It’s no secret that I enjoy using social media to discuss topics associated with pain. After all, I wouldn’t have been blogging for as long as I do if I didn’t find this medium interesting in some respect!
At the same time, social media “debates” can truly be unhelpful, unpleasant and even harmful. Yet possibly one of the most harmful communicative strategies that I see is reference to “research says”. What? you say – but, but you LIKE research! Well yeah I do – but research is not a neutral “Truth” that means we can simply grab a published paper, find the results we like, then hang on to that for the rest of our careers!
What do we mean when we say “Research says”?
You know the Background part of a paper? And you know the Discussion section? The only bits read by some people – if they go past the abstract? These sections are important, but not perhaps for the reasons you might think. When I first started reading research papers, I used to think the Background was intended to highlight an unanswered question, and the Discussion was to put the answer (from the Results) into context and to establish “where next”? And there’s truth to this perspective. But it’s a beginner’s look at research. It’s a start to understanding the context of a piece of investigation. Reading these sections does give an insight into how the authors want to frame their piece of research.
Let’s pick it apart a bit. As Schostak and Schostak (2012) put it: “Each text is itself a framing of voices and their agendas, shaped to present a debate slanted towards a conclusion.” They go on to say “…whilst acts of framing bring and impose order, those very processes of ordering and categorisation select and edit so that some things are chosen
to be foregrounded, others to be background and yet others to be excluded.”
In other words, these pieces of writing offer a selected view of what is going on in this part of the research and knowledge landscape. It’s understandable that people new to an area of study might not know what else is being said, or what else has been prioritised – but it’s rather less forgivable in people who have been working in, or studying or teaching in an area for many years.
So how do we “interrogate” research so we go beyond accepting the literature review and discussion at face value? And why does it matter?
I’ll answer the last question first.
It matters because Truth with a capital T is not really a thing, at least not when it comes to pain. Pain is “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” Further to that,
- Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
- Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
- Through their life experiences, individuals learn the concept of pain.
- A person’s report of an experience as pain should be respected.
- Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
- Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
In particular, I want to draw your attention to the first note: “Pain is always a personal experience that is influenced to varying degrees by biological, psychological and social factors.” My interpretation of this is that my experience of pain is mine. And while some people may have similar experiences, the particular way I experience pain is unique. It’s different from anyone else’s.
For clinicians – and researchers – respecting the unique experience of the person in front of us (or participating in a research study) is crucial. Yet we mainly read about GROUPED experiences in research, many of which are reduced to a single number on some questionnaire or scale.
One of the unspoken assumptions in much of our research, particularly quantitative studies, is that although we lose detail by grouping information, we retain essential information. Another assumption is that only the essential data really matters. Those details, that nuance, the individual isn’t relevant, or at least, it’s less relevant than the consistent information.
So interrogating, reading research critically matters – not only reading the methods section, but also reading the background and discussion. Because the background and what is selected from previous research and writing is used to frame what is thought important, while the discussion is used to illustrate and situation the importance of the research results. The reader’s job is to read these sections and look to the voices that are put in the foreground (thought important) and to look at those placed further back, or perhaps not even included.
And one set of voices often omitted are the people who live with persistent pain, those who experience acute pain, and those who care for and are affected by pain of any kind. We have yet to move pain research and management towards an inclusive “nothing about us without us” stance. Our research is dominated by studies about but not with people in pain.
How do we interrogate research?
Some key points (because people write whole books on this!)
- Hold all research very lightly.
- Never consider a single study to be sufficient.
- Read widely. Read the background to the research and ask “Who isn’t included?” and “Which voices are foregrounded, which voices are backgrounded?”
- When reading, ask yourself who will gain benefit from this? Who might lose?
- What assumptions (explicit or implicit) are held when asking the research question, deciding on a method, analysing the results, and situating the piece in other research literature.
I really like the “cheat sheet” below for stretching my critical reading muscle.
And at the foreground for me is always “how is the voice of people experiencing pain represented in this paper?”
This is a great piece on critical reading – click – from Pavel Zemilansky and OpenOregon.
This piece from Massey University is also very helpful – click
And this is the book – click – by Schostak and Schostak