If you’re reading this blog, you’ll know that I adore words. Finding the perfect term for a specific context or situation; that’s something I truly love to do. I even create my own word puzzles, not only crosswords, but also find-a-word or circle-a-word puzzles; with no letters left over after the solution is found!Try it sometime; it’s very challenging to develop this type of word puzzle, using only pencil and paper!
My favorite example of finding the perfect word dates back from when I was research coordinator. This was when I was part of an epidemiology and biostatistics team, at university hospital’s research centre; our team focused primarily on possible environmental causes of cancer, for example workplace exposure to carcinogens.
Our team had even been involved with a large and complex international research project, for a World Health Organization (WHO) agency; the International Agency for Research on Cancer (IARC). That particular study investigated whether cell phone use was linked to brain cancer:
INTERPHONE was initiated as an international set of case-control studies focusing on four types of tumours in tissues that most absorb radiofrequency energy emitted by mobile phones: tumours of the brain (glioma and meningioma), parotid gland and acoustic nerve (schwannoma).
The objective was to determine whether mobile phone use increases the risk of these tumours and, specifically, whether radiofrequency energy (RF) emitted by mobile phones is tumourigenic.”(1)
Many of our team’s graduate students and post-doctoral fellows were from other countries, and English was rarely their first language. So whenever one of them would write a manuscript – an article – to be submitted to a medical or scientific journal, I’d proofread it for them. Sometimes several times…
Although I didn’t necessarily understand the scientific basis for their writing (my background is philosophy and bioethics, not epidemiology or statistics!), I could improve the quality of their use of the English language. I often joke that a graduate degree in philosophy is intensive training in the fine art of writing!
These team members’ scientific presentations would also get a heavy dose of my proofreading, and I’d usually also transform their PowerPoint presentations. Too often these slides would be entirely composed of bullet-pointed lines of text… perhaps an artifact of their statistics training; reading lines of code ‘-)
At one point our Research Chair (similar to a department head) was preparing a presentation for an international meeting, in which one slide included the word ‘clarify’. That word has two meanings; in baking or cooking you would clarify butter, while at a scientific conference the same word would mean to explain something.
Do you remember that, at the start of this post, I told you that I love finding the perfect word for a given situation? In this instance I suggested that he instead use the word ‘elucidate’. That’s my all-time favourite word:
To “elucidate” is to make something clear that was formerly murky or confusing – and it is perfectly clear how the modern term got that meaning.
“Elucidate” traces to the Latin term lucidus, which means “lucid.”
“Lucidus” in turn descends from the verb lucēre, meaning “to shine.”
So “elucidating” can be thought of as the figurative equivalent of shining a light on something to make it easier to see.”(1)
Isn’t that a perfect word, for presenting the results of scientific research at a medical conference? Shining a light on the research findings… By now you get the idea, right? I’m a word-nerd! And yes, that world-renowned researcher took me up on my suggestion – and then went on to use the word ‘elucidate’ in his medical and scientific presentations and publications ‘-)
When I was diagnosed with Complex Regional Pain Syndrome (CRPS) earlier this year, I thought it would be a temporary condition; something that would go away after a few months of treatment. Unfortunately that doesn’t seem to be the case – although I’m still hopeful that medical team will be able to get rid of it soon! – and I was recently accepted as a patient at a pain management unit (PMU). The PMU is part of a university hospital, and is more or less a multidisciplinary chronic pain clinic.
That means that I’m now considered to be a chronic pain patient. With this change in my status, I began looking into research on chronic pain – in general. My background is in clinical or medical research ethics, so I wanted to try to gain a basic understanding of what’s happening to my body, to my brain. To try to get an overview of what differentiates chronic pain from acute (temporary) pain.
Given the complexity of this topic, and of my disease, I started with some reviews of the history of pain research. One of the first medical journal articles that I read described how Dr. Ronal Melzack first became interested in the study of pain. His breakthrough medical journal paper in 1965:
and a subsequent extension of the theory three years later, went on to be among the most cited neuroscience articles of all time.
Dr. Melzack equally went on to become one of the most widely recognized authorities in the neuroscience of pain.”(3)
What was the basis for his innovative and ground-breaking research into the science of pain? The backbone of his creation of the McGill Pain Questionnaire (MPQ), “which is now widely used in research on pain and anesthetics”(4)? Words. Patients’ words, for their own experiences of pain. In the 1950s:
I was fascinated by Mrs. Hull’s phantom limb pain, particularly by her descriptions of burning, shooting, cramping pains.
Soon, I began to record these descriptions.
They were a superb refutation of the idea that pain was a single sensation that varied only in intensity.
Shortly after I met Mrs. Hull, her “good leg” became diseased and I visited her after it was amputated.
Even more words were used to describe the pains in both limbs.
I jotted down her descriptions and also began to record the words used by other patients who had tabes dorsalis, reflex sympathetic dystrophy, back pains, and so forth.
My list grew.
By the time I left Livingston’s department, I possessed more than a hundred words, but I had no idea of what to do with them.
I knew that patients with different pain syndromes used different sets of descriptors, and more intense pains were described with more words.
Mostly, I saw them as evidence of the complexity of pain mechanisms.”(4)
Despite his fascination with these patients’ words for their pain, it took him years to find a way to apply them to pain science. This was, in large part, because: “Pain, at the time, was a sensation, and affective, emotional words did not belong in a sensory system.”(4)
Over the years, he never gave up on the idea of incorporating these patients’ own words for their pain into a clinical (treatment) and research tool. Finally, after decades of intermittent work on the problem of how to build a scientific tool around these words:
It gradually dawned on me that the words could serve as a questionnaire that would provide credible evidence of the perceived, subjective qualities of a person’s pain and perhaps throw light on what parts of the brain were involved in producing such feelings.”(4)
From this idea was born the McGill Pain Questionnaire (MPQ), named for McGill University because by this time Dr. Melzack had returned to his home town – and his home university in Montreal. Which is also the home of my PMU:
Ron, however, has done much more than stimulate the development of a rigorous pain research agenda at the University.
Understanding that research had to be driven to clinical application and that the lessons from the clinic had to be fed back to the academic world, he helped establish what is now called the Alan Edwards Pain Management Unit of the McGill University Health Centre in the 1970s.
This clinic… was created as a multi-disciplinary treatment centre for patients whose chronic pain had proven intractable.”(5)
If you’ve found this post interesting, I wholeheartedly encourage you to read Dr. Melzack’s own description of his early years of research in “The McGill Pain Questionnaire: From Description to Measurement”.(4) He published this in the journal Anesthesiology in 2005, and it’s available as an open-access (no charge) publication.
As always, thanks so much for reading! Happy holidays, and my best wishes to you and your loved ones for a joyous new year in 2017 ‘-)
References:
(1) World Health Organization (WHO). The INTERPHONE Study. WHO: International Agency for Research on Cancer (IARC). Online. Accessed 21 Dec 2016.
https://interphone.iarc.fr/
(2) Merriam-Webster, Incorporated. Elucidate (definition). Online. Accessed 21 Dec 2016.
https://www.merriam-webster.com/dictionary/elucidate
(3) McGill University. It Hurts Where? Ron Melzack reckoned the pain is in your mind. McGill University: The Brain at McGill – Research and Discoveries; Brain Stories. Online. Accessed 21 Dec 2016:
https://www.mcgill.ca/brain/research-discovery/brain-stories/it-hurts-where
(4) Ronald Melzack. The McGill Pain Questionnaire: From Description to Measurement. Anesthesiology 2005;103(1):199-202. doi: https://doi.org/. Online. Accessed 21 Dec 2016:
https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1942256
(5) McGill University. The Alan Edwards Pain Management Unit: About us; History. McGill University. Online. Accessed 21 Dec 2016:
https://www.mcgill.ca/paincentre/about-us/history