Editor’s note: The 17th IASP World Congress on Pain took place September 12-16, 2018, in Boston, US. At the Congress, 12 early-career pain researchers took part in the PRF Correspondents program, a science communications training experience that provides participants with knowledge and skills needed to communicate science effectively to a wide range of pain researchers, and to patients and the wider public. As part of this program, the participants conducted interviews with plenary speakers at the meeting.
Here, plenary speaker Christine Chambers, PhD, RPsych, chats with PRF Correspondent Amanda Stone, PhD, a research assistant professor of anesthesiology at Vanderbilt University School of Medicine, Nashville, US. Chambers is the Canada Research Chair (Tier 1) in Children’s Pain, and a professor in the Department of Pediatrics, and the Department of Psychology and Neuroscience, at Dalhousie University in Halifax, Canada. Her research lab is based in the Centre for Pediatric Pain Research at the IWK Health Centre. She has published more than 100 peer-reviewed papers on the role of developmental, psychological, and social influences on children’s pain, with a current research focus on the role of families in pediatric pain and social media for health knowledge mobilization. In this interview, Chambers discusses her path to pain research, the importance of knowledge translation, her advice for young women entering the pain field, and much more. Below is an edited transcript of the conversation.
How did you get into pain research?
Totally by accident. I always wanted to be a child psychologist; I read a book about one when I was in grade six. When I got to university, I met with the undergraduate advisor and told him I wanted to be a child psychologist. He replied that if I wanted to be a psychologist, I would have to do a PhD, and if I wanted to get into a PhD program, I should start doing research. I asked him about the child psychologists they had in the department, and he said that they had one, and he studied children’s pain.
That child psychologist was Patrick McGrath. So I bought his book that had come out a few years before; it was one of the first books on children’s pain. I read the book, approached him, and started working with him when I was an 18-year-old summer student. He gave me a lot of opportunities, and I quickly felt very connected to this community of pediatric pain researchers. I decided to stick with it for graduate school. I went out to the University of British Columbia to work with Ken Craig. That’s how I got into pediatric pain—first by circumstance, but then I really enjoyed it.
Your research underwent a large shift over the last five years toward dissemination and implementation science. How did that happen?
There were a couple of things that came together around the same time that contributed to this shift. One is that I applied to the Mayday Pain & Society Fellowship Program. The first two times I applied, I did not get selected. But persistence pays off. The year I was accepted, I had to decline the opportunity because I found out I was pregnant with twins and could not get insured to leave the country to go to the States for the training. They said that they’d wait until I was able.
It really worked out well that I delayed the experience because it was through a series of medical experiences with my own children that I really had my eyes opened to the challenges of making sure that children actually receive evidence-based pain care. The Mayday Pain & Society Fellowship Program was really transformative for me, in that I was able to engage with experts from a communications company who could help me get my message out in a different way.
I was also at a time in my career where people start to pivot. I’ve been doing research in pediatric pain for 25 years, so 20 years in, I was ready to go in a different direction. The new focus on dissemination and implementation was a good fit for me and who I am.
How did you build the partnerships that you have now for knowledge translation?
Up to five years ago this past summer, I had never thought about engaging partners in research. I had only worked with research students and research collaborators, and those were the only people I thought I needed to do research. And then I had the experience five years ago as the lead pen on an institutional application to a federal program that required partners. I had to pitch to partners to pull them in for the first time.
Through this experience, I realized that people outside of my academic world are really interested in pain in children, want to be a part of a solution, and have really interesting expertise to bring to the table. I also realized that I’m good at pitching, at getting people excited about being a part of something. Here again persistence paid off because we didn’t get that institutional grant. However, the experience of working on that application really changed my perspective.
The partner I’ve worked most closely with, Erica Ehm, from the Yummy Mummy Club [YMC], has always said: “Don’t be afraid to ask.” That’s really what I’ve learned about approaching unconventional partners—not to assume they’re not going to be interested, and to figure out where there’s alignment in interests.
You recently published a review of e-health tools developed for pediatric pain. You concluded that most of them are not available to the public. What are your thoughts about improving the dissemination and implementation of these tools for the public?
That paper was led by Kristen Higgins, a PhD student in my lab, and was a collaborative project with a group of pain researchers, e-health researchers, a computer scientist, and also end-users—patient and parent partners. We found that fewer than 30 percent of e-health tools that are developed by researchers and published ever become available to end-users. The cost associated with each unavailable tool was US$300,000 of grant money.
I have a few thoughts on this. First, it’s not the researchers’ fault. They did their job, which was to get a grant to do a project and to publish the results. Then, they use those results to get another grant to extend their work to another health condition. That’s what a scientist is supposed to do. So it’s a systems problem. In the paper we offer a number of different possible solutions, such as getting funders to be more engaged with the dissemination of e-health tools. Distributing money to researchers to try to disseminate their own research is often wasted money. People will make a video or some other product that isn’t very good and, even if it is, they struggle to get it out to the public.
We found an interesting predictor of tool availability: If people had engaged end-users in developing the tool, it was more likely to be available.
I also think universities need to set up better mechanisms to market the products that their researchers develop. Researchers should not have to become startup business owners to be able to market their products. I personally have no interest in owning my own business, nor should you have to in order to make the results of your research available to those who could benefit.
You have some high-quality videos, like the ones you showed during your plenary (It Doesn’t Have to Hurt, and Busting Silos: The #ItDoesntHaveToHurt Initiative). How did those videos come about?
I did not make the videos because I am not a video producer; we worked with people who knew what they were doing. Our original video was made by the communications company, Burness, which provided my Mayday Fellowship training. They told me it had to be less than three minutes and that I could only have three messages. And I was like, “No, but I need references!” This is why academics should not be producing their own videos!
The other video I showed at the end of my plenary was a video made by a video production group in Halifax called Accomplice Content Supply Co.; we’ve worked quite a bit with them. They are smart, creative, amazing people. They came up with the storyboards and made it happen.
What advice do you have for other researchers who want to disseminate their research via video?
Giving up control is a problem for many researchers. Researchers love to control everything, and as a graduate student, you learn you have to do everything yourself, from photocopying to creating your own slides. We bring in expertise to some degree on research projects; when you know you don’t have expertise in a particular method, you’ll collaborate with someone. We need to do the same thing in other areas. We have to capitalize on other experts; don’t try to do it yourself. All our videos for It Doesn’t Have to Hurt, the social media initiative, were led by Erica Ehm and her team at YMC. But again, wouldn’t it be great if we had some mechanisms where we could link researchers with the content creators they need to do what they want to do instead of trying to do it themselves?
You’ve been involved in several initiatives for trainees in pain research. What have you learned from these initiatives?
I’ve had the good fortune of being involved in the Pain in Child Health training program, which is based in Canada but has become an international collaboration; the North American Pain SchoolCanadian Child Health Clinician Scientist Program. The training pieces have always been fun for me. I love working with trainees—I love their energy and excitement. I get just as much out of the training programs as the trainees do, because being surrounded by smart, energetic young people with fresh ideas who challenge your thinking is a real treat.
Being involved in the North American Pain School the last couple of years has been fantastic; just like the trainees, I am learning about brain imaging, optogenetics—the full range of pain research. When I started my career, I probably wouldn’t have been interested in those types of research at all because I just wanted to study children’s pain. Now I see how all of these things are connected.
Pediatric pain is a really well-networked research community, which is both a good thing and a bad thing. The good thing about it is that we all know each other, and we’re very supportive of one another. In some ways it holds us back, though, because we’re not ever really challenging our thinking. We’re talking to people who think the same way that we do, and we’re not exposing ourselves to other types of science and ways of thinking. Becoming engaged in a training program is a wonderful way to be energized and exposed to new ideas.
There was a negotiation workshop at the 2018 North American Pain School last June, and no women volunteered to role-play a negotiation. You called attention to this issue at NAPS, which inspired many follow-up conversations.
That was a really interesting situation, because whenever we’re planning that workshop, in advance, I always say we need to address the gendered aspect of negotiation. Usually the leadership committee says, "Well, Christine, you just make sure you bring it up." I get tired of always having to be the one to bring it up, but I brought it up.
What happened was so interesting to me. We had 20 female trainees and nine male trainees in four different groups. Each group was instructed to prepare one person to role-play a negotiation with the male workshop organizer in front of the larger group. Across the four groups, there should have been two to three women selected to negotiate, but all four groups selected men.
It was not one person’s fault that this happened. In some cases, I think a male trainee wanted to do it, and the female trainees were happy to let them. Other times, I think the female trainees felt anxious about negotiating with the male workshop organizer and suggested to their male colleague that they do it. It was just a real-life, fascinating example of how these things can play out. People often say, "Oh, look at all these women at NAPS—the gender imbalance is improving." But guess what? When you get to my stage, that’s not the demographic. We know we lose a lot of women through the pipeline, especially after they have children. There are very few females at the full professor level relative to men.
What advice do you have for young women entering this field, in terms of negotiation and career development?
In terms of advice, I really don’t know what to say, because I struggle with this every day. Relative to my male colleagues, despite my best attempts, I’ve done poorly when it comes to negotiating most aspects of my position—space, startup, salary, etc. When I’ve tried to negotiate, I have received advice from people, from men, about how to approach negotiation, and everything you read about what happens to women happens to me. And it’s really hard.
My advice is to get training when you can and to be aware of the issues. I honestly think men are a big part of the solution in terms of being champions for women. We know that women are less likely to apply for jobs, promotions, and awards if they think they’re underqualified, whereas if men aren’t quite qualified, they’re more confident going forward. I try to be a champion for other women. The reason I was a plenary speaker this year at the World Congress on Pain was because a woman on the Scientific Program Committee put my name forward.
We have come a long way, but there are still a lot of barriers. Being aware and finding champions will hopefully help the next generation of scientists make more progress. What came out of that workshop at NAPS was that Jeff Mogil, director of NAPS, said that at the next NAPS he would like for me to do a workshop for the NAPS trainees on gender bias. Jeff is an example of a great male champion who makes sure the committees he puts together comprise 50 percent men and women. I don’t know that I would have thought to suggest a gender bias workshop myself, or I would have been nervous about suggesting it myself because of how it might be perceived.
When you’re not doing pediatric pain research and tweeting, what do you like to do?
I really love my work, so for me, work is fun. But I have a very busy family life, too. I have four kids between the ages of 7 and 12, and a husband who’s very supportive, and my extended family. We live in a beautiful place, Nova Scotia, so we like to do a lot of exploring. Mostly I spend my time chauffeuring my kids from activity to activity because they’re at that age now. We like to travel and take vacations. I also like to cook and to read. Sometimes I just like to do nothing.
And I should mention, I have a huge support team. I’m always very open about it because people often ask, How do you do it all? I have an amazing nanny who looks after our kids 10 hours a day and sometimes more when I’m traveling. She is super—like a third parent in our house. My mom lives nearby and helps out. It is a challenge for women balancing both career and family, and we need to be really honest about the kinds of support that we need and have.