Michael G. DeGroote Institute for Pain Research & Care - Annual Report 2023

Annual Report n 2023

The Michael G. DeGroote Institute for Pain Research & Care

Toward the conquest of pain

Vision

Using the conceptual model of chronic post-surgical pain, bring together behavioural, clinical and basic scientists to develop a new understanding of the origin, mechanisms and treatment of chronic pain.

TABLE OF CONTENTS About Michael G. DeGroote & His Gift

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page 4

A Message from the Scientific Director

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page 6

Budget

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page 7

Fast Facts

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page 8

Digital Impact & Media Presence

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page 9

Graduate Studentships

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page 10

Fellowships

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page 12

Seed Grants

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page 16

Catalyst Grant

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page 23

Engagement

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page 27

Partnerships & Collaborations

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page 29

Team

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page 32

A Lasting Legacy...

A Pivotal Gift

About Michael G. DeGroote and his gift In 2003, businessman Michael G. DeGroote made history when he made the largest single donation ever to a Canadian university or institution. His donation of $105 million has had a wide impact on health sciences research, education and care, and accelerated the pace of discovery at McMaster.

“Mr. DeGroote was a tireless advocate for advancing the management of pain and promoting research of novel therapeutics, including medical cannabis.”

- Dr. Jason Busse, Director of the Michael G. DeGroote National Pain Centre McMaster’s Faculty of Health Sciences followed a “people first” strategy in allocating the $105 million gift from Mr. DeGroote.

Emphasis was placed on hiring international caliber experts in health education, research and care, particularly in the areas of pain, infectious diseases, stroke prevention and cancer. One of the key initiatives was the Michael G. DeGroote Institute for Pain Research & Care, which received a $15 million endowment. “With this gift,” Mr. DeGroote said, “I know McMaster will be able to make new breakthroughs and make a real difference in more people’s lives.”

Michael G. DeGroote died in September 2022, at the age of 89. Though he is no longer with us, his generosity and philanthropic efforts ensure his legacy will live on and enable innovation in research for years to come.

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“We have been fortunate in the past year to see support from the federal government for patient advocacy across the country, and the creation of one new interdisciplinary provincial society, called Pain Ontario. We continue to advocate for increases in pain specific research funding.”

- Dr. Norm Buckley

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Message from the Scientific Director Antoine de Saint-Exupéry, author of The Little

caregivers and community organizations to

Prince, once said, “A rock pile ceases to be a

ensure that our research aligns with the real-

rock pile the moment a single man contemplates

world needs of those living with chronic pain.

it, bearing within him the image of a cathedral.” It

Among other things, this includes the Canadian

is inspiration that leads to innovation. It is about

Pain Care Forum, where patient advocacy groups

changing the way we see the challenges before

engage with members of industry, government,

us - seeing things from a new perspective - and

clinicians and researchers, to providing expert

pushing the boundaries of what we know. This is

opinions on initiatives like the revision of the

especially true of science and health research.

Canadian Guideline for Opioid Use in Non-Cancer

Innovation, in our context, extends beyond the

Pain and assisting with knowledge translation

laboratory and clinical settings. It encompasses the integration of technology, the exploration

produced documents to ensure they are both

of novel therapies and the cultivation of a

relevant and readable for a patient-audience.

holistic understanding of pain and its impacts on

In research, even when best practice change or

individuals and society. It also involves changing

a research project doesn’t quite yield the results

the way we do research - from the first inkling

we were looking for, it doesn’t necessarily mean

of an idea, right through to the publication of the

that we were wrong or that we wasted time; it just

first paper. The last decade has seen a shift to

means we now have more information to guide us

better incorporate people with lived experience

along a path to become increasingly right.

(those living with the conditions we are studying) into the research process and doing so in meaningful ways, as opposed to mere tokenism.

The Institute and National Pain Centre pride themselves on continuing to seek out new ways to bring innovation to pain research. We recognize that innovation must be a two-way street, and we actively engage with patients,

Norm Buckley, BA (Psych), MD, FRCPC

Scientific Director Michael G. DeGroote Institute for Pain Research and Care McMaster University

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efforts of Institute and National Pain Centre-

Institute for Pain Research & Care Budget 2022-2023 Percentage

Amount

Administrative Costs

38%

$385,896

Operating Costs

7%

$74,515

Research Awards and Projects

55%

$553,942

TOTAL

100%

$1,014,353

Budget Categories

Research Awards & Projects (55%)

Fifty-five percent of our annual budget is spent directly on research awards (grad studentships and postdoctoral fellowships) and

Operating Costs (7%)

research projects (seed grants, IPRC/MIRA catalyst grant, and other funded research projects). Annual administrative cost is 38%

Administrative Costs (38%)

of the total budget, while the operating cost (including community engagement throughout IPRC Symposium, Canadian Pain Care Forum meetings, National Faculty meetings) made up of 7% of the annual expenses.

In addition to the research and operational activities funded by the Institute, our IPRC research and operational team administers 24 projects funded by various sponsors:

Sponsor

Amount

Number of Projects

Canadian Institutes for Health Research

$4,564,425

5

Chronic Pain Centre of Excellence

$1,761,782

2

Donor (Chronic Fatigue Syndrome)

$4,343,840

1

Health Canada

$545,977

1

McMaster University

$290,652

7

Centre for Medicinal Cannabis Research

$500,000

1

Institute for Pain Research & Care

$602,500

5

Workers’ Compensation Board of Manitoba

$160,396

1

University of British Columbia

$45,000

1

$12,814,572

24

TOTAL

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Institute for Pain Research & Care Fast Facts

5

129

full-time and part-time Institute staff members, overseeing all operations and activities.

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Institutefunded research projects.

$553,942 spent on research awards and projects.

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publications, from Institute members, on the topic of pain.

At a Glance 2022/2023

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partnering institutions.

23

multidisciplinary research team members from ten health disciplines.

Institute for Pain Research & Care - Digital Impact & Media Presence We live in a digital age where the Internet and social media have become a critical component when it comes to knowledge translation and engaging with target audiences. This past year, the Institute for Pain Research & Care and the National Pain Centre (NPC) set out to build their presence - both in traditional and digital media.

The overarching goals were to continue to establish ourselves as national leaders in chronic pain research; increase overall media presence; foster partnerships with other health research institutes and organizations; increase knowledge translation initiatives of institute-funded research and foster and grow relationships with potential donors.

Modest targets were set in all these areas to determine a realistic baseline to help inform future goals.

Website This year saw the Institute and NPC undergo a redevelopment of their websites. The new design incorporated additional features to meet the Accessibility for Ontarians with Disabilities Act, as well as switched to a new content management system that was implemented across the McMaster campus. One of our primary objectives has been to increase the number of visitors to our website. Since their launch in February, the websites have experienced significant traffic, with the Institute receiving more than 1,000 hits each month and the NPC receiving nearly 2,000 hits.

This next year will focus on Search Engine Optimization to improve organic search rankings, as well as improving the bounce rate (number of visitors who leave after only seeing one page) for both sites.

Social Media Building a substantial Twitter following is vital for amplifying our research messages. Twitter has been our most prominent platform for disseminating research updates and engaging with audiences. This past year saw the NPC’s Twitter account gain nearly 500 new Twitter followers - an increase of more than 40%. Our engagement rate on Twitter posts has also shown steady improvement. The last year saw our engagement rate rise to an average of 4% per impression - an engagement rate between 1% and 5% is considered to be good. Our social media channels earned more than 19,000 impressions, which was an increase of more than 80% over last year’s reporting period. These metrics suggest that our social media efforts are seeing success and that our content is resonating with followers and generating meaningful interactions.

The Institute also launched a LinkedIn page as a new way to assist with knowledge translation initiatives. One of our goals for this coming year will be to better utilize this platform as a means of reaching our target audiences.

Traditional Media A few notable highlights from the Institute and Pain Centre’s representation in traditional media this past year include Dr. Norm Buckley’s appearance on an episode of CBC’s The Current, discussing the impact of pain on the lives of those living with it and addressing the gaps in policy and pain research. The Institute also saw the publication of the first in a series of five articles with Open Access Government, addressing issues surrounding the use of opioids.

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Institute for Pain Research & Care Graduate Studentships

“This study examines the feasibility of an e-health presurgical rehabilitation (prehab) for individuals scheduled for LSS surgery.”

- Nora Bakaa

Nora Bakaa, RS PhD Candidate Project Titles: Feasibility of a Presurgical Rehabilitation Program for Lumbar Spinal Stenosis Supervisor: Dr. Luciana Macedo

Brief Overview and Progress to Date For my pilot RCT, Prehabilitation for Lumbar Spinal Stenosis, we have completed recruitment for this study and have just started the final stages of follow-up. There will be two manuscripts for this study - the pilot RCT and the longitudinal qualitative interviews that were competed as part of the mixed-methods design. In addition, I have completed several studies as part other ongoing projects that are not part of my main PhD thesis. Specifically, I was looking at cultural competency among rehabilitation providers. I have published five papers from this work.

Related Publications Bakaa N, Gross DP, Carlesso LC, MacDermid J, Thomas K, Slomp F, Rushton A, Miciak M, Smeets R, Rampersaud R, Nataraj A. Presurgical rehabilitation program for patients with symptomatic lumbar spinal stenosis: A pilot randomized controlled trial protocol. Canadian Journal of Pain. 2022 Dec 22;6(4):2137009.

Bakaa N, Southerst D, Côté P, Macedo L, Carlesso LC, MacDermid J, Mior S. Assessing cultural competency among Canadian chiropractors: a cross-sectional survey of Canadian Chiropractic Association members.

Chiropractic & manual therapies. 2023 Dec;31(1):1-2.

Southerst D, Bakaa N, Côté P, Macedo L, Carlesso L, MacDermid J, Mior S. Diversity of the chiropractic profession in Canada: a cross-sectional survey of Canadian Chiropractic Association members. Chiropractic & Manual Therapies. 2022 Dec;30(1):1-1.

Bakaa N, Southerst, D, Mior, S, Cote, P, Carlesso, L, MacDermid, J, & Macedo, L. Assessing Cultural Competence among Canadian Physiotherapists: A Qualitative Analysis of a Cross-Sectional Survey Part 2. Physiotherapy Canada. 2023(In Press).

Bakaa N, Dhir, J, Southerst, D, Mior, S, Cote, P, Carlesso, L, MacDermid, J, & Macedo, L. Assessing Diversity and Cultural Competency Among Canadian Physiotherapists: A Cross-Sectional Survey Part 1. Physiotherapy Canada.

2023(In Press).

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Institute for Pain Research & Care Graduate Studentships Maram Khaled, BSc, DC, MSc PhD Candidate Project Title: Postsurgical Pain and Neurocognitive Outcomes After Non-Cardiac Surgery in Older Adults Supervisor: Dr. Maura Marcucci

Brief Overview and Progress to Date Chronic postsurgical pain (CPSP) may increase the risk of postoperative cognitive dysfunction (POCD) directly or through negatively impacting mobility. A comprehensive measure of satisfaction with surgery that accounts for ability to perform activities might be even more strongly associated with POCD. There might be complex mechanisms underlying the interplays between postoperative pain and cognition.

In this prospective cohort study we aim to explore whether CPSP at 6 months is associated with POCD (≥2-point decline in the Montreal Cognitive Assessment (MoCA) compared to preoperative) at 12 months.

We will also explore the association between satisfaction with surgery and POCD; the role of pain medications (opioids) in the association between CPSP and POCD; the role of patient preoccupation /optimism and coping in determining the effect of pain on cognition; and the hypothesis of neurogenesis-interference as an underlying mechanism.

Patients ≥50 years old undergoing elective total knee/hip arthroplasty are included. Socio-demographics, comorbidities, pain, and pain

“The ArthroCaP study will provide important insight into the association of chronic postsurgical pain and patient satisfaction with postoperative cognitive dysfunction and underlying mechanisms.

It will inform larger confirmatory and interventional studies to enhance perioperative care.”

- Maram Khaled

medications are assessed preoperatively. Patients are followed upto 12 months postoperatively to measure coping (SPOC questionnaire), pain and satisfaction. MoCA and neuropsychological tests are administered at baseline, 4-6 weeks, 6 and 12 months. Blood is longitudinally collected for biomarker analysis.

Recruitment has been completed with 80 participants enrolled in the study. So far, 22 participants have completed the study.

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Institute for Pain Research & Care Fellowships Cheryl Chow, MSc, PhD Postdoctoral Fellow

“This study has the potential to guide future research on the development of preventive interventions in managing pediatric postsurgical pain.”

- Cheryl Chow

Project Title: Predictors andTrajectories of Pediatric Postsurgical Pain Supervisor: Dr. Norm Buckley & Dr. Louis Schmidt

Brief Overview and Progress to Date Postsurgical pain affects up to 1 in 5 children undergoing surgery in Canada each year. It is associated with myriad of adverse clinical, psychological and developmental sequelae including increased analgesic use, delirium, delayed recovery, and fear of future medical care. Although the impact of postsurgical pain in adults is wellestablished, the literature on postsurgical pain in children remains largely unclear and incomplete. The extrapolation from adult data is limiting because children experience, express and perceive pain differently than adults. To date, only a handful of studies have described the course of pediatric postsurgical pain and no studies have examined the predictors and trajectories of pediatric postsurgical pain using objective and valid neurophysiological measures. Given these shortcomings and needs, the proposed project will aim to establish biological, psychological, and social predictors of the development on pediatric postsurgical pain and its trajectory. Moreover, this will be the first study to examine the associations between biomarkers (i.e., EEG, cortisol and heart rate) and pain in pediatric surgery. The findings of this project may help to clarify the roles of anxiety, stress and parental factors on acute and persistent postsurgical pain.

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Institute for Pain Research & Care Fellowships Shirin Modarresi, MSc, MPT, PhD Postdoctoral Fellow Project Title: Pain CareYoga for People with Knee Osteoarthritis: A Feasibility and Pilot Randomized Controlled Trial Supervisor: Dr. Lisa Carlesso

Brief Overview and Progress to Date Osteoarthritis (OA), of which the knee is the most affected joint, is the leading cause of pain and disability in older adults, affecting more than 500 million people worldwide and significantly contributing to healthcare costs. Despite its high prevalence and widespread impact, no disease-modifying drugs are currently available, and the efficacy of the current available treatment options in alleviating pain remains limited. This project aims to address this gap in knowledge by introducing a program which we refer to as Pain Informed Movement. This unique intervention combines mind-body techniques with neuromuscular exercise and pain neuroscience education (PNE) and aims to improve endogenous pain modulation in people with knee OA. In this project we investigate the impact of the Pain Informed Movement program on pain intensity and pain modulation, which includes physical testing, questionnaires, and blood analysis of Brain Derived Neurotrophic Factors and Nerve Growth Factors. We have successfully completed the feasibility phase of the study and the results are accepted for publication

“This project will lay the foundation to inform a larger multi-site RCT to assess the effectiveness of the Pain Informed Movement program and provide an understanding its underlying mechanisms.

The larger RCT will contribute to the clinical recommendations for management of knee OA pain for clinicians across multiple sectors.”

- Dr. Shirin Modarresi

at the Osteoarthritis and Cartilage Open journal. Furthermore, the protocol for the next phase of the study, a pilot randomized controlled trial (RCT) comparing Pain Informed Movement to standard treatment (strengthening exercises and OA education), is also accepted for publication at the same journal. The pilot RCT is currently underway, and we anticipate completing this phase by May 2024, after which the results will be ready for publication.

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Institute for Pain Research & Care Fellowships

“This review is part of the BMJ Rapid Recommendations project, a collaborative effort from the MAGIC Evidence Ecosystem Foundation (www. magicevidnece.org) and the BMJ. This systematic review informed a parallel guideline published on bmj.com and MAGICapp.”

- Dr. Xiaoqin Wang

Xiaoqin Wang, MD Postdoctoral Fellow Project Title: InterventionalTreatments for Chronic, Local or Radicular, Non-Cancer, Spinal Pain: A Systematic Review and Network Meta-Analysis of RandomizedTrials Supervisor: Dr. Jason Busse

Brief Overview and Progress to Date Chronic axial pain is common in Canada, and interventional pain medicine (IPM) procedures (e.g. trigger point injections) are commonly used. Given escalating use, and the associated costs, government payers are becoming increasingly concerned about the value of these services. Specifically, despite limited evidence of effectiveness, unpublished data from Health Quality Ontario (HQO) using Ontario Health Insurance Plan (OHIP) billing data indicate that the use of some IPM procedures have more than doubled from 2011 to 2015, primarily by an increase in the number of procedures without much increase in the number of patients.

Several conventional systematic reviews have explored the effectiveness of interventional procedures for chronic noncancer spine pain; however, all have important methodological limitations.

We conducted a systematic review and NMA of randomized trials to assess the comparative effectiveness of interventional procedures for chronic noncancer spine-related pain that addresses these limitations.

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Institute for Pain Research & Care Fellowships Malahat Khalili, MSc, PhD Postdoctoral Fellow Project Title: Comparative effectiveness of pharmacological prophylaxis for chronic migraine: a systematic review and network meta-analysis of randomized controlled trials Supervisor: Dr. Behnam Sadeghirad

Brief Overview and Progress to Date Migraine is a common chronic neurological disorder characterized by episodes of pulsating headaches, often accompanied by symptoms like photophobia, phonophobia, nausea, and vomiting.

Approximately 12% of people worldwide suffer from migraines, with women aged 15 to 49 being disproportionately affected.

Selecting the right pharmacotherapy for migraines is challenging for physicians and patients. Medications can be divided into symptomatic (acute) treatments for active attacks and prophylactic treatments to reduce the frequency and severity of headaches

“Our synthesized evidence enhances treatment decisions, facilitates the prescription of precision medicines, and guides identifying areas for further investigation in the challenging field of migraine treatment.”

- Dr. Malahat Khalili

over time. However, medicines used for migraine prophylaxis show variable effectiveness. A better understanding of comparative effectiveness

among

currently

available

pharmacological

prophylactics may optimize clinical decision-making and guide further studies. Then, we conducted a systematic review and network meta-analysis of randomized controlled trials to compare the effectiveness and harms associated with available pharmacological prophylaxis for chronic and episodic migraines.

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Institute for Pain Research & Care Seed Grants

“Our study will help our understanding of perceived causes of chronic pain, which will help identify potential targets for prevention.”

- Dr. Jason Busse

A Persistent Post-Surgical Pain Survey Primary Investigator: Jason Busse, DC, PhD Start Date: 2020

Brief Overview and Progress to Date An influential survey of 5,130 patients attending 10 outpatient chronic pain clinics found that 23% attributed their complaints to a surgical procedure. According to Google Scholar, this survey has been cited over 350 times; however, there are limitations with this report. The sample was restricted to patients in North Britain, there are no details reported regarding the response rate, and the data was acquired between 1989 and 1992. These issues suggest that generalizability to the current Canadian context is uncertain.

We surveyed 756 Canadian adults living with chronic pain to establish to what cause they attributed the development of their pain, and what interventions they have pursued and perceived effectiveness. We are currently finalizing the analyses and drafting the manuscript for publication.

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Institute for Pain Research & Care Seed Grants Feasibility of a Definitive Trial to Evaluate the Effect of Cannabinoid Oil, Versus Placebo, on Chronic Pain PostSurgical Pain and Functional Outcomes in Patients Undergoing TKA Primary Investigator: Jason Busse, DC, PhD Start Date: 2017

Brief Overview and Progress to Date Each year, approximately 67,000 Canadians undergo knee replacement surgery. Up to 20% develop persistent post-surgical pain - a complaint that is associated with depression, anxiety, unemployment and reduced quality of life. Moreover, chronic pain after surgery is often managed with opioid therapy, which typically provides only modest benefits and is associated with rare but serious adverse events, such as overdose and death. Several studies have found that greater pain just before and after knee replacement surgery is associated with the development of chronic pain, suggesting that reducing peri-operative pain may help prevent

“If our trial demonstrates feasibility, we will be positioned to pursue a definitive trail to establish if peri-operative administration of CBD is effective in reducing the prevalence of persistent pain after knee replacement surgery.”

- Dr. Jason Busse

chronic post-surgical pain.

We have been pursuing a pilot randomized controlled trial to explore the feasibility of a definitive trial of peri-operative cannabidiol (CBD) to prevent persistent post-surgical pain after total knee replacement.

We had to overcome several bureaucratic hurdles to receive Health Canada approval for our interventional product, but have now recruited 10 of our target 40 patients.

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Institute for Pain Research & Care Seed Grants

“This project will enable us to identify molecular mechanisms responsible for chronic neuropathic pain.”

- Dr. Gurmit Singh

Artificial Intelligence to Improve Understanding of the Biological Mechanism(s) of Chronic Neuropathic Pain Primary Investigator: Gurmit Singh, PhD Start Date: 2022

Brief Overview and Progress to Date In this project we utilized computer programs to analyze experimental data generated using electrophysiological recordings in model animals that were experiencing chronic neuropathic pain. It provided an avenue to examine a large amount of data and formulate pattern recognition for identifying neural fibers responsible for conduction of pain.

Related Publication Zhu YF, Kan P, Singh G. Differences and Similarities in Spontaneous Activity Between Animal Models of Cancer-Induced Pain and Neuropathic Pain. J Pain Res. 2022;15:3179-3187 https://doi.org/10.2147/JPR.S383373

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Institute for Pain Research & Care Seed Grants An Investigation into the Effectiveness of a New Transitional Pain Service (TPS) on Opioid Cessation After Broad Range of Surgeries Done at Hamilton Health Sciences (HHS) and its Affiliated Hospitals Primary Investigator: James Paul, MD, MSc, FRCPC Start Date: 2019

Brief Overview and Progress to Date Hamilton Health Sciences (HHS) affiliated hospitals use the Transitional Pain Service (TPS) model. Collecting data from the Acute Pain Service (APS), TPS and chronic pain clinic, our retrospective study seeks to elucidate risk factors associated with the development of chronic postsurgical pain (CPSP) and long-term opioid use and evaluate the efficacy of TPS in reducing opioid use in the Hamilton-Niagara Region.

Very few studies have taken a comprehensive large-scale approach in assessing whether a TPS is more effective at getting patients off opioid analgesia (in comparison to patients in a control group with usual pain care), instead choosing to examine the incidence of and risk factors for developing CPSP. Results from our study will provide additional evidence for TPS as a standard of care for managing CPSP, decreasing opioid use and giving insight into the role of the pain clinician’s increasing role in

“Transitional Pain Service physicians have more training and experience in managing patients with complex pain problems. Our research seeks to ensure that the care and followup provided by theTPS is effective at reducing the amount of opioids prescribed postoperatively and reducing the number of patients on long-term opioids.”

- Dr. James Paul

the opioid crisis.

Implementation of a new hospital information system at HHS has resulted in logistical problems, requiring this project to be put on hold for the time being. Along with COVID-19, it has been difficult to implement a transitional pain tracking system at the pain clinic. We are making progress in reaching a solution. Dr. Madi Ali, who has been working with the TPS for the last five years, has agreed to work on this project in order to help track patients and collect study outcomes.

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Institute for Pain Research & Care Seed Grants Topicals for Osteoarthritis Pain in Knee Surgery (TOPIKS): A Pilot Randomized Controlled Trial Primary Investigator: Harsha Shanthanna, MD, PhD, FRCPC Start Date: 2019

Brief Overview and Progress to Date The primary objective of this pilot trial is to assess the feasibility of a definitive trial to determine the effect of topical cannabidiol (CBD) and/or topical diclofenac versus placebo on postoperative pain and opioid use in patients after primary total knee arthroplasty.

A Pilot Study of Association of BIOmarkers and Neuropathic Pain with Intercostobrachial Nerves Sparing in breast surgery to improve Persistent postsurgical pain-an International RandomizEd controlled trial (BIO-INSPIRE) Primary Investigator: Harsha Shanthanna, MD, PhD, FRCPC Start Date: 2021

Brief Overview and Progress to Date BIO-INSPIRE is a feasibility study that aims to evaluate cytokine levels of IL-1β, IL-6, and TNFα and neuropathic pain in patients

This will be a 2x2 factorial trial assessing the following treatments: Topical

participating in the INSPIRE study (a multi-centre pilot study of

diclofenac, Topical CBD, Topical diclofenac and topical CBD, and Placebo.

50 patients to establish the effect of intercostobrachial nerve

The conduct of this trial requires No Objection Letter (NOL) from Health

preservation on persistent post-surgical pain following breast

Canada for the use of CBD product. We have been in discussion with

cancer surgery) and underwent axillary lymph node dissection

several medical Cannabis suppliers to support this trial to provide us with

during breast cancer surgery. The INSPIRE study recruited

topical CBD product that is manufactured as per GMP compliant practices

participants from two hospitals in Canada and two hospitals in India

and preclinical data.

and 46 of the 50 patients were included in the BIOINSPIRE study.

After multiple discussions, we are now working with a company that is

Study samples of BIOINSPIRE were analyzed at Hamilton (Canada)

interested in providing support and working towards getting safety data to

and Bangalore (India) separately. Presently, we are working on the

facilitate Health Canada application.

statistical analysis and we plan to publish the study results in the next few months.

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Institute for Pain Research & Care Seed Grants Opioid Reduction in Orthopedic Surgery (OREOS): A Feasibility Randomized Controlled Trial in Total Knee Replacement Patients Primary Investigator: Harsha Shanthanna, MD, PhD, FRCPC Start Date: 2022

Brief Overview and Progress to Date

“The trial aims to establish feasibility of a larger multi centred trial.”

- Dr. Harsha Shanthanna

The main objective of this pilot trial is to assess the feasibility of a multicomponent pathway on patients having elective total knee arthroplasty, while the clinical objectives are to determine the effects of the pathway on opioid-free pain control, persisting pain and opioid use, functional knee outcomes, quality of life, and return to function. Patients in the intervention group will undergo a multicomponent intervention pathway that will be facilitated by an intervention coordinator linking each patient and their surgical/ perioperative team. We have completed recruitment and surgery of all study patients and we are working on data collection to ensure minimal loss to follow up.

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Institute for Pain Research & Care Seed Grants

“Our project uses pain signature levels to interrogate the Connectivity Map database to identify drugs and natural compounds that can be repurposed for treating chronic postsurgical pain for the OA patient group that are susceptible to developing chronic pain.

The derived pain signatures will be used to inform new drug discovery/repurposing to treat chronic postsurgical pain of OA patients.”

- Dr. Fei Geng

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Who is Susceptible to Developing CPSP? A HighThroughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility Primary Investigator: Fei Geng, PhD Start Date: 2021

Brief Overview and Progress to Date Most, if not all, cases of CPSP include neuropathic pain (Gerdle and Ghafouri, 2020). The remainder having nociceptive (somatic or visceral) pain. The long-term goals of this research are to 1) define pain signatures to predict who is at risk for and who is resilient to developing chronic postsurgical pain from OA patients; 2) develop precision medicine to prevent or treat lasting pain from OA patients who are susceptible to chronic pain, potentially reducing reliance on opioids. The short-term goals are to 1) discover the pain signatures using high-throughput proteomic analysis of CPSP negative and positive plasma samples from OA patients after TKA; 2) validate the pain signatures using a separate validation cohort of OA patients. 3) clinical application of pain signatures in predicting chronic postsurgical pain for OA patients.

Through this process we will identify and validate molecular signatures predictive of conversion from acute to chronic pain (pain signatures), which would provide new avenues to predict, prevent or attenuate chronic pain conversion, with a wide range of biochemical species that could provide a novel multi-molecular signature to chronic pain conversion.

Institute for Pain Research & Care / McMaster Institute for Research on Aging Catalyst Grants Persistent Post-Surgical Pain, Postoperative Cognitive Dysfunction, and Resilience in Older People Undergoing Elective Knee Surgery: A Mixed Method Project to Explore Associations and Underlying Mechanisms Primary Investigator: Maura Marcucci, MD, MSc Start Date: 2021

Brief Overview and Progress to Date The ArthroCaP project is a mixed methods study exploring the association between chronic post-surgical pain and cognitive decline in ≥50 years old patients who are undergoing total knee arthroplasty (TKA). The quantitative part is a cohort study where patients are longitudinally followed after surgery and assessed remotely upon their pain and cognitive function; it includes also the evaluation of biomarkers associated with pain and of development of cognitive dysfunction. For the qualitative part, a sample of study participants will be interviewed either before or after surgery upon their expectations and lived experience with surgery. The study was initially a substudy of the SPOC cohort study. To deal with the impact of the pandemic on

“Given the catalyst nature of the funding, we designed the study as a proof-ofconcept study expected to provide preliminary data and inform future observational and possibly interventional research involving post-surgical pain and perioperative neurocognitive disorders.”

- Dr. Maura Marcucci

the pace of recruitment we amended the initial protocol to continue the study as a stand-alone study and to include also patients undergoing total hip arthroplasty. We closed the recruitment in the study and we are now completing the 6- and 12-month follow-up. We estimate to have 80 patients with complete data for the final analyses, with 30 patients included in the biomarker evaluation. We obtained extension of the project timeline. We plan to complete the analyses including the 12-month follow-up in June 2024.

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Institute for Pain Research & Care / McMaster Institute for Research on Aging Catalyst Grants

“Future research and treatments are directly impacted by the research.

Specifically, we are testing a new intervention that may improve pain symptoms and become a treatment for chronic neck pain. We are also creating new knowledge that will direct the objectives of future research.”

- Dr. Aimee Nelson

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Corticomuscular Coherence Brain-Computer Interface to Treat Chronic Neck Pain Primary Investigator: Aimee Nelson, PhD Start Date: 2022

Brief Overview and Progress to Date The project investigates the use of augmented reality which is a form of sensorimotor training in individuals with chronic neck pain.

The goal of the research is to determine whether the effects of augmented reality can be enhanced by the delivery of repetitive transcranial magnetic stimulation (rTMS).

Forty participants

diagnosed with chronic neck pain will be recruited to create equally sized groups receiving real or placebo rTMS. Real or placebo rTMS will be delivered immediately prior to engagement in augmented reality.

The augmented reality involves neck

movements to targets presented in a systematically increasing excursion from center point. Each participant experiences 2 to 4 weeks (3-5 times/week) of placebo/real rTMS + augmented training. Dependent measures include corticomuscular coherence assessed before and the intervention, functional assessments and clinical outcomes related to pain and quality of life.

Institute for Pain Research & Care / McMaster Institute for Research on Aging Catalyst Grants A Feasibility Study to Assess the Added Value of Integrated Musculoskeletal BiofFeedback Device (IMBED) Combined with Neuromuscular Exercise and Education (GLA-Dtm) to Decrease Chronic Pain in Older Adults with Osteoarthritis Primary Investigator: Pasqualina Santaguida, PhD, PT, Stuart Phillips, PhD, MSc, BSc and Qiyin Fang, BSc, MSc, PhD, LEL Start Year: 2020

Brief Overview and Progress to Date The purpose of this catalyst research project will evaluate the feasibility and added value of a new technology called Integrated Musculoskeletal BiofFeedback Device (IMBED). We hypothesize when IMBED output is used while administering a specialized neuromuscular exercise and education program called Good Living with Arthritis in Denmark (GLA:D™) training for lower extremity osteoarthritis (OA), participant outcomes may be optimized. In Phase I we developed a software to integrate three well established technologies (digital mapping of chronic pain, EMG biofeedback for muscle activity and body motion sensors (IMU). User testing in Phase 1 will evaluate how IMBED output will be used and accepted by clinicians to adapt and improve training. Similarly, we will evaluate feedback from participants of the GLAD program about integrated Smart Pain App. In Phase II a feasibility trial during the GLAD program and will evaluate the added value of the IMBED

“This catalyst grant will address feasibility of using integrated technology during exercise training in participants with OA. IMBED output will provide quantitative evaluation of movement of the lower extremity during training and provide data to direct clinicians to refine or adapt exercises to improve outcomes and adherence.”

- Dr. Pasqualina Santaguida

output for clinical decision-making and training and the benefit of the feedback for participants.

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“There is tremendous synergy between the IPRC’s focus on supporting pain research, and the NPC’s focus on collating primary evidence to support the development of clinical practice guidelines. The result is a coordinated effort to optimize evidence-based management of pain.”

- Dr. Jason Busse

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Engagement Canadian Pain Care Forum About the Canadian Pain Care Forum

90

participating organizations.

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advocacy groups or organizations representing people with lived experience.

JF Leroux, of Health Canada, discusses the current state of pain in Canada and the recommendations from the Canadian Pain Task Force reports at the September 2022 Canadian Pain Care Forum.

The Canadian Pain Care Forum (CPCF) was

pain-related issues in public policy, barriers

established in 2016. Its primary objectives

facing those living with chronic pain and

are twofold: (1) to serve as a platform for

current pain research.

the exchange of information and ideas to enhance the general education of members regarding public policy issues related to pain treatment, and (2) to coordinate voluntary commitments to address a wide range of public policy issues impacting pain treatment in Canada.

The September 2022 meeting saw Health Canada’s JF Leroux give insight into the federal response to the recommendations from the Canadian Pain Task Force. The action plan outlined in the presentation provided more than 150 recommendations on priority actions to ensure that people with pain are

It holds regular meetings throughout the

recognized and supported, and that pain is

year and is open to organizations with a

understood, prevented and effectively treated

demonstrated interest in improving national

throughout Canada.

and provincial pain care public policy.

12

participating hospitals or clinics across the country.

9

participating provincial or national healthcare associations.

Other recent CPCF meetings have featured

Comprised of more than 125 individuals,

updates

representing more than 90 organizations

PainCanada, the Power Over Pain Portal,

from across the country, the CPCF provides

and the Circa Pain Research Project.

from

organizations

such

as

educational sessions that seek to address 27

Engagement Annual Research Day “A patient once told me, ‘It’s hard to maintain personal relationships when it hurts to be hugged,’” said Dr. Tara Packham, discussing the functional consequences of allodynia. Dr. Packham was just one presenter amongst many at the Michael G. DeGroote National Pain Centre’s 2022 Annual Research Day. In addition to her presentation on allodynia, Dr. Packham, along with her colleague Dr. Lisa Carlesso, also provided an overview of the IMPRinT Lab and the importance of understanding pain with movement to optimize rehabilitation for musculoskeletal disorders.

The 2022 Annual Research Day saw a return to an in-person format and was held in the Royal Botanical Gardens’ Café Annex, in Burlington, Ontario. In addition to Dr. Packham, presenters included Dr. Parminder Raina, of the Canadian Longitudinal Study on Aging (CLSA), who discussed building a population-based platform for research on aging and the opportunities for pain research within CSLA; Dr. Fei Geng, who discussed who is susceptible to developing CPSP; Dr. Yong Fang Zhu and Peter Kan of McMaster’s Singh Lab, who looked at computational analysis and modeling for neuropathic pain; Dr. PJ Devereaux, who provided an overview of the PVC-RAM-1 Trial and potential to improve post-hospital discharge pain after surgery.

The 2023 Annual Research Day took place in May 2023. Subjects included statin-based muscular pain research, corticomuscular coherence brain-computer interface to treat chronic neck pain, treatment of chronic temporomandibular pain disorders: a clinical guideline; Opioid Reduction in Orthopedic Surgery (OREOS): a feasibility randomized controlled trial in total knee replacements; and a systematic review on postoperative pain and neurocognitive outcomes after non-cardiac surgery.

The Institute’s Research Days serve as a wonderful way to introduce exciting new projects, as well as showcase interdepartmental collaborations at McMaster University, addressing the way that pain presents across a multitude of illnesses and following many medical procedures.

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Top: Dr. Parminder Raina, of the Canadian Longitudinal Study on Aging discusses building a population-based platform for research on aging.

Middle: Drs.Tara Packham and Lisa Carlesso of the IMPRinT Lab discuss understanding pain with movement to optimize rehabilitation.

Bottom: Dr. Kim Madden, of the departments of Surgery and Health Research Methods, Evidence & Impact (HEI), presents on the OREOS project at the May meeting.

Partnerships & Collaborations Centre for Medicinal Cannabis Research

The Michael G. DeGroote Centre for Medicinal Cannabis Research is an international leader in medical cannabis research. As a partnership between McMaster University and St. Joseph’s Healthcare Hamilton, the Centre leverages world-class scientists and acclaimed expertise in health research and evidence-based medicine to advance the science of medical cannabis

A collaboration between McMaster University and St. Joseph’s

Communications, Events, and Continued Education

Healthcare Hamilton, the MGD CMCR leverages world-class scientists

The Centre continues to prioritize outreach via its communication channels,

and acclaimed expertise in health research and evidence-based

enhancing knowledge sharing on medicinal cannabis through revamped

medicine to advance the science of medical cannabis, assessing its

social media and newsletters.

potential benefits and risks. Since 2017, it has united nearly 50 McMaster faculty and initiated 26 research projects.

Routine events remain crucial in fulfilling the MGD CMCR’s mission. In May 2023, the ‘Cannabis and Women’s Health Half-Day’ attracted 130+

The Centre’s vision is to establish a research-based understanding of

participants through a hybrid format. The 5th Annual Innovations in the

medical cannabis, encompassing its therapeutic effects and potential

Science of Cannabis Conference, scheduled from October 10th to October

risks. Its mission revolves around three key strategies:

12th, 2023, plans to focus on the five-year impact of recreational cannabis

1. Curating existing literature to determine the state of evidence.

legalization in Canada.

2. Conducting cutting-edge research for generating new evidence.

The Centre continues outreach initiatives like the Science of Cannabis

3. Establishing a network of cannabis researchers to support its vision.

Certificate Program, a post-secondary partnership with the

Research Grants & Projects

McMaster Centre for Continuing Education, covering cannabis

The Centre’s commitment to advancing medical cannabis knowledge

science basics, applications, and risks.

is reflected in its funded external grants totaling nearly $4 million, supporting topics like cannabis and psychosis, metabolism, pain management, anxiety, and more.

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Partnerships & Collaborations Chronic Pain Centre of Excellence for Canadian Veterans Creating a national community of care for Veterans & families.

The Chronic Pain Centre of Excellence for Canadian Veterans is a research centre focusing on improving the well-being of Veterans with chronic pain. The Centre was announced in July 2019 and launched in April 2020 at McMaster University.

The Chronic Pain Centre of Excellence for Canadian Veterans (CPCoE) is honoured to have a collaborative relationship with the Michael G. DeGroote Institute for Pain Research and Care (IPRC). The IPRC participated heavily in the creation of the CPCoE and embedded our organization with a focus on the importance of working with people with lived experience. The CPCoE continues to uphold this principle of engagement and have recently adopted a new priority setting process. Using a process based on the work of the James Lind Alliance, the CPCoE solicited issues of importance from the Veteran and clinician stakeholders. The research team then explored these issues with the assistance of their Advisory Council for Veterans (ACV) and then prioritized these uncertainties that could be explored through research. Through this challenging but rewarding process, the ACV identified top research priorities for the CPCoE that will help set the scientific direction for their research over the next few years.

In fiscal year 2022-2023, the CPCoE funded 15 new research projects bringing the total number of active research projects focused on chronic pain in Veterans to 30. To date, the CPCoE has partnered with a total of 26 different research institutions across Canada as well as in the United States and Australia. To accelerate the knowledge mobilization of research 30

findings, the CPCoE actively collaborates with funded researchers to support the development and dissemination of knowledge mobilization resources. The most successful knowledge mobilization endeavor of the year was the launch of the Most Painful Podcast which covers all aspects of chronic pain by presenting evidence-based information that provides better insight into chronic pain.

The IPRC looks forward to working with the CPCoE to reach new milestones in the goal of keeping hope alive through Veteran-first chronic pain research.

Partnerships & Collaborations Chronic Pain Network: Knowledge Mobilization & Implementation Science

Scientific Director Dr. Norm Buckley and Person with Lived Experience and Advocat Therese Lane present a panel session at the Canadian Pain Society’s Annual Scientific Meeting in Banff, Alberta.

The Chronic Pain Network is a pan-Canadian research network with a specific focus on improving pain care, improving function, participation and quality of life for those affected by chronic pain, while alleviating the economic burden of pain over one’s lifespan.

It was launched in 2016, as one of five networks in chronic disease funded through the Strategy for Patient-Oriented Research (SPOR), as part of the Canadian Institutes of Health Research (CIHR).

In August 2021, CIHR announced a new competition for funding, open to the existing five Strategy for Patient-Oriented Research

Jessica Bottomley as Administrative Assistant.

As part of its efforts to generate greater awareness, this past year saw the CPN join Research Canada. Research Canada is a health research advocacy organization based on Parliament Hill, providing opportunities for researchers to educate Members of Parliament on key issues and trends in health care research across the country.

CPN-KMIS will hold its first annual meeting in October 2023.

networks in Chronic Disease, with the specific focus of mobilizing and applying knowledge generated during the first phase of the networks. The CPN was successful in its application for this funding and received $3,750,000, to be used over a four-year period.

The new iteration of the Network has seen the formation and implementation of a new governance structure, with new committees and memberships. In 2022, the Network welcomed Brandon Van Dam as its new Managing Director, and has since grown to include Divya Kanwar Bhati as its Engagement Lead and 31

Team Director Norm Buckley

Scientific Director, Michael G. DeGroote Institute for Pain Research and Care; Professor Emeritus, Department of Anesthesia, McMaster University

Eugene Maida

Medical Director, Michael G. DeGroote Pain Clinic; Assistant Clinical Professor, Division of Physical Medicine & Rehabilitation, Department of Medicine; Assistant Clinical Professor (Adjunct), Department of Anesthesia, McMaster University

Scientific Advisory Board Members Manon Choinière

Ian Gilron

Henrik Kehlet

Mark Lema

Professor, Centre de recherche du Centre hospitalier de l’Université de Montréal

Professor of Perioperative Therapy at Rigshospitalet, Copenhagen University

Director of Clinical Pain Research, Professor of Anesthesiology and Biomedical Sciences, Faculty in the Centre for Neuroscience Studies at Queen’s University

Joel Katz

Distinguished Research Professor of Psychology, Canada Research Chair in Health Psychology York University

Professor and Chair, Department of Anesthesiology, Jacobs School of Medicine & Biomedical Sciences State University of New York, Buffalo

Executive Members Jason Busse

Lisa Carlesso

Eleni Hapidou

Professor, Department of Anesthesia; Director, Michael G. DeGroote National Pain Centre; Joint Member, Department of Health Research Methods, Evidence and Impact (HE&I), McMaster University; Canada Research Chair in Prevention & Management of Chronic Pain

Associate Professor, School of Rehabillitation Sciences, McMaster University

Associate Clinical Professor (PT), Department of Psychiatry and Behavioural Neurosciences; Psychologist, Michael G. DeGroote Pain Clinic, McMaster University Medical Centre, Hamilton Health Sciences

Luciana Macedo

Michael McGillion

James Paul

Assistant Professor, School of Rehabilitation Sciences, Institute for Applied Health Sciences, McMaster University

Associate Professor and Assistant Dean Research, School of Nursing, Heart and Stroke Foundation/Michael G. DeGroote Endowed Chair of Cardiovascular Nursing Research, McMaster University

Professor & Chair of Anesthesia, Research Chair & Director, Acute Pain Services, Department of Anesthesia, McMaster University

Ian Rodger

Gurmit Singh

Florentina Miftodi

Professor Emeritus, Department of Medicine, McMaster University

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Professor, Department of Pathology and Molecular Medicine, McMaster University

Manager, Finance and Administration Michael G. DeGroote Institute for Pain Research and Care; Michael G. DeGroote National Pain Centre, McMaster University

Research Members James Bain

Mohit Bhandari

Philip J. Devereaux

Professor, Department of Surgery; Head, Division of Plastic Surgery, McMaster University

Professor and Chair, Department of Surgery; Associate Faculty, Department of Health Research Methods, Evidence and Impact, McMaster University

Director, Division of Perioperative Care, Department of Health Research Methods, Evidence and Impact; Professor, Department of Medicine, McMaster University

Laura Katz

Assistant Clinical Professor (PT), Department of Psychiatry and Behavioural Neurosciences, McMaster University; Psychologist, Michael G. DeGroote Pain Clinic, McMaster University Medical Centre, Hamilton Health Sciences

Joy MacDermid

Professor (PT), School of Rehabilitation Sciences, Institute for Applied Health Sciences, McMaster University; Professor, School of Physical Therapy, Western University

Randi McCabe

Aimee Nelson

Tara Packham

Irena A Rebalka

Behnam Sadeghirad

Louis Schmidt

Holger Shünemann

Professor, Deparment of Kinesiology, Associate Professor, Department of Biomedical Engineering, McMaster University

Assistant Professor, School of Rehabilitation Sciences, McMaster University

Assistant Professor, Department of Anesthesia; Biostatistician, Michael G. DeGroote, National Pain Centre, McMaster University

Professor, Department of Psychology, Neuroscience & Behaviour, McMaster University

Harsha Shanthanna

Li Wang

Associate Professor, Department of Anesthesia; McMaster University

Professor, Department of Psychiatry and Behavioural Sciences, McMaster University

Assistant Professor, Pathology and Molecular Medicine, McMaster University

Professor, Department of Health Research Methods, Evidence and Impact, Director, Michael G. DeGroote Cochrane Canada Centre; McMaster University

Assistant Professor, Department of Anesthesia; Michael G. DeGroote National Pain Centre, McMaster University

Staff Brandon Van Dam

Managing Director, Chronic Pain Network, McMaster University

Rachel Couban

Librarian, Michael G. DeGroote National Pain Centre, McMaster University

Megan Groves

Communications Coordinator, Michael G. DeGroote Institute for Pain Research and Care, McMaster University

Jessica Bottomley

Administrative Assistant, Chronic Pain Network, McMaster University

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“With the Canadian Pain Care Forum we have had a series of talks focusing on healthcare professional curricula in the various professions - Psychology, Occupational therapy, Physiotherapy, Medicine, Nursing, Pharmacy, Chiropractic. This has led to not only greater awareness of projects underway, but also identified some gaps. As a result, The IPRC has entered into a partnership with the Canadian Psychology Association to create a series of teaching modules aimed at psychologists in independent practice to enhance their ability to work with people living with pain, and also to establish informal partnership with other professionals in their community to create ‘virtual’ interdisciplinary teams where these do not exist in other structures. This will launch in early 2024.”

- Dr. Norm Buckley 34

Mission

The mission of the Michael G. DeGroote Institute for Pain Research and Care is to become a cutting edge institute in the area of chronic pain and a magnet for researchers and trainees in the field.

Institute for Pain Research and Care, McMaster University 1280 Main Street West, MDCL 2101, Hamilton ON, Canada, L8S 4K1

Phone: 905.525.9140 Ext. 22743 Email: npc@mcmaster.ca Web: pain-institute.healthsci.mcmaster.ca