Dr. Amanda Williams

About Dr. Amanda Williams


Clinical Reader
Clinical, Educational & Health Psychology
Div. of Psychology & Language Sciences
University College London(UCL)

Q1.

I’d like to start the interview with this question. For the audience who might not be familiar with your work, Could you briefly introduce your research?


Yes. Thank you. I’m very interested in how people express pain in their behavior. There are two main areas apart from speaking about pain. One is the face and then there are all sorts of behaviors in their body. The face is particularly interesting because we express our emotions in our face. We also have an expression for pain and that expression is absolutely specific. It only occurs with pain and you can see it right from premature infants through to elderly people even into dementia. That is what’s so interesting clinically because it’s going to allow us to understand better the pain of premature and small babies who often have quite painful procedures done to them like taking blood. We need to know about their pains so we can relieve it. Also, with many elderly people who often have painful disorders and yet as they become demented, they’re much less likely to tell us about their pain. The same is true with anyone with cognitive impairment.


Even now, there are studies in people who are unconscious and who still, when they’re moved or blood is taken show a little facial expression of pain. We perhaps should be giving analgesia even to unconscious people to try to prevent pain memory developing, which then may cause problems when they come out. So, there are many clinical applications of understanding the face. The body, there are no specific behaviors. We all assume it’s pain if we see someone rubbing or limping but it could be for other reasons. So those behaviors are harder to understand. And they may be more related to anxiety about causing further damage than the direct measure of pain. But that’s still speculation.


Q2.

And estimating on others’ pain, it’s like tomorrow’s workshop’s title. Can we get it right, really? What’s the biggest challenge when we have to estimate others’ pain?


We are better at estimating someone else’s pain if they are like us, ethnically, gender, age and so on. We are not so good across differences and yet as you know in medicine, our patients are often very different from us and we need to understand their needs just as well as our own people. It’s often things in the person who’s doing the estimating of pain. We know that in healthcare professionals as well, there are certain beliefs, some healthcare professionals believe that many people exaggerate their pain either to get drugs or to get sympathy or to get a time in hospital or whatever.


And those who really think a lot of people exaggerate tend to downgrade their estimation of everybody’s pain. So, it isn’t that they are good at identifying people who do exaggerate, but they just discount everyone’s pain by a certain amount. That can mean that they really underestimate how bad the pain is. So whether the person can tell them or not, they downgrade it. We see this tendency more the longer someone’s been in practice. That can be quite a problem for most experienced doctors can be more skeptical about all those pain. And we need to counter that skepticism and get accurate understanding of the pain face.


Q3.

Do you have a recommendation for the research of chronic pain researches using complex interventions?


I think one needs to get back to why one’s trying to treat the pain. Of course the best thing is always to get rid of the pain. And then assume that life will get back to normal quite quickly. But we know that a lot of pain can’t be relieved. And even in some patients when it is relieved, they’re so worried that it’s going to happen again that they may not get back to their normal activities because they worry it would hurt it.


Headaches for example, some people avoid bright light even though they hardly have a headache, but they think because they avoid bright light, that’s why they don’t have a headache. So, that’s quite disabling. I think we need to broaden out our outcome measures. So not just pain but sleep if they’re having sleep problems, mood if the pain distresses them, anxiety about the pain and the effect and quality of life, activity, things that happen from the real world, because if they’re going to have to live with pain, then what matters is that they live the life they enjoy. Spending time with their families, rather than having to go lie down separately. Being able to go to theater, cinema, music, art, just out and about. Enjoying being with other people and not being isolated.


There aren’t perfect measures of that or the quality of life measures, measures slightly different things. The American ones are full of driving. Sportier life. Some people don’t drive but have good quality of life. It might be more about being able to play with the children or grandchildren or care for one’s family members or enjoy cooking or doing sport. Can be lots of things and I think we need to routinely include those in our outcomes. Because quite often, even making the pain a little bit better makes someone able to do those things. So the pain relief might not be great but they are free to start to do things.


Q4.

Could you tell us what kind of qualities you look for when you’re interviewing a candidate student?


I look for a real curiosity about pain and compassion for it, too. Because they’re not always easy patients to work with and one needs to really feel for their difficulties. Even if one finds them hard to work with, in the immediate term. And I think students have to accept that the more they put in, the more they will gain. If they have other commitments to their lives like children and so on, that can be fine as long as they know how to balance them. I would never want to discriminate against anyone for having children or being a carer perhaps of a parent but they need at least to be able to think about, discuss the demands. As you see here, you can spend years reading everything that’s here in just a few days and there’s always more to read, more to do. They need to be able to balance.



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