Dr. Pavel Goldstein: How to help someone in chronic pain

Dr. Pavel Goldstein is an assistant professor at the School of Public Health, University of Haifa (Israel). He is a director of Integrative Pain Laboratory and a head of the Biostatistics Master Program. His research aims to gain a deeper understanding of chronic pain conditions to develop new ways of measuring, preventing, and treating chronic pain.

Q: What motivates you to study pain and how did you first get interested in it? 

A: I know how it feels to live with persistent pain. I’ve been living with low back pain for years.   Also, a lot of people around me suffer from chronic pain. We may not see them in pain - chronic pain is a silent epidemic. But I get up in the morning with the feeling that I can help these people and help reduce their suffering.

My relationship with pain research started in a delivery room when my wife gave birth, asking me to “shut up and just hold my hand”. I wondered about how just touching her made her feel supported and relieved. And this influenced my first research projects on pain. .

Q: You’ve done a lot of work around relationships, touch, and pain. How do these pieces relate to each other? 

A: We have run a series of experiments to understand whether a romantic partner’s touch can reduce pain and how it works. Firstly, we demonstrated that the partner’s hand holding reduces pain better than just his/her presence, the handholding of a stranger, or being alone with the pain. Then we showed that a partner’s hand holding made their heart rates, breathing rates, and brain waves synch up more closely. Moreover, it turned out that increased resonance is associated with stronger pain reduction, meaning that holding a loved one’s hand can help relieve their pain!. ‍

Q: Why can't we find a simple solution for treating pain?

A: Pain is a very complex system that has helped us survive for thousands of years. It helps us learn to not hold our hand in a fire or touch a stove. However, it turns out that the pain system may break down, leaving many people with persistent pain with no clear reason for it. In such cases, the line where the damage caused by this system outweighs the benefits is still unclear for us. Although we are starting to understand the mechanisms of chronic pain, I believe the big discoveries will surprise us in the future. 

Q:  What challenges in treating chronic pain patients stand out to you and how can we start to solve them? 

Recent research findings shifted our perception of pain, especially regarding chronic pain. In the past, we focused on treating the painful location in the body. Today we understand that the pain-related system is much more complicated and mostly based in the brain that can trigger painful sensations. Unfortunately, this new scientific knowledge contradicts the training of clinicians. In addition, pain patients already have established their therapeutic expectations based on the old model. Thus, I think our main challenge is … mental. We may have great therapeutic approaches, but if clinicians and patients reject them we are in trouble. In our lab, we dedicate a lot of resources to developing accessible materials for communicating the known pain model with clinicians and their patients. ‍

Q: What are you working on now that most excites you?  

A: For years, we used a sophisticated approach to study pain, but forgot one key element - the personal experience of chronic pain patients. Now we want to address this deficiency by asking for help from the world’s foremost pain experts - people who have lived with and experienced pain over time. We want to understand the story behind your pain. How it started and how it affects your life. That’s why we initiated the PainStory project. PainStory collects pain narratives around the world to gain a deeper understanding of pain to improve diagnostic tools, relieving suffering and reducing stigma of chronic pain.‍

Q: When you are not working on helping people tone down their pain, what do you do for fun? 

A: I love spending time with my family and friends and hiking, yoga, and practicing mindfulness. Sometimes I get inspiration for writing new words for the songs I like. I even made a song called "Pain Chronification’" adopted from the Red Hot Chilli Pepper’s "Californication."