Brain fog and chronic pain in the workplace

Hello, welcome everybody. Um, we are here together on the idea early career researchers talk. My name is Ana. I am the host for this monthly discussion forum. uh inviting early career researchers to various early career researchers to initiate this course on some interesting topics uh that can help us to elevate our understanding on workplace accessibility and inclusion. Um I am a post-doctoral researcher at Queens University under the supervision of Dr. Daniel and supporting the idea in Hub 3. Currently I am researching on disability inclusive mentorship for transition to work and uh career success of persons with disability. I am also interested in researching uh on the health and employment outcomes of injured workers uh with acquired disabilities. Please note that we are recording this session and the recordings will be made available on our idea website. For those who may not know about what IDEA is, it's an acronym for the inclusive design for employment access. IDEA is a social innovation hub focused on creating stronger and diverse labor markets that is inclusive and accessible for persons with disabilities. Idea researchers and partners engage in developing various evidence-based tools and resources through a co-designing process. The vision of this innovation hub is uh that these tools and resources would help to advance workplaces capacity for recruitment, hiring, on boarding, retention, mentorship and promotion of uh workers with disability. Thank you for joining us. Um today I'm hosting Aronisa Das to speak on a topic that is brain fog and chronic pain in workplace. This is a very interesting topic rarely addressed mostly in the workplace discourses for inclusion and accessibility. Reanessa is a second year uh joint PhD candidate in rehab science at um McMaster University. Um her research work is funded by the capacity building initiative for from the chronic pain center of excellence for Canadian veterans. Renaiss also work as a research assistant and with an idea and perhaping various projects. Um uh Ronisa will guide us to uh understand and engage with critical thinking about what chronic pain related break fog means and how it might have impact people's participation in the workplace and why it is important to consider when providing employment support for um persons with disability. She will also share preliminary strategy on on how workers experiencing brain fog uh can be supported uh in the workplace. From what I review, Aranisa is an emerging scholar and a passionate young researcher. I'm so excited to learn about uh your research. Aronisa is here with us today grounding our understanding about brain fog and supportive strategies. housekeeping for all the audiences. After our speaker talk, um I will lead a discussion session using questions that I am hoping to receive from you uh our audiences. Please use the Q&A function at the bottom of uh your screen to post your question reflection about this topic and um you can paste or post your question while the presentation is underway or you can wait until u the Q&A session starts. Ronissa, thank you for joining us today to speak about your work and I will now turn the stage open for you to start your presentation. Welcome. Awesome. Okay. Thank you so much for the introduction and thank you everyone for being here and for the invitation. I'm really looking forward to today's discussion. Before we get started, I just wanted to start with a land acknowledgement. So, McMaster University recognizes and acknowledges that is located on the traditional territories of the Missasaga and the Houndeswani nations and within the lands protected by the dish with one spoon wamp and agreement. And as a second generation Canadian, I'm grateful for the opportunities I'm afforded to this land while also recognizing that they're only possible because of its history of injustice. So, I aim to be respectful of this history by giving more than I take. A few disclosures before we get started. Um, so as was mentioned, I'm currently a joint PhD candidate in rehab sciences along with a masters of OT student. And so my research actually doesn't explicitly look at employment. It actually looks at brain fog and within a healthcare context for veterans with chronic pain and it's funded by a capacity building initiative from the chronic pain center of excellence. But we have thought a bit more broadly about what other contexts might this be prevalent in as well as what other populations. Um, and as mentioned, I also work as a research assistant for Hub 2. So, we'll share some of our preliminary Hub 2 findings in terms of how they relate to this work. I'd also like to give a thank you to the chronic pain community, to the School of Rehab Sciences, to the CPCE, the Hub 2 team, and to my lab for all of their support throughout this process. And so, just a brief overview for today. We'll first talk about what chronic pain related brain fog is. We'll next talk about how it's addressed in the workplace. We'll talk about why it's relevant to think about as well as some recommendations. So, starting off, what is it? And we'll start broadly with chronic pain. So, chronic pain affects 7.6 million Canadians. And pain isn't just physical. It also has mental, emotional, cognitive, and even social impacts. And collectively, these can influence how people do their day-to-day activities and can also reduce quality of life. And the cognitive impacts of chronic pain tend to be one of the most overlooked symptoms. Which brings us to brain fog. And in its simplest of forms, it's defined as a state of mental cloudiness associated with issues with thinking, attention, and memory. And here we have a much more complicated definition of what it is, but I'll break it down. So it has four key pieces. So the first here is fluctuating. So this means that it's different from things like mild cognitive dysfunction or dementia or Alzheimer's which is typically talked about in relation to pain and it means that it also tends to be categorized or thought of as an episodic disability or an episodic experience. The actual feeling of it is often described as sort of this mental cloudiness that is associated with cognitive and emotional impacts. So it might be things like having difficulty paying attention, remembering or word finding and these can be quite frustrating and anxietyinducing and collectively they can also influence how people participate. So if I'm having trouble paying attention, I might struggle in a word in a work meeting. And I just have a quote here from a person with lived experience to show how brain fog affects how he views himself and how in his dayto-day. So you know I have a degree. I've gone through many difficult educational and training scenarios. And now with brain bug, it can be a challenge to even get up during the day and meet the expectations of making an appointment on time. And because of this, I get these feelings of inadequacy or failure. All because for whatever reason, I can't remember something or forget something at home. And last, within my study, we also saw that there were some differences in terms of gender and how brain bug was experienced. So, women veterans in my study described having a huge strain on their identity because they were unable to do things like manage their health along with other competing responsibilities like taking care of the children, household responsibilities, and going back to work. And men in our study describe offloading a lot of these tasks to their women's spouses. And from a traditional gender role perspective, we know that these are roles that women tend to take on and they often don't have anyone that they can offload these tasks to. And in fact, when we ask women which management strategies they use, most didn't describe the use of any and instead advocated for their development in future work. So in the next few slides, we'll talk about how is chronic pain related brain fog currently addressed in the workplace. And spoiler alert, it's often actually not addressed, but there's a few reasons for this. So one, brain fog is not a diagnosed condition. It's more so described as a cluster of experiences or symptoms. And typically diagnoses are key for accommodations. Brain fog is also an invisible experience embedded within other invisible experiences and there is a stigma associated with that and particularly when it comes to cognition because people often tie that to intelligence and they don't want to be perceived as less than because of their cognitive abilities. And just a last potential reason is that brain fog isn't very well understood. So people don't always know what you mean when you use that term and so they might attribute it to a personal failure rather than something that can be related to a healthcare condition. And when we think about how to address chronic pain in the workplace or or sorry within research and in healthcare we often talk about this biocschosocial approach. So recognizing that pain isn't just physical but it has these more widespread impacts. But when we actually think about how it's addressed in the workplace, most recommendations are really only physical. So the things like minimizing repetitive movements, posture changes, modifications to the environments to reduce physical demands. And often times these psychological and social pieces aren't really addressed. More so, there has been information on the psychological pieces, but it's not always explicitly tied to pain or explicitly tied to that physical piece. So it's really missing that integration, which is key for chronic pain. And the social supports tend to be most often completely neglected. And where brain pock falls is typically within the intersection of all three of these components, which is why in the next few slides, we'll talk about why it's important for us to be thinking about it within the workplace. And so I'll present four main arguments as to this. So without accommodations at work, pain and brain fog might lead to lost wages, reduce access to supports to manage pain, reduce social interactions, and a diminished perception of self. And I'll describe arguments for all of these um or I'll describe examples for all of these arguments in the next few slides.

So first pain is expensive in Canada. The direct cost of pain treatment for the healthcare system was $ 38 billion in 2019. And this is precoid pre-inflation. So it's likely that this number is higher. And this is also just what the government spends. But individuals might spend a,000 to $4,000 per year out of their own pockets to manage their pain. And again, this is a problem because chronic pain disproportionately affects those from equity deserving identities, including those from lower socioeconomic statuses. And I just have two quotes here to help to illustrate this point. So here we have a veteran who shared that people have tried to go back to work, but there's this perception that companies can't afford to be accommodating. So, on top of having to navigate your health and your pain, you also have to navigate financially not knowing where your income will come from. And here's another example from a healthcare professional who shared that they currently had three patients on their case load who just kept asking when can I go back to work because financially they were in a really bad place. But from the healthcare professional perspective, they didn't think that they were at a place or at a point in their care where they'd be able to sustain going back to work. But people actually they do need to go back to work because for many people going back to work is actually how they manage their pain. So for pain, our first line treatments are things like rehab services, so physio and OT. And these often aren't covered by provincial health care plans and they're most commonly obtained through private insurance plans from employers. However, access to pain management appointments typically occur during typical work hours. So to illustrate at this point, we have a veteran who shares that they went back to work but only lasted 30 days because they weren't able to attend the medical appointments used for pain maintenance. So these last two examples show how people are being put in these really impossible situations. So they're having to choose between managing their pain along with getting money to survive. And this is unfortunate because as we'll discuss in the next section, they're often very feasible and sometimes easy to implement solutions that can address this. So on a slightly different note, employment is also a helpful management strategy for some people and it can also help to improve social interactions and social abilities because for many people with a chronic pain and brain fog, they tend to have reduced social interactions which can lead to worse quality of life and mental health symptoms. And employment can support with this because on average individuals spend about 30% of their waking time at work. It's also associated with lower levels of loneliness and it can help to provide a sense of social fulfillment. But as mentioned, social interactions can be a lot more challenging when you're experiencing brain fog. So I mentioned that people with brain fog might have trouble dealing with emotions or regulating their emotions. And at work, this can be particularly challenging because even if you're in pain or even if you're experiencing brain bug, you still have to be sociable and professional. So you kind of have to micromanage how you're reacting. And for some people, this sort of micromanagement of themselves can actually be very exhausting and can hiden their feelings of brain fog. And then another piece is that that stigma piece that we've talked about. So people might hesitate to go back into the workplace or to have social interactions and to be around others because they're not sure how their brain fog will be perceived. So if they try to say that I'm experiencing brain bug, will they be perceived as being funny or will they be perceived as being lazy and not wanting to pay attention? So these are these challenges which can make social interactions a bit more difficult for people with brain fog. And this last piece here is on diminished perception of self which we've talked about in the last few slides and that brain fog can affect how people view themselves and employment is often tied to people's identity. And so as this veteran shares, if I work too little, I get depressed and I feel like I'm not contributing to the world in the same way that I used to, but also if I work too much, then I get anxiety. So it's important to note that employment of course isn't the only source of social fulfillment, but it is particularly a key one, especially in Western society. And it was also particularly prominent in our study because for veterans, employment was a very central component to their identity. So for those of you who are unfamiliar with veteran culture, there's often this term called military identity or military mindset, which is something that is very deeply embedded within their initial training. And they tend to carry that throughout their career as long along with when they actually reintegrate back into civilian communities. And to use a pop culture reference, it's sort of similar to how surgeons are portrayed in Grey's Anatomy in terms of that employment being very central to how they see themselves and also part of their social circle. And the last piece is that even though employment isn't the only sense of social fulfillment, it's all really about autonomy and opportunity because if people would like to work and if they have the capacity to do so, then they should absolutely have the choice to be able to pursue employment. So that brings us to our next discussion for the day, which is how can brain fog be managed in the workplace? And I'd just like to preface that at this point my research really hasn't looked explicitly at management strategies or we haven't actually tested any yet. And also to our knowledge what we have collected so far is more so healthcare supports and there hasn't really been a lot of work looking at how brain fog can be supported in the workplace. So, we'll share some of the strategies we've created and the ones that we think would be relevant to workplaces. But it's important to note that some might not be relevant to all workplaces and some might not be relevant to all people because brain bug is fluctuating and episodic. But this first strategy here is one that I think is relevant to most situations and it's compassion. Because generally when people feel understood and supported at work, they're more comfortable to ask for help. So, it's very important that we show our colleagues compassion. But it's also key that we show ourselves compassion and not be hes or not hesitate to ask for help because brain fog is fluctuating. So there are good days and there are bad days. So it's key to show yourself grace during these bad days. And this importance of compassion came up through some of our preliminary Hub 2 findings. So we're currently finishing up a study looking at the supports employers need to hire and retain workers with disability. And many employers actually describe using a compassionate approach. So, for example, here's an employer who shared using things like training programs, participating in different awareness months, and really just having embedded continual learning within their workplace to really create this compassionate and inclusive workplace culture where people feel supported and welcomed at work. Another strategy can be activity modification. And this is already talked about in terms of the physical impacts of brain fog, but there are opportunities for the cognitive challenges as well. So, for example, people describe feeling brain bug more at the end of a long workday or when they're more physically and mentally exhausted. So, trying to minimize activities that can be exhausting or trying to spread them out throughout the day could be helpful. People also describe feeling brain fog more when there's kind of a lot going on in their environment. So, if they're trying to multitask, if there's a lot of people talking at once, or people often describe feeling it a lot in places like Costco where it's just a very hectic environment. So limiting external stimuli as much as possible, especially if you're doing a task that's a bit more challenging, might also be helpful. People often describe using things like cognitive support. So things like calendar reminders, sticky notes, journaling, and think out loud strategies. And planning can also be helpful because having some sort of planning done or having some sorts of routines can actually reduce the decisional load you have throughout the day. And some people have described actually integrating planning into their work schedule because it was so key for them and it was so helpful. And they described that when they're doing that planning, they also try to think about what are the emotional, physical, and cognitive impacts of the task that they're doing. So for example, people might feel brain fog more at the end of the day. So they tend to do strate or tend to do tasks that are more cognitive demanding at the beginning of the day. Some people have also described knowing that they experience brain fog a lot after a busy work meeting. So they actually plan their breaks for after that meeting so that they don't overexert themselves. And this last point here is one that I think that many of us could probably resonate with and that sometimes we have these amazing well-th thoughtout plans and then they simply don't work the way that we'd like them to. So it's also key to have flexibility in these plans recognizing that brain bug is episodic. And that brings us to our last piece around flexibility because everyone's experiences with chronic pain and brain bug are different and even people's experiences day-to-day might differ. So strategies like flexible hours can be helpful. So for example, for that veteran who couldn't go back to work because they had a strict 9 to5 and they couldn't go to their physio appointment. Perhaps if they were able to have an 8 to4 or maybe if they had a break throughout the day where they could go to work, go to their appointment and then come back to work, then they'd be able to both go to work and manage their pain. Another strategy could be remote work. So typically when people work from home, they have a better control over their environment. They can limit distractions. They might be able to take a rest throughout the day if they need to do so. and they just have more control and opportunity to be able to manage both demands, both professional and personal. And it's also important that when we're thinking about flexibility that we actually have infrastructure and policies available to allow room for that. So, I'm sure we've all been in a situation where we might have encountered a very rigid policy. And if we actually take a step back to critically examine why that policy exists, sometimes it doesn't actually make sense. And sometimes they don't actually contribute to better outcomes in the workplace, but instead they're inherently ableist and they continue to put people in difficult situations where they have to choose between employment and choose between their health. And this importance of flexibility also came up in our Hub 2 findings with several service providers describing that generally when they work with smaller organizations or just organizations that are a bit more flexible in general and that don't have this red tape that they're able to provide accommodations a bit smoother and that typically it also leads to better relationships between employers and employees. And so no matter what strategy you're using, it's also important to consider an intersectional approach because people are often coming from more than one identity. So they're not just experiencing chronic pain and brain funk, but they might also be experiencing other challenges and other just general opportunities in life. So for example, we describe how people how there might be gender differences based off of brain bug. And we also know that there are gender differences in the workplace. And if you're interested in learning more about the importance of intersectionality, I encourage you to read this other paper which just came out of hub 2 which looks at employment supports for racialized disabled workers by acham. I'll just leave it the QR code here in case anyone's interested.

And so this last piece here, this so this is our more novel findings that we actually just submitted for peer review yesterday. Um, so I ask that you don't take any screenshots yet, but I did want to share it to show kind of the next steps and what we're currently working on. So what we've created is a theoretical framework of brain bug which has the impact strategies and triggers. And what we're hoping for it to be is actually a tool that people can use to identify possible impacts or triggers for them to help them to figure out or to help them to better describe their experiences with brain fog and identify strategies that can work for them. And so far, we've really only thought about it within a healthcare context, but in doing this presentation, I've really thought about how it could be applied to other contexts like employment. So, if you have any suggestions on how this could be tailored or how this can be used in the workplace or just know any kind of questions, recommendations in general, we'd love to hear them because I believe that it's through having these conversations and it's through raising awareness that we can help to clear up some of the fog and help to support people with this experience. And I just have a slide here with a few other resources. So a few of our peer-reviewed papers as well as some talks that we've done um as well as some references here. And that is all I had prepared for you all today. So I'll just stop sharing my slide, but I can bring them back up at any time if anyone has any questions.

Thank you. That's that's terrific. Um very wonderful presentation. very um insightful that opens up our our understanding about what brain fog is and how can we um understand the challenge of people who are experiencing brain fog and with the I I like the way how you frame it though your research is more healthcare focused but you and you fit this presentation for uh how can this knowledge this understanding be transferable for workplace context And also because people are not though they are sick they have other aspects of life work and that needs to be well uh understood and in their workplace context very um insightful. Thank you very much for this presentation. We have some um some questions um posted in the Q&A. One of the question is actually linked to what I have um in my mind as well um as this frame brain fog chronic illness and return to work aspects are highly linked to what I am doing as well. One of the question from our audience is does it doesn't a biocsychosocial perspective ignore the cognitive aspects of u the person. So this um with this you can think this question it is linked to my question as I uh mentioned earlier there is um a wider other aspects of human um or the the person in in our life. So what other various types of um our life domain for example um the spiritual aspects of the person or yes um um and other self self connection aspects of the person you mentioned that actually they might lose their um selfworth and when they experience this problem at workplaces. So you might address that how the biocsychosocial framework uh might address or might um like might have a gap as well. Just reflect what how do you how you perceive it. Yeah, that's such a great point. That's yeah because it's the cognitive pieces aren't explicit in that title there with the biocschosocial. I think that when people typically look at it then they're typically put the cognitive under the psychological but there are some critiques with that because it doesn't quite exactly align. I think the intention of the biocycle approach is to take this holistic kind of look of of pain in general which and I think we also recognize some of those limitations with the biocycle social approach which is why we decided to make our own theoretical framework to explicitly look at the different pieces of brain fog. Um but I think it's also important to note that the biocycle framework isn't the only model out there. There's also a biocschosocial spiritual one and people also often tend to use ones like the ICF which provide a more broad look into different factors as well.

Thank you. Um I I think there are many other like in when we speak about how can we holistically address the needs of those workers who are experiencing brain fog at workplaces we can think of this holistic uh framework that might address the cognitive spiritual bio psychosocial all those components so that in your future plan as well you might think of that kind of holistic approach that may be one of the contribution where you can Um yeah that that was a great point. Thank you for raising that. Yeah. Uh the other question that we have on the Q&A continue our audiences please continue your posting your reflection question on the Q&A function. We have a lot of time to discuss here. So we will unpack most a lot of uh concepts here. Um so they have appreciated your presentation. It was great presentation and thank you but they want to understand if there are any guidance or suggestions for senior leaders of organizations like cos uh board members or high level leaders um are there any specific things you think they can do to support so you can I in my um understanding you can address this either to help their um employees like they are senior managers senior leaders of the workplaces so that to help uh their employees who are experiencing brain fog and chronic illness. I think that's the concept that I understood and so yeah you can see that question and yeah that's a great question. And I'll just again preface so that we haven't actually explicitly looked at it within employment context yet. But I think that actually that piece around flexibility or having um policies that actually allow room for that flexibility is really key particularly because I think one of the things that people struggle with with chronic pain and brain fog in the workplace is that it is very sometimes episodic. So sometimes you know people they can generally manage their pain quite well and then they'll experience something like a pain blare and then some people might struggle to understand that because they'll think oh well you were fine for these few days before why are all of a sudden you are you experiencing a pain flare? So I think sometimes employers might struggle with that. There's also the piece that pain management um can also be tricky when you're exper when you're in the workplace because sometimes physio clinics are open at like a 9 to5. So, I think having flexibility, whether that's allowing people to work from home on the days that they're experiencing pain flares, um allowing flexible hours so that they can attend their work their workplaces, or just kind of generally understanding that if sometimes somebody's, you know, in pain, maybe that's not the best time for them to be speaking with a bunch of clients or just allowing room and compassion in those spaces, I think, is really important. and maybe even kind of critically examining some of the policies that you have in your workplace and think about, you know, is this policy one that's helpful or is this one that's actually preventing people from engaging in work in a way that's meaningful for them.

Um and uh yeah, similar similar appreciation here from audiences. I think the the figure and your your um they suggesting that your your figure the triggering about brain fog trigger and impact could make a great awareness building resource for managers. So you might share that the the next uh question the next reflection as well I just try to share more of this this evidences these resources for absolutely yes as soon as it's available I'll show the network try to share that um and there's one question do you think sain workplace might be better able to address brain fog um you have been mentioning remote work how could remote work can help uh for people who are experiencing brain fog so just you reflecting this question. Yeah. Yeah. Sorry. Which one is that? Uh I'm just looking one. Do you think certain work might be better to address brain? Oh yes. How does that be addressed if we are thinking uh remote work as one of the strategies? Yeah, I think that remote work it can be a good option because people might have better control over their environment. So they might be able to reduce distractions, but also sometimes people said that if they just, you know, take a quick nap or use an ice pack and try to do something to relieve the pain that they're feeling that which might be hiding their feelings of brain fog, then that it allows them to then go back and to be able to work on their tasks. So I think it's again about that flexibility that remote work provides. I like that flexibility and when we are approaching this supporting for uh employees with who are experiencing brain fog with compassionate um like framework then we'll be able to understand what do they need do they need to work at home do they need um some flexible just like accommodation at workplaces maybe there like I see connectedness I mentioned from personal social um other spiritual and and nature connections. Um so where can they get this connectedness like when where can we maximize disconnectedness? Maybe that's the best place is in their workplace or at home. So when we approach it compassionately I think we'll be able to understand. So the the tools and resources that we are producing or the policies also need to uh be aware of this this flexibility so that uh we can address the individual personal absolutely care for for these people. Yes. In our model, what we've tried to center is um right at the core of the model is the person with lived experience. And we use that that was intentional so that we could highlight that everyone's experience are different and we really have to think about all of these different features with the person in mind and taking these very individualized approach and I feel like sometimes people don't love individualized approach because it sometimes there's this impression that it means that there's more work to be done or that it it'll be easier if you could of course apply the same strategy to everyone. But unfortunately that's just not reality and that's often not what we're doing in the workplace anyways even if it's with a worker without a disability. Interesting. Um actually I think in your future plan you have um you have indicated that you are um under like you are developing something to support healthcare providers and also workplace um communities uh to support these um persons who are experiencing brain fog. There could be some misinterpretation like it's quite common to misunderstand uh what is that person experiencing really when we go to the workplace um manager supervisors might perceive as it is a a performance problem while the person is is struggling to manage their task because of their brain yes challenge. So do we in your study you have done uh spoken radio and uh you're doing uh some other studies as well. Did were you able to identify some resources or measurement scales to identify whether it is um like early signs of yeah like this chronic illness or brain fog or like so that we can um promote that tool resources for employers or practice to um help those uh workers. if if you have any. So, we are actually um developing an assessment tool right now that is one of the stages. I'm we're actually just finished up a Dell by consensus study where we were identifying items for that and I'm just right now trying to get in the ethics to actually test out that tool. But that's what we're working on right now is a tool that'll be able to identify that. Interesting. Yeah. We have one more. Yes. Okay. One more question. Was there any information how the veterans were treated within the military? Um were their brain fog experience respected? Did they experience any stigma? Were there any good social support system within the vet system or in the military? Just reflect on that. That's a great question and it it definitely varied by a few different factors. So I think it varied based off of when they were in the military. So some were in the military decades ago. So they really grew up at a time where there was a lot of stigma within the military around PTSD and around mental health and invisible experiences. So they tend to um some of them tend to still kind of hold some of that internalized stigma and we're really working towards undoing some of that. And then that there were some that were um they came up at the time where the military had then recognized PTSD or they were exposed to a lot of different peer support groups for PTSD and they had a lot of friends and family members who were able to provide those social supports. So, I think it's slowly getting better, but there are definitely some residual I think um there might be a bit of residual stigma still there

and I hope I hope um one of the learning from what you're doing and from what I I listen and also review your work this has a focus more of on uh right do you see any any kind of like transferable understanding for the the contemporary work, other civilian workplaces so so that we can uh do more improvement in that area. Yeah, absolutely. So the veterans that we were speaking to, so they had already left the military. So they were already working within civilian jobs. Um yeah, so when they're talking about their challenges with the workplace, they're most talking about it within the challenges of civilian workplaces. Um but it was just the piece around the veterans is that culture piece there. So because they kind of have that culture of the mission first and the self-last mindset, sometimes that makes it harder to kind of explain that you're experiencing a health issue because you feel like you're there to support other people. So you don't want to talk about your own issues. Interesting. One one interesting question that I see in the Q&A what makes you what triggers you to study this this topic? Um they have asked that how did you want to study this subject? Yeah. So I so my mom experiences chronic pain from um a previous injury. So, I've always been really interested in chronic pain um particularly within the cognitive impacts because I did my undergrad in cognitive science and I noticed that my mom was experiencing chronic ch or cognitive challenges from chronic pain but we didn't really see a lot of supports around that within when we were talking to our healthcare professionals. So I got really interested in that and I ended up working with my supervisor Tara Packham who also thought that it was an interesting topic and then we came across this grant from the chronic pain center of excellence and we thought that this was a great opportunity because one veterans are more likely to experience brain fog because they are more likely to experience multimurbidity so things like chronic pain and mental health but also um a lot of invisible experiences first get legitimized within the veteran population so like PTSD. Um so it w it was really just a nice opportunity to kind of do a win-win for everyone. Interesting. Uh I'll come back to the the other question uh on the talk but one of the last the the the question that posted at the end is uh you have shared about health care like healthare and workplace contextes. But there are other contextes where this work the evidence that you are generating the resources can be applied uh to support like people with brain fog may not be only in the workplace and um and healthcare there any other contexts where these people can be. Yeah. So something that I would really love to do and that I'm hoping to do as the next pages of our study is really look at it within the family context because oftent times or for example the women in our study described that they were kind of put in a very difficult position because they kind of had to start relying on their children for a lot of stuff and so it started to then affect their family dynamics. So, we really think that'd be really interesting to look at it within a family context and to see if if there's anything that we can do to help people within their family roles because that's such a big piece to people's everyday and to how they view themselves. Very interesting. Thank you for bringing that um lens because when these people we're considering they are working age population mostly like when we think of workplaces they are working they have families they have other other uh social networkers that might be impacted because of their their work disruption because of their illness their um um health challenge. So considering that as both as um to understand their quality of life changed in their life and also to to use that as a um a source of as a resource to support their um recovery and also to manage their chronic pain um and improve the quality of life of these people. So it would be very interesting to to see that work focusing from your end. Uh I love that that that concept. Yes, we'd love to do that. I think that'd be really fun. Yeah, that would be very that will cut out more the full scopes of um the social connections. There are workbased social connections, there are family connections, there are other policy aspects as well. So that will we will try to address that whole domain of the social connection through addressing their um families as well. So the other one um you have done other so can you share um us where can we get your other work? I mean like this work is so well done. I'm wondering where I can find your other projects as well. Maybe if you can uh tell our audiences like inform our audience where they can access your work published or unpublished or as ongoing. Yes. So we have three papers around the three or four around this that have already been published. So I think you can find them. They should be available on my Google Scholar and my LinkedIn. Um, we also have done different talks and different podcasts around it as well. And we're currently wrapping up a few more studies, so we should have more um in the works and available to read as well. And I'd be happy to share them all um with idea or with anyone who's interested um and I always post everything on my LinkedIn. So happy to connect with anyone there. Yes, I connected with Nice. Um and the other um very interesting question actually. Uh were there any urban rural differences in your in the experiences? I have one other question as well. Did you see other other inter intersectional factors that could be one of the living residents as as this person mentioned also what other intersectional factors that we need to understand so that we can any difference that you have observed that might contribute. Yeah. Yeah. That's a great question. So, we didn't explicitly look at any rural urbal urban differences. So, we didn't see any. But I guess kind of anecdotally, what we've seen people talk about or heard people talk about was that when you're in urban centers, you typically have better access to services. So, different healthcare professionals, but also different social services and even kind of community support. So, sometimes it was easier to regain a sense of self and easier to manage your pain once because you have access to all these different supports. and people from rural areas often didn't have that piece. I'm just looking at a figure of intersectionality to see if there was anything else. Um, oh, age. Age was one as well. Um, this didn't come from my work explicitly, but it came from some of discussions with patient organizations that we've had and that people who are younger and experience chronic pain and brain fog, typically people don't often take them seriously. So, they think that, oh, you're too young to be having pain or you're too young to be thinking like this. So those are the groups that tend to be seen more as the lazy and unproductive. So those are the ones who I think it'd be really important to do an explicit study on younger adults experiencing brain bug as well. One other aspect would be um the workplace contextes um in terms of like uh small businesses and large scale industries and service sectors versus uh manufacturing construction sectors might have a difference. And so that's one other area we might see. We might observe some differences in terms of access to support can definitely vary across those employment sectors. For sure. Yeah, because yeah, even like if it's a fast-paced work environment where they might not be as accommodating versus um a more flexible environment. Yeah, that's really interesting. I never thought of that. Thank you for bringing that up. Yeah. Um another person I think you mentioned that about like I was interested earlier. So they they they really appreciate your uh your career path seems really neat and um their question is like how did you come to choose that? You might replace I I found it really very interesting and also you are very active and very responsive in every com that we had. I just see I just want to see what makes that path really clear. Yeah, thank you. Yeah, so my degree is so it's a joint PhD in rehab sciences and then it's a masters of OT. So it works as you do two years strictly within your PhD, two years within the occupational therapy degree and you're also supposed to be doing your PhD along with that and then one year wrapping up your PhD. So it's a 5-year program. Um, I kind of came into it because I really loved OT and I really wanted to work clinically and I thought that there's just such value in working clinically. Um, but I also just really loved the research that I was doing and wasn't really willing to give it up at that time. So, I applied for the joint degree at MAC. I think Western also has one and so does UBC. Um, and then yeah, able to work out. There's a few if anyone is interested I'm always happy to answer questions about the dual degree because there are a few logistics around it which can be challenging but I do think it's also a really interesting and cool opportunity. I see that smart approach. I really appreciate that. Yeah. One interesting question on top of what I have asked you actually they have appreciated how you uh addressed the age um the issue of age in that but they want to know also um if there are other other aspects of the uh the factors that we consider for example they have mentioned that was there any difference with if they work longer for if they had longer work experience or shorter work experience in terms of their uh brain pulse place. Yeah, I don't know in terms of timing in the workplace, but I do know that we've had people who share that, you know, they were in roles that were really all about inclusion and about support. So, um like they were in those kind of um don't don't remember the exact title of the roles, but there were like basically an inclusion kind of officer is what the term that they used. So obviously in that kind of workplace there were a lot more supports and they did seem to be a lot more supported and seem to have better coping strategies because of this. So I don't know if it's something I it might be less to do with the timing of a workplace versus actually the kind of compassion and the culture that's actually within that workplace. And I think actually who your colleagues are and if they're able to provide that compassionate support actually does make a huge difference. Yes, definitely. there like I think although I have seen the question from brain brain p symptoms there are two true direction that we can observe this in terms of brain f symptoms they may or may not have a difference on the in terms of um like the trajectory of what employment for example people might have various types of employment experiences at different stages so that their symptom might vary but the support system could also vary actually depending when it is small or large scale Definitely the support system at workplace part there may be in a workplace where there is only one person or two person and other than the the person who is experiencing this health challenge. So that will like diminish the available social support in the workplaces and also the sometimes the workplace policies will vary when it is a large scale industry and small scale. So I I think for sure yeah that's absolutely true. That would be one of our future. Yeah. Yeah. These are great future ideas. I'm really loving this. Thank you all for your questions and comments. Very interesting. Um, one like one other question that I have. Um, did you observe any gap any any gap in terms of knowledge or practice that researchers or healthcare providers in what business could should pay attention on on these factors and support strategies from your like I like the way how you approach your study. You have a scoping paper that will help what are the available resources what has been done so far and so that what are the key gaps that we have observed so that our early care researchers here can pay attention to to research to do more research if you are if you have any student coming in this field what do you advise that person to to pursue yeah so I think the benefit is if you're coming into this field specifically um not a lot has been done so you can really do kind anything. um um really anything. There's just so many gaps especially when it comes to employment um because there really like even within our scoping review really it's just looking at it within a health context and people don't really actually look at it within employment and I think that that's a huge missed opportunity because so many people experience chronic pain and it's not just those and sometimes when we think about it we're thinking about people who are experiencing the most debilitating form of pain who maybe aren't working. Um but people typically it might even be people that you work with they also might be experiencing chronic pain and without proper supports or without really thinking about how we can best accommodate them then that can actually over time make pain worse. So I think it's really important for us to think about these different strategies about maybe what are some preventative measures or maybe even just how can we get people with chronic pain back into the workplace because some might also have a perception that employers won't be accommodating. So they won't even you know they they might be too scared or might be too discouraged to enter the workplace. So I think it's also encouraging people to reenter it. So lots of opportunities if you'd like to enter opportunities. Yeah. If if anyone like to further extend your conversation with I think she's very fant open to to Yes. I would love if anyone has any questions um or even just has wants to have a discussion. I'm open at any time. I don't know. Can I use the chat? I think I can use the chat. I'll just put my email. Yeah, use the chat function there. Perfect. Yeah, I put my email there. So, if anyone has any questions after the session or you'd like to have another chat or even if you have an idea, I'm really open to hearing it all. And again, as I said, I really think that it's through having these discussions and thinking about it in different ways that we can really help to kind of move the research forward. Interesting. Um probably um we have some time to fill our our our uh conversation people are sometimes hes to disclose their health condition and particularly since it's related to stigma and u work places you have been mentioning some of the challenges that might affect their uh disclosure. Um yes. So what can workplace do like to create what needs to be done at workplaces to to provide safer more um trusting uh workplace environment uh so that people can get unless they disclose they will not it's challenging right disclosure is part of the research actually that's coming but what is your reflection on this direction? Yes. Oh, I think Oh, sorry. Oh, sorry. I was just looking at the chat, but I think theres put the email in, so I think we're all good. But I'll just say just in case. It's d5 by mcmaster.ca. Um, and then going back to your question around disclosure, I think that that's really interesting because I don't really know the best way to answer it honestly because disclosure is so tricky and some people might not be comfortable with that because you know, you never know how people will take it or because there is that stigma out there. But I do think that nothing can be done unless we talk about it. So I think probably a lot more work has to be done in disclosure before I could make kind of um any inputs on that. But I think that conversations and continuing conversations are really important. See development in that area and actual buildings actual support structure has to be in place so that people can get more feel more safe to dispose for sure. Absolutely. Request accommodation at work places. Yeah. I mean ideally what I kind of talk about with some of my committee members is ideally you know you wouldn't have to need a disclosure. we wouldn't have to need an accommodation. People would just be able to get the supports that they need. Um because we all need supports in some sort of capacity. So that is what I would love to see in an ideal world. Interesting. That was um Okay, we have one more question. Oh, uh

yeah, that's I'm sorry. I'm just reading from the Q&A. Yeah, that's the thing, right? You're technically people aren't supposed to hold, you know, use it against you, but they still might. So, it's it's a really difficult situation. It will be up to the the individual actually until we make sure that there is really strong support and also um there has to be somehow um not only in terms of structural support or workplace accommodation things like that. What will happen? How are we going to protect the employee if they are experiencing those negative impacts because of the disclosure is not really fully addressed in the in this uh system. So um having said that as we begin to um wrap up our session I would love to ask you one final question. What is one takeaway? It was very interesting conversation here. You provide us so much time to have this to deep dive into this topic. Uh what is one takeaway you workplace um parties um the healthcare providers and us researchers uh to remember from your your talk today? Yeah, I think one thing that I'll say is that I think that a lot of us might or more people than we think might be experiencing brain fog and chronic pain, but they might just be sometimes people just might be hesitant to describe their experiences cuz they don't know how it will be perceived by others. Kind of like what we've just talked about around disclosure. So, I think it's really important for us to, you know, as if you're a health care professional or if you're employer to maybe take a proactive step to see what you can do to make either your patients, your clients or your workers a bit more comfortable and supported in the workplace. And also just at the end of the day, always showing that compassion and that flexibility. I think that those are really key things um no matter what you're experiencing. Thank you. Thank you again for sharing your research, your insight and you it gave me personally I've learned a lot. Thank you. This um from your work and so and thank you for joining us today uh at this mi uh series and and thank you our audiences for joining us today in our live session and also for those who are going to watch or listen our recording at your convenience. uh we will appreciate your engagement. We really appreciate your engagement and also we we'd love to to hear from you um with various uh kinds of feedbacks. We hope this conversation encourage our collective effort to design more inclusive, accessible and compassionate that you recommended compassionate pathways to implement for persons with disability and also for those who are experiencing ongoing work disability due to various health challenges including brain fog and chronic pain. And now we are closing our today's early career researcher talk session. uh feed feedback mechanisms. Um you will receive the survey after this session. You can also email to the idea national office uh any feedback that you might have and so that it can help us to improve for our future uh events interested if you are interested to to to join us in our future talk learn from idea website. However, I would like to tell you at this time that we our next webinar will be our next ACR talk will be on uh May 25th and we're going to announce that so that please register and join us again to to learn together. And for those who need a certificate of participation, please reach out to the idea national office. They will uh give you an a response. Thank you everyone. And as always, let's continue to learn from each other and grow our community of early career researchers. Uh thank you. Thank you all so much. I really appreciated all the questions and comments.