Seven early-career pain researchers took part in the PRF Correspondents program during the 7th International Congress on Neuropathic Pain (NeuPSIG 2019), which took place May 9-11, 2019, in London, UK. This unique science communications training program provides participants with knowledge and skills needed to communicate science effectively to a wide range of pain researchers, and to patients and the broader public. In addition to blogging and writing summaries of scientific sessions, the Correspondents also conducted interviews with plenary speakers and other researchers at the meeting. At NeuPSIG 2019, PRF Correspondent Danielle Perro, a DPhil candidate at the University of Oxford, UK, caught up with Harriet Kemp, Chair of the Trainee Committee of NeuPSIG, for an interview.
Kemp is a National Institute for Health Research (NIHR) Clinical Lecturer with the section of Anaesthetics, Pain Medicine and Intensive Care (APMIC) and the Pain Research Group at Imperial College London, UK. Clinically, she works as an anaesthetic registrar in the Imperial School of Anaesthesia. Having completed an NIHR Academic Clinical Fellowship in anaesthetics, Kemp was appointed to the NeuroPain Grant to investigate pain in patients with HIV. She completed her doctoral thesis on chronic pain in HIV infection in 2019. Her areas of interest include quantitative sensory testing, conditioned pain modulation, and other deep phenotyping measures in neuropathic pain. She was also the joint project lead for the Pain in INTensive Care (PAINT) Study with Helen Laycock and the Pan-London Perioperative Audit and Research Network, and continues to work on studies investigating acute and chronic pain in the critically ill. She is also currently working on the NIPPR study (funded by the British Pain Society Clulow Award) investigating neuropathic pain in HTLV-1 infection with the National Centre for Human Retrovirology.
In this interview, Kemp discusses her route to pain research, how her career is shifting, the issue of gender in science, and much more. Below is an edited transcript of the conversation.
How did you first become involved in pain research?
I’m an anesthetist and a bit of a strange one in some ways, in that I went into anesthesia to do pain medicine. There are not many anesthetists who actually can say that; most want to fly around in helicopters and cure people in intensive care.
But I was lucky enough to get some funding to take part in a master's in pain medicine with the University of Edinburgh when I was a junior doctor, and that opened my eyes to the huge challenge that we face in pain medicine—how poor our therapies really are for treating chronic pain—and showed me how interesting research was. I ended up doing an Academic Foundation Program, sponsored by the NIHR [National Institute for Health Research], which combines clinical training as a junior doctor with some time for research.
And, more and more, I did small projects looking at clinical pain problems and then got another NIHR-funded award called the Academic Clinical Fellowship. That allowed me to develop some work to convert into a PhD, which I did with Andrew Rice at Imperial College London, looking at ways to improve trials in HIV-associated sensory neuropathy using phenotyping. I actually just graduated from my PhD two days ago.
On the topic of chronic pain management, cannabis as a treatment option has become a hot topic. Is this relevant to the patients you work with?
Clinically, we’re increasingly asked questions about cannabis and whether we could prescribe it for our patients. In the UK, the use of cannabis for non-pain indications has also hit the headlines. I’m very much of the belief that we don’t really have enough evidence for its use in chronic pain yet, and specifically, we don’t have enough evidence for the potential for harm with cannabis use.
I know that a lot of patients I’ve recruited and see clinically do use cannabis, and they report that it helps; when I say cannabis I mean that it’s street cannabis that they’ve sourced themselves, not something they’ve been prescribed. For some people it worked well to relieve their symptoms, and so they continue to use it.
The IASP Task Force looking at cannabis will really help draw together all the evidence and help us make a community decision. The Royal College of Physicians in the UK is also developing a task force to look at this, and they’ve released various statements that have not supported prescribing it willy-nilly quite yet.
It’s also important to consider what we can offer our patients once we can’t provide them opiates, or when we don’t want to prescribe them opiates. If there’s no interventional or pharmacological therapy that we can offer, because of cost, access, or contraindications, what do we offer them? It seems like we have run out of options because we don’t have enough effective non-pharmacological therapies or, rather, good enough evidence for non-pharmacological therapies. And the Lancet Neurology systematic review of pharmacological therapy showed that we have quite limited options for many neuropathic pain conditions, and we do need new compounds. So it does make sense that we’re exploring cannabis. I wholeheartedly think we should be exploring any options that we can.
Having just finished your PhD, and as an early-career investigator, what hurdles have you encountered and overcome to ease your transition from trainee to where you are now?
There are a couple of challenges. First, when you combine clinical work and research work, you never have enough time for both. I’m lucky that I have a funded post that is 50 percent clinical and 50 percent research, and my research time is protected. Working in the NHS, there’s always clinical pressure to get more and more work out of you. So I’m very privileged to have that protected time in a postdoctoral environment, so that has been great. Having said that, I still feel that I don’t have enough time to do everything well enough, so I’m still trying to work out how best to manage my time to be productive and up to scratch in both areas.
Second, toward the end of my clinical training and moving into the early-career stage of my research training was also the time I had a baby. That has presented me with a whole extra part of my life that I have to fit in, and that has definitely been a challenge.
Going out a bit more on your own is also quite daunting. I’m going to move somewhat out of the area that I did for my PhD; I’m taking all the skills I use, but I am going on to a different clinical problem, and that is quite daunting.
What is the switch that you are making?
My PhD was based on phenotyping patients with HIV-associated sensory neuropathy, and I’m trying to move toward looking at chronic pain after critical illness because I work in that environment clinically. I see that acute pain isn’t managed very well. It’s definitely not assessed properly in the UK in intensive care, despite there being great new published guidelines. There’s a lack of translation into many critical care units in the UK.
We don’t really know enough about pain in critical care survivors. There are some signals from quality of life outcome data that pain is a real problem. Of course, it’s a very difficult heterogeneous population to work with, but as pain experts we’re very good at working with heterogeneous populations. We’ll see how that goes; these are just some ideas that I’m following now.
Can you say a bit about the mentors that have been pivotal in your career?
When I was a junior doctor, I was very fortunate that I had a very good personal connection with one of my tutors at my college in Oxford. He had done some amazing things and was able to put me into contact with lots of people so I could gain clinical experience. I did some of the helicopter emergency medical services because he had helped set up the service in the past. It felt very natural, and it was an informal type of mentorship because our personalities connected.
I’ve been fortunate enough to be a part of formal mentor and coaching programs where you’re allocated to someone outside of your field of expertise, and you present that person with a problem, such as my issue with time management and splitting my time between clinical work and research. These people have the training to be extremely good coaches, and I found that hugely beneficial.
Sometimes with mentoring programs it seems that everyone can be a mentor: All you have to be is good at your job and then, spontaneously, you’ll be a fantastic mentor. But I don’t think that’s true, though it comes very naturally to certain people. It is a question of being in the right place at the right time, and accessing mentoring programs that many universities offer. But it does come down to personality; you’ve got to feel comfortable with your mentor.
A lot of the time it’s not about your mentors putting you into contact with their network, or about them giving you didactic advice. It’s more about your mentors helping you work these answers out for yourself and tackle those problems. That’s the most fruitful type of mentorship I’ve received.
There are well-known gender disparities in science, technology, engineering, and mathematics (STEM), including in the pain field. Initiatives like the Athena SWAN Charter have been implemented in the United Kingdom to promote the careers of women in STEM. In 2011, the NIHR said it would only consider funding applications from organizations that obtain a certain benchmark (the Athena SWAN Silver Award). Is this a step in the right direction?
The NIHR’s decision instilled panic into a lot of institutions, and it’s been very good. This is a massive coincidence because I think it was yesterday that I received an email from our head of the department saying we had just been awarded an Athena SWAN Silver Award. They are delighted that they can now apply for funding, but I felt a bit that this missed the point. What we have to be careful to do is make sure that these aren’t token programs that we never go back and look at to see if they’re actually making a difference.
Many top 15-ranked universities had a drop-off in senior female academics, and a lot of them had these kinds of programs specifically targeted to women, and yet, still, only 20-30 percent of their senior faculty are females. So it’s a step in the right direction, but we just can’t sit on our laurels, having received an Athena SWAN Silver Award—we have to keep revisiting the issue.
What advice do you have for young female researchers, knowing that there is this leaky pipeline in academia, which can be quite discouraging?
Don’t be put off by that at all, but recognize that there are gender differences; however, the world is changing and is more supportive. But one thing that can never change is nature, and if you are considering a family, that will have an impact. I’m not saying it’s a negative impact, but it will have an impact on your career, and so women need to think about it.
I can only hope that in the future there will be a societal norm for partners to take parental leave so women have more of a choice as to how much time they take out from their careers, and that the work environment is more family friendly to everyone, not just women.
We all know that you have to put a lot of time, work, and effort into your career, and that is incredibly rewarding, but it shouldn’t have to be to the detriment of your personal life. So I hope that things will change. It looks like things are going in the right direction.
You previously participated in the PRF Correspondents program at the North American Pain School (NAPS) and have said it had a positive impact on your career. For those interested in becoming more engaged in science communication, what value do you see in it?
There are two parts to science communication. One is communicating about science with other scientists, and the other is communicating with patients and the general public. As a clinician, I thought I was pretty good at communicating with my patients, but it turns out I’m not very good at that.
There’s a big push in the UK to get patient and public involvement even at the grant writing stage, and I have a fantastic patient partner who’s worked with me on a couple of grants, and completely changed the way I’ve designed experiments and how I plan to disseminate results. I’ve been blown away by the interest that patients have, and their desire and willingness to take part in research, and spend time helping us with it.
I don’t think pain patients are unique in this, but they are certainly a very motivated group because they recognize that their pain is not being treated well and that there’s a big clinical need. Our lab now has a patient focus group that we can go to whenever we have ideas to bounce off them. I’ve been quite astounded at how that’s changed my research.
In terms of disseminating the results from my PhD, I haven’t actually done that in a publicly digestible format as yet. But it’s not something I want to rush out. I want to consult with our patient focus group and make sure that it’s in a format that they want to look at—that it is understandable and reaches as many people as possible.
It’s been a real eye-opener doing science communication. We’ve also made a video to try to communicate more with other researchers about what our lab does. I showed it to the patients and they didn’t like it. So I think we’re going to have to revisit that or think about our target audience for that a little bit more.
Danielle Perro is a DPhil candidate at the University of Oxford, UK.