Jennifer L. Christofferson and Liana R. Galtieri
The podcast series, What a Pain, explores the field of chronic pain through interviews with individuals from different pain disciplines and patients with lived experiences. The co-hosts of the podcast are Glyn Williams, a pediatric anesthetist at Great Ormond Street Hospital, and Konrad Jacobs, a clinical psychologist at Oxford. Through their involvement in pain medicine, they have met and collaborated with many of the leaders in the field, which they reflect has helped grow their knowledge and perspectives on pain management. Their main goals are to share these perspectives and help to explain and understand the many factors that contribute to the complex presentation of pain that healthcare providers see in clinics. Each episode is structured by introducing the topic and speaker, interviewing the guest speaker, and providing their thoughts after the discussion. In our review of the podcast, we noticed several themes covered across the episodes: mental health and pain, treatment options for chronic pain, and patient-focused topics. While this review separates the podcasts by themes, it’s important to recognize that these themes are present across many of the episodes.
In the pilot episode of the podcast, Williams and Jacobs reflect on the multifaceted nature of pain and its treatment in children and adults. They interview Dr. Allison Bliss, a pediatric anesthetist at Leeds General Hospital, as their first guest. The co-hosts and Dr. Bliss discuss the importance of understanding the interdisciplinary nature of treating chronic pain. Dr. Bliss emphasizes the importance of “finding the voice of the child” and “the wider context of everything” to help better treat the pain. The three speakers reflect on a recent meeting of leaders of chronic pain services in the United Kingdom and the future directions of the field. They highlight the challenges and complexities of working with patients with chronic pain and note the importance of thinking about the whole person and their context, not just the presenting pain.
One of the primary themes highlighted throughout the podcast is the association between mental health and pain. Psychological and emotional distress can both contribute to and be a potential outcome of chronic pain (Caes et al., 2021; Liossi & Howard, 2016). In Episode 2 of Season 1, they interview Dr. Jeremy Gauntlett-Gilbert and explore the vulnerability to pain in individuals with autism spectrum disorder due to increased hypersensitivity. They point to the role of sensory sensitivity in the perception of pain and how pain rehabilitation may be more challenging for neurodiverse individuals compared to neurotypical individuals, based on neurodiverse individuals’ greater struggles with cognitive and sensory load. They discuss potential ways to tailor treatments for neurodiverse patients. In Season 1, Episode 10, they interview Dr. Jane McNicholas and speak about common mental health diagnoses seen in pain clinic populations (e.g., anxiety, low mood and depression, PTSD). Importantly, they discuss the bidirectional relationship between mental health and pain and how this interplay can add to the complexity of the patient’s presentation, potentially impacting conceptualization and treatment recommendations. They note that it is crucial to have collaborative conversations with the family when discussing mental health and chronic pain.
Another theme threaded throughout the podcast is different treatment approaches to managing chronic pain. Importantly throughout their episodes, Jacobs and Williams highlight the interdisciplinary approach to managing chronic pain, as this is often the most evidence-based approach for better quality of life outcomes in children (Claus et al., 2022; Randall et al., 2018). In Episodes 3 and 4 in Season 1, they interview Julia Smith, a physiotherapist (PT), and Anne Marie van Es, an occupational therapist (OT), both working at the Oxford Center for Children and Young People in Pain. During Episode 3, they emphasize the importance of patient education about their disorder, as this helps patients and families understand the rationale for PT/OT. Additionally, they emphasize the importance of building rapport with patients and families and getting to know their specific interests, as it is often through those interests/hobbies that they are able to get more engagement in treatment. In Episode 9 of Season 1, they speak with Dr. Navil Sethna, MD, and Clinical Director of the Mayo Family Pediatric Pain Rehabilitation Center at Boston Children’s Hospital. They discuss how IIPT came to be developed through clinical experiences, the difference between interdisciplinary care and multidisciplinary care, and barriers to engagement and recovery. Interestingly, Dr. Sethna highlights how psychosocial factors (e.g., family relationships, finances, anxiety) might interfere with patient and family engagement in IIPT as well as long-term recovery.
A final theme noted is patient-focused topics. In Episodes 5 and 6 of Season 1, the podcasters interview 18-year-old Sofia Fateh, a patient who developed chronic widespread pain at 12 years old. Sofia shares her pain journey, including describing the tremendous impact it had on her life and her time at an interdisciplinary pain treatment program in Boston. Sofia presents a story of resilience and hope for other patients and serves as a helpful guide for providers. The podcasters and interviewee have a collaborative discussion on what is and is not helpful for patients, including tangible take-aways for providers. In Season 1, Episode 11, Jacobs and Williams interview Professor Chris Eccleston from Bath University, and they review and discuss a recent Lancet Commission report focused on improving care for pediatric pain (Eccleston et al., 2021). Eccleston stresses that in order for providers to improve treatment and management of pediatric chronic pain, they must focus on four tenets: (1) make pain matter, (2) make it understood, (3) make it visible, and (4) make it better. He highlights the importance of healthcare providers listening to patients’ complaints and symptoms, as well as validating patients’ pain when reported. He also argues that for pain to be better understood, research about pain should be more interdisciplinary and should involve patients and families. More interdisciplinary research would allow for providers from various backgrounds to gain a fuller understanding of the mechanisms (biological, mechanical, psychosocial) that contribute to pain. Additionally, by involving patients and families in research, they can help to inform language and communication about pain.
In Episode 8, Season 1, interviewee Dr. Kashikar-Zuck discusses what happens with young people with chronic pain when they become adults. The focus of this discussion is that chronic pain in childhood can have long-term outcomes (e.g., pain, social, emotional, and developmental; Kashikar-Zuck et al., 2019). Dr. Kashikar-Zuck discusses potential trajectories of chronic pain in adulthood, pointing to a small subgroup that end up with more severe pain. She and the interviewers discuss potential ways to identify the patients who may fall into that subgroup in order to potentially intervene sooner. In Episode 1 of Season 2, they interview Dr. Katie Vincent, an adolescent gynecologist. They discuss how pelvic pain (e.g., severe menstrual pain, endometriosis) is often addressed with surgical interventions or procedures that may not relieve the pain fully. Dr. Vincent urges for the focus to be on the quality of life of patients, which for chronic pelvic pain may include an interdisciplinary approach. She points to the importance of psychology with chronic pelvic pain (Powell, 2014; Sieberg, 2020) to help address the stigma associated with pelvic pain and particularly for gender-diverse patients who often associate pelvic pain with tremendous distress related to their identity.
Overall, What a Pain with Konrad Jacobs and Glyn Williams presents a wide variety of topics associated with pediatric chronic pain disorders, from episodes focused on specific types of pain disorders to those with a focus on approaches to treatment. Similar to a multidisciplinary approach to pain treatment, their podcast episodes include a wide variety of speakers from different specialties (e.g., physicians, physical therapists, etc.). This allows the listener to learn more about treatment and management of chronic pain. Generally, the podcast seems oriented toward healthcare providers. Each episode is peppered with education and facts about chronic pain as well as evidence-based treatment for chronic pain, which could be of particular interest to trainees in pediatric pain and providers who are interested in learning more about chronic pain conditions. In addition, Episodes 5 and 6 of Season 1 would be good resources for a clinician to recommend to patients. The speakers include helpful metaphors and tips that providers can use in their clinical practice. To expand the reach of their podcast, Jacobs and Williams might consider including more patient perspectives throughout their episodes. It is possible that joining more patients and families in conversation with healthcare providers might lead to richer discussion about chronic pain and its treatment. Not only would more patient-focused episodes allow for broader representation and for patient voices to be heard, but this would also potentially increase the reach to be suited to a wider audience of patients and families.
Jennifer L. Christofferson, PhD
Boston Children’s Hospital, Department of Anesthesia, Critical Care, and Pain Medicine
Department of Psychiatry, Harvard Medical School
email: Jen.Christofferson@childrens.harvard.edu
Liana R. Galtieri, PhD
Boston Children’s Hospital, Department of Anesthesia, Critical Care, and Pain Medicine
Department of Psychiatry, Harvard Medical School
References
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