(Marcia is currently Deputy Chair of the BMA Medical Academic Staff Committee and Chair of the Council of Medical Academic Representatives)
When I started Medicine at Lucy Cavendish after a decade-long career in the music business, I thought more about just getting through the degree than what I wanted to do afterwards. However, I have always been curious and have loved research- designing the question, working out protocols and the intellectual curiosity of seeing whether some seemingly random occurrence can be explained or predicted.
I had some lab experience before I started Cambridge. I spent the summer before First Year working in a busy public heath lab in Manchester. But by the end of a disastrous Part 2 project, I knew that the life of a “lab rat” was not for me. I was never able to run a successful PCR or convincingly wield a Gilson pipette. I envisioned a peripatetic life on qualification; perhaps travelling the world, perhaps as part of Medicine Sans Frontieres. But by graduation, I had a husband, three young stepchildren and considerable geographical restrictions.
With that door seemingly closed, I rediscovered my love of research, but this time it was translational (or clinical) research. It was a relief to discover that research isn’t all rats, cells and pipettes. Despite the long hours of a 1990s junior doctor, I enjoyed teaching; and my MSc dissertation was researching educational methods in Anaesthesia.
As a trainee in Pain Medicine, translational research in Pain Medicine was almost non-existent. I saw the paucity and limits of current drugs for people suffering with chronic pain. Despite the plethora of nerve blocks and neurodestructive techniques, few researchers had looked at real-world usage and efficacy in the general Pain Clinic population.
My boss and mentor, Professor Munglani, introduced me to clinical pain research. He came from a background of basic science but had decided to concentrate on clinical treatment for real patients. Our shared values made it a priority to try to find the right treatment for the right patient at the right time. Our patient group was very difficult- often refractory to every treatment, with years of suffering. We learned first hand that pain is not only a physical sensation, but also suffering, social and psychological isolation- and that assessment and treatment were infinitely more complex than just medication and nerve blocks.
We had little funding and performed our real-world clinical research on real live patients coming to clinics. We used new techniques: we were able to get approval if we agreed to carefully research their effects on our patient group in the context of a multimodal pain management strategy. Our work on pulsed radiofrequency introduced a useful treatment to a wider group through conference posters and presentations, but also uncovered a phenomenon that is only just being understood- the longer patients are in pain, the higher they tend to score their pain. We also discovered that pain scores changed little over treatment, but functional activity, medication usage and a sense of well-being did improve dramatically. This had implications for future pain research; and led directly to a controversy that still rages about whether pain scores are an appropriate outcome measure for studies in chronic pain, and what constitutes a “successful” treatment. This is especially relevant when set against today’s NICE recommendations. Financial decisions about which treatments to offer are based on meta-analysis of studies that may have used inappropriate outcome measures.
With publications, invited conference presentations and speaker meetings, our ability to offer novel treatments greatly increased our visibility and attracted patients from across the country. We were able to seek and receive funding for a bigger team; and despite being a small District General Hospital, began to attract notice and funding from organizations looking for experienced clinical principal investigators in pain medicine.
For the last 10 years, I have collaborated with a small British company interested in the use of whole-plant cannabis extracts in the treatment of chronic, neuropathic and cancer pain. My position as an experienced clinician and researcher allows a unique perspective; and in many instances, I am involved at the earliest planning stages of the protocol in multicentre trials.
There is no substitute for really knowing your population- the barriers that prevent patients taking part in research; the problems that my patient population has- whether mobility, transport or ability to use technology. Our team has done their best to educate designers of clinical trials about how to use appropriate endpoints in clinical research.
When the British Pain Society started an educational special interest group, I became a founder officer and worked on my first multi-professional collaboration across multiple sites- Pain Medicine content in the undergraduate medical and nursing curriculum. In contrast with veterinarians- who complete more than 80 hours of study in pain management- we found that physiotherapists get only about 20 hours, while nurses get about 15 hours and medics a bare 2 hours! Publication led to a Parliamentary reception, and to the founding of the Chronic Pain Policy Coalition, which continues to work on behalf of people living with chronic pain.
Education (more recently in e-education for both doctors, patients and other members of the multidisciplinary team) is still a passion. I became a senior lecturer on Cardiff University’s MSc course, collaborating with Napp on www.PainCommunityCentre.org, the largest free pain education site on the Web. I also curate my own youtube playlist, www.youtube.com/user/apaindoc and work with the BMA at a national level to promote and protect the role of clinical academics in the NHS.
Involvement in translational research has been the way for me to argue from experience about the relevance of data; and fight for the widest possible choice of treatments for a very disadvantaged and difficult group of patients and their families. Research has kept me up-to-date and made me a well-informed doctor for my patients, but more importantly, has kept me curious, excited and challenged every day.