Professor Emma Borg
thinking through pain
Professor Emma Borg at the University of Reading tells us how philosophers are leaving the armchairs behind to apply their learning to critical clinical issues such as the understanding of pain.
"Philosophers have traditionally thought very hard about pain: they want to understand the relationship between the mental state of pain and the changes in the body and behaviour."
“We want to take that philosophical thinking out of the armchair and into the lab and clinic. We want to understand whether different philosophical theories translate into different understandings between patients and clinicians."
Emma's research focuses on understanding pain, so that clinicians can assess and treat it better:
"At the moment we are doing experimental philosophy which is right at the border of philosophy and psychology: we're trying to understand how ordinary people understand pain and how they relate pain to bodily injury – the outward presentations that are associated with pain.
We are primarily concerned with pain scales and how pain gets assessed in the clinic. Pain scales are notoriously bad at capturing the patient experience, and clinicians can't use them as quantifiable evidence. Reports using scales, whether numerical or visual, are meaningless unless you have a public way of anchoring the ends of it. If a clinician asks me and someone else where we rank our pain, we might give the same number yet be experiencing completely different levels of pain – we don't have any guarantee that, for instance, my '6' is the same as your '6'. Similarly with questionnaires, they can use biased language or be difficult to answer, thus preventing open and honest communication, which draws on my other research project in the philosophy of language."
“We should be doing something smarter about how we assess pain. If we have a better understanding of the concept of pain, it would open the door to much better ways of assessing, communicating and treating pains."
researching to solve today's problems
In working to understand, and hopefully treat, pain better, Emma hopes to make a huge difference to everyday life:
"Philosophy has traditionally thought about acute pain – for example, a cut on your hand – but chronic pain is a huge issue socially and medically at the moment. In the West there's a growing understanding that medication is causing problems: it is a huge cost to the cash-strapped NHS; it can create high levels of addiction to pain medication, which is at epidemic levels in America; and continued use of particular pain medication can actually result in hypersensitivity to pain. There are also horrific figures about the amount of working days lost to chronic pain, such as back pain, which is a huge drain on the economy and on quality of life. On the flipside there is a serious problem with under-medication of pain in non-western countries, where they don't use available medications for historical reasons."
"To understand chronic pain we work with the Royal Berkshire Hospital pain clinic. Pain clinics are for patients who have exhausted all the regular routes for pain management within the hospital. The clinic has a range of different therapies they recommend, including workshops on how to live with pain, and mindfulness."
"Part of what we are trying to do is to assess who does well under these non-pharmaceutical therapies and why, to see if we can improve outcomes for others. Richard Harrison, who is a PhD student in the Centre for Integrative Neuroscience & Neurodynamics, crosses between the University of Reading and the Royal Berkshire Hospital: having a student work across both institutions is groundbreaking. We do a lot of work with that student about what they're doing in the pain clinic, and how they're measuring and assessing pain in the hospital. We're also in touch with various pain support networks, we've given talks to support groups, and listened to their views, in order to try and understand the current problems that need addressing.
If we can help clinicians and people to assess pain better through our research, it might be possible to design therapeutic interventions that helps patients to cope better with pain."
an interdisciplinary approach
Emma is proud that this project is crossing the boundaries between a variety of disciplines:
"The project on pain is run through the University of Reading's Centre for Cognition Research (CCR), of which I'm the director. It is truly interdisciplinary, involving philosophers, psychologists, clinicians and patients. We also have people in typography interested in how you design appropriate pain questionnaires, people in history thinking about pain through the ages, and people in English thinking about the way pain gets expressed linguistically. It's quite unusual to have a project which involves both clinicians and academics, in terms of developing understanding rather than developing a new medicine.
We are also able to give our graduate students a truly interdisciplinary training programme. We are creating a generation of researchers who are naturally going to go out and find other people thinking about the same problems, regardless of which discipline they are from."
"Philosophy doesn't take place in a vacuum. The way philosophers think about things have real-world applications, and can advance our understanding of a variety of problems, moving us towards a solution."