Associate Professor Melanie Noel

Associate Professor Melanie Noel is a paediatric pain scientist and psychologist at the University of Calgary, Canada. Noel is also the team lead of the Pain Education, Advocacy, Knowledge (PEAK) Research Lab, a dynamic and interdisciplinary group housed between the University of Calgary and the Vi Riddell Pain Program at the Alberta Children’s Hospital. She is passionate about partnering with people with lived experience to transform how we understand and treat people with pain, advocating for the use of evidence-based and developmentally tailored interventions. Noel is an international keynote speaker at the upcoming 43rd Annual Scientific Meeting (ASM) of the Australian Pain Society, which will be held in Canberra from April 2-5, 2023. In the lead-up to the ASM, Noel spoke with Lincoln Tracy, a researcher and writer from Melbourne, Australia, discussing how she became a paediatric pain scientist and psychologist after starting as a business student, how the way she thinks about pain and research has changed over time, and more. Below is an edited transcript of their conversation.

What was your path to becoming a paediatric pain scientist and psychologist?

I always say that I fell into the field of pain – if you’ll pardon the pun. I was an undergrad who didn’t really know who I was or what I wanted to do. I ended up studying business initially because that’s what my dad did. Along the way I took a psychology unit and ended up having a not even quarter life crisis – I was only 20 at the time – and realised I would much rather do psychology than feed the capitalistic machine.

It was really one professor, Carole Peterson, who played such a pivotal role in this change. She was passionate, quirky, and had such big ideas… she really helped me fall in love with developmental psychology. Carole was looking for research assistants to sit in an emergency department one summer and wait for parents to bring in their injured children. She was interested in whether children could be reliable eyewitnesses and used following them up over time after painful injuries as a model to test that. I still remember the moment when I was working with a particular child – going to their home, interviewing and engaging with them – I knew I was hooked. I knew I had to work with children.

After that I pursued a master’s in developmental psychology, mostly focusing on language. It was around this time I knew I wanted to understand how to combine science and working therapeutically with kids. This led me to apply for clinical psychology programs and found Christine Chambers. As I’m sure a lot of people know, Christine is a guru in the paediatric pain field, but I was drawn to her because she merges paediatric pain with developmental psychology. I was really lucky – I certainly wasn’t the top applicant – but Christine saw my potential and hired me as a research coordinator. Eventually I got a spot in the clinical psychology program.

What was it like working with Christine as a graduate student?

I knew she was a mum in academia when I saw she had pictures of the junior scientist – her child – on her website. Christine was doing this incredible, clinically informed work on pain in the children’s hospital that was also developmentally relevant, so it seemed like a great fit. And she’s one of those brilliant supervisors who doesn’t get graduate students to simply propel her own agenda. I remember her asking me what I wanted to do from a research perspective and not really knowing – I wasn’t expecting her to give me the option! It was daunting at the time. But I went away and thought about my earlier experiences back in Newfoundland as an undergraduate, and ultimately decided on memory for pain. Christine loved that idea, helped me shape it, and things went from there.

What are you working on most intensely at the moment?

I always want this to be a simple answer, but it’s hard [laughs]. If I had to explain the main buckets, it would be memory, narrative and story, trauma and mental health, and intergenerational transmission. I can’t nail it down to just one thing, but language and narrative tie it all together to try and understand what are the external forces that influence the experience of pain and what happens inside the brain and the body.

So as one example, we have projects focusing on memory, both in terms of the interplay between the memory regions of the brain and our language and memories in the transition from acute to chronic pain. We’re looking at this transition in concussion and surgical populations – amongst others – about the narratives of pain. What are the cultural or societal narratives? Or the narratives between clinicians? And what are the stories we tell? How do we reminisce and talk about things that happened in the past? We have developed interventions to teach parents and clinicians how to talk to children who have experienced pain in simple ways to reframe how they remember and reminisce about the pain. And these interventions can improve pain experiences, as well as helping to shape empathy for pain in the future.

This relates to another line of work I have about the intergenerational transmission of pain. We’re interested in if and how the pain or trauma of your parents or grandparents can influence the likelihood that you will develop or have issues with pain. We work with developmental neuroscientists in Australia – namely Professor Richelle Mychasiuk from Monash – on the neurobiological and epigenetic mechanisms that underlie the intergenerational transmission of pain and trauma. In addition, we have amazing collaborations with other researchers who have large birth cohorts where they followed pregnant mothers and their children, who are now 13 or 14, to explore how the pain and trauma reported by mothers affects the risk of pain and mental health conditions in their children. I’m really passionate about the merging of pain and mental health fields. There’s such a strong bidirectional relationship between the two – pain needs to be on the mental health agenda.

Lastly, I’m fascinated about the social and clinical interactions people with pain have. For example, we are studying diagnostic uncertainty, and why people believe something serious is causing their pain and the doctors simply haven’t found it? What role does the validation – or invalidation – of pain play here? This ties in with an interest about how pain is portrayed in popular media, like cartoons, on Netflix, and in Hollywood movies. We’re doing some rigorous coding of pain instances in these shows and movies, which means taking an intersectional lens and looking at how the sufferers are being responds to, whether people are empathic, and whether that differs based on your race, ethnicity, gender, and sexuality. The broader systems and systemic influences play such an important role.

In a 2018 interview you said that your most pressing research question was why acute pain becomes chronic in some children. Is this still the case?

That’s a great question. Prevention is still very important, but the way I think about prevention and has changed. At that time, I was thinking about the brain, and what’s happening at the individual level in terms of the child and their parent at the clinic. Now, I think more about how we can inform prevention before a child is born – how can we understand how to address or prevent pain from a cultural or societal levels? That is, thinking about systemic structural issues, influences, and oppressors, and how they influence and drive ideas and policies around pain.

I’m still thinking about what happens in the brain – but as I mentioned before, we need to focus more on those broader influences. And we need to be actively recruiting sociologists, political scientists, anthropologists, and a suite of other people who think about these broader systems. I feel that if we don’t understand the influence institutional, societal, and cultural factors have on pain, there’s only so much you can do to change how someone thinks and feels about pain, or how someone talks to them about pain, if they’re going straight back into communities that aren’t set up to validate and support them.

Speaking of change, what impact do you feel COVID has had on the way you and others work?

While I can’t speak for all of Canada, the impact of COVID depends on who you were and your approach. But I feel it’s given us a lot more freedom, made us more nimble, flexible, and creative. The last few years have also removed barriers for people. I say that from my experience as a single mother of triplets, but also from seeing what some of my trainees who have relationships abroad or who have disabilities have experienced. It’s made it easier for them to engage and to be a part of this community – and that’s fabulous. I’m also on sabbatical this year, and that’s been amazing in terms of the freedom it allows. I was in South Africa recently teaching workshops, and someone said “pain is the signature of humanity”. And that’s so right – it’s the great unifier. People think pain is such a niche area, but it shows up everywhere.

But the last few years have also changed how we, myself included, think about equity, diversity, and inclusion. It’s accelerated and caused discomfort in a good way, that we are more accountable for the things we do and don’t do. The way I conceptualise research and the questions that I ask are completely different – I’m more structural and systemic than I ever was. Even being a PI has changed as a result of the last few years, my lab is so much more diverse now than it was in the before times. But I don’t know if I would have gotten to this point if things such as the pandemic and [the murder] of George Floyd really shone a spotlight on how out field is not as inclusive as it needs to be, despite pain being the signature of humanity. We need to be better are recognising that we’ve all dealt with a collective – but not uniform – stressor and trauma.

If you could offer one piece of advice to your younger self, what would it be and why?

Expect the unexpected – and hope for it. Some of the best ideas have come from things that were unexpected, and some of the best directions or changes in my life were because unexpected things happened, even if it was a difficult journey to get there. I think you need to learn and grow outside of academia. I feel I’m a much better pain researcher because I spend time taking in the arts, learning about things that I think have nothing to do with pain because eventually you find yourself drawing amazing connections from understanding other things beyond what your dissertation is about. It’s important to keep evolving and learning about things, rather than just staying in our own lanes, and doing things the same way. But don’t do it with the mindset of trying to relate things to pain. Fuel your passions and your interests. One of the cool things about pain is that it touches everything. The connections will appear eventually – you don’t have to force them.

What are you looking forward to the most about coming to Australia for the ASM?

The people! I have incredible Australian colleagues – there’s a different energy that I love about the Australian pain community. You are global leaders in this area and there’s a real rigor about what you do, yet you’re so fun and quirky. There’s an authenticity about Australian pain researchers, which really speaks to me. Your country is like Canada, but more fun and with better weather! I’m excited about engaging and connecting with the people and community when I’m over there for the ASM. I can’t wait to see how you come together to solve problems and have fun at the same time – I’m looking forward to being part of that energy and coming up with new ideas.

Lincoln Tracy is a postdoctoral research fellow at Monash University and freelance writer from Melbourne, Australia. He is a member of the Australian Pain Society and enthusiastic conference attendee. You can follow him on Twitter (@lincolntracy) or check out some of his other writing and interviews on his website.

About Australian Pain Society

The Australian Pain Society is a multidisciplinary body aiming to relieve pain and related suffering through leadership in clinical practice, education, research and public advocacy.

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