Jane Chalmers, PhD, is a senior lecturer in pain sciences and the leader of the pelvic pain theme under the Innovation, Implementation And Clinical Translation in Health (IIMPACT) research concentration at the University of South Australia. Her doctoral research focused on exploring the clinical aspects of provoked vestibulodynia, a condition characterised by unexplained vaginal pain. Chalmers was recently announced as the Australian Pain Society’s Rising Star for 2024, an award showcasing up-and-coming researchers.
As the Rising Star Award winner, Chalmers will deliver a plenary lecture focusing on understanding pain science education for women with persistent pelvic pain at the upcoming 44th Annual Scientific Meeting (ASM) of the Australian Pain Society, which will be held in Darwin from April 21-24, 2024. In the lead-up to the ASM, Chalmers spoke with Lincoln Tracy, a researcher and writer from Melbourne, Australia, about her journey to becoming a pelvic pain researcher, what winning the Rising Star Award means to her, and a recently launched project that combines art and sexual health education. This interview has been edited for clarity and length.
You trained as a physiotherapist prior to moving into a PhD – what first drew you to this line of work?
I think I was the same as a lot of other people when I was younger. I loved playing sport, and I was interested in helping people. I thought, maybe I could do medicine – but I wasn’t cut out for blood and all the other gory stuff that comes with medicine. I was about 10 or 12 years old when my aunt, who I adore, said ‘why don’t you become a physio?’ and since then I was hell bent on being a physio. I always thought I was going to be a sports physio and get to travel around with teams and do fun things, but luckily, I realised there were lots of other things we could do outside of working with sports teams.
How did you transition from working clinically to starting your PhD and moving into research?
It all started when I did my honours degree with Lorimer Moseley and David Butler, which focused on motor imagery in people with low back pain. I didn’t know anything about that topic when I started, but I quickly became interested in the research I was doing – but also pain more broadly. Lorimer and David really sparked my passion for research.
Then when I started working clinically, I realised a lot of the people we see present to us with pain, regardless of what stream of physiotherapy you’re working in. I was the only female physio in the practice I was working at, so anything that came up in the pelvic region in females was sent to me. I started delving into the research and realised what a neglected area it was, so I went back to Lorimer after working clinically for a few years and asked if he would take me on as a PhD student looking at pelvic pain.
Were there any other factors that contributed to your interest and curiosity about pelvic pain?
I’ve had a history of awful period pain since I was 11 or 12. And growing up in Alice Springs, my ability to access healthcare for my period pain was severely limited. I think I’ve always been interested in pelvic pain because I know how hard it is to get the help that patients need. But despite living with the pain for years, it took me until I was doing my physio degree to acknowledge that I needed to see someone about it and get help. The degree also sparked a passion to help other women in similar situations to get the help they need earlier than when I realised I needed help.
What are some of the similarities and differences between pelvic pain in men and pelvic pain in women?
This is quite a common question, and it’s funny because I think a lot of clinicians are quite scared by pelvic pain – they think it’s different from other kinds of persistent pain. But it’s not that different, and it’s important to highlight some of the similarities to make pelvic pain a little less scary. And there’s also a lot of overlap between pelvic pain in women and men.
We know they’re both influenced by biopsychosocial factors, but I think there’s more sociocultural factors around pelvic pain in women that makes it difficult for them to talk about. Pelvic pain is also far more common in women than in men, especially if you include period pain – around one in 12 men compared to nine in ten women.
The trajectory of pelvic pain is also different. In men it tends to start later in life, particularly if it’s prostate related, but in women it starts at the other end of life. We see a lot of young girls and women starting to develop pelvic pain, particularly around the time of menstruation. Some will grow out if it but others won’t.
Given the fear and misconceptions about pelvic pain, is there a particular book or paper you recommend researchers and clinicians should read to gain more of an understanding about pelvic pain?
I’m working a lot in the endometriosis space at the moment, which is going to influence my answer, but there’s a researcher at the University of Oxford – Associate Professor Katy Vincent – who was involved in a 2017 review about the mechanisms of pain in endometriosis. I think it’s a great summary of the various mechanisms, which is important because there is a prevailing myth in endometriosis that if you cut the endometrial lesions out the person will get better. And I think we, as a whole health and medical profession, have an unhealthy obsession with doing laparoscopies on women with endometriosis and expecting it to be a panacea – but we know that’s not true.
Many women will have a laparoscopy and then either not see any changes in their pain or will report their pain getting worse. Vincent’s review goes through the peripheral and central mechanisms and looks at the role of the nervous and immune systems and how everything fits together. I think they’re going to keep doing laparoscopies for the time being because that’s how you diagnose endometriosis. But if we can look further and see that endometriosis is more than just lesions, we can then start thinking about the other things we could be doing around the surgery to help the patient.
You are the Australian Pain Society’s Rising Star Award Winner for 2024. What does winning this award mean to you?
Professionally, I am honoured to receive the award and to be recognised for the work that I’m doing. It’s amazing because research is a bit of a murky journey – particularly in the current climate – and there’s no real map to guide you. Awards like this confirm you’re doing good things and are on the right path. It’s also a fantastic opportunity because I’m really excited about getting to go to Darwin and continue the conversation about pelvic pain.
But then personally, 2023 was a tricky year for me. I had returned from maternity leave after having my first child and was finding it tricky to juggle the work-life balance as a new mum. Then I fell pregnant again – which was planned – but had some health issues which made things a little tricky. I had also been applying for a lot of grants and awards and not having a lot of success, which made me start to question who I was as a researcher and even as a human being, and whether I was on a path that aligned with my values. The award came at an amazing time and provided a lot of reassurance to show I am on the right path and doing good things.
What do you hope attendees will take away from your presentation at the ASM in Darwin?
There are probably three things. The first one is an understanding of how big a problem of pelvic pain is. The second is understanding some of the similarities and differences between pelvic pain and other persistent pain conditions we see in women. And the third thing is a bit of a confidence boost to go away and start tackling the problem of pelvic pain in whatever they’re doing, whether that’s research or working clinically.
What has been the most interesting paper or research project you’ve been involved in?
I’ve been very fortunate to work on some awesome projects with great people over my career thus far, so it’s hard to choose just one. But the one that particularly springs to mind is one of the papers from my PhD, where we developed a new outcome measure for pelvic pain after I realised many of the existing outcome measures were fairly limited. I’m particularly proud of this paper because I was doing this project in the midst of packing up and moving from Adelaide to Sydney to take a full-time lecturing job at Western Sydney University.
It was absolutely chaotic and at the same time I was trying to focus on a new concept and methodology. We ended up getting published in PAIN and the questionnaire has since been implemented in several clinical practices and research trials across the world. Knowing the work I do is making a difference from a clinical perspective has been a really nice boost.
If you had an unlimited bucket of money to fund your dream research project, what question or problem would you like to tackle?
A key part of what I want to achieve in my career is to help women with pelvic pain access good treatments. But there are a lot of steps to that – you could poke a stick at almost anything and do it because we don’t have much research in this area. I’m really interested in finding out what we consider the optimal treatment for women with pelvic pain, so I guess if I had all the money in the world, I would design a project that would help understand what treatments are available, what treatments work, and who they work for, and why.
If we could identify factors that make clinical decision making a bit easier – like learning more about which people would respond to certain types of treatment – that would be really nice, because at the moment we just throw a lot of stuff at the wall and see what sticks for each patient. This means patients are going through a lot of unnecessary treatments and spending a lot of time getting treatments that are suboptimal for them. The Victorian government has recently launched a year-long inquiry into women’s pain, which I’ve written a piece for The Conversation about, which will hopefully start us on a path of looking at how healthcare services operate in this space. But I wonder what else we could be looking at, and what else we could be doing for these women.
What’s something you feel all early career researchers, clinicians, and trainees should know?
Something that has resonated with me recently, and continues to resonate with me throughout my career, is the saying that comparison is the thief of joy. As I mentioned before, there’s no rules or path in a research career, other than you go from a researcher to a senior researcher to associate professor to professor. We’re in a super tricky space in research at the moment – funding is tight and everything is competitive. Consequently, it’s hard not to look at others and think, ‘I did my undergrad with this person and now they’re doing all these things with their clinic’, or ‘I did my PhD with this person and now they’re doing all this amazing stuff’. I know I get down thinking about this at times.
But you need to remember that everyone’s on their own journey, and as long as everyone is doing something to the best of their ability and aligns with their values based on the resources available to them, then you can forget about the comparison to everyone else. You are doing what you need to do to make a difference. You’re already on the right path.
Lastly, what’s something people might not know about you? Do you have any interesting hobbies or secret talents?
Over the last 12 months I co-founded the Yes Please Collective with two friends – another physiotherapist who is super artsy, and my best friend who has a background in marketing and is a comedic genius. We run paint and sip style workshops where people come and paint an abstract vulva while we provide education and run a discussion around sexual and reproductive health over a glass of wine or three. We’re about to run a couple of events at the Adelaide Fringe Festival, which we’re all very excited about.
My artsy friend runs the art and education part, then I get to run a fun discussion around what we know about the parts of the vulva in terms of sexuality and pleasure. My best friend shares stories of her own experiences with pelvic pain and realising something wasn’t quite right with her vulva. She struggled with pelvic pain for two years before she told me about it, which was funny, because when she finally told me, I was like, ‘you know I have a PhD in this, right?’. And she simply turned to me and said, ‘well, what do people do if they have pelvic pain, and their best friend doesn’t have a PhD in pelvic pain? How long does it take them to talk to someone and seek help?’. And I think that really highlights the crux of the problem – that we don’t feel comfortable talking about it. So, we’re trying to educate and empower women to talk more about pelvic health, one workshop at a time.
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 X (@lincolntracy) or check out some of his other writing on his website.
Australian Pain Society 