A big "herzlichen glückwunsch", or congratulations, to Cary Brown, assistant professor of Occupational Therapy at the University of Alberta's Faculty of Rehabilitation Medicine.
She will be heading to Baden-Baden, Germany, this August as the Outstanding Scholarly Contribution Award (OSCA) winner and a keynote speaker at the jointly held 31st Annual Meeting of the International Institute for Advanced Studies (IIAS) and the 23rd International Conference on Systems Research, Informatics and Cybernetics.
"I'm just really excited to be going because the idea exchange opportunities are going to be amazing," Brown said. "I was very pleased because the person who contacted me is a well-known scholar in complexity theory. I thought, 'It's the George Lasker,' so I felt quite flattered."
And so she should be. IIAS President Lasker wrote that the 2011 OSCA "is a scientific equivalent of the OSCAR Award given in the movies" and that Brown's work is "unique and represents Canada at its best."
Brown received the honour for her paper, "Mazes, Conflicts, and Paradox: Tools for Understanding Chronic Pain." To understand the topics covered in the paper, Brown says to imagine you have a whiplash injury after a car accident. With support from family, friends, healthcare providers and coworkers, you could be feeling better in no time.
"But what if your injury has left you jobless and financial burdens are stacking up?" she asks. "Friends may start avoiding you because the other driver was injured and they think the accident was your fault. Your family is upset that your pain is slowing you down. How might these factors influence your recovery process? Injury and healing are not a straightforward process and little events can have large, long lasting effects."
The idea that how pain is experienced is unique to each individual and involves many social and personal factors unknown to health-care providers, such as insurance company policies and self-image, is explored in Brown's piece.
She is one of the first to apply complex adaptive systems theory to understanding chronic pain. At this point in time, she describes the understanding of why people have chronic pain and what can be done to alleviate it as "illusive as panning for gold with our bare hands."
But Brown believes that framing chronic pain as a complex system influenced by paradox, conflict and interactions between unknown variables will enable health-care professionals to find better strategies to help patients manage their chronic pain. She explains that some health issues are linear, such as broken bones and bacterial infections, but chronic pain is much more complex.
"We say, 'You have a broken leg, we'll put a cast on it, it'll heal,'" Brown says. "Here's the problem, here's the cure, here's the end result. And usually that kind of approach works for those kinds of problems. But then there are problems that aren't so straight forward like drug abuse, diabetes, and chronic pain. Those things are influenced by interactions between other factors like social networks, culture, politics, environment and personal beliefs. So they don't follow a straightforward cause and effect pathway. The outcome can be unanticipated and how we deal with that unexpected emergent behaviour determines whether there is a positive or negative outcome."
She also thinks that health-care providers should take paradox, two contradicting things existing at the same time, into consideration when dealing with the chronic pain experience.
"Paradox is a characteristic of complex systems and recognizing that helps us understand what forces may be acting on the person with pain," she says. "Paradox in chronic pain management could be the belief that pills are good for you because they take away the pain, but at the same time people fear that pills are addictive. So that paradox is going on for people with chronic pain and it causes a lot of conflict. It can lead to actions that the healthcare provider can't understand and keeps people with pain unable to move forward and unable to actually resolve their pain."
Because Brown wants to continue to build awareness around the complexities of pain and pain management, she is especially looking forward to sharing her research at the upcoming conference.
"I'm very excited! I think it'll be a great opportunity," she smiles. "One of the nice things when you take a systems approach is that information and new ideas from one discipline inform how you think about things in your own discipline. So engineers listening to this will have comments that will help me refine my ideas, and my ideas will help them develop new ideas as well. A lot of the examples make sense in different disciplines. We can learn lessons from each other that lead to exciting innovations."
About the University of Alberta Faculty of Rehabilitation Medicine
As the only free standing faculty of rehabilitation in Canada, the University of Alberta Faculty of Rehabilitation Medicine balances its activities among learning, discovery and citizenship (including clinical practice). A research leader in musculoskeletal health, spinal cord injuries and common spinal disorders (back pain), the Faculty of Rehabilitation Medicine aims to improve the quality of life of citizens in our community. The three departments, Occupational Therapy (OT), Physical Therapy (PT) and Speech Pathology and Audiology (SPA) offer professional entry programs. The Faculty offers thesis-based MSc and PhD programs in Rehabilitation Science, attracting students from a variety of disciplines including OT, PT, SLP, psychology, physical education, medicine and engineering.