In Your Pants with Dr. Susie G - Treating Chronic Pain in Children

Starting point is 00:00:00 on this episode yeah sure i guess pain is tricky because we often grow up thinking that it's like a real a really accurate measure of tissue damage you're listening to the in your pants podcast i'm your host dr suzy gronski your penis friendly pelvic health physical therapist sex counselor and educator helping you get in the know down below today's episode is brought to you by curable the curable app provides a step-by-step chronic pain recovery program complete with bite-sized pain neuroscience lessons brain retraining exercises meditations and more the curable app has helped thousands of people overcome a variety of different chronic symptoms, including pelvic pain, through its evidence-based biopsychosocial

Starting point is 00:01:03 approach. Click the link in the description below for your exclusive free six-week trial to Curable's full healing program. In today's episode, we're simplifying the complexity of pain for kids and adults. The research tells us that the relationship between pain and damage is not accurate and everything and anything can influence pain regardless of the state of the tissues if maybe everything and anything can change pain how do we do that how important is language and modeling of pain behavior for kids who then grow up to become adults and how might this influence the development of chronic pain. Where does pain science education fit in all of this? Dr. Joshua W. Pate joins me

Starting point is 00:01:59 today to unpack these questions. Dr. Joshua W. Pate is a researcher of pain in childhood and related education. He is a senior lecturer in physiotherapy. Josh is also a children's book author. Zoe and Zach's Pain Hacks has just been published, and it's a series of five books covering the latest science about pain. We hope you enjoy the show. Josh, thank you so much for being on the show today. Thanks for having me. So let's dive into this topic around pain and the complexity of pain. As a researcher yourself, help our audience, help myself and our audience unpack this complexity? Yeah, sure. I guess pain is tricky because we often grow up thinking that it's like a really accurate measure of tissue damage and health. And if we have pain,

Starting point is 00:02:58 that means there's damage. And if there's more pain, there'd be more damage. But what we see, and even in like really controlled lab studies, is that the relationship isn't that that's strong and so um and then the latest kind of theory would suggest that pain is biological psychological and social and maybe some of the listeners have heard of this biopsychosocial model um it kind of applies to all of health but i think for pain specifically it's helpful because it points out that even when you fall over and scrape your knee as a kid like if your parents are watching or if your teacher's there or if you're trying to be cool in front of your friends or like all these little tiny things and if you've had it happen before expectation lots of

Starting point is 00:03:37 things are going to play into how much pain you feel. And so I guess that is one part of the complexity. And that's something that really made me curious working when I first graduated as a physical therapist, as you call it in the States. And yeah, I was just like, how do we deal with this? How do we account for all of those other variables? And it's interesting that you mentioned the context of learning about learning how we respond to pain or potentially noxious stimulus with other people around and particularly our caregivers. I'm curious as to what research you know about, or maybe have done about when our caregivers, when our, when our caregivers respond to, when they respond to children's, you know, scraping of their knee or when they're in pain,

Starting point is 00:04:27 how does that then shape or shift the influence of that pain and that learning experience for them as adults? Yeah I think it has a huge influence and there's some lots of great psychologists working in that space of looking at the parents themselves and how does that shape like their childhood experiences predict their adult experiences and things like that and I think it certainly does. My particular research interest is in the language that gets used and And so if someone hasn't been given the vocabulary to express or communicate their pain, often you say, what's wrong? And it's just, I don't know. And you, I don't know, even now as a dad, you get frustrated.

Starting point is 00:05:09 You're like, oh, just explain what's happening. And they can't localize pain until they're a few years old. And there's all these challenges as kids grow up, like their developmental influences are influencing their vocabulary. and then if they haven't had pain experiences or haven't observed that it's a very different thing like we we did a study with eight to twelve year old kids and half of them had chronic pain experiences present or past ones and then half had never had any of those and and all of them drew injuries when we asked them to draw whatever you think of when you hear the word pain but the kids with chronic pain also then drew like hearts and and tears and sad faces and and it was like

Starting point is 00:05:47 these emotional elements the kind of if you google the word pain like the suffering part of that definition like that once someone has felt the suffering the long-term suffering that's how they define it whereas i think prior to that or if they haven't had the chronic experience of a long-term horrible time right you think of pain oh it's quite helpful like if i put my hand on the hot stove it gets it off those kind of things yeah so i guess it's maybe that different some people think of it as acute versus chronic pain um but it like our system is kind of just changing in sensitivity all the time and as time progresses if pain persists it definitely gets more and more wound up and more and more sensitive or excitable whatever word you want to use

Starting point is 00:06:33 right exactly and oh this this reminds me of a situation where you know my in my profession i specialize in pelvic health uh for for male body for for penis owners particularly and and there was a mom of a a little boy who reached out who had penile pain and and it was chronic and it just you explaining the language of like how do we explain the inexplainable of like the sensation that's going on in our body but then add to that the layer of complexity of the genitals and and and that part of the body i can't even imagine yeah and i think even like without the genital part i think it's even really hard because if a parent has a certain concept of pain we we've seen like we've got data from last year at stanford's pediatric pain clinic and and parents

Starting point is 00:07:29 don't think the same way about pain as the kids when they're even after a three-hour appointment with a health professional team they're still thinking differently and um and and a lot of it is similar but there are certain differences and they're the those differences seem to be the same things that um the research is suggesting that the education would be helpful for so maybe for that that boy that you're talking about he might think it's a really serious life limiting thing and then the mom might think a completely different thing and the dad might think a completely different thing and and so for a health professional it's like where do you start what how do you know like whose story do you prioritize and and that kind of thing I think is a real um frustration

Starting point is 00:08:12 because that's not in a textbook yet anyway um and that's really hard it is and do on that note do you have any advice for all those individuals that you named as far as how to navigate such a complex conversation like that and situation and help guide them in the best way possible that we that that we know with what we know now yeah so i've been working on these children's books which you you just showed me that you hold on a second hold on a second zoe and zack's pain house right here yeah so we've been doing research on these books and and piloting them and developing them over the past like five years or so and the language in that is very very particularly designed and even the way that it's laid out and the story focused and the characters are the main

Starting point is 00:09:03 drivers and all of that stuff I think having a common vocabulary and it probably needs to be like that lowest common denominator thing like you wouldn't want to go all right well let's just use what the the textbook of pain says like obviously you would use the simplest language and so my personal hunch is that these kids books will become the kind of common language that hopefully everyone starts using and because we don't need to over complicate something that's already very complex um so it's yeah my kind of goal with these next five or ten years is working out what's that minimal amount of intervention and education that we can give that then facilitates these conversations because i think say for that boy that you mentioned imagine he's getting home

Starting point is 00:09:46 and he's like oh mom i can't put on my undies or i can't do that like my pain will stop me from doing that um but if the education and there's been there's been advice around how it is safe to move even if it is a little bit sore or something like that having that framework and everyone on the same page can make such a difference um and then if it's framed as like an active learning journey for the kid then the parents and the coaches and the teachers everyone around them just kind of becomes the the cheer squad almost in a really positive way like it becomes very empowering for the kid rather than being told what's wrong with you buddy and they're just like i don't know and they're unable to communicate it's like hey you're learning so

Starting point is 00:10:32 much and you're growing and you're changing all the time and your your brain is amazing and all of that stuff i think those messages have like subconscious positive effects as well as the obvious ones that you see when like the messages I get saying, oh, I love the illustrations or whatever. Yeah, I think there's something really exciting in that. Wonderful. And speaking of the complexity and simplifying it for kids, kids and their parents and caregivers and educators, etc. How did you manage that? I guess, what was the process for you with Zoe and Zach's pain hacks, because you really did take such a complex topic and really funnel it into the key target pain concepts of understanding. Can you walk us through that a little bit?

Starting point is 00:11:20 Yeah, sure. Maybe if we pick one, like say in the second book, the key message is many things can turn the volume of pain up or down. Yeah. So there's this idea that there's all these biopsychosocial influences that can turn the pain up or down and and my favorite study when i was working clinically prior to doing academia was i love talking about this study it's from the early 2000s and basically people had a really cold metal rod put on their hand it was like minus 20 degrees celsius so freezing freezing cold and they felt more pain in the presence of a red light in the room than in the presence of a blue light and that just was mind-blowing to me and it opens up all these possibilities like in the book we say if a little light can change the volume of pain

Starting point is 00:12:05 like there must be so much more possible in your brainy brain like that that kind of um fun exploratory idea of going oh like zoe went and visited her smart grandma we we personified the authors as a as zoe's grandma um being a science uh lab expert superstar kind of person and i guess so where that so it started with a scientific paper that has good scientific rigor and merit and it's worth talking about as a clinician and then it was like well you can't just say the results oh the confidence interval didn't cross zero so like you can't you can't say that to a kid right like that doesn't make sense so it's like okay let's build this into a narrative and let's make this rhyme and and then we did there were several ideas and then i we piloted one

Starting point is 00:12:52 one of the books and compared it to a sham book and so i've worked on with ted ed on some animation videos and they let me use the images so both books had awesome pictures they both rhymed but one just explained how to rate pain out of 10 and then the other book explained this message of pain doesn't mean damage or it doesn't necessarily correlate with damage and what we did was give them it's called it's called a sked study it's a complex methodology but the idea was kids got to act as their own control group and we saw that the language that they use is different once they receive the the real the intervention book and and the number of times they're reading the book is it's more engaging and um the way that they think about pain also changed um in the interview

Starting point is 00:13:40 following the the real book rather than the sham book and and so i guess a lot of um data has driven what what ended up being in the book because that was a couple of years ago now like we're still writing up the paper but um the books changed a lot because of that and it meant so we initially had that qualitative study where we got the kids language and then we used that in the books combined with the scientific papers and then we grabbed all of that stuff made the stories then we've been testing that and i guess it's those iterations like all the co-design co-design is all the rage at the moment and like it's for a good reason like if you get kids to be a part of the design it's way funnier like there's all these jokes the second time you read the books like if

Starting point is 00:14:23 you're looking out for dogs there's dogs everywhere and and then there's like little easter eggs and things um and and yeah if you just didn't have kids involved in that the books wouldn't be as like they wouldn't want to come back as many times as they what i am hearing that they do so far um does that make sense have i answered your question it totally makes sense and i just want to just again because you you you referenced the second book in your five book series here it is as far as uh lights up zoe zoppins lights it up and this is the particular study in section uh around there it is around the the red light and the blue light and the cold rod uh it's brilliant it is absolutely brilliant the linguistics how intentional how purposeful everything has been

Starting point is 00:15:12 i mean you can't miss it and i i'm it's just such a wonderful not just for kiddos but also for adults I have found. And I have to say that it really does help bring that narrative to light for someone and understanding it in the most simplistic way. And as an educator myself and clinician, this is just priceless to have as a resource in my back pocket to say, you know, you're feeling really overwhelmed today. This might seem really silly. Just take one of these books it seems like a kid's book but it's packed it's packed with life-changing information are you willing are you willing to kind of make this book for a ride you know because it's simple it's easy and you know you know i don't have to tell you this but the overwhelm that the even the

Starting point is 00:16:04 ability to concentrate and process new information and learn is really difficult with chronic pain And so having this and saying like, this might be silly, it's got lots of images, it's a cartoon, think of it as a comic book, just go through it and let me know what you think, you know? So simple. Yeah, yeah. And that, yeah, that idea of kind of lowering the bar for entry, like that was one of the main criticisms of this pain science education type work is it, or not everyone needs to become a scientist to get better. And I totally agree. And so that's why it's five separate books, like maybe there's a specific gap or a specific misconception that you identify clinically, and then you can start there. and so you're taking them on a patient-led journey like they're you're there with them but they're kind of guiding the process and i i really i think that's so powerful like and even when we're up to the very first book and i was working clinically in an adult pain clinic the non-english speaking patients and like who speak a tiny bit of english and the patients who are on high doses of medications like lyrica where they have brain fog kind of like what you were mentioning they really

Starting point is 00:17:13 liked the kid's book idea because it just it's like oh okay well i could get this because a kid understands that like it it just has the perception of this is possible um whereas sometimes if you show a video of a scientist or if you i don't like there's just other resources out there that that are brilliant and accurate and true but i think what sets this apart and what we're seeing is that it's that accessible like it looks like a mainstream pop culture book kind of thing like it just you want to read it and check it out and and kids want to keep reading it and and i think that's the other thing that's really exciting is like i've done some work with amazing animators and done online things but kids the video reading of the book in the studies they only watch the

Starting point is 00:18:01 video once like that was the maximum number of times someone engaged with the book whereas if they had the physical copy it was like two to four times in in a week period like it was so much more and this is a small study and it's an early thing but to me like and it makes a lot of sense even just with my I've got a five-year-old and and seeing her children's book you keep coming back every bedtime it's like oh what are we going to read tonight like and I think that is yeah there's something there like hearing the the same key messages over and over helps it to stick a bit deeper because for a lot of people, they hear the message, oh, feeling pain, like even a light can change the experience of pain. Wow, that's crazy. And that's it. They leave it as a fun fact

Starting point is 00:18:44 and they don't apply it to their life. And so at the end of each book, we've got these interactive questions and then it takes you to an online platform and then you can print stuff off and there's worksheets. All of that stuff is built to try and engage actual behavior change. We don't want to just change the way you're thinking or just provide language. Those things are great and i do want to do those things but we also want to see actual change in improvements in life um in a long-term capacity not just short term yeah right and thank you for bringing up that very important point of we how do you apply this information practically otherwise it's just a dump of information that is meaningless without the experiential um discovery of wow actually this

Starting point is 00:19:28 is really true and gaining some conviction about this education and this knowledge that then really transforms into something powerful because once you really gain that conviction it's really hard to take that away you know a really strong belief in something is very challenging then to kind of just it's not so wishy-washy anymore yeah yeah that's right and and the kids so the kids really relate to the characters and so in the fourth book we zoe's cousin zach has he's looking back and being like hey i'm back at school like my back pain isn't interfering in my life anymore and zoe's just kind of they're playing in the backyard dressed up and being silly and she's just like i don't how how did that happen like i've got tummy pain and it's not happening for me

Starting point is 00:20:12 and then he talks about how he degraded exposure and pacing and some of the strategies in a kid friendly way um and then in the fifth book it fast forwards and you see zoe looking back seven weeks into her action plan she's not completely recovered or anything yet but she's now the things that were triggering her like public speaking and getting teased and all these different moments we walk through a typical day like she's at soccer training all these things where her tummy pain would have flared up and now it's not and and then you're left the readers kind of left going well what did she do and then you fold out and there's like 50 something strategies she's been implementing consistently for seven weeks um and and you start seeing that hey zach

Starting point is 00:20:54 did it that way zoe did it that way and then zoe like zoe turns to the reader and says like what's your action-packed action plan gonna look like and and i think that's where the rubber hits the road for me like that's the moment for a kid where it might be four or five sessions into seeing them where the parents just like okay i think they've got it now like they've read that fifth book a few times and they want to make their own plan like can we do that in the next session together that moment is really nice i think because that's going to be stuck on their wall that's going to be the thing that they refer to as like that anchor of that was when i checked like that was when i returned back to school or that was when i started playing sport again

Starting point is 00:21:34 um and and it it really um empowers those small accumulating small wins like those small behavior changes yeah and how it just really blends into their these are life skills it's it's these are life skills of of resiliency and mental flexibility and that they can pass along to others and it's kind of like you're planting seeds with these books you know all over the world planting seeds that's awesome I'm so glad you've spotted that because we're doing like I have a PhD student who were going into schools and teaching teachers like hey if danger outweighs safety it makes sense that there would be pain in the classroom and then they like straight away they're already thinking biopsychosocially but they don't have the language like they're teaching well-being and resilience

Starting point is 00:22:25 they know this stuff but they go oh that makes sense like all the kids have that that's when they have their tummy pain when there's a maths test and you're like oh okay yeah and so we're just in such early days of this preventative type education being tested and to see if it's effective like i i think it has the potential and it and it makes logical sense um but we haven't tested to see if if someone learns this at say age eight to ten and they don't have chronic pain does it prevent pain-related disability or something like like that's kind of where we want to head down the track. And yeah, I just think of my experience as a kid, I didn't have chronic pain, but like the statistics show that there's a couple of kids in every classroom on

Starting point is 00:23:10 average who have it and it's invisible and it's impacting on their life. And I reckon a lot of the stigma and a lot of these other issues around how it's managed in a class actually could be addressed with this kind of education as well like if everyone knew that it was really burdening them and that there's support out there and that multidisciplinary care is good and those kind of things I think there would be that like I reckon I would have been a nicer person I don't know if I can't remember if I was nice or rude to anyone in particular but like I'd imagine there's this increased empathy maybe like of going hey this is really complex like every when you see someone crying it's like wow those feelings are really complicated i wonder what the the web of

Starting point is 00:23:56 complexity is underneath those tears um rather than being like oh why are they crying again like it's such a different reaction as someone kind of just observing and then i think if you saw that manage well then you would like if i was to develop pain for a few months or something the chances of me then having days off work or from school or whatever it was would be less because you would realize that the behaviors are influencing the future outcomes and and some of that stuff like kind of will naturally flow like as you say planting seeds is is kind of that's the dream right like i haven't shared this whole lot yet but but that's where we're heading with our research is we want to test this and and see if there is merit in in this kind of hypothesis

Starting point is 00:24:39 oh i'm glad i went there because that was actually my question of like where do you see this heading and what's the future like for for this research and these books and i think you really you really nailed it yeah yeah it's a really exciting time and I think there's more and more teams working on this around the world and I think I just want to highlight that that I'm not it's not my books like there's so many people who have contributed to this this project um in particular but then also like the future of research is not in one person or one team like there's so many people that need to work on this and and what we're seeing even like in the one of the studies we're doing in australia is different school systems are able to implement this kind of education in

Starting point is 00:25:22 different ways like sometimes it's in the health and well-being curriculum and sometimes it's in the neuroscience in early high school um and like that's going to be different in different cultures that's going to be different in different countries with different languages like there is so so much work to be done and so i guess to answer that future question it's like there is there is a million options and uh maybe maybe all this ai will help us or something ah yes yes oh speaking of different languages and cultures do have and and forgive me for my ignorance if i don't know but are the books there are they just in english or do are you planning to have the moment okay yes i i would love that and there's people emailing me and i am um the instructions i've

Starting point is 00:26:06 had from the publishers just let us know if people want to translate it and it kind of i think it just it costs a lot to produce books like from a publisher's point of view and so to make a new language or whatever they really would need like the the uh what do you call it like the market need or whatever um really obvious and so there's a bunch of people kind of lined up for different languages but it hasn't started yet um and i'd imagine just people doing it informally um is kind of the the starting step and and i guess this is maybe a good moment to mention we built an online portal like that relates to the books and and that's freely available and people are translating some of those worksheets and stuff like that because it's just like a couple of

Starting point is 00:26:49 sentences it's not a whole resource that rhymes um and i really i'm so excited about that because as the evidence changes and and as we learn more about these key messages and what's most beneficial and all of those things we can keep updating it and so you finish reading a book you scan the qr code it takes you to the website then there's videos and then for clinicians there's all the evidence behind the the books and for the parents there's instructions and some facilitating kind of questions and and for teachers there's like lesson plans and and then for the kids there's just more activities like heaps more fun stuff so um yeah i i think that this kind of back and forth engagement in resources will be the future from what i can gather um but yeah i'm really

Starting point is 00:27:34 excited to keep developing more and more help hopefully helpful um patient resources and testing them out in my research so yeah oh that's wonderful and we'll be sure you know josh can use we'll share that link and have it in the show notes so people can access it um readily the online portal that you're talking about yeah cool it's just zoeandzachspainhacks.com yeah awesome awesome awesome well speaking of other resources um i know you had mentioned a couple of other resources other than the book and then the online um anything else that you'd like to share with with the audience as far as resources and support um yeah i mean it's funny working as a researcher like you you spend years on a paper and you publish it and then like a couple of

Starting point is 00:28:21 thousand people maximum sort of read it within that first little period um and whereas if you're developing a resource it's like you're on the radio and it's going out to the masses and and the first time i experienced that was working with ted ed on an animation and it and like i've done two of them now and it's just millions of people see this and so i think that's like this whole another level of engagement and that like say say the mysterious science of pain video i think that's in like 13 languages and and that's been seen so so many times and not just in clinics or in houses or in schools or like it's in hospitals and in academic settings and i think that's the that's probably the video that the resource that I've been a part of where I get the most random like

Starting point is 00:29:06 cold emails um from and that's really exciting so if anyone's listening I'd love to hear from you I find it very encouraging um and yeah I guess there's so there's a bunch of resources on my website that I set up there's just kind of links lists of links and videos and things and podcasts like this um yeah I I think it'll be an ever-growing list and as the number of people working in the field there'll be better and better resources available and i'll be spruiking for whatever is out there and is best so um that's it's an exciting time i think i think we have more reason for hope about chronic pain than we've ever had in terms of the science yeah i i agree i agree wholeheartedly absolutely josh thank you so much uh i one last question as far as where you

Starting point is 00:29:53 live on the social social media platforms if folks clinicians anyone listening or watching this wanted to connect with you yeah if you just type in joshua w pate it will come up most like so i post academic-ish stuff on twitter primarily um instagram is like more directed to families and clinicians and kids um and then like linkedin is like i guess i also have that um i teach at a university the master's of physio program so that's kind of there um so i'm around i'm available i i haven't gotten into the um those other platforms where like people are scrolling every three seconds i i don't know how to engage someone in three seconds about this stuff so um if anyone has ideas or wants to to launch a tiktok for me happy i don't don't really want

Starting point is 00:30:45 to do it. I hear you on that one. I refuse to jump on ship on that. Yeah, YouTube and Instagram is enough for me. It's more than enough at this moment. Well, thank you, Josh. Again, thank you so much for being on the show. And we'll make sure to link the Mysterious Science of Pain, your videos, your website, Zoe and Zach's Pain Hacks, everything that you've mentioned here, we will definitely link to the show notes and the description below in the YouTube video. So much appreciation for all the work that you have done in collaboration, certainly with many other mentors and giants that we ride on the shoulders of. So I really thank you so much for changing the world. I know you have really, really supported my practice and helped in so many ways.

Starting point is 00:31:37 so thank you oh thanks suzy that yeah and likewise you thank you for doing what you do i think you do a great job promoting evidence-based stuff online which is great too thanks thanks and to all of our viewers and listeners out there thank you so much for watching and being here as always and loving wellness for your pelvis this is dr suzy g thanks for listening to today's episode be sure to visit Visit my website drsusieg.com for show notes and related resources on today's topic. If you like what you're hearing, head on over to YouTube and subscribe to my channel. On my YouTube channel, you'll find content related to sex, pelvic health, and expert interviews for men.

Starting point is 00:32:27 If you got a question or a topic that you'd like me to answer on my channel, be sure to to type it in the comment box below.

In Your Pants with Dr. Susie G - Treating Chronic Pain in Children

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