On 11 January 2024, the Interdisciplinary Chronic Pain Symposium took place. Worldwide, including in the Netherlands, there is a lot to gain in the treatment of chronic pain.

There were several inspiring talks by e.g. a psychologist, anesthesiologist, biologist, physiotherapist, artist and of course a patient-expert. It became clear that, although we need pain as a warning system, chronic pain disrupts patients’ professional functioning, finances, social life, emotions etc. Also, talking about pain is often not socially accepted. Hence, pain patients generally resist pain both by not talking about it and by trying to suppress or treat it. This, in turn leads to experiences of loneliness, and also fear.

How much patients often restrict their talk and thinking about pain, became clear from a presentation by artist Nienke Koek. She asked pain patients ‘unusual’ questions like: ‘What color is your pain?’ and ‘Is it in front, behind left or right of you?’ in the waiting room of a pain clinic. Whereas people first struggled not to talk in diagnostic terms and treatment, answering these questions was emotional for many. For once, rather than trying to suppress pain, it could be given a shape. And not only that, it also helped patients to focus on what they wanted to achieve in their doctor’s appointment.

This ‘free talk’ without diagnostic categories also related to the issue of defining pain. One problem with talking about pain is that we can never know exactly what someone else feels. This also makes it very difficult to talk about and define pain. Yet, it does seem possible to discuss what pain means for someone. This also highlights another point namely that ‘one size does not fit all’. Due to the complexity of chronic pain, what works for one patient, may not work for the other. What does seem to work for some, is really simple with no negative side-effects. If the partner strokes the patient twice a day for fifteen minutes on the underarm, this can reduce experiences of pain. Another way can be to do excercises that help patients to gain trust in their bodies again.

The general finding was that there are many professional and academic disciplines and patient associations that try to reduce chronic pain and improve treatment. Yet, communication between these groups can be improved. Another way forward is more actively applying the knowledge that is already available, and train professionals.

In order to facilitate the exchange of ideas, and maintain and expand our collaborations, the Defeating Chronic Pain team can now be found on LinkedIn as: iPOP-NL: interdisciplinair PijnOnderzoek Platform Nederland, which better emphasizes the interdisciplinary nature of our approach. The team is very happy to be contacted by anyone who wants to contribute to better understanding and treatment of chronic pain.

Two artists from Aaaaha! Bureau voor live communicatie – inspireren, activeren en verbinden made a wall-report of the meeting, bringing together all perspectives.

On November 10, 2023 the Defeating Chronic Pain research team and writer and journalist Sanne Bloemink visited the Institute of Advanced Studies (IAS) in Amsterdam. Sanne Bloemink told about her experience as a chronic pain patient and about her book Pain. Sylvia Brugman showed what we a study as a multi-disciplinary team, and how difficult and fantastic that is.

We discussed the medical and biopsychosocial models of pain, and our mixing console as a metaphor. Patients, philosophers, immunologists, linguists, neurologists, artist, anesthesiologists and patients all introduced their perspective.

One of the things that became clear is that everyone has a different definition of chronic pain. Some find a definition important because they need to work with it. Others find a definition unimportant because life goes on. If we accept that a definition is fluid, and changing, that is okay. Everyone has their own language for pain to make clear what it is, to communicate about it, to work with it, to do research about it. While we are open to each other’s language, patients should be treated. Like in the general population, one out of five people was a chronic pain patient in this group.

Our assignment is clear: combine forces for large-scale interdisciplinary research!

Background: Pain is a complex phenomenon, and the experience can be affected by a plethora of genetic, physiological, psychological, and environmental factors. The peripheral and central nervous systems (PNS and CNS) form the core of pain perception, as these are the places where stimuli are perceived and processed. One factor affecting pain perception is conditioned pain modulation (CPM), a phenomenon in which a noxious stimulus inhibits the pain caused by a different noxious stimulus. This factor is studied extensively in one of the experiments. This study aims to identify factors influencing pain experience in healthy visitors of a festival in two separate experiments. Additionally, this study proposes a more complete method to compute an individual’s CPM.

Methods: In the first experiment performed during the Betweter Festival in Utrecht, menthol and capsaicin creams were applied on the forearms of subjects, who after 5 minutes described the pain and rated it on a 0 to 10 numeric rating scale (NRS). Using data on sex, age, and selfreported pain threshold of the subjects, a logistic regression model was created. In the second experiment, CPM was investigated in subjects using cuff algometry on the lower legs. The cuff was inflated (~1 kPa/s), during which the subject rated pain on a 10-cm visual analogue scale (VAS). The pressure at which the subject started sliding was defined as the pressure pain detection threshold (PDT), the pressure at which the experiment was stopped was extracted as the pressure pain tolerance threshold (PTT). Additionally, the subjects rated pain on a 0 to 10 NRS after the test. The methods to calculate CPM were based on literature and newly developed by the study team. A logistic regression model was created to study the relation between sex, age, chronic pain, pain threshold, activity level and alcohol consumption, and an efficient CPM system.

Results: In the first experiment, 76% of the individuals (n = 181) receiving the capsaicin cream and menthol cream, were between 21 and 40 years old, and 63% were female. Overall, the capsaicin cream was considered to be more painful than the menthol cream. Being female or having a high self-reported pain threshold significantly reduced the chance of experiencing discomfort. For the menthol cream, no variable significantly affected the experience of discomfort.

In the second experiment, 82% of the individuals (n = 49) undergoing the cuff algometry study, were between 21 and 40 years old, and 61% were female. Especially at the lower pressures, there were significant differences in pressures at which a certain VAS score was reached between the baseline and conditioning tests. At the higher pressures these differences did not exist, but VAS scores were considerably lower in the conditioning test. Being female significantly increased the odds of having a good CPM mechanism.

Conclusion: Women have a smaller chance of experiencing pain following capsaicin application, and a greater chance of having a good CPM mechanism. This opens the door to the possibility that current insights on gender and sex differences in pain may be outdated. In addition, this study proposes a new method to calculate the effectiveness of CPM mechanisms, which can be improved in further research.

When people interact online, they usually present their thoughts within the context of a certain community. Naturally, just as in live face-to-face conversations, stances must be taken. The complex mechanism of stancetaking discloses how individuals evaluate their own utterances, the entities in their talk, (potential) audience and interlocutors in the online environment (following the Stance Triangle of Du Bois, 2007). This master thesis offers an innovative combination of (online) discourse analysis, medical communication and conversation analysis, since it focuses on a specific target group of chronic pain patients. The study applies the analytical toolbox by Kiesling et al. (2018) to annotate stance in the selected comments on Reddit, “the front page of the internet”. It demonstrates the universal nature of stance defined by two unifying factors: (1) online background (public social platform) and (2) topic (chronic pain). Stancetaking helps to see how chronic pain patients anonymously relate to each other, showing extremely high levels of investment and alignment. The quantitative and qualitative data analysis reveals how commenters shape and negotiate their identities online. The stances of “suffering” and “invisibility” were found to be the most common choices in patients’ comments, representing the core of their common experiences. Online communities offer a safe space in which the invisible identities of chronic pain patients become visible and acknowledged.