Editor’s Note: The first-ever North American Pain School (NAPS) took place June 26-30, 2016, in Montebello, Quebec, Canada. An educational initiative of the International Association for the Study of Pain (IASP); Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION); and the Quebec Pain Research Network (QPRN), NAPS brought together leading experts in pain research and management to provide 30 trainees with scientific education, professional development, and networking experiences. Six of the trainees were also selected to serve as PRF-NAPS Correspondents, who provided first-hand reporting from the event, including summaries of scientific sessions and interviews with NAPS’ six visiting faculty members, along with coverage on social media. This is the first installment of scientific session recaps from the correspondents, whose work will be featured on PRF and on RELIEF, PRF’s new sister site for the general public.
A major goal of pain research is to find more effective pain management and treatment strategies to help patients. However, pain is not only influenced by biology but also by psychological, environmental, social, and cultural factors, making it complex and difficult to treat. Adding to this challenge is the time gap between basic science discoveries and actual changes in clinical practice—the long road to translation. Some studies estimate that it takes 17 years for original research to be implemented into patient care (for a review, see Morris et al., 2011).
In the NAPS scientific session “Implementation Science: Mobilizing Pain Evidence Into Practice,” Christine Chambers, Dalhousie University, Halifax, Canada, discussed how the scientific research establishment is not set up for translating science. However, there are effective tools, such as social media, that researchers can use to successfully navigate the “valleys of death”: places where translation encounters roadblocks and often fails. Chambers explained that the crux of successful translation is to make sure that research is presented in an easily digestible format, for the right audience, and made widely available on a platform that the audience already uses. To illustrate these points, she focused on her social media campaign that is raising awareness of how to improve pain treatment for children.
The scientific research system problem
Chambers, a clinical psychologist who studies pediatric pain, says the problem begins with today’s scientific research system, which emphasizes publication of new findings above all else. This system includes coming up with an idea, writing a grant, conducting the experiments (if funded), and, if all goes well, publishing the results. Then it’s time to start over and move on to the next idea.
But what happens to original research published in the literature? It’s been estimated that only 14 percent of original research actually makes it into clinical practice (Balas and Boren, 2000). In the literature, the failure of translation has been called the “valley of death,” where “discoveries fall into a technology purgatory instead of smoothly transforming into new building blocks accessible to the problem solvers” (Friedl, 2006).
Expanding on this concept, Chambers identified two valleys of death for translation. The first appears between the publication of basic biomedical research and its incorporation into clinical research/knowledge. This results from the failure to propagate new findings to clinical researchers and practitioners. “The system doesn’t really build in a mechanism to ensure that knowledge is disseminated to the knowledge users that need it,” explained Chambers.
Chambers says that part of the difficulty is that most health professionals are poorly trained when it comes to pain. A study published in 2009 found that veterinary programs in Canada spent an average of five times more hours on pain education than medical programs did. Only 32.5 percent of health science programs surveyed in the study could specify any formal amount of time devoted to pain education in their curricula (Watt-Watson et al., 2009).
The second valley of death appears when clinical researchers and practitioners are aware of the research but it is not implemented into practice for reasons including a lack of public interest in the findings, a dearth of funds, and a general deficiency in motivation for change. Thus, knowledge may get to the right people, but that does not ensure it will find its way into practice. Chambers’ work with social media has been directed at ensuring that clinical research about children’s pain survives passage through the second valley of death and becomes implemented into practice.
Surmounting the translational hurdles
In 2010, Chambers and other like-minded researchers and stakeholders published evidenced-based guidelines on how to reduce vaccination pain in children (Taddio et al., 2010). This is not only a pain relief issue for youngsters but also a major public health issue more generally since painful and fear-inducing childhood medical experiences significantly predict avoidance of medical care in adulthood (Pate et al., 1996). Some of the guidelines were adopted by the World Health Organization, thus helping to overcome the second valley of death, since the guidelines synthesized clinical science in a way that would hopefully lead to implementation into clinical practice.
However, while many evidence-based pain management strategies for children are currently being applied globally, studies have pointed to a significant underuse of pain reduction strategies, such as topical local anesthetics, sugar water, or breastfeeding, during childhood immunizations (Taddio et al., 2007; Harrison et al., 2013). Meanwhile, a 2012 Canadian study found that, of over a thousand children included in the study, needle fear was present in two-thirds of them, resulting in vaccine non-compliance in 1/12 (Taddio et al., 2012).
To overcome these types of challenges, instead of waiting for her target population to come to her, Chambers went to them by making her research accessible and bringing it to a platform they use. She was awarded a grant to make an educational video, which is posted on YouTube. The video, “It Doesn’t Have to Hurt,” shows a child and mother visiting the doctor, with the child explaining some simple methods that doctors and parents alike can use to reduce fear and pain during needle procedures, such as playing games or using the “special cream.” Chambers explained that delivering new findings in an entertaining way, even using humor, rather than simply listing them off makes it more likely that the audience will remember the findings and share them amongst peers.
However, the video alone was not enough to reach the intended audience. “Just because you build it doesn’t mean they will necessary come,” Chambers said. So she partnered up with a popular parenting site based in Canada to share her research and draw attention to the video, which has now earned over 200,000 views. Chambers is also using social media to publicize research about children’s pain. By using the hashtag #ItDoesntHaveToHurt, the project became a “trending topic” in Canada and even crashed a children’s hospital server due to the increase in website traffic.
In summary, it requires more than a great idea for pain research to have a long-lasting impact on clinical practice. It also entails post-publication effort by researchers to continually push their work out to knowledge users in order to produce real-world change. To this end, research findings must be made easily digestible and accessible, using the right format and platform. Making use of social media tools and partnering with organizations and communities where investigators can reach their target audience are powerful ways to give research a chance to live on beyond publication.
Erinn Acland is a PhD student and scientific illustrator who researches pain and mental illness at the University of Toronto, Ontario, Canada. Find her on Twitter at @ErinnAcland.