Unravelling the mystery of pain
Patients with chronic whiplash experience long-lasting pain, but doctors and researchers struggle to explain the causes. Solbjørg Makalani Myrtveit wants to help these often misunderstood patients.
What is whiplash?
“Immediately after car accidents, in particular rear end collisions, people can experience pain and stiffness to the neck. Most people then recover and have no lasting afflictions. However, some develop whiplash, a condition with long-lasting pain and other symptoms, as well as reduced quality of life and function.”
What, in your own opinion, is most important in your research?
“To me it is important that though we do not yet completely understand this long-lasting condition, the suffering the patients experience is just as real. The pain is genuine, even if we cannot explain it using X-rays or blood tests! It is vital that the patients do not experience the weight of their condition not being accepted, in addition to struggling with this illness.
Maybe we need a change of attitude among the Norwegian people? Sometimes it may seem like we are ranking illnesses, and that some conditions, such as cancer and heart disease, have a higher “status” than pain conditions. We should ask ourselves if we look at some conditions as accepted illnesses and others not. And here we are not just talking about whiplash. For example, fibromyalgia and chronic fatigue syndrome are other conditions that we do not fully understand, and where the patients may face scepticism. It might seem that these conditions have much in common. They clearly have common symptoms, but perhaps we can also find a common treatment, so that we can help several patients, across different conditions?”
What is pain?
“Everyone knows what it is like to be in pain. But we also know that the pain experience can vary immensely depending on how you feel when pain occurs. If you scratch your knee during a soccer game, you may not notice it until half-time. But if you are sitting in the doctor’s office about to take a blood test, you may experience a great deal of anxiousness and pain. This shows that it is not only the degree of tissue damage that leads to pain. Pain is experienced in the brain. Pain makes perfectly sense to us, for instance, if we have an acute injury, and have to keep a foot or an arm still for a period of time to get well. But sometimes we can continue to experience pain even after the recovery period is done, and no damage will occur by moving. An example of this is back pain. You may experience pain, however, the best thing for you is to be active and go hiking in rough grounds. Then you may experience a conflict between what is good for you and what seems to be good for you.”
In your doctoral dissertation you try to find characteristics for patients at high risk of developing chronic symptoms after whiplash accidents. What did you find?
“We wanted to determine whether patients at high risk of chronic complaints could be identified early after the injury, so that those most in need get help. We found that people who have experienced pain previously in life, have an increased risk of chronic pain. In addition we see that patients that believe they will need help and medication are at risk of prolonged illness. And I guess it makes sense that people have an idea of their most likely outcome. After all we all know ourselves best.”
Did it surprise you that the connection was that obvious?
“There is quite a lot of literature on this, about the patient’s thoughts and their predictive value. Patients who think they will return to work quickly after an illness, frequently do so. So we know that there is a connection between expectations and the prognosis. On the other hand we know less about whether we can alter the patient’s perceptions, and whether such a change can contribute to the patients recovering more quickly. We hope to find thought patterns that can be affected by talking to a doctor or a psychologist, and that this may aid to the patients’ recovery.”
During the PhD period, you went on an exchange programme to New Zealand organised by WUN (Worldwide Universities Network). What was this experience like?
“In the beginning it was quite challenging to be completely new and not knowing anyone in the big research community there. But it was very exciting to experience so many different ways of working. Things I had taken for granted could be met with “but why do you say that?”. That was great learning for me.
Keith Petry, the researcher I visited, works a lot on how patients reflect on disease and illness. He has a research team that includes many doctoral students and post doctoral fellows. We met once a week and he supervised us all at the same time. Everyone had to tell the others what we had done since the last time we met and what kind of challenges we had faced; then we discussed our experiences. All the projects were completely different, varying from research on cancer to HIV/Aids and placebo effect. In the beginning I was thinking “huh, what kind of way is this to spend our time?” But it was great. When you do this over time, you closely follow the development of multiple projects. I gained much better insight into what you have to be aware of as a researcher than if I had only known my own project. Additionally, I was pushed to speak in front of a group of people, receiving critical questions and expressing myself every week. It was very instructive.”
What has it been like, being a PhD student at UiB?
“I have really enjoyed working with my PhD project. You have this big topic that is yours, and then you have to work your way through it. I find it very exciting to work with analysis and statistics. And I loved to have a lot of time to spend on the same project. It has been a great balance between being challenged and being guided by my supervisors. I have received a lot of support. I have been pushed just enough to get things done, but at the same time, I have had a good feeling while doing it.”
What is your dream for your future career?
“At this point in my life, I first and foremost dream about a postdoctoral fellowship. I would love to continue working like I did on my PhD: enjoying exciting topics, challenging methods, learning new stuff and having inspirational people around me.”