Meet the researcher: Amanda William

I’m a clinical psychologist and have worked for many years in the field of pain.

I’m a clinical psychologist and have worked for many years in the field of pain. There are many aspects to pain, but first it is necessary to establish that I am talking about physical pain, felt in the body, and often requiring health care. But pain is not just a physical event, or a sensation: it is also an emotional event – if it were not unpleasant and aversive, it would not be pain. It is defined as both a sensory and emotional experience, without any requirement for a detectable disease or lesion, since much pain is produced by changes in the central and peripheral nervous system.

There are several lines of my research.  One is on treatment of chronic pain – pain that continues long after resolution of the original cause and is distressing and disabling – and evaluation of treatments, including systematic review and meta-analysis that combines many randomised controlled trials to provide a more precise summary of treatment effects. This work also involves critical consideration of outcome measures, of which pain is one of the most important and the most difficult. Because people find it hard to communicate their pain, and there is widespread scepticism among health care staff about whether pain ratings mean anything, I have done some research in UCLH to try to improve pain assessment and therefore response to patients’ pain.

Part of the scepticism of health care staff is based on quite narrow expectations of how someone with pain does and does not behave. If a patient is smiling and chatting to another patient, staff will often assume that s/he cannot have pain, and not ask. But the patient who is groaning and writhing in pain is often thought to be “putting it on”, and may also not be asked about pain or offered analgesia. People communicate pain through bodily and particularly facial behaviours, but these– like all behaviour – are sensitive to context, and may be expressed fully in the presence of a close family member, or friend, or trusted health care professional, but suppressed in the presence of strangers, including health care staff. The beliefs of the person observing the person in pain can also concern gender, ethnicity, age, and various other factors, and reported pain can be ‘discounted’ when these factors are thought to be important. Avatar faces are a good way to research these judgement biases since the avatar expression can remain constant while varying attributes of gender and ethnicity.

The third area of research is on pain from torture and the extent to which it is not assessed, understood, or treated in state health services and in the voluntary sector, in the UK and beyond. It is common for torture survivor services to focus on mental health problems, post-traumatic stress in particular, and to assume that physical symptoms (particularly when the survivor shows no marks of torture) are secondary to the mental health problems and will remit when the mental health problems are treated. Again, there are widespread but unhelpful beliefs among health care staff about how a torture survivor might look and present, making those staff less likely to ask the survivor about his or her experience.