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After training as a musculoskeletal physiotherapist in India, the Kolling Institute’s Dr Saurab Sharma returned to Nepal to treat patients with musculoskeletal pain conditions but quickly found that Western practices to assess and treat pain didn’t translate well to his community. One issue was the internationally-recognised numeric pain rating scale, where zero indicates no pain and 10 is maximum pain.

“Some people in Nepal struggle with it because they can’t compute numbers in their head,” he explains, making it difficult for them to rate their pain accurately. “Also, not many people take surveys in their day-to-day life. For many, it’s the first time in their life.”

Saurab also noticed a lack of local research. “There’s no research on musculoskeletal pain in my region, specifically back pain,” he says. To address this, he collaborated with Professor Mark Jensen, a prominent pain researcher, and later completed a PhD in New Zealand.

Now Chief Scientist for Clinical Research at the Kolling’s Pain Management and Research Centre Saurab emphasises the need for more pain research in low and middle-income countries, as well as culturally relevant interventions for diverse communities in Australia.

Saurab’s work has focused largely on Nepal. He compared four pain scales and found that the numeric scale had the highest error rate and was disliked by patients.

The “Faces rating scale,” which uses facial expressions to indicate pain intensity had the best results and was preferred by patients.

He has translated and validated 29 pain assessment tools for Nepal, but there’s still more work to be done. He also developed educational resources using local language and metaphors to describe pain; they have now been adapted for four countries and languages.

Importantly, he believes the West can learn from Nepal’s approaches to pain management. In countries with limited access to multidisciplinary teams, peer support groups in communities often play a vital role.

“We could implement similar models here in Australia,” he suggests, proposing that individuals could be trained for a few days in evidence-based pain management and then support others in their community.

To boost back pain research, Saurab formed a consortium of researchers, clinicians, and patients from 35 low- and middle-income countries. “In many countries, there’s no local pain research. We don’t even know how back pain is managed.”

In a recent study, he found that in majority of countries patients have to rely on pharmacotherapy and electrotherapy, neither of which is recommended. Harmful interventions with no evidence of effectiveness such as bloodletting is also used in some countries.

“Education and self-management are recommended by most global back pain guidelines but are rarely used,” Saurab notes. He’s now developing interventions to treat pain in Australia’s diverse communities, including Nepali, Chinese, Indian, and Vietnamese populations.