Understanding Social Relationships in Kids With Chronic Pain: A Conversation With Jessica Fales

Understanding social relationships in children with chronic pain.

In this interview, Dr. Jessica Fales discusses her career path, the research she is most excited about, and her advice for early-career psychologists. Image credit: sila5775/123RF Stock Photo.

February 21, 2021

This interview originally appeared on the IASP Pain Research Forum.

Jessica Fales, PhD, is a clinical psychologist and associate professor in the Department of Psychology at Washington State University Vancouver, US. She runs the Adolescent Health & Wellness Lab, which focuses on social development and pediatric pain. Her work has been supported by the Society of Pediatric Psychology, the American Pain Society, and the National Institutes of Health, as well as by New Faculty and Grand Challenges seed grants awarded by WSU. Fales recently spoke with PRF Correspondent Mary Lynch, PhD, a postdoctoral fellow and pediatric psychologist at Indiana University School of Medicine, Indianapolis, US, to discuss her career path, the research she is most excited about, and her advice for early-career psychologists. Below is an edited transcript of their conversation.

Can you tell me a little about the career path that led you to your current research?

I went to the University of Maine, and at the time they offered dual training in both developmental and clinical psychology. I always talk about it like it was double majoring at the PhD level. My research interests while I was at UMaine had to do with peer relationships, including romantic relationships, but also things like peer victimization and friendship quality. My clinical interests had more to do with depression and social anxiety in young people.

Then, pretty late on in graduate school, I ended up having several clients in a row who had chronic pain. There were two teenagers with chronic pain; one of them had recurrent abdominal pain, and the other had chronic migraine along with daily headache.

There were lots of connections to the research that I was doing, because some of the major challenges that these girls had were with respect to their peer relationships and being removed from school. And they were both very, very different! One of them was a real social butterfly; for her, being out of school was disruptive in a certain way. For the other one, she was quieter and more reticent to begin with, and was having some difficulties in her peer relationships that predated development of her pain problem.

Jessica Fales

Jessica Fales

I was really intrigued by these cases from a social development perspective, but they were also extremely challenging from a treatment perspective. The evidence supported doing cognitive-behavioral therapy and parent training. I was doing those things, and it was helping to turn the volume down on their pain, but it wasn’t getting them back to school, and it wasn’t doing anything to affect their social relationships, either.

I had all these thoughts about what we could do, but I didn’t know if these things would be helpful or harmful. It was at that moment where I thought, this is really frustrating and there needs to be a lot more research here!

What are the methods you use to get a good idea about aspects like friendship, relationships, and victimization in teens with chronic pain?

The easiest or most convenient way to do that is through self-report. Self-report is really valuable because, for adolescents, only they can know their full phenomenological experience, and so what they say really matters, especially when it comes to whether they feel like they have been the target or recipient of peer victimization. And, of course, they have valuable insights into the quality of their own relationships.

But there are some downsides to that. One of my “white whales” in working with the chronic pain population is that a lot of the measures that we use have been developed for kids who are healthy and kids who are regularly attending school. With some of the best peer victimization measures, and the best measures of friendship quality and of social competence that we have, there are things that are missing or would be answered differently by a child who has chronic pain. They might read or interpret the questions differently, or the questions might just not be as relevant to their experience.

For example, thinking about some of the instructions on measures for bullying or peer victimization, they specifically talk about stuff that happens to kids in school. But a good portion of the kids who we work with haven’t been in school or haven’t regularly attended school in traditional settings, and so they may be responding differently.

I do use a lot of self-report measures, but I want them to be different, and I’d love to develop a measure of social competence that speaks to the experiences that are more common and challenging for kids who have chronic pain.

Of all the many different projects going on in your lab, is there one in particular that you’re most excited about?

I have a wonderful experimental psychology PhD student, Maria Moylan, who’s interested in exercise-induced hypoalgesia. This is the notion that people’s perceptions of pain are reduced when they are engaged in physical activity. She wanted to test that out empirically among young people to see whether lower-intensity exercise could produce an analgesic effect. She proposed her thesis in early March, and then we all know what happened after that. Within a few weeks she had to change her procedure so that she could do a modified version of her study online.

It actually ended up being really cool because, originally, she was going to have healthy participants come into the lab. But because she had this opportunity to go online, she decided to recruit a chronic pain sample, and she got these young people to participate in a self-paced exercise. She is seeing whether or not this affected their pain during and immediately after exercise, and then later at the end of the day. I was impressed with her flexibility, and I’m excited about the data she has.

It’s amazing that your student was able to shift like that. That’s a lot of flexibility.

Yes, and she took it all in stride. She was total grace under fire.

As a PRF Correspondent, I am interested in how researchers share their findings with a wider audience, beyond our typical academic bubble. How do you share research with the general public?

The real way that I disseminate my research, or other research that is interesting to me, is through my classes; I think about this a lot. I have a fun opportunity at the Washington State University campus. Most of the students I teach are from the area where I live, and they are going to stay in that area. I use my platform as an instructor to share findings that are interesting or that I want them to know – not just my own research but also cutting-edge research that’s happening both within my university and elsewhere that is valuable for my community members to know. I try to use my classroom as a platform for that.

What advice would you give to new trainees who are starting the journey of graduate school?

With time, one of the things I’ve come to appreciate is what a privilege it was to be in graduate school: to have all that time devoted towards learning, to be able to spend as much time in the world on something that you’re passionate about, and to have people all around you – your core lab and your core mentors – who are just as interested in the thing that you’re interested in. Embrace that.

What are some of the best service-type activities you said yes to as an early-career psychologist?

I served as the conference co-chair and chair for the Society of Pediatric Psychology. I had no idea what I was agreeing to when I said yes, but I learned so much through that process, and it really demystified the whole conference experience. It demystified the board of directors and all the different people who sit on it, and what their roles are.

It was a lot of work, and sometimes it’s thankless work, but it was to my benefit in the end because I learned so much about it and about myself as a leader. If anybody ever asks you to become a conference organizer, say yes, be a part of that process, and see what it’s like on the other side. It will be really illuminating as an experience.

Is there anything else you want to share in terms of your experiences or your research?

I’d like for there to be more people who choose a research career in pediatric pain, and especially more people who choose to examine social relationships in kids who have chronic pain. I wish there were hundreds of us; there’s so much work to be done! And so that’s my plug: If anybody is interested in doing this kind of research, please reach out to me. I’d love to collaborate.

Mary Lynch, PhD, is a postdoctoral fellow at Indiana University School of Medicine, Indianapolis, US.