Professor Bonnie Stevens has received the Canadian Institutes of Health Research (CIHR) 2014 Knowledge Translation Prize. Nominated by her research peers at SickKids Research Institute, the prize recognizes Stevens’ contributions in the research of pain management and child health outcomes over several decades, and her efforts integrating the findings and evidence from that research into practice.
Stevens’ research accomplishments are impressive. Receiving more than $15 million as a lead investigator on a number of studies, she is also a co-lead at the SickKids Pain Centre, Director of the University of Toronto Centre of the Study of Pain, principal investigator of the CIHR Pain In Child Health research training initiative, and a founding member of the US-based ChildKind International, an NGO that focuses on reducing the pain and suffering of children in hospitals around the world.
Most people think of pain as a headache, or joint and muscle pain. We take a pain killer and move on with our day. Why is the study of pain so significant?
Pain is a widespread problem for individuals, families, health care systems and society as it has both immediate and long-term consequences. It causes stress and discomfort and frequently disrupts normal functions such as eating or sleeping. We know through research that pain signals are processed in the brain, and can impact how individuals respond to pain now and in the future, resulting in suffering and affecting quality of life for the patient and their family, even their ability to work or attend school. Billions of dollars are paid out annually in Canada for individuals with chronic pain to manage their pain and for loss of work and productivity.
Pain seems like a fairly subjective topic, and difficult to quantify, especially in children. How do we study pain – what is involved in the study of pain?
Pain is a subjective and elusive phenomenon, it’s difficult to describe and to quantify, especially for those who are incapable of voicing their discomfort. This includes not only babies and young children, but individuals who are elderly, may be disabled, unconscious or otherwise unable to tell us how, when and where they hurt. When patients aren’t able to communicate about their pain, we can observe patient behaviour – are they grimacing? – examine heart rate, breathing rate or blood pressure, and whether the individual is able to settle, be soothed or concentrate. There are also promising indicators through EEG and imaging of what is happening during painful events in the brain.
Working with pain sufferers, and particularly children suffering from pain, must be challenging at times. What brought you to this subject?
I started my career as a nurse working with children with cancer and children with disabilities. I was struck repeatedly by the number of painful procedures these children underwent for diagnosis and treatment of their conditions, and how we as health care providers did not seem to know either how to prevent the pain, or treat it successfully when it occurred. My goal was to try and solve these mysteries so that we could improve this situation for children, their families and the health care providers who cared for them.
The University of Toronto Centre for the Study of Pain leads a flagship interprofessional educational program for students from across the health sciences, and not just Nursing. What is the importance of teaching about pain?
Pain is a very common but difficult issue that requires attention from multiple health care professionals in order to prevent or treat it effectively. We not only need the knowledge of different health care professionals involved in the various aspects of pain assessment (e.g. nurses, doctors) and treatment (e.g. pharmacists, physiotherapists, psychologists) but also health care professionals need to learn how to work together to prevent and solve this difficult problem. The Interfaculty Pain Curriculum provides a concentrated opportunity to learn about the newest knowledge on pain treatments and to experience how health care professionals from different disciplines can work together to achieve the best outcomes. A highlight of the pain curriculum is the patient panel who share their experiences first hand with students and faculty in a way that is so compelling, it is difficult not to learn about the impact of pain on people and their lives.
One of your principal achievements is the development of EPIQ (Evidence-based Practice for Improving Quality), which I understand is in use across 15 units at SickKids. Can you tell us a little bit about the EPIQ program, and what it involves for nurses, and the impact on patient care?
EPIQ (Evidence-based Practice for Improving Quality) involves collecting data on existing pain practices, selecting champions to lead practice changes, determining specific aims for improvement based on current practices and the latest evidence, and implementing knowledge translation activities (e.g. reminders and education) to facilitate change and evaluating success. With funding from CIHR, we were able to evaluate the effectiveness of EPIQ to improve pain in eight children’s hospitals across Canada.
When we learned that EPIQ was effective in changing pain assessment and management practices, we were able to use these findings at SickKids. Pain is a priority at SickKids, and with the support of the leadership there, we were able to implement this strategy across every inpatient unit to achieve better outcomes for children, parents and healthcare providers. EPIQ has improved pain assessment and management and reduced the odds of experience severe pain by 51%.
In your years of the study of pain what has been the most challenging aspect of your work, and conversely, the most rewarding?
I am always challenged by knowing we have excellent researchers who are generating new knowledge to effectively prevent and treat pain in children, but that knowledge is not always translated into something that is usable by those providing direct care to patients. That is why the main focus of my research is now on how to get “what we know” into “what we do”.
I am most rewarded by knowing that there is exceptional will on the part of everyone who cares for children to prevent pain, and do anything possible to make sure that children are as comfortable as possible with the best quality of life no matter what their health situation is. It is this passion and dedication to the well-being of children that keeps me engaged in this area of research.