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Dr Stuart Derbyshire

Dr Stuart Derbyshire is an associate professor and faculty member of the University of Birmingham where he conducts research in the area of functional pain: that is pain that cannot be explained by injury or disease.

There clearly is a nervous system that’s necessary for pain, heads full of sawdust do not complain of pain.

On getting interested in science

Actually it was a pain experiment, my middle school teacher did a really bad trick on us…well, actually, it was a great trick.  He asked for volunteers to take part in something, he didn’t tell us what it was, and I volunteered, so he sent me and two other kids out of the classroom.  And then about two minutes later one of the naughty kids came out and said, ‘Look, I’m really sorry but Mr Tennant is going to plunge your hand into a bucket of boiling water when you come back in.  I just told him I was going to the loo, I thought you should know,’ and off he went.

And then two minutes later, Mr Tennant comes out of the staff room carrying a kettle of boiling water and then a minute later he pulls the first kid in, there was lots of screaming, then he pulls the second kid in, there was lots of screaming and then he pulls me in, he plunges my hand – he blindfolds me before he plunges me in – plunges my hand into this bucket of water and I scream.  And of course it’s cold, but for a split second I really felt something, and it was the first psychological…the first pain experiment I ever took part in and it really stuck with me.  And when I got to university there was an option of some pain experiments in the second year that we could take part in and run and I volunteered for it. 

On examining pain

I’m particularly interested in what the brain does when you feel pain, when you experience pain, however you want to precisely put it.  I’m particularly interested in disorders where there’s no obvious reason why they should be in pain, so things like fibromyalgia where the patient says, I’m bruised all over, it hurts when I put my clothes on, it hurts when I shower, but you test them, there’s nothing wrong with their muscles, no disease processes, no injury, there’s nothing objectively that we can line up with pain.

On testing pain in people

A lot of what happens in terms of cognition and even perception is about how we relate to each other, it’s about language, it’s about culture, it’s about things that you can’t just crowbar into a single individual brain, and he’s got a strong point…

When it comes to something like pain, everything gets simpler and more complicated at the same time.  So the simple part of it is, well, if I hit your hand with a hammer, it’ll probably hurt and those two things are not arbitrarily linked.  At the same time, you can be on a battlefield, lose a leg and not notice.  So what is it that’s going on in the nervous system that makes hitting your hand with a hammer always painful and yet other things that should be painful not painful and things that shouldn’t be painful painful; that’s kind of what we’re trying to dig at. 

My most famous paper is in the British Medical Journal which is looking at whether or not foetuses feel pain, which is difficult because, you know, the foetus doesn’t have much of a conceptual apparatus as one would assume, so my basic thesis is that you feel pain not in addition to psychology, it’s not like it’s something that’s separate from your general cognition and ability to think but it’s something that you feel through your psychology and if you don’t have any psychology, then you can’t feel it.

On pain experiments

The very first experiment I did was reasonably simple: I was using a bucket of iced water, you plunge your hand into a bucket of ice, it hurts fairly quickly, about 20 seconds in you’ll start to ache and you want to take your hand out.  And we were asking the question, when you’re in pain, are you more attentive towards pain-related items, and we just had a simple task where they had to detect words on a screen and some of them were pain-related and we wondered if they’d detect the pain-related words faster.  They didn’t, as it happens, it didn’t work at all, but what was really interesting was that in a pilot run up to this I just wanted to work out how long people would keep their hand in a bucket of ice water for, to work out how long to run the study for, and I discovered that if I worded it such that I expected that they would keep their hand in for at least two minutes, they would definitely keep their hand in for two minutes, whereas if I worded it that you can take your hand out whenever you want to, a large proportion of people would take their hand out after about 30 seconds, and the thing that was interesting about that was I was instructing them to keep your hand in for as long as you possibly can, that was the aim of the experiment, you know, I want to know how long you can cope with it.  So why is the wording manipulating that?  And there was one guy who was particularly funny, he put his hand in and you could see that he was in an unusual amount of discomfort, and I could’ve said, well, you can’t take your hand out, but I didn’t, I said, well, we’ve just done this with Julie and she kept her hand in for about five minutes.  I don’t think he would’ve ever, ever taken his hand out of that bucket, I mean, just like, that’s it, this is staying in.  So what is it about the point of tolerability that is so flexible? That’s what got me interested in this whole question of what the fricking hell is pain and how does it work.

Another one that we did was, we’ve had people looking at pictures of people who are injured and whenever you see someone injured, there’s a tendency to share the emotional side of pain, so you’ll feel, you know, “ouch”, that kind of thing, but we figured, well maybe there’s some people who’ll share the physical side as well and not just go “ouch”, they see someone with a broken leg and go “ooh”[touching leg as if sore] and to our surprise, there’s about third of people who actually do say that they feel something akin to that, if they see someone else injured, they’ll be like “ooh”.  So they avoid horror movies, they don’t watch the news very often and, you know, they have to be quite careful about what it is they see, and that made a bit of a splash when that came out.

On the subjective nature of pain

I love pain because it really taps into both those worlds.  So, on the one hand you have this ineffable, subjective experience that only you really have access to and only you can really describe and you describe it in terms that are to do with subjective stuff.  And it’s a bit like trying to describe what blue is or what cold is, you know, it’s like, you can’t boil it down to a physical, it is a subjective; there’s a property to it, there’s something that is like…to be in pain and all the description of pathways and all that stuff doesn’t help you understand what this phenomenal logical experience actually is and how it works and why we have it.

At the same time, there clearly is a nervous system that’s necessary for pain, heads full of sawdust do not complain of pain.  There’s something about the pathway through your body which contributes in an important and necessary way the experience of pain.  So we study both: if we want to study pain in an objective kind of way, then you put somebody in a scanner, you burn them, and you see which parts of the brain activate and how it works on that level.  And you can find out interesting things, so one of the things we found out that’s reasonably interesting is that every time you have a noxious stimulus you have two processes going on, one is an ascending activating process and presumably is involved in the feeling of the “ouch”, the other is a descending inhibiting process which prevents the feeling of “ouch”.  And possibly the balance between those two things can go wrong  and maybe it goes wrong in some of our patients and that’s why they feel the experience they feel. At the same time, you take somebody who’s got fibromyalgia and you ask them about their pain and their experience and you very, very quickly realise that this is wrapped up in all kinds of existential stuff, the reason why they can’t hold down a job, the reason why their family is falling apart, the reason why their lives are difficult is because they have this disorder that nobody can fix and cure.  And it’s become a kind of identity, a prism through which they view all their life problems.  And there’s no reason for that to happen, even if you have something like cancer or arthritis or whatever, you can see that as being separate to who you are as a being, but these functional, chronic pain syndromes don’t seem to have that character to them.

So there’s something about both the physical and subjective at the same time that makes them utterly fascinating.

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