Dispatches from the “Olympics of Pain”

By Ingrid Birker

Remember the scene in Shrek? The one where the ogre voiced by Mike Myers is shot in the butt by an arrow and his talkative sidekick Donkey (with Eddie Murphy’s voice) goes into hysterics exclaiming: “You can’t die on me, Shrek! I’m too young for you to die! Keep your feet elevated!”

Now you may have been struck by the egotism of Donkey, but according to McGill psychologist Michael J.L. Sullivan, Donkey sees Shrek’s pain as an injustice to him and he is responding by “catastrophizing.”

Sullivan was part of a large McGill contingent at the 13th World Congress on Pain, held in Montreal Aug.29-Sept. 2. He and the team at his Centre for Research on Pain, Disability and Social Integration have used a 13-item self-report “pain catastrophizing scale” (that they developed in 1995) to measure and understand pain in terms of psychosocial categories such as rumination, magnification and helplessness. Their scale has been used in over 200 published studies to come to terms with the impact of pain on a variety of populations from athletes to dental patients.

In one of his presentations, Sullivan explained that while most people who are injured at work are able to return within a reasonable amount of time, almost 20 percent do not recover quickly and continue to live with prolonged pain and disability, resulting in a delayed return to their job. This segment of the population has strong “catastrophizing” tendencies and often fears the worst. Their fear of a re-injury, especially if the damage involves muscles or bone, makes the injury last longer and delays their return to work by months and even years if the accompanying depression is not treated.

Published last year in the journal Pain, Sullivan’s study of workers’ pain also used another famous McGill pain measurement device, the questionnaire developed four decades ago by McGill pain pioneer Ronald Melzack. Melzack’s collection of 78 “pain words” such as burning, stabbing, flickering, pulsing, radiating and nauseating, to name a few, have become the gold standard of pain metrics but it was obvious at this Congress that 6,000 international pain scientists still puzzle over why some people develop chronic pain while others are spared.

“A lot of this conference is soul-searching about what’s going on in order to make it better,” said Jeffrey Mogil, (Psychology, Canada Research Chair in Genetics of Pain), a leading authority on behavioural genetics and organizer of the Scientific part of the Congress. As McGill’s successor to Ronald Melzack since 2001, Mogil was one of the first people to identify sex-specific genetic circuitry that governs the way males and females respond to pain. Under the auspices of his Pain Genetics Lab he explores the genetic and environmental influences that combine to ‘govern’ reactions to pain and summarized the overall zeitgeist of the Congress on the first day: “Ultimately, I think it comes down to the fact that pain is deeply complex.”

Dubbing the Congress the “Olympics of Pain,” Mogil said that “pain is the number one reason people seek medical care. It is the health-related issue that people are most afraid of. If you have arthritis, your joints are degenerating, but what bothers you is the pain. Cancer sufferers are upset that they might die, but what they’re really upset about is the pain that they have to endure.”

Over the four days of posters, plenaries, workshops and presentations we learned how researchers worldwide are investigating numerous factors such as environment, genetics, gender, age and lifestyle – and how they are linked to pain. They are also making progress on regenerating nerves and preventing nerve damage. They are working on analgesics such as cannabis and fentanyl.

Mogil noted that pain isn’t often studied directly – the idea has always been that you treat the disease, and the pain will go away – because it’s underappreciated as a health problem unto itself. “In addition to being a symptom of any number of diseases, pain can be a disease in its own right,” he said. “What we really should be treating, first and foremost, is the pain. According to statistics from a presentation on ‘global pain’ by Kathleen M. Foley (Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York) we have more people living in pain in the world than living with AIDS. Mogil concurs: “There are more pain sufferers in the world than cancer, diabetes, and heart patients combined,” he said.

Ingrid Birker is the Science Outreach Coordinator. She attended the Congress to target potential speakers for McGill’s Mini Science series on Science and Pain planned for spring 2011. With apologies to DreamWorks Animation for psychoanalyzing Donkey.