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Joe Tatta, PT, DPT

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How To Translate Research Into Practice And Improve Pain Management with Dr. Steven Kamper, PT, PhD

Welcome back to the Healing Pain Podcast with Dr. Steven Kamper, PT, PhD

A niche in the medical field that is rarely explored is children and pain. This is where Dr. Steven Kamper, PT, PhD found a good place to research as he reviewed its relationship to the parents’ pain. This also leads to his passion to pursue the process of integrating research into practice. Dr. Kamper takes us into a more profound understanding of research as he discusses the importance of evidence-based practice or research into clinical care.

We are discussing how to translate the rapidly growing body of medical research surrounding pain into clinical practice. Our expert guest is Dr. Steven Kamper. He is a clinical researcher with a background in physiotherapy. His PhD was awarded by the Sydney Medical School at the University of Sydney in 2011. He is an Associate Professor in the School of Public Health at the University of Sydney where he leads the pediatric team. He also established and co-leads the Centre for Pain, Health and Lifestyle. A practice research partnership focused on investigating the interaction between pain and broader health risk factors such as obesity, smoking, alcohol misuse and poor mental health. Dr. Kamper has a large and growing body of research. He has published more than 120 articles and has presented his work more than 60 times in over ten different countries.

As a free gift, Dr. Kamper has provided two of his research articles which will help inform what we’ll talk about on this episode. The first article is called Musculoskeletal Pain in Children and Adolescents: A Way Forward. This is an update and a fresh perspective about pain in children and adolescents. The second is a paper called Evidence in Practice: A New Series for Clinicians. This will help practicing physical therapists build expertise and understanding research so they can translate the knowledge into clinical practice. To download these two free papers. All you have to do is text the word 125 Download to the number 44222 or you can open up a new browser on your computer and you can type in the URL, www.DrJoeTatta.com/125download.

Make sure you take a moment now to either text that or download that information there. They’re great articles, especially if you’re a practitioner and you want to get a taste of what’s up and coming as far as pediatric pain and research. If you want to learn how to read research so that’s easy to integrate into clinical practice. I’m excited about this episode. It’s a great one. Steven is an expert at research and health and lifestyle as it relates to chronic pain. Let’s begin and let’s welcome Dr. Steven Kamper.

 

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How To Translate Research Into Practice And Improve Pain Management with Dr. Steven Kamper, PT, PhD

Steven, welcome. It’s great to have you here.

Thanks so much, Joe.

I know we’re going to talk a lot of things about kids or adolescents with pain. We’re going to touch on that topic and we’re also going to touch on the importance of translating evidence-based practice or research into clinical care or how it can inform clinical care. Why don’t you tell us first how you got started out and how you became interested in pain?

Being a physio is a second career for me. I had a bit of an early midlife crisis. I was an environmental scientist originally and I worked in that field for a while. Then I went back and took a vow of poverty and did an undergraduate degree in physio. At that point, I was thinking, “I’ll have a clinical career.” During that time, I did some casual work as a research assistant for one of the researchers who was also one of the teachers in the program and enjoyed it. I enjoyed the atmosphere, the environment and the work. I did that for a short period of time. When I finished my degree, I went into clinical practice for a bit and after not too long a time, I had an opportunity to do a PhD, so I came back and did a PhD and worked clinically part-time during that period. The research topic on that was people with whiplash. I did some researching in people with whiplash.

The group generally is probably best known for working in back pain. That has also formed part of the stuff that I was interested in and the stuff that I did. I didn’t go into it with a burning desire to solve the problems of pain in the world. I like the work we did. It was stimulating and interesting. I like the environment, I like the people that we’re working with and that was the work that I’ve been doing. All of us spend a bit of time in their career where you start to think, “What the hell am I doing? What am I doing?” What I’ve come to at this point is I’m interested in trying to understand what happens in the world. That goes back to the environmental science stuff I was doing as well. I’m interested in the way the world looks and those things. I see this as an application to people. The other side of it is I feel like I’m doing something useful. Working with the goal of making life better with people for particular conditions fits for me. I could equally have been happy doing research into diabetes or cancer or brain injury or whatever else. It just happens this is where I ended up and I enjoy it so it’s good.

Where did you complete your PhD and how long did that take?

I was at the University of Sydney. It was three and a half years. I did full-time. During that time, the group that I was working with moved from the University of Sydney, the Faculty of Health Sciences to a medical research institute called the George Institute, an institute which does research into non-communicable diseases in a lot of fields. They do cardiovascular research. They do injury research, neurological and mental health, food policy, those things. We had to vision out our group came and formed a musculoskeletal health research group within the George Institute. That’s where I did most of my PhD work.

I know you’re involved in lifestyle medicine. How did you segue from PhD in whiplash to lifestyle factors?

After I finished my PhD, I did a post-Doc in Amsterdam. I also did very much in the MSK pain world and also a bit of methodological stuff, understanding measurement, that sort of thing as well and also some stuff in patient expectations and placebo effects and so on. That time also, any person involved in a research career will tell you after you finish your PhD that if you’re lucky enough to get a postdoc position somewhere, that’s when the pressure comes, “Who are you going to be? How are you going to be known as a researcher?” There’s this period where you’re going, “What am I going to do? Where’s my nation?” I spent a couple of years in Amsterdam trying to work that out and to be honest, I came up with a few ideas that were not going to work. Towards the end of that, I started to work more closely with a colleague who had done his PhD. He’s a couple of years behind me at the George Institute. He subsequently went and worked for a population health unit in a city about two hours north of Sydney.

He started working the research that we’re doing in that unit and the service that they were providing was very much around population health stuff. It’s around smoking, alcohol use, diet, physical activity and that stuff. He brought his background in pain research to that environment. We started working quite closely together a few years ago and developing our ideas as they are. These may not be unique ideas, but it’s given us this nice perspective where we have a background and are based in clinical services and understanding pain as it relates to people who are presenting for care with pain conditions, this idea of what’s happening to people in the broader population. Because population health and public health services have never considered pain within their remit, that blend of perspectives is what opened up my eyes in terms of the possibilities to the things that we might be involved in.

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Just define for us the difference between population health versus public health.

It depends on who you ask. One way of defining it, public health might include things which go way beyond what we might consider health. We might be considering the effects of social housing on health. We might be considering the effects of education on health. Socioeconomic factors more broadly that indirectly affect health. That whole sphere might be defined as public health sphere. Population health services tend to be interventions broadly which are delivered to the broader population. That’s beyond people who are presenting the care. That might include things like television ads to encourage people to stop smoking or to use sunscreen or to use condoms or whatever else. It might include programs into schools to increase physical activity in the playground or this sort of stuff. The idea is that public health might be considered a broad concept within which population health services might be delivered as well. That one definition.

Probably it gives everyone some good perspectives. When it comes to public health context, you study it with regard to Australia.

Certainly in terms of public health. The factors which might be influential is very different from one place to another. You’re absolutely right. If I understand where you’re going with this, the influences on people’s health in Australia might be very different from the influences on people’s health in Central Africa or something like this.

When you start talking about public health, you were talking about advertising. Advertising can be leveraged for good reasons, to educate the broader public like you mentioned, condom use to prevent HIV for instance. We can use our advertising dollars to broadcast an opioid commercial in the middle of Super Bowl, which is probably one of the largest events in the world which may benefit some patients, but maybe adversely beneficial for others. It’s interesting to think about those things. What have you learned about Australia as far as public health and pain that maybe can apply to other countries? I’m here in the United States, but I think our countries are similar although you guys have pretty good research and are ahead of us as far as pain research goes.

HPP 125 | Pain Management

Public health might include things which go way beyond what we might consider health. Population health services tend to be interventions which are delivered to the broader population.

 

One of the key things that stressed as well, this is a relatively new field for me and for Chris Williams that I work most closely with. We’re finding out our ideas developing all the time. One of the things that we have become increasingly interested in is this idea of conceptualizing pain as public health or population health issue. If we think about the health of the general population and the things that we might think about in that context, we were very used to or comfortable with the idea of thinking about obesity, cardiovascular risk, smoking, alcohol use and those sorts of things. We don’t think about pain in terms of how that affects health more broadly.

We think of pain as this specific clinical issue which is attached to us a certain condition. One of the things we’ve become interested in, and this is eminently transferable across different contexts and places, is the idea of what does it mean to talk about pain in terms of public health? The nice thing is that what we think is beneficial in terms of reducing the impact of pain on individuals is probably quite similar for a lot. If we think about what we should be doing to reduce overweight and obesity or what we should be doing to reduce the burden of diabetes or even cancer or whatever else, we need to get people active. We need to reduce anxiety. We need to get people involved in having a good diet and all these sorts of things.

One of the things we also come to is this idea that it’s hard to get people to change their behavior for the good of the health in the long-term. It’s hard to get people to exercise more so they’re less likely to have a heart attack in 10,20 or 30 years. It’s hard to get people to stop smoking so they don’t get lung cancer in 30 years’ time. We’re interested in this idea that perhaps there’s something we can leverage about the immediacy of pain to promote behavior change. At this point, that’s an idea that we haven’t worked out how to do. We have this idea that moving more is likely to help the way that you feel. Whether that affects your pain intensity as we measure it per se immediately or whether that makes you feel a bit better about your life in the context of having pain. Then we think that’s maybe a hook that we could potentially use to get people moving more. These are ideas that are relatively new for us that we haven’t quite worked out how to do that.

It’s interesting though because what you’re saying is the lessons are the same, but the messaging might have to be different for the condition. We have the guidelines for physical fitness in the United States of America for years that pretty much haven’t changed much, but they’re general guidelines for exercise. We may need to forget ways to deliver them in a different way or in a way that is more exacting for people with pain.

We also need to think about what does the package look like. Exercise is more than just saying you need to do this activity for this period of time. Why should you do that? Is it going to help me or harm me? The important element about it is how do we generate that motivation and address whatever the barriers are to delivering that. Because we know people know that exercise is good for them, but most people don’t do it. We’re missing something. It is something between the knowledge and the behavior. I suspect that is something which needs to be tailored to the individual. There are some general things that we can talk about to people who have pain, which may make that link.

The other thing about pain is from a population perspective. There are lots and lots of people who have pain. If we’re thinking, “You need to be more active in order to reduce your risk of heart attack.” Someone says, “Okay but when I go for a run my knees hurt.” That’s a specific barrier. That’s not a small group of people. That’s a very large group of people. We’ve got a barrier to physical activity, which we know is beneficial and that’s what we don’t address in the population health context. The interventions that are delivered out don’t pay any attention to people’s pain. Our suspicion is that pain is potentially a barrier to those healthy behaviors for some people.

Looking into the behavioral aspects of change that’s required for people with pain, I know another area of passion of yours is adolescents who have pain or children who have pain. We’re trying to look into that because we don’t have a large body of research around that. Tell us where we are currently with children and pain.

This is an interesting area for me and particularly because there’s not much out there. From a purely pragmatic perspective from my point of view as a researcher, I need to find a niche. Areas which we think is a problem and don’t have much research, it might be a fertile ground for research niches. There are some practical reasons why I might be interested in this thing. There are a couple of good reasons why I think it’s a good place to be researching also. One is that full musculoskeletal pain, particularly things which have a big burden in back pain and neck pain and that sort of stuff. Particularly with my background anyway. The most consistent risk factor that comes up is having had a previous episode. If we’re going to understand something about prevention or even something about the pathology, we need to start looking earlier on. That gives us a reason to be thinking earlier on.

The other thing which is relevant is there are also some data which suggests that having persistent pain as an adolescent makes you at higher risk of persistent pain as an adult. We don’t know the nature of why that might be or whether that’s confounded or whatever else it is, but it suggests it’s a good place to be looking. The other thing is just the prevalence of pain during that adolescent period. Things like back pain and neck pain go from tiny insignificant figures in terms of the prevalence in children under ten, eleven years of age. By the time they reached the end of adolescence, that prevalence is starting to look like adult figures. We have this massive rise through adolescence and we have no idea what is going on there.

Why is that happening? In terms of understanding these conditions which are associated with a huge burden societally and individually throughout the lifespan. It just points to the idea that it seems like a good place to go looking for or to try and develop our understanding of what’s going on. The other thing is because there’s no research in this area, what do we tell parents to do? How do clinicians know what to do? How do it will not know what to do? There is very little information being fed into those groups of people and the young people themselves as to what they should do. There are a whole host of reasons why it’s a good place to be looking at pain.

What you’re saying is for many adolescents, we can start to figure out where we can put detour signs. If they have started to develop pain in the adolescence that goes into early adulthood, that might be the prime time.

For sure and there’s an even more immediate issue. We don’t know who to be worried about. It’s very likely that for the majority of adolescents who experience pain, it’s just going to go away and it’s not going to be a great problem for them. Maybe I limped around where it will be sore for a couple of days or whatever else, but it goes away and it doesn’t have a significant impact that doesn’t need care and whatever else. For another group and probably we suspect a substantial but still quite a minority. There may be missing school. They may be taking medication. They may have to seek care. They may be missing out on sport and leisure activities. They may not be able to socialize, these sorts of things.

It’s undeniable that all these things are important to the development of people generally, but developmentally they’re important for adolescents as well. The point is that we don’t know how to pick one from the other. If someone goes out to care to a physio or to a doctor, to a chiropractor, osteopath or whatever. The back hurts for two or three days, we don’t know whether to say, “You’re going to be fine. It’s going to settle down. Do this, do that, but don’t worry about it. This is something we need to do.” Quite apart from the fact that we don’t know what we need to do. That’s an important thing because one of the things we don’t want to do is put people in care who don’t need it. The only thing we can do then is stop them. We don’t want people who are going to get better anyway in front of healthcare professionals. We don’t want people in the healthcare system that don’t need to be there. At this point in time, I don’t think we have any good information to know who is who.

We don’t know, for instance, if a teen develops low back pain. That early physical therapy might prevent that from progressing. We don’t have that information yet.

We don’t and I would suspect some of them are going to get better anyway or most of them are probably going to get better anyway. Some of them are going to need something more. The first thing we need to work out is who’s who and make sure that those ones who are going to get better anyway are given some reassurance and given some support. Their parents are given some reassurance and support. This is where we feed into the broader understanding of what pain is and how it worked in the population. Hopefully, their teachers understand that this is going to be okay and they’re going to be all right and when they need more care. This is probably a nice example where those different perspectives fit together quite nicely. That involves educating parents that may or may not have pain themselves, involves educating teachers who may or may not have pain themselves, but have people in their care. That’s a key thing that we need to get at initially along with trying to understand, these kids who we suspect might have the problem, what do we do for them?

HPP 125 | Pain Management

If we’re going to understand something about prevention or even something about the pathology, we need to start looking earlier on.

 

I know you’re in contact with a lot of researchers. Maybe we can dance around some of the myths about kids and pain. A lot of them might revolve around back pain but not necessarily. Maybe this is a good way to test my biases too in any way. Backpacks and kids with back pain.

I was involved in a big review which came out. We had 70 studies or something which looked at the association between backpack use and pain. In some ways, this is an unusual case in the pediatric pain field because there is a lot of research there. What I certainly would expect if there was a real and important connection between pain and backpack use, then across that many studies, we’d get some relative consistency. There’s always going to be noise if you like. What we found was pretty much only noise. When we look at what we think is the most robustly designed studies, there’s very little there.

The message or what we took out of that is there are better things to worry about than backpacks. We’re best to be guided by if you’ve got a kid and they’re fine and they put their backpack on and bicycling and bicycling, they may take it off. Then look what’s in your backpack and maybe we can reduce it or whatever else. As a general rule, and this is also one of the things that we thought was actually a good news message out of this. Parents have got enough stuff to worry about with their kids, don’t worry about their backpacks.

That’s the least things to worry about is how many books are in your kid’s bag. That’s okay. What about sports? I was a gymnast as a kid. There are numbers of people who have said to me, “Your spine must be trashed from doing that sport as a kid.” I laughed at them. The sport probably made me stronger and taught me how to care for my back more than anything else. What’s the research say about sports and kids with pain?

Sports in particular and physical activity more generally. There are some ideas around this. This idea of U-shaped relationships. If you do very little, you’re more likely to have pain. If you do a lot, you’re more likely to have pain. If you do something in the middle, you’re probably best off. There’s a little bit of support for that, but not much. The studies that have been done are all over the place. It’s hard to know essentially. There’s this research a little bit more generally that early specialization is potentially not a good idea. This idea that it’s best to expose children, probably people generally, do a range of activities rather than the same thing over and over again. That seems intuitively pretty reasonable.

As far as the research on sports and pain, it’s a bit mix. There’s a suggestion that focusing kids on the high-intensity stuff, repetitive stuff is probably not a great idea. Beyond that, we don’t know. The problem with those studies is they tend to be very small because there are not bags and bags of those kids. The other side of this is understanding research, which is aimed at understanding risk factors. When I talk about risk factors, I’m talking about causal risk factors. Factors which would actually cause an outcome. It’s really difficult to do well. It’s costly. It takes a long time. It takes enormous resources. In some ways, it’s not surprising that the information that we have is not particularly robust. It’s relatively easy to collect data from the whole hype of people at one go and then collect some variables in it and look at associations. That’s easy but there are also the problems with interpreting that information in a way which suggests what is causing pain.

We can go down the list with kids but moving from the physical biomechanical type to psychosocial, kids going through stress, through adolescence can be challenging for kids. Any impact on that as far as the permanence, so the persistence of chronic pain.

It’s very likely that there’s an association between the social and psychological stresses that kids might have in adolescence and the experience of pain. Where the one causes the other, one or something else causes both, we really don’t know. Part of the issue is that they’re pretty plausible arguments in both directions and also probably plausible arguments at something else does calls. Interestingly, we’re involved in the final touches of a review at the moment, which looks at whether there’s a relationship between where the parents have pain, whether the kids who have parents who have pain are more likely to have pain. We found a reasonably consistent relationship.

If parents have pain, it’s more likely that their kids will. As to what the mechanism by which that occurs, we have no idea. You could posit a genetic argument that there might be something about that person structurally. You can posit a genetic argument which relates to psychology as well. You could posit an argument which is something about the environment that’s created within that family unit and so on. This probably speaks to the last point that I made that showing relationships between variables are relatively easy. Understanding causal relationships, which is what we need to, I understand the pathology, but to design targeted treatments is difficult. It’s a very difficult research to do or to do well, anyway.

That’s a perfect segue into our next topic. I know another passion of yours is helping clinicians look at the evidence and integrate it into practice. You’re a researcher and it’s a sweet spot for you. When I hear that, I’ll give you my personal opinion on that. My first thought is, “Didn’t I learn about research in PT school?” We took classes and I probably took up probably two classes, probably worth six credits on research. Education varies from US-based schools to other types of schools. How deep do we need to understand the research for us to work in evidence-based practice?

I would say the short answer to that is you need to be able to pick up any article and tell whether it’s any good or not. You also need to understand that I’ll test my own biases. You also need to have an appreciation of what they are and how they relate to whatever it is that you’re rating. My experience in talking to some people about research is that I don’t think generally the understanding that a lot of clinicians have of research methods is sufficient to appraise a study that’s sitting in front of them. What that does is it just makes you so much more susceptible to interpreting something on the basis of your own biases as opposed to interpreting something on the basis of the quality of the evidence that’s presented. Maybe we have a different view of what I think generally the competence of a lot of clinicians is in terms of understanding evidence. Certainly, some of the surveys that have been done have identified that lack of skill as a barrier to engaging or consuming evidence well.

I did some research on my PhD programs and looking at them and I can see these are US based programs. Most of them want you to do about twelve to fifteen credits in biostatistics and evidence-based type of research classes that prepare you for your research and your dissertation. The average PT program, the average DPT program in the US has six credits built into the program of research. As a DPT in the US, we’re getting at least six credits. If you want to go on to your PhD and do formal research, you need more training. My question as a practitioner, because I’m mostly a practitioner, is the onus on me as a practitioner to understand research or is it on the researcher to skillfully write their paper in a way that I can understand it and makes the points of the research clear and maybe points out, “This is what I discovered. This is what I know. This is what we don’t know and here’s how you can now use that?”

I see where you’re coming from. In an ideal world, that would be the case. This is not to excuse poor practice among researchers, but the reality of great working research is that there are some perverse incentives to which result in a lot of stuff being published, which is not relevant and not a good quality and a lot of stuff which is misinterpreted. That’s the environment or the situation that clinicians have to work in. From my point of view, I take my responsibility very seriously to present research in a way which is faithful to the research. I can make that commitment myself. In short, there’s a lot of garbage out there. At the end of the day, clinicians got to see through that garbage.

I appreciate you saying that because it can be a challenge. Even if you’re looking at a meta-analysis, personal judgment and personal bias even route up in the meta-analysis, which technically is at the top of the pyramid as far as research is concerned. I would love to see a paper on that. How would you read between the lines and figure out where someone’s personal bias might be in the research? That is super interesting.

This is where I grew with it completely. I’ll get my take on that is the way for you to learn that or the way for people to learn that is to understand the method. If as a consumer research you understand best practice and I’ll touch on what you mentioned that meta-analysis is at the top of the evidence tray. You need to understand why that is and also the fact that just because it’s called a meta-analysis and therefore should double the tray, it doesn’t mean it provides worthwhile evidence. Everything needs to pay a price. There are issues with that evidence hierarchy because it doesn’t overcome the problem of poor studies. You can have a poor study of a design which is by any other measure robust, but still a poor study. That’s what clinicians need to understand that it’s not enough to know that evidence tray. What it needs to come through is first of all, why does that tray exist? What is it about those study designs which puts things above or below or whatever else it is?

HPP 125 | Pain Management

It’s very likely that there’s an association between the social and psychological stresses that kids might have in adolescence and the experience of pain.

 

Then you still need to go into that study and read it and understand the method and understand what’s good and bad about it. The way that I’d like to think about this is as a clinician, as a person, we have information which comes from all different sources. If a clinician is standing in front of a patient, you have information from your training. You have information which comes from the person in front of you which you interpret and you interpret what they say, the way they’re moving and the way that they’re looking and all this stuff. You have some skills in that which should be developed by being a person among other people. There are sources of information and the whole time, you’re appraising those sources of information. You’re trying to think what does this mean and what cannot be wrong about this and could not be right about this? How should I interpret it?

It’s no different for research evidence. It’s just another source of information which comes in. The difference is that there’s a framework for helping you decide what’s worthwhile and what’s not. You do that automatically for other sources of information. You don’t do it automatically for research because we’re not as familiar with that stuff. I don’t see evidence as we call it, as any different to another source of information. It’s all information which we need to put together. This is the fallacy of evidence-based practice that it wants to turn everyone into a robot and make all treatment like a cookbook.

My view is to be an evidence-based practitioner is much harder because it forces you then to apply all these sources of information including these other sources as well. You don’t get to just bring that in and stick it over the top of it. It was never the idea of it. The idea is it’s a practice which is informed by the best available research. It’s informed by it, it’s not directed by it. What’s the alternative of that? The alternative to that is not informed by the best available research. Why would you do that? To me, that doesn’t make sense to practice in a non-evidence-based practice way, if that’s what we understand by it. That’s my view on that.

The pain research is interesting because if a practitioner is involved, it can be very difficult to blind them, which can make us study difficult. Do you think we need to do more qualitative type of research versus the quantitative type, which seems to be more prevalent in the PT research?

Quantitative versus qualitative research is a broad aspect of research design. It matters because it’s relevant to the question. Whether or not you use a qualitative or quantitative study or non CTU, a cohort study or diagnostic tests equity, it depends on the question. If there are questions which are outstanding, which are important, which we need to get at, which require a qualitative design, then we need to do more qualitative research. If we think the questions that are important are of some other nature, then when we need a different design. The answer to that question depends on what the specific question is. Do we need to know more about the experience of individuals who have pain and the impact of that in their lives? We probably do.

That’s what I was leaning toward because we don’t have a whole lot of studies like that. When we talk about evidence-based practice, it’s what they’re just saying. It’s what the practitioner is doing or what he’s comfortable doing and then there’s what the patient values. Do we really know what’s the patient value at this point? I personally think that’s the biggest part of the three-legged stool there that we’re missing as far as pain goes. We’re researching all these wonderful things, but what does the patient want? If the patient wants to know, “Does CBD oil work, yes or no?” You’re a PT and you’re ignoring that, then you’re not working through evidence-based informed practice.

Probably at an even more fundamental level. If you’re trying to deliver something which is completely contrary to whatever the patient believes, I’m not going to engage with it anyway. At some point, it becomes pointless.

Which is interesting to think about because when we talk about bias, be it personal, professional bias, even in research bias. I love exercise, I preach it all day long, so do you, the research supports it. For a lot of different types of conditions, there’s pretty good research on it. I think a lot of patients would tell you, “I don’t want to move. I don’t want to exercise.” What’s the other alternative? It’s an interesting paradox we have ourselves in as practitioners. However, as you look at lifestyle, you could say, “Exercise and diet, exercise and meditation, exercise and stress reduction.”

This probably comes to the question of where the responsibility of the clinician lies? Is it just to say, “This is what’s good for you, this is what you should do?” If that’s it, the job’s done. In the chronic disease space, we come to this idea now that this is about getting people to change behavior. Chronic pain is similar. It’s about getting people to behave in a certain way. As a researcher, the onus is on us to work out well. If we know that telling people to exercise doesn’t work, then we need to do something different. What that difference is, is what we need to work out. Certainly, there’s a whole framework around behavior change stuff. Psychologists have been doing this stuff. They have frameworks for this. What are the barriers? What are the enablers? How do we address them? All that stuff. That’s where chronic disease research needs to go. There is stuff around knowledge. There is stuff around beliefs. They’re the things towards the directions that we need to be working in.

Since you’re passionate about it, you’re writing a column in JOSPT, is that correct? Is it monthly?

Yeah, every second month now. Originally, they were every month but every second month now. This is building on this what we talked before about the idea that oftentimes clinicians need a bit more support in terms of understanding how to interpret research to be more effective consumers of research. For me, the nice thing about teaching in this space is the concepts are pretty simple. That’s pretty easily understandable by clinicians generally. It’s just about trying to find a way to deliver that information the way that people want to and can they direct with. Something comes to mind and part of this was something I witnessed when I was going through physio and doing my degree.

As a student, I don’t think it was made clear to us that understanding research was part of the job. Those research subjects are something to be gotten through. We’ll get through them and then we can learn the stuff we need to know about treating patients. Potentially, there may be the content delivered in different programs, but I’m not convinced that clinicians generally have engaged with it and taken on board what I think is important to take on board. This column is an attempt to try and deliver this information, which is a bit more palatable. I don’t know if it’s the right way to do it. It’s probably one way of doing it. Maybe it will resonate with some people, not with others. It probably needs to be delivered in a whole different way for different people.

I’ve read through them. The first one was called Evidence in Practice: A New Series for Clinicians. It’s an editorial, June 2018, volume 48 of the Journal of Orthopedic & Sports Physical Therapy. Another one which is cool is called Engaging with Research: Linking Evidence with Practice. That’s June of 2018. Two great articles. If you subscribe to the Journal of Orthopedic and Sports Physical Therapy, you can look out for that.

If anyone is interested or wants to get hold of them, just contact me and that goes for anything of one. I’m always happy if someone reads what I’ve written.

I’m sure a lot of clinicians appreciate that as they’re trying to read the research and having access to it is beneficial.

HPP 125 | Pain Management

If you’re trying to deliver something which is completely contrary to whatever the patient believes, at some point, it becomes pointless.

 

It’s a problem with the model we have at the moment but certainly, I’m very happy to get emails from people saying, “Can you send me something?” It takes no time for me. It’s very easy. I’m very happy to do it.

Every time I interview someone, I say, “Send me your most recent article or the article you want to talk about,” because it’s a great way for me to prepare for the interview. Thanks for doing that. Steve, it’s been great chatting with you. I can’t wait to learn more about what you have going on in the world of pediatrics. I know that’s a growing field and I’ll look out for the Evidence in Practice. Tell people how they can learn more about you, if you have a website or a Twitter handle that you want to point people to.

I’m on Twitter, which is @SteveKamper1. Chris Williams and I, we’ve brought together the research that we do in this pain and lifestyle field under the umbrella which is called the Centre for Pain Health and Lifestyle. We have a website which is a little bit under construction, but there’s some stuff on there. I have a website through the University of Sydney as well if people are interested. I’m very happy to get emails from people who want to know something about what I might know, and I’m also very happy to tell you if I don’t know about that. I’m happy to be contacted if that helps.

You can reach out to Steve, @SteveKamper1. That’s his Twitter handle. He’ll be happy to connect with you, share his research and point it to the right website, you can learn more. I want to thank all. Make sure you share this episode with your friends and family on social media, Facebook, Twitter, LinkedIn. We’ll see you again on the Healing Pain Podcast. Thank you.

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About Dr. Steve Kamper, PT, PhD

HPP 125 | Pain ManagementDr. Steve Kamper is Associate Professor in the School of Public Health and leads the paediatric pain theme in the Institute for Musculoskeletal Health. He has been continuously supported by NHMRC fellowships since 2008 and is currently NHMRC Career Development Fellow. He has over 100 publications in peer-reviewed journals, has presented his work in >10 countries, and received >$2 million in competitive research funding from Australia, Ireland, Canada, and Noway.

 


 

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Dr. Joe TattaHow To Translate Research Into Practice And Improve Pain Management with Dr. Steven Kamper, PT, PhD
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