new, emerging scientific proofs of what's going on under the surface. But in terms of treatments, I think these technologies are allowing new things like monitoring, exercise programs, taking notes, all sorts of positive things, but there's also different risks as well.

And we want to weigh up whether or not it's worth sharing data or not. I don't think the policies are in place yet to have a really firm answer. But it's certainly something that we need to be thinking about in society. Why is it so important to show empathy and acknowledge someone's pain even when it can't be seen?

I recently did a TEDx talk and in this talk I said there is no way I could ever fully understand what someone with chronic pain has gone through, like the complexity of all their experience. And after the talk, I had people coming up to me in tears saying that they felt heard. And afterwards, I've been thinking about this a lot because I think what they're saying is they feel like their misunderstandings have been acknowledged by what I said because I wasn't hearing them.

I was just acknowledging the fact that they've been misunderstood. And so this is a huge issue. If someone doesn't feel understood, they're not going to engage in the recommendations that the other person provides. And so a lot of my research work is on providing that common understanding, and I think it starts with stuff like a common language and a common understanding of what's going on with the problem.

And so there is a bit of work to be done. It's not as simple as a one size fits all, magical cure, quick fix. I think there is an element of we need to work together and have people around that are the support network, and that's what makes good sense to me. That was all the questions for today. I hope you learned something new.

If you'd like to learn more about my research on the science of pain, scroll down and check out the link in the description below. Until next time, stay curious.