Flavia Di Pietro, PhD, is a National Health and Medical Research Council C.J. Martin Early Career Fellow in the School of Medical Sciences at The University of Sydney, Australia. Her PhD research investigated cortical representation in complex regional pain syndrome using brain imaging. Di Pietro recently won the Australian Pain Society’s Rising Star Award for 2018, which showcases up-and-coming pain researchers in Australia. Di Pietro sat down to chat with Lincoln Tracy, a research fellow from Monash University, Australia, at the 2018 Australian Pain Society 38th and New Zealand Pain Society Conjoint Annual Scientific Meeting, which took place April 8-11, 2018, in Sydney, Australia. Di Pietro discussed her interest in brain imaging, why researchers should write for the public, her love of ocean swimming, and much more. Below is an edited transcript of their conversation.
What first got you interested in science?
I did my undergraduate degree in physiotherapy, and then worked for a year as a physiotherapist. I found myself working in a pain management clinic, and while I enjoyed the musculoskeletal and acute pain side of things, I was fascinated with people whose pain persisted, and the patterns of their pain.
What led you to brain imaging research?
I completed my undergraduate honors project on chronic back pain, looking at sensory discrimination on the skin of the low back using tactile tools. We weren’t finding any differences in basic sensory profiles, but we were seeing differences in discrimination and graphesthesia tasks [the ability to identify writing or shapes drawn on the skin using only the sensation of touch]. This got me interested in the role of the brain, and shortly after I was lucky enough to be part of a project that used brain imaging.
What kind of imaging techniques do you use in your research?
One of the techniques I use is electroencephalography, or EEG. The study participant wears a cap—not unlike a swimming cap—containing sensors that measure the activity of neurons very accurately with respect to time. I’m using EEG with some colleagues of mine over at the University of South Australia in Adelaide, investigating neuronal activity in complex regional pain syndrome.
I also use functional magnetic resonance imaging to measure brain activity via changes associated with blood flow, as well as a related technique called magnetic resonance spectroscopy, which looks at the amount of particular molecules in the brain. I’m particularly interested in looking at γ-aminobutyric acid [GABA], an inhibitory transmitter in the brain, and its role in complex regional pain syndrome and orofacial neuropathic pain.
What are some of the challenges associated with undertaking pain-related imaging research?
The biggest challenge with any imaging project is making sure that we go into the project with a really clear-cut rationale, question, and hypothesis, and probably even a pretty good idea of how we’re going to analyze things before we start. Otherwise, we run the risk of not being as rigorous as we should be when we are running the project.
When someone comes out of the scanner, we have a bunch of files which we analyze with respect to outcome measures such as neuronal activation, or blood flow, or brain chemistry, and we have to interpret them. Without a really strong rationale, question, and hypothesis, we may misinterpret these measures and go in the wrong direction. I have this line of thinking in my head when I’m designing any study or working on the data collection for a broader project.
You also study children with widespread musculoskeletal pain. What research are you doing in this area?
This is work I’m doing with Bob Coghill at Cincinnati Children’s Hospital in the US. The key question we’re investigating is the spread of pain in these kids—why the pain spreads to adjacent or previously unaffected sites. We are also interested in whether or not the kids have altered sensory processing, such as altered tactile discrimination, over the painful part of their body. If this is the case, then we can ask whether or not we can use some kind of sensory discrimination training to prevent pain from spreading.
When I first went over to Cincinnati I thought this would be a pretty straightforward study. People have previously used tactile discrimination training in adults—over the stump in phantom limb pain, for instance, or over the painful hand in complex regional pain syndrome—and this has had a positive effect on pain. But it turns out that no one has done anything like this in kids before! So even just characterizing two-point discrimination—registering whether they feel two points on the skin or one, depending on how close together those two points are in space—and then using that tool as a treatment program is something that we seem to be the first to do.
It’s been a really fun study to put together, and it’s great that we’re doing this work in kids. The two-point discrimination training is a non-invasive treatment; it allows the kids to focus their attention on what we are doing and respond to it, and we can give the kids feedback. The training is low-risk to the kids, which is important, and based on the science behind the project. We really think that the treatment should benefit them.
What’s the most interesting study you have been involved with in your career to date?
In terms of subject matter, a complex regional pain syndrome and functional MRI study that I did for my PhD was the most interesting—but not for the reasons that I expected. I thought it would be interesting because I found the concepts of cortical reorganization and neural plasticity to be fascinating. However, I didn’t know that we were going to have surprising findings, which prompted us to question widely held notions of cortical plasticity in complex regional pain syndrome.
In terms of tools, I really enjoyed learning how to use new neuroimaging tools as part of my postdoc. I had to get my head around using EEG and spectroscopy, and it was interesting to see how these tools can offer us something different. You need to pick the specific tool carefully, because one particular technique is better for spatial resolution, another is better for time resolution, and another for neurochemistry. There are so many different ways we can use each technique to home in on specific research questions with different demands. So the methods side of it is really fun and interesting.
But, on the frustrating side, I do get to a certain point with each of these tools that is beyond my level of understanding—where I have to accept that I’m not a physicist or a chemist. I come from a clinical background. I would love to learn more about the physics of the MRI, but I need to remind myself to be aware of the amount I need to know to get the most out of the tool I’m using to answer a well-directed question. The beauty of that is everyone can bring different strengths to a project. I may not have the best idea of the intricacies of the physics, but I might be better at writing or dealing with patients, for example. It’s just a matter of playing to each other’s strengths.
You have an editorial role with the BodyinMind blog. How important is it that researchers make an effort to share their work with the general public?
It’s really important. We research important questions and publish important findings, and then more often than not they go into a scientific publication that members of the general public will have to pay for to be able to see. And if they are able to see it, it won’t necessarily make a lot of sense to them, as it’s written in a way that only other academics understand.
Not every piece of research is going to be rapidly translatable, or mean anything to a patient or a member of the general public. But I feel that the public should be able to see what we are up to, because often they’re really interested in what we are doing. Think about when you catch up with friends or family—they’re always dying to know what we’re studying and what we have found out. So it’s really important that we are able to explain even the little steps in a manner that the public can understand—that this first bit will lead to the next step, which leads to the next step, and so on.
Now more than ever, with the influx of information we all have on our phones and laptops, and the filtering we all need to do to pull apart the quality from the noise, the onus is on us to present what we do to a lay audience that is interested in our work. That’s where resources such as BodyinMind or The Conversation are great. People don’t necessarily need to understand all of the details of the research, but we need to write about our work in a way that’s interesting and allows the reader to appreciate how the research impacts us all.
What is the most important thing you try to teach the trainees you work with?
One thing that I get to do at the University of Sydney is run a small journal club with advanced neuroanatomy students; I feel really lucky for this. I pick recent papers in pain and imaging, and we discuss these as a group. I am constantly challenged by the students, which I really enjoy. A key thing I try to teach them is not to assume that a paper is perfect just because it is in a good journal, or from a prominent lab at a top university, but to really pay attention to the introduction, methods, results, and discussion. This teaches the students to look at what the researchers did, what they found, and how they reported and interpreted it. That’s always a fun exercise that I use to help students think critically about what they are reading, and it also teaches them not to be afraid to ask questions.
When you’re not doing science, what are you doing?
I really enjoy food and drink, so I cook, eat, go out to restaurants, and enjoy a nice wine. I love cooking Italian food. My dad’s side of the family is Italian, and it’s really fun to get out the pasta maker. Mind you, my husband is actually a much better cook than I am. I also really enjoy keeping active—which is important given my love of food! I compete in ocean swims. This year we’ve had races at Bondi, Balmoral, and Manly beaches, and a few others, and they’re great fun. It’s nice to get out there in the ocean and get competitive. I also run, and I’m very lucky to have the beautiful Centennial Park next to my home in Sydney.
If you could have a dinner party with anyone from history—and where you would make your husband cook—whom would you want at the table with you?
I would definitely want to have a few foreign correspondents there because I find them so brave. I want to have people who have been on the frontlines, in dangerous situations, and would love to hear what they have to say. Similar to that theme, I would love the opportunity to have Malala Yousafzai there. She is the advocate for female education in Pakistan who was shot by a Taliban gunman before going on to win the Nobel Peace Prize.
And although it’s cliché, I’d want Barack Obama there, too. Being the first person of color to become president of the United States is extraordinary, and I’d love to meet him and his wife, Michelle, as she also fascinates me. I’d also like to meet someone who has done amazing things in advancing Aboriginal people’s rights in Australia—Eddie Mabo or Vincent Lingiari. I would also love to have a couple of members of my family there because, while we often think of these famous names, often the people sitting around us—our own mums and dads—are doing extraordinary things. This would be a fun dinner party.
Additional Reading
The relationship between thalamic GABA content and resting cortical rhythm in neuropathic pain.
Di Pietro F, Macey PM, Rae CD, Alshelh Z, Macefield VG, Vickers RE, Henderson LA
Hum Brain Mapp. 2018 May; 39(5):1945-1956.
Di Pietro F, Moseley GL, Stanton TR
Eur J Pain. 2016 Nov; 20(10):1763-1765.
Interhemispheric somatosensory differences in chronic pain reflect abnormality of the Healthy side.
Di Pietro F, Stanton TR, Moseley LG, Lotze M, McAuley JH
Hum Brain Mapp. 2015 Feb; 36(2):508-18.
