A think tank on chronic pain
Dr Anica Zeyen
From the 19th to 21st February, researchers from South Africa, Zambia and the UK met in a lovely little conference centre outside of Stellenbosch, South Africa. Why? To discuss chronic pain. Researchers came from across the medical field including physiotherapists, psychologists, GPs and neurologists. They were joined by some social science researchers.
As most of us had not met before, we spent part of the first afternoon getting to know each other by hiking through the vineyard mountains surrounding the conference centre. This informal exchange allowed us to better understand our personal motivation for wanting to join a research team on chronic pain. We enjoyed an amazing Braai (South African BBQ) which made sure that we didn’t even notice that the electricity cut off – a regular occurrence in South Africa to reserve energy.
After breakfast, we got working. Romy from the University of Cape Town kicked off the discussions by highlighting the situation on chronic pain within South Africa. Together with her colleagues, they talked about the situation in townships, the scattered and varied approaches to pain treatment across the country and the fact that we don’t even know how prevalent pain really is. What I found most astonishing was when they talked about a previous study where people who experience chronic pain were given mobility trackers (similar to Fitbit and the like). In the Global North, chronic pain significantly reduces the activity levels of people, it didn’t in South Africa. Why is that? Is it cultural? Does pain mean something else to the various ethnic groups within South Africa? Is the understanding of how to respond to pain different across cultures? Does it have to do with poverty and the need to push on to generate income? We don’t have the answers yet, but it raised many interesting research questions. And it showed again how simply using insights from research in the Global North will not provide the answers in the Global South.
Then Hazel and her Zambian team talked about the situation in their home country. It was fascinating to hear about it. They talked about how pain patients are treated by neurosurgeons – arguably the most expensive medical professionals. In comparison to South Africa, the challenge is not a variety of approaches and an uncertainty which ones actually work best, the Zambian challenge is that there is hardly a landscape of pain treatment.
We discussed the methodological challenges of doing research in both South Africa and Zambia. Challenges of languages. Zambia has over 70 languages. So how to design research that works across cultures and languages in such diverse settings? How can we overcome the challenges of illiteracy? How can we ensure that we capture indigenous and tribal approaches to dealing with chronic pain? How do we design research to understand why some might not decide to seek medical help for chronic pain?
Another aspect that came up constantly is that the chronic pain treatment challenge in both South Africa and Zambia is fundamentally different to that of, say, the UK and especially the US. While the US is trying to fight an opioid crisis, they are struggling to get sufficient pain medications. Because the Global North wants to avoid spreading the pain killer addiction crisis to Africa, it means that many hospitals struggle to get morphine for post-op treatments. Just imagine what it must be like if you had a hip replacement and afterwards cannot take morphine. While we all agree that opioid addiction should be avoided within both South Africa and Zambia, all medical professionals present said they need to be able to access the medications they need to treat their patients. ´based on their needs not based on what others say they should get.
The Think Tank again highlighted to me and everyone present how important interdisciplinarity – working together across academic disciplines – is when dealing with grand challenges. Each one of us has different expertise in terms of knowledge and the way we go about research. It took some time to understand each other’s viewpoints but once we did, they complemented each other very well and led to more fruitful discussions. After all, it is not possible to address chronic pain without a medical perspective. However, we also need the view of doctors and nurses on the ground as well as those from traditional healers. In addition, we need to understand not just what chronic pain means medically but also for someone’s life, their families and that of their community and country at large. This is where social science and humanities perspective provides the tools to generate insights. For instance, we saw how a tool that was designed for women empowerment could be adapted to this field and generate valuable insights.
The Think Tank was very productive. We had ample discussions and designed various research projects. Since we came back, we have submitted our first research grant proposal on the issue of pain in Zambia. However, more will follow. Our next meeting will be in Zambia in early 2021 – if travel restrictions allow. This issue is so important that we will be busy for many years. So watch this space. I make sure to update you.
The Think Tank was primarily funded through Royal Holloway GCRF QR funding with support from GCRF QR funding from other UK universities.
This piece was written by Dr Anica Zeyen, you can read more of her work here
Rob Smeet, Tamar Pincus and Brona Fullen
Tamar Pincus, Rob Smeet and Brona Fullen presented a workshop at EFIC in Valencia, exploring behaviour change, reactivation, and health literacy in people with pain.