Dr Joshua W. Pate is a Senior Lecturer in Physiotherapy at UTS with expertise in the complexity of pain and pain management. His research has received a global audience through his TED-Ed video 'The mysterious science of pain', and his children’s book series 'Zoe and Zak’s Pain Hacks'.
Dr Joshua W. Pate says on average, there are one or two kids with chronic pain in every classroom. Photo: Jacqueline Middleton.
Can you summarise your research expertise?
My research focuses on pain in children, particularly chronic pain. I aim to help address the enormous burden of chronic pain by identifying ways to prevent and manage it in children, which would ultimately benefit the next generation.
What is chronic pain exactly?
That word ‘chronic’ is technically about duration. Acute pain refers to pain that lasts less than three months, while chronic pain is pain that lasts for more than three months. However, chronic (or ‘persistent') pain is also labelled as such when it continues beyond the expected healing time. So, if the average healing time for an injury or disease process is reached, but the pain persists, it is usually classified as chronic pain. With chronic pain, various mechanisms come into play involving the brain, spinal cord, nerves, and even other systems like the immune system. Many (more than you think!) factors contribute to the experience of chronic pain.
How long have you been researching pain in kids?
I've been researching childhood pain for about eight years so far. What excites me about this field is the opportunity to make a difference. Many traditional treatments for chronic pain have not yielded meaningful results. However, educationally-based interventions have begun to show promise as a foundation for other treatments. When individuals change how they think about pain, they can influence their behaviours and outcomes.
What is the value of researching childhood pain in particular?
Childhood pain is important because the burden of chronic pain can often be traced back to childhood and adolescence. Adverse childhood events, such as trauma, can have long-term impacts on individual’s pain experiences that may initially seem unrelated. By investing in prevention and considering the long-term effects of childhood pain, we may be able to help improve academic performance, reduce opioid use, and decrease the likelihood of future mental health conditions. In addition, chronic pain affects not only the child but also their family, friends, school, teams, and various aspects of their lives. It often goes unnoticed due to its invisible nature, but this long-term pain can have far-reaching consequences.
By investing in prevention and considering the long-term effects of childhood pain, we may be able to help improve academic performance, reduce opioid use, and decrease the likelihood of future mental health conditions.
Tell me about some of the research you’re working on right now.
One of the projects I'm most enthusiastic about at the moment is an educational program led by one of my PhD students, Rebecca Fechner. She is running a pilot study in schools. In it we are providing a framework to teachers about the complexity of pain – without the health jargon – and our intention is to allow teachers as educational experts to implement and adapt a program in line with their preferences and their school's policies and procedures. This study will help us understand how to translate scientific knowledge into school curricula, policies, professional development programs and cultures.
Can you give an example of how your expertise in pain has made a difference on an individual level?
Sure. I remember working with a patient who had been experiencing debilitating pain for about two years. He was unable to bend forward because of pain, and he had significant limitations in his daily life. During our session, I asked him to try touching his shoes while lying on his side. To his surprise, he could do it. This moment sparked a shift in his mindset and very intense curiosity. He became motivated to learn more about the complexity of pain, and he started implementing strategies like graded exposure and pacing. Within six weeks, he was back to work and experiencing positive life changes. While this single case is inspiring, research currently suggests there will not be a one-size-fits-all solution. I want to emphasise the individualised nature of pain experiences and how there is a need for further research to understand who benefits most from specific interventions like pain science education and cognitive functional therapy.
What kind of broad impact are you hoping to make through your research?
My PhD focused on assessing and understanding how individuals think about pain. I wanted to start unravelling the link between a person’s thoughts and behaviours related to pain. Doing so is a complex and individualised process. Now we are building on that assessment of people’s concept of pain to develop and test educational resources. We want to create bite-sized resources that target specific gaps and misconceptions, then make these resources available to everyone.
Over the past five years I developed a series of children's books called 'Zoe and Zak’s Pain Hacks'. Each book focuses on a specific topic related to pain, for example the second book, 'Zoe Zoppins Lights It Up', explores how many various factors can affect the intensity of pain experiences. These books promote curiosity and encourage readers to explore influences on their own pain. We want to determine the minimum amount of education required to bring about change.
Dr Pate's book series 'Zoe and Zak’s Pain Hacks' is designed to help children learn and talk about pain. Photo courtesy Noigroup Publications.
So, the books are part of the research process? Do you see them as a way to test and inform your work?
I developed the books separately from my research based on the latest neuroscience. And now, independently, researchers from various parts of the world are testing them in different settings, such as in schools in Switzerland and with teenagers in America. It's fascinating and rewarding to see how this series is reaching a wider audience and ideally making a real-world impact.
It's interesting how the books can reach and influence so many people beyond traditional research audiences. Is it important to you that your research is understood by ordinary people as well as practitioners and researchers in your field?
Absolutely! I am interested in translating research findings and witnessing tangible change in people's lives. I love seeing individuals embrace curiosity and apply the knowledge to their own experiences. I find it incredibly rewarding to contribute to the improvement of people's lives alongside many other researchers around the world.
What led you to study physiotherapy initially, and how did you transition to become an academic?
I studied physio at university because I was broadly interested in helping people. I really enjoyed my allocation year at the Children's Hospital at Westmead. I also love being an uncle (and now a dad, too!). During those early years one of my supervisors provided a paediatric research opportunity, which gave me a taste of what that’s like. Over time, my clinical and research interests merged, and I found it exciting to explore uncharted territories in research, which eventually led to completing my PhD in paediatric pain. Now I have the honour of helping others to do so too.
I am interested in translating research findings and witnessing tangible change in people's lives.
Dr Joshua W. Pate
Looking back on your career, what advice would you give your undergraduate self?
During my undergraduate degree, I asked a respected professor about pursuing research. He advised me to gain clinical experience first and said research opportunities will arrive over time. His suggestion of being open to opportunities turned out to be valuable advice. I now encourage my Master of Physiotherapy students to be curious and dip their toes in various areas, including research.
So, what's next?
Our next step is to test different learning outcomes about the science of pain, and to bridge the gap between sectors of health and education. For example, when we approach schools about partnering for an educational study on chronic pain, some say their school doesn’t have any kids with chronic pain. However, the latest data shows that, on average, there are one or two kids with chronic pain in every classroom. The invisibility of pain can create a very tricky tension! Challenges lie here, as well as the different vocabularies we use in educational and health sectors.
I want to contribute to creating a common vocabulary by speaking in the media, creating resources like children's books, and involving the voices of those challenged by pain in our research. Ideally, I would love to conduct a large prevention study to test the long-term effects of pain science education on school absenteeism, teacher burnout, and pain interference in the classroom. I think the many paediatric pain research teams around the world are heading in the right direction. The field of pain science education for kids is still relatively new and I’m excited that our knowledge will continue to evolve and change over time.