At the upcoming 17th World Congress on Pain, to take place in Boston, US, September 12-16, 2018, the International Association for the Study of Pain (IASP) will present awards to honor the achievements of young investigators. In advance of the meeting, PRF spoke by phone with each of the recently announced winners, who discussed their path to pain research, the projects they are working on now, and what they hope to learn in the future. In this interview, we chat with Melanie Noel, PhD, winner of the Ulf Lindblom Young Investigator Award for Clinical Science. This award honors an individual who has achieved a level of independence as a scholar in the field of pain for clinical science.
Noel is an assistant professor at the University of Calgary where she studies children’s pain memories. Her doctoral research established several factors implicated in the development of pain memories in children, as well as the influence these memories have in shaping subsequent pain. This work led to her co-development of conceptual pediatric models of acute and chronic pain, which outline the cognitive (memory), affective (anxiety), and behavioral (parent-child pain narratives) factors implicated in children’s pain trajectories. She also co-developed several conceptual models of children’s pain memories and pediatric chronic pain, and refined parent and child pain-related measures.
How did you become interested in pain research?
I kind of fell into pain—pardon the pun! I was an undergraduate psychology student, and initially I was working with rats in a learning lab and realized working with these animals wasn’t for me.
So I found a summer research position working with a developmental psychology researcher, Carol Peterson, who was studying children’s ability to be reliable eyewitnesses. This research had me sitting in the emergency department of a children’s hospital, where I waited for children with acute injuries, and their parents, to come in. Of course, these injuries were painful, ranging from lacerations, to dog bites, to broken bones.
We would recruit parents and children in the emergency department and interview them, and then we’d go to their homes and interview them over the course of seven years. We were coming at this as developmental psychology memory researchers, but what I realized was that it was really pain memory work. And that just hooked me, as did working with children; I just knew this was where my heart was. This idea of having a memory for painful experiences and studying how these pain memories develop early in life and are influenced by how parents and adults talk to children—it was very exciting to think about.
What is the overall aim of your research?
My research straddles the spectrum of acute to chronic pain in children, and it also straddles the spectrum of development. I study kids around the time that they can talk and reliably report pain, so this includes preschool-aged children up to older adolescents. The aim of my work is to understand what children remember about painful experiences, how those memories develop, and how we can harness those memories and target them in interventions to foster more positive, accurate memories.
We’ve shown over the last decade that sometimes these memories of pain are more important, in terms of how children cope with pain in the future, than the actual experience of pain itself, and we’ve recently shown that these memories for pain underlie the development of chronic pain. This work in memory has important and exciting prevention angles because if we can target memories of acute pain, we may be able to prevent the development of chronic pain.
One of the reasons I’m so hooked on working with kids is that a lot of these problems do start early in life; 60 percent of kids with chronic pain will become adults with chronic pain. So if we can improve how children in early life remember their pain experiences, it can set the stage for better pain experiences and better health outcomes far into adulthood.
Under this umbrella topic of memories for pain, I also study more pathological forms of remembering, such as re-experiencing and intrusive remembering in post-traumatic stress disorder, which is comorbid with chronic pain. So I am now also looking at memory and other mechanisms underlying these comorbid conditions in adolescents.
What are you working on most intensely right now?
We recently wrapped up an observational study where we followed kids who were undergoing surgery and their parents, and had them come back to the lab and reminisce about that experience. We wanted to see if the way parents talked to children fostered positive memories, accurate memories, or negative memories of pain. Based on this study, we have developed a parent-led, memory-reframing intervention that we’re now testing in three randomized, controlled trials. We’re doing this in the context of school-based vaccine injections, adolescents undergoing major surgeries like spinal fusion and pectus repair, and younger kids undergoing tonsillectomies.
I’m really excited to be at the stage where we can actually modify these children’s memories to foster better remembering and better pain outcomes. These interventions are very simple, take between 15 and 30 minutes, and focus on having parents talk to kids in ways that emphasize the positive; correct negative exaggerations; and foster self-efficacy in their ability to cope with pain. I’m pretty confident this will work because it’s based on some solid observational data. If it does work, this could be a really fantastic pain management strategy that parents and kids could utilize to improve pain outcomes.
What’s the most exciting or intriguing result you’ve gotten so far?
What’s really exciting right now is that I’m partnering with pain brain imaging scientists to understand what’s happening in the child’s brain when these biased pain memories are present and when chronic pain develops. We have some preliminary, unpublished data based on kids with chronic pain and age- and sex-matched controls. We’ve found important differences in the structure and function of the hippocampus, a brain region involved in memory. So we’re not only showing that kids who develop pain problems have biased autobiographical memories for pain, but also that there’s something concurrently happening in a memory region of the brain. Piecing these two perspectives together, I think, will really propel forward this area of inquiry and, importantly, inform how to better harness memory to improve pain outcomes in these youths.
In your area of research, what else do you hope to know in the next five or 10 years that we don’t know now?
The biggest pressing question for me is why acute pain becomes chronic for some kids. As a field we don’t really know how to prevent pain or its transition to chronicity, and what all of us in the field want to know is which kids will go on to develop chronic pain, what the mechanisms are, and how we can prevent it. That’s why the memory work is so exciting, because I think it is one important piece of the puzzle.
When you look more broadly at the pediatric pain field, is there anything that really stands out to you?
We’re such a young field and there is so much left to learn. For instance, it’s only recently that we have learned what the cost of this problem of pediatric pain is, and what happens to kids with pain when they grow up.
What also stands out is how the field is thinking not only in terms of how pain experiences affect future pain experiences, but also how they affect development—cognitive development, social development, language development, and attachment relationships. This is a really important direction the field is taking, because what could be more intense between a parent and a child than a pain experience? And that experience is shaping broader social and emotional development, not just the development of pain behaviors.
I have a line of work where we’re looking at parent-child reminiscing about pain versus other emotional events like sadness and fear, and we’re seeing fundamental differences between how parents socialize children around pain versus those other emotional events. This is really fascinating—what is it about our culture and society where we repress and deny pain, and might those cultural and social attitudes around pain be trickling into our interactions with our children? That’s got me spinning in a good way.
What’s the most challenging aspect of doing pain research in your area of investigation?
For me, as a woman in science who has three young children, it’s a challenge to balance being a mother with a really busy career that is also a huge part of my life and identity. It’s amazing that in pediatric pain we have some of the most fierce mothers in science who are leading the field with many children in tow. That’s pretty inspiring, and it’s blazed the trail for women like me.
When I’m at parties and people ask me what I do, and I tell them that I study children’s pain, I get a lot of sympathetic looks and responses. None of us like to watch the videos of children whose pain is not being adequately managed, and I will never habituate to that; I still have this visceral reaction. But at the same time, we are working on solutions and are intervening. As a scientist, a big part of what I do is help clinicians and the public recognize that pain is an undertreated problem in childhood, and so I find that what I do is a very positive role and job.
What is it like to be an early career investigator in pain research?
It is a challenging time for research, and this is not unique to Canada. Funding rates are among the lowest they’ve been, and there are systemic barriers to women who want to work in science, technology, engineering, and mathematics (STEM).
Being a young mother who is also launching this pre-tenure research career is a zany, busy, and challenging life, but the pediatric pain community is one of the most supportive and collaborative research communities, and we have amazing mentors; I couldn’t even list all of my mentors because there are so many!
So I acknowledge the challenges, and I mentor young women in a very honest way about the barriers to being a woman in research, academia, and science. But we have this amazing, supportive community that makes it possible. It’s exciting for me now to be on the other end, to be a role model for my students, like the role models I had, and still have, in Christine Chambers and Tonya Palermo. Whether my students are clinicians or researchers, that’s up to them, but my goal is to get them excited about research and show them, in an honest way, the highs and the lows. For me, the highs far outweigh the lows.
Is there anything about you that people might be surprised to know?
It’s probably not a big secret, but I am the mom of triplets. A lot of people know that, but I think it’s my superpower. I’d like to say that I run marathons and have all of these extra interests, but between that and my pre-tenure, early career life, I’m pretty busy.
If you could have a conversation with any scientist, living or dead, inside or outside the field of pain research, who would it be, and what would you want to talk about?
I am such a fan of the astrophysicist Neil deGrasse Tyson, and I would like to talk about the cosmos with him. I follow him on Twitter, and he’s almost like my science Yoda. He has made this incredibly complex scientific area so digestible to the public, and I would just love to pick his brain.
Interview by Neil Andrews, PRF executive editor.
