There is a pressing need for ongoing pain research given that persistent pain is an escalating healthcare problem that has reached epidemic proportions.  Multiple surveys in several countries show that the prevalence of chronic pain is in the range of 20-30%.  Our own research revealed that approximately 30% of adult Canadians suffer from chronic pain and the prevalence increases in older age groups (Figure 1).  This means that chronic pain will affect 1 in 3 Canadians over the next two decades.  The National Population Health Survey of 1996 found that, compared to the general population, people reporting chronic pain had more disability days off work, spent more days in hospital in the past year, and had 12.9 more annual physician contacts.  The annual economic impact in terms of lost work, clinic and hospital visits, and medication costs of chronic pain were estimated to be approximately $14,758/ person which translates into today’s dollars at a cost of $65 billion annually in Canada. 

The University of Western Ontario has an established track record in a number of areas of clinical pain research including fibromyalgia, whiplash, the use of long-acting opioids for non-cancer pain and psychological responses to chronic pain.  We are building on these successes with a number of ongoing high profile peer-reviewed grants which will further advance our knowledge of the mechanisms and management of chronic pain.  These ongoing studies are outlined as follows:

1)      Placebo Responses In Acute and Chronic Pain: The Canadian Institute for Health Research (CIHR) has awarded an interdisciplinary team of researchers from the University of Western Ontario and the University of Montreal a 5-year grant of $1.2 million to improve our understanding of the mechanisms underlying placebo effects in both acute and chronic pain and sleep disorders.  We know that psychological responses can have a huge impact on how pain is perceived.  The expectancy that a certain treatment modality will relieve pain can, in fact, do so through psychological means and this is known as a placebo response.  We are investigating the role of placebo responses in our clinical pain trials and we are also studying the expectations that patients have when they arrive in the pain clinic to see if we can predict the success of treatment based on these expectations.

2)      Canadian Pain Trials Network: This is a network that was established to facilitate clinical pain trials through funding from the Canadian Foundation for Innovation (CFI).  The Canadian Pain Trials Network was granted CFI funding in the amount of almost $2 million in May 2004 to provide infrastructure for psycho-physiological pain research and data processing equipment.  The U.W.O. Interdisciplinary Pain Program received seed funding in the amount of $141,000 as part of this grant to set up a pilot neuropathic pain database in the outpatient clinic of St. Joseph’s Health Care.  This database provides standard information on demographics, diagnosis, treatment and outcome of patients with neuropathic pain who are followed for at least two years.  The pilot study enrolled approximately 200 patients and is now nearing completion.  Observational studies of this kind over two years or longer provide valuable information about the “real world” clinical effectiveness of specific interventions over the long term.  There is increasing realization that this provides more useful data than randomized, controlled trials which are necessarily short term and often involve a relatively small number of patients confined to highly specialized pain clinics.  This database is designed to allow generation of outcome measures including quality of life and economic data that will assist health care planners and policy makers in knowledge transfer.  Our goal is to expand this pilot database into a multi-centre Canadian neuropathic pain network that will provide similar data at a national level.  The patient registry including diagnostic information will also facilitate recruitment for multicentre trials involving industry-sponsored research.  The neuropathic pain database will serve as a template for the development of modules regarding other types of pain (eg. musculoskeletal, pelvic pain) allowing for expansion to a comprehensive chronic pain network across Canada.

3)      Cannabis (marijuana) For The Management of Pain;  Assessment of Safety Study (COMPASS): There is a growing body of evidence that various marijuana agents (cannabinoids) are effective in relieving certain types of chronic pain.  In particular, clinical trials have shown that cannabinoids are useful in the management of pain as a result of multiple sclerosis.  However, there is very little information on the safety and efficacy of the use of marijuana over the longterm.  The COMPASS study was funded by CIHR in 2003 in the amount of $1,640,000 to study the role of marijuana in patients with chronic pain.  This is a multicentre study across Canada which will examine the response to marijuana (either smoked or ingested) in 350 patients with chronic pain and in 350 control subjects.  At our centre, we are specifically studying chronic pain due to nerve injury (including multiple sclerosis) and we are about halfway through this study as of May 2006.

4)      Cancer Pain Research Network – New Emerging Team Grant on Difficult Cancer Pain Problems: There are several pain syndromes in the setting of cancer that are particularly difficult to treat.  This includes neuropathic pain and bone pain related to movement (so-called incident pain).  The Cancer Pain Research Network was established in 2004 following a CIHR New Emerging Team Grant in the amount of $1,400,000 to study difficult cancer pain problems.  This is a 5-year grant with Dr. Neil Hagen as the principle investigator from Calgary.  Through this cancer pain network, we are developing a classification system for difficult cancer pain syndromes and we are also studying the role of sublingual methadone in the management of incident pain.  We are also developing a validated tool for incident pain called the Breakthrough Pain Assessment Tool.

5)      The Role of Low Frequency Magnetic Fields in Biological Systems: It is clear that relatively weak magnetic fields can produce biological effects.  This has been shown in human and animal models.  Under the direction of Dr. Frank Prato, as the principle investigator from the Lawson Health Research Institute, we have been awarded a 5-year grant in the amount of $930,175 to further our studies of the role of magnetic fields in rodents and also in patients afflicted with chronic pain.  The work in humans will be performed using electroencephalograms (EEG—brainwave tracings) and functional magnetic resonance imaging (fMRI).

6)      STOP PAIN: This is a multicentre study which is the first step of a larger research program aimed at improving chronic pain management in Canada.  This was a 2-year study funded by CIHR in the amount of $85,000 for the period 2004 – 2006.  This study is now nearing completion.  Two studies have been carried out.  The first evaluated the human and economic burden of chronic pain in Canada by portraying the bio psychosocial profile of the patients waiting to be seen in multi-disciplinary pain treatment facilities and documenting the direct and indirect costs of their pain.  The second study described and analyzed the services that are currently offered in public and private multi-disciplinary pain treatment facilities in Canada.

7)      The Neuropathic Pain Special Interest Group (SIG) of the Canadian Pain Society: The Neuropathic Pain SIG has been very active in the pursuit of clinical, educational and research goals related to improving the management of neuropathic pain.  The Clinical Director of the Neuropathic Pain SIG is Dr. Dwight Moulin, Earl Russell Chair in Pain Research at the University of Western Ontario.  The Neuropathic Pain SIG was industry supported in the amount of $156,900 for 2005-2006.  Further funding totalling $75,000 has been obtained for 2007.

A 1-day symposium was held in November 2005 in Toronto devoted to further development of a national Neuropathic Pain Database that will allow us to have a national patient registry for neuropathic pain.  It will also allow us to track long term “real world” outcomes in the management of neuropathic pain – important data that is not yet available.  Members of the SIG consolidated the database and are now pursuing funding from a variety of sources to implement the database at multiple centres across Canada.  This is a powerful tool to facilitate randomized, controlled trials and improved management of neuropathic pain.

In April 2006, another symposium was held to achieve a national consensus on an evidence-based approach to the pharmacological management of neuropathic pain.  This was a very successful meeting where members of the SIG drafted an evidence-based approach to the pharmacological management of neuropathic pain and the manuscript entitled “Pharmacologic Management of Chronic Neuropathic Pain - Consensus Statement and Guidelines from the Canadian Pain Society” appears in the Spring issue of the journal, Pain Research and Management.  A third symposium was held in December 2006 to fine tune the elements of the neuropathic pain database with an expected multi-centre launch of the database in 2007.  

Symposia planned for 2007 include a systematic review of the non-pharmacologic approaches to the management of neuropathic pain and the development of a core curriculum for the assessment and management of neuropathic pain.  This core curriculum will form the basis for preceptorships that will be made available to physicians and allied health care workers who may be interested in attending regional pain clinics to further their understanding in the management of neuropathic pain.

 8)  Industry-Sponsored Trials: We are involved in 3 industry-sponsored trials that are protected by confidentiality agreements.