The Train to Pain Is Mainly in the Brain (by NAPS, We Got It!)

Now, once again where is the pain? In the brain! In the brain! – My Fair Clinician (NAPS 2019 Film Festival, Montebello, Quebec, Canada).

The North American Pain School (NAPS) is a unique experience. The combination of great faculty and trainees, awesome discussions and talks, and a beautiful location help produce a week that will continue to pay dividends far into the future. In this post I want to give future NAPS attendees an idea of why I loved NAPS so much, interspersed with photos that give a feel for what to expect. And for those who want to experience a firehose of NAPS, scroll through the posts at #NAPainSchool. Onward to my NAPS recap!

Faculty and patient partners

Montreal at night. Visiting Montreal before or after NAPS is a great idea. Photo credit: Biafra Ahanonu.

The faculty truly took the experience to another level. From enlightening discussions about hype in research with Dr. Jeff Mogil (@JeffreyMogil) to intense chats about calcium imaging with Dr. Michael Gold and a useful workshop by Dr. Christine Chambers on dealing with sexism in the workplace. The rest of the executive committee provided valuable insights: I enjoyed talking with Dr. Roger Fillingim about pursuing passion vs. finding a job and doing it well, along with Dr. Petra Schweinhardt’s workshop in which the NAPSters got to experience several different pain tests themselves (e.g., “To know what kind of pain you’re dealing with”), and with Dr. Charles Argoff, who provided valuable clinical insight.

In addition, the visiting faculty—Drs. Yves De Koninck, Troels Jensen, Judith Paice, Cheryl Stucky, Robert Edwards, and Jennifer Laird—also helped enhance the experience, both from their talks and in discussions with them (keep an eye out on PRF for summaries of their talks). The patient partners Billie Jo Bogden (@BogdenJo) and Justina Marianayagam (@_justinam) provided great insights into the overall experience on the patient side as well as providing needed constructive feedback on both word choice and mindsets of researchers and clinicians; continuing to have patient partners or even a couple more would further improve NAPS.

Networking

(1) Food! There is a lot of great food at NAPS. (2) People apparently hate hip-hop. That is all I learned from the ice breaker (just kidding [but not about the hip-hop]). (3) Faces are hilarious, but pain is not. Much discussion about pros and cons of pain scales during NAPS. (4) The awesome Dr. Roger Fillingim giving a fantastic workshop on mentorship. Photo credit: Biafra Ahanonu.

Networking always sounds so…clinical (pun alert!); however, NAPS could also be known as NAPS (North American Pain Socializing) as it provided one of the best experiences in terms of getting to know both established and up-and-coming researchers in pain. You also gain insights into the different routes people took to become pain researchers, which more often than not appeared to be by chance or unplanned (as I wrote in The Origin of Pain Researchers).

The best thing you can do at NAPS is continuously try to talk to new people. Meet all the trainees! During NAPS I encountered people who work with returning combat veterans, have done veterinary work, interact with patients in rural areas of developing countries, spent time studying obesity and then moved into sleep research, gave me new insights into the culture of Iran, provided a Canadian’s perspective of moving to and living in the (USA! USA! USA!) American South, and talked about their different perspectives on pain having come from a more computational background. And this is only a slice! It is one of the great benefits of NAPS that people from such a broad set of backgrounds are brought to one place where ample time is given to explore and learn.

Pain

(1) The bonfire. For some a way to test their pain thresholds... (2) Maple taffy. This stuff is amazing. (3) Dr. Mogil giving an informative workshop on presenting. Featuring Dr. Allan Basbaum. (4) Effective rhetoric at the student debates. Photo credit: Biafra Ahanonu.

The focus on NAPS was on pain. Going in, I actually thought there would be more wrestling with the never-ending philosophical debate about what “pain” is. While these types of discussions can be useful, it was refreshing at NAPS that pain was treated as, or taken as a given to be, a sensory and affective-motivational percept that we can study objectively. I will write more about this in the future, as it is possible the lack of discussion of what we really mean by pain could be hindering discoveries, but this allowed more fruitful time to learn about all the amazing research going on; to hear about initiatives taking place in the clinic, by patients, and at universities; and to discuss how our understanding of pain could be improved.

In particular, I am still thinking about Dr. Charles Argoff’s workshop, “Interviewing and Diagnosing Pain Patients.” In particular, during the workshop there was a good amount of discussion about asking patients if they have returned to pre-pain function rather than using a quantitative pain scale. While I still have questions about having patients self-report restoration of function (I would have liked to see data showing that patient’s reports agree with assessments by their loved ones, work colleagues, or others who know them), this brought up a good point. It also reminded me of a fun lunchtime topic discussion with Dr. Petra Schweinhardt about the use of functional brain imaging to assess pain and my questions about how it could be used to obtain a secondary verification of pain—inspired by discussions with trainee Saurab Sharma about rural Nepalese claiming to not be in pain (for cultural reasons) while limping away as if they are suppressing a great deal of pain. From this you can get a feel for how various conversations throughout NAPS intertwined with one another to help trainees begin to synthesize the clinical, technological, and cultural aspects of pain to address an urgent issue: how do we measure pain and use it to verify whether therapies are working? This is one of the great benefits of NAPS and I have only highlighted one topic of the many discussed.

Culture and activities

(1) Andy Tay's birthday celebration. (2) Picture taking, Dr. Mogil edition. (3) Rhetoric at the debates, do we want a "cure" for pain? (See plot of Black Museum). (4) The amazing NAPS crew; ignore the person hogging the left part of the picture. Photo credit: Biafra Ahanonu.

Did you know that, in the course of several generations, Francophone-Anglophone relations have improved even though nearly 25 years ago Quebec came within a hair’s breadth of passing a succession referendum (for those interested, read more here)? NAPS included people from a variety of countries (including Yarim De La Luz-Cuellar from Mexico and Saurab Sharma from Nepal), which helped inform the science (learning how different cultures approached pain, especially in the case of Nepal) and provided a richer background for discussions. At the same time we were able to bond over a variety of activities, such as white water rafting (our boat was known as the “Wave Killers” [“Coming to save the day!”]), where I learned that our guide made the important point that [paraphrasing] “I could either be at home watching Netflix on the weekends or guiding people down the rapids.” These helped break up the intense discussions about pain, leaving me more refreshed and ready to dive back in.

Research

Student talks from NAPS Day 3 (June 25^th). Photo credit: Biafra Ahanonu.

One of best aspects of NAPS was the student talks. Pain-related cognitive impairment, battlefield anesthesia & acupuncture, epigenome sex differences in pain, dopaminergic pain modulation, parent-child interactions, and more! Future trainees should definitely spend time asking as many people as possible about their research during breaks. You can find out about the various topics discussed at NAPS 2019, but as has been highlighted here, there were a plethora of great talks, workshops, and lectures that will prove valuable jumping-off points at NAPS and going forward after trainees are back home.

I would like to thank Jess Ross (@JRossNeuro) for informing me about NAPS, Neil Andrews (@NeilAndrews) for providing guidance and support as a NAPS Correspondent, and all those who helped organize and coordinate (a special shout out to Drs. Erwan Leclair and Helene Beaudry). NAPS was without a doubt a top-tier experience; from the networking to research to enjoying Quebec, there is much here to offer. Coming from a non-pain lab, Dr. Mark Schnitzer’s at Stanford, NAPS has enhanced the training I received while collaborating with Drs. Grégory Scherrer and Gregory Corder. Prospective NAPSters can get in touch with me (bahanonu [at] alum.mit.edu), as I would be happy to answer questions about the program and encourage any trainees interested in pain to apply.

Biafra Ahanonu, PhD, Postdoctoral Scholar, Stanford University, Stanford, CA, USA.