Michael G. DeGroote Institute for Pain Research & Care

The

Toward the conquest of pain

Vision

To further the understanding of the origins and management of chronic pain by bringing together behavioural, clinical and basic scientists to explore underlying mechanisms and therapeutic paradigms.

Message from the Scientific Director

at a Glance

and Outreach

Pain Care Forum

Symposium

Research Day

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page 15 Centre for Medicinal Cannabis Research

page 16 Chronic Pain Centre of Excellence

page 17 for Canadian Veterans

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McMaster and Around the World

page 19 Research

Studentships

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page 23 Seed Grants

Seed Grants

Catalyst Grants

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A Lasting Legacy. . . A Pivotal Gift

About Michael G. DeGroote and his gift

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

“Mr.

DeGroote’s gift has been pivotal in advancing pain research in Canada. It has paved the way for organizations like the Chronic Pain Network and the Chronic Pain Centre of Excellence for Canadian Veterans and prioritized engaging people with lived experience, helping to improve patient care and remove barriers that too often stand in their way.”

- Dr. Norm Buckley, Scientific Director of the Michael G. DeGroote Institute for Pain Research and Care

Michael G. DeGroote passed away in September 2022, at the age of 89. Though he is no longer with us, his generosity continues to shape health research and patient care, leaving a legacy that ensures innovation will thrive for generations to come.

“One in five Canadians live with chronic pain, and many still face barriers to the care and treatments they desperately need. That is why it is so critical to prioritize research and initiatives that bring us closer to equitable, accessible and effective pain management for all - especially our most vulnerable populations.”

- Dr. Norm Buckley Scientific Director, Institute for Pain Research and Care

Message from the

Scientific Director

The movie The Big Sick is the fictionalized retelling of how comedian Kumail Nanjiani met his wife. On a cursory level, the movie examines the challenges of intercultural relationships and intergenerational incongruencies in acculturation. However, at a slightly more subtle level, it looks at the emotional impact and obstacles in diagnosing rare diseases and navigating healthcare – especially for those who may not have the knowledge, words, or capacity to fully communicate their experiences or advocate for themselves or loved ones.

Sociologist Émile Durkheim argued that the strength of a society depends on its social bonds and collective compassion— the willingness of individuals to care for one another and maintain cohesion. When those bonds fray, societies weaken. But how compassionate are we to our most vulnerable today? In 2022, 27% of Canadians 15 and older had at least one disability—an increase of five percentage points from 2017. Among persons with a disability, the most common type was pain-related, with 62% reporting this type.

The Institute for Pain Research and Care is committed to improving access to care and breaking down barriers for marginalized populations. This has been a driving force behind our involvement in establishing initiatives like the Chronic Pain Network,

the Chronic Pain Centre of Excellence for Canadian Veterans, and more.

With research projects like Dr. Li Wang’s, which develops a risk prediction model for chronic post-surgical pain after breast cancer surgery, we are addressing disparities in outcomes among underserved populations, including racialized, disabled, low-income, and unemployed individuals. Evidence shows immigrant women who undergo breast cancer surgery experience a disproportionately higher burden of chronic pain.

By integrating chiropractic and medical care within Community Health Centres to reduce reliance on opioids for noncancer spinal pain, Dr. Peter Emary’s project will benefit vulnerable and marginalized populations who rely on CHCs for accessible pain management. We continue to grow our network of trainees to help shape pain researchers who include people with lived experience, address challenges faced by marginalized communities, and ensure diverse perspectives are represented in our Canadian Pain Care Forum so everyone has a voice and can contribute to the national conversation on pain.

Together, these efforts position us as global leaders in advancing equitable and innovative pain research and care.

Norm Buckley, BA (Psych), MD, FRCPC Scientific Director

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

Year at a Glance Fast Facts

7 full-time and 14 parttime Institute staff members overseeing all operations and research activities.

26 multidisciplinary research team members from 10 health disciplines, within 4 McMaster faculties.

Numbers at Glance

114 publications on the topic of pain by our members.

10 research awards and projects funded every year.

$611,785 spent on awards and research projects.

Fifty-eight percent of our annual budget was spent directly on research salaries, research awards (graduate studentships and postdoctoral fellowships) and research projects (seed grants and other funded research projects). Annual administrative cost was 33% of the total budget, while the operating expenses (including community engagement throughout IPRC Symposium, Canadian Pain Care Forum meetings, National Faculty meetings) made up of 9% of the annual expenses.

Additional to the Institute’s activities, our IPRC research and operational team administers 34 current projects funded in the last eight years by various sponsors: The current balance available amounts to $10.3M for research projects to complete by 2030.

Education and Outreach

Communications

Platforms & Strategy

The Institute for Pain Research and Care and the National Pain Centre currently utilize six social media platforms: Facebook, Threads, Instagram, LinkedIn, BlueSky and YouTube, in addition to maintaining their own websites. Each platform has been selected based on its ability to reach specific audiences and deliver tailored messaging in the most effective format.

• Instagram and Threads focus on visually driven content and community-building conversations.

• Facebook provides an opportunity to reach an older, but still tech-savvy demographic, providing updates for a broad public audience.

• LinkedIn is used to engage professionals, researchers and healthcare providers.

• BlueSky allows participation in emerging health conversations in decentralized networks.

• YouTube is leveraged for hosting educational, testimonial and campaign video content.

As we refine our strategy in the

coming year, a core focus will be on better aligning our messaging with the unique strengths of each platform and better optimizing content delivery and scheduling for maximum engagement. A critical part of this work will be creating better strategy to reach disenfranchised populations, including those who may face barriers to care, experience health inequities or are underrepresented in traditional health communication channels.

Campaign Highlights

Our primary campaign each year is National Pain Awareness Week. In 2024, this took place from November 3rd to November 9th. The Institute and NPC published 39 posts across four social media platforms, resulting in a 30% increase in impressions and a 31% increase in engagements compared to our 2023 campaign. Building on this momentum, we aim to increase both impressions and engagement by 50% during our 2025 campaign through expanded multimedia content, improved audience targeting and strategic scheduling.

Community Building

National Pain Awareness Week also provides an opportunity

to collaborate with other pain organizations across Canada, uniting our voices to highlight the experiences of people living with chronic pain and the systemic barriers they face. In 2024, the campaign was coordinated by Pain Canada, and saw organizations from across the country joining together. The campaign saw:

• 1,505 participants

• 4,670 posts shared across platforms

• 9.4 million total impressions

• 2.7 million people reached

This kind of coordinated digital activism is critical to creating awareness about the challenges experienced by those living with chronic pain, as well as helping to inform policy to better improve access to treatments.

Websites

Both the Institute for Pain Research and Care and the National Pain Centre maintain individual websites that provide trusted, evidence-based information for clinicians, researchers, people with lived experience and the general public. These sites are key tools for knowledge translation and resource distribution.

In 2024, we saw consistent engagement across both websites:

Institute for Pain Research and Care

• More than 2,000 unique visitors and 7,000 page views

• Most traffic is from direct referrals, followed by Google search results

National Pain Centre

• More than 4,600 unique visitors and 13,000 page views

• Most traffic is from direct referrals, followed by Google search results

Looking ahead, we will place greater emphasis on using social media and digital campaigns to drive targeted traffic to these websites. This includes integrating clear calls to action in posts, sharing website-based resources in accessible formats and using analytics to better understand how users interact with content after clicking through. Ultimately, our goal is to create a seamless bridge between awareness campaigns and deeper engagement with highquality resources.

Looking Ahead

Moving forward, we plan to expand our use of video to enhance our social media presence.

This includes creating content featuring researchers, trainees and individuals with lived experience, as well as animated videos using original characters (currently in development) to represent different types of pain. These videos, ranging from 30 seconds to 5 minutes, will be tailored for general audiences and designed to make complex information more accessible, relatable and impactful.

Social Media Metrics

15,142 Impressions

1,056 Engagements

7% Engagement Rate (per impression across platforms)

Institute for Pain Research & Care

Seed Grants Education and Outreach

Trainee Network

The Institute for Pain Research & Care (IPRC) continues to strengthen its support for emerging pain researchers through mentorship, collaboration and skill-building. The expansion of the IPRC Trainee Network has created more opportunities for trainees to develop their research and communication skills while connecting across disciplines.

also introduced lunch and learn events designed to strengthen presentation and communication skills. The first session, held in July 2024, featured Dr. Filipe Reis who discussed the role of artificial intelligence in pain research.

Our most recent session, held on April 24, 2025, was a hands-on workshop led

management and signaling. Submitted slides were used to demonstrate effective design in real time and a working lunch allowed for peer discussion and feedback.

More sessions are planned for the coming year. Through practical training and community building, the IPRC continues

“I really enjoyed the workshop by Dr. Kim and have already found it useful in preparing my research presentations. Since then, I’ve presented at two conferences where my talks were well-received, and I even won a top research prize at one of them! This was exactly the kind of practical training I needed to improve my presentation skills.”

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Dr. Peter Emary 2023 Pain Fellowship Recipient

The Trainee Network brings together students and early-career researchers from behavioural, clinical and basic science backgrounds. Its mission is to foster mentorship, raise awareness of funding and award opportunities and promote collaboration. This growing community is integral to advancing the IPRC’s goal of improving understanding and treatment of chronic pain.

Recent initiatives include the launch of the IPRC Trainee Hub, an online resource with information on funding, networking and proposal development. The Institute

by Dr. Joe Kim, Associate Professor in Psychology, Neuroscience & Behaviour at McMaster University and multimedia specialist Paulina Rzeczkowska, called The Science of Designing Powerful Presentations. The session addressed the challenge of overly text-heavy research presentations, teaching participants how to engage audiences through story and design.

Trainees learned to improve slide structure, narrative flow and visual coherence using multimedia principles such as cognitive load

to empower its trainees to communicate research with clarity and confidence— advancing the future of pain science.

Pictured Above: Dr. Joe Kim and Paulina Rzeczkowska gave trainees

Education & Outreach

Canadian Pain Care Forum

Established in 2016, the Canadian Pain Care Forum (CPCF) is a national initiative committed to improving pain care, education, and policy through collaboration. It brings together healthcare professionals, researchers, and individuals with lived experience—from across the country—to address one of Canada’s most pressing yet often invisible health challenges: chronic pain. Among the many initiatives shared through the CPCF, one notable project comes from Karen Jukes of SaskPain, who presented Rikki’s Invisible Pain, a children’s book and curriculum package designed to raise awareness of pediatric chronic pain in Saskatchewan. Co-led by Jukes and Ross McCreary and co-designed with a diverse working group, the initiative aligns with provincial curriculum standards and aims to support students, families, and educators. “Children and youth with chronic pain report that sense of invisibility due to that lack of understanding,” Jukes explained, underscoring the importance of education in building empathy and support early in life. She added, “Pain treatment isn’t just about interventions. We need to

address stress, trauma, sleep, mental health.”

Also shared through the Forum is the forthcoming update to the Opioid Guideline for Non-Cancer Chronic

Pain, led by Dr. Jason Busse. Funded by Health Canada’s Substance Use and Addictions Program (SUAP), this guideline offers evidence-based recommendations for healthcare providers, patients, caregivers, and policymakers to help navigate the complexities of pain management and opioid prescribing.

Psychologist Max Slepian of Toronto General Hospital contributed insights to the Forum, highlighting the critical gap in access to psychological care for people living with pain. “Less than 25% of psychologists receive any training in pain,” he noted. “Psychology developed as a scientific discipline... not a treatment discipline.” To address this, Slepian advocates for digital interventions, collaborative care models, and enhanced training in pain psychology.

Another key innovation is the e-Chronic Pain Recommendation Map,

introduced by Andrea Darzi. This digital platform is designed to clarify the variability amongst pain guidelines and promote trustworthy, accessible, and patient-centered care. With features like plainlanguage summaries, decision aids, and multilingual access, it supports shared decision-making and aims to standardize care across Canada— particularly benefiting under-served populations.

These efforts highlight the ongoing work across the country to make pain care more accessible, inclusive, and evidence-informed. Together, they reflect CPCF’s commitment to transforming how pain is understood and managed - especially for vulnerable populations too often overlooked in traditional models of care.

Education and Outreach

Pain Symposium

The 2024 Pain Symposium, hosted by the Michael G. DeGroote Institute for Pain Research & Care (IPRC) at McMaster’s University Club, delivered a day of focused on research and discussion on the subject of chronic pain. The Symposium is an annual, accredited event and serves as a critical platform for researchers, clinicians and trainees to share their work, and latest advancements, as it relates to pain and growing knowledge in this area.

The day opened with remarks from IPRC Scientific Director Dr. Norm Buckley, setting the tone for a program focused on meaningful impact and clinical relevance. Dr. Serge Marchand launched the first session, examining endogenous pain mechanisms, highlighting how internal systems can both contribute to and protect against chronic pain. Dr. Mike Salter followed with a nuanced exploration of the “mechanistic mélange” of pain, emphasizing its multifactorial nature and the ongoing challenge of untangling its neural underpinnings.

Morning talks continued with Dr. Maxwell Slepian’s review of non-invasive brain stimulation,

particularly transcranial direct current stimulation, as an emerging therapeutic modality. Dr. Arnav Agarwal then presented findings from international guidelines on spinal decompression surgery, offering much-needed clarity in a space often fraught with clinical uncertainty.

The mid-morning lineup also included Dr. Stevie Foglia’s innovative approaches to risk prediction and intervention with the application of machine learning to predict chronic post-surgical pain, and Dr. Harsha Shanthanna’s review of photobiomodulation therapy following C-section.

Dr. Jiyeon Park discussed advanced magnetic stimulation in diabetic neuropathy, while Dr. Behnam Sadeghirad shared a comprehensive meta-analysis on perioperative pain prevention strategies.

Talks by Dr. Raghava Neelapala and Dr. Dena Zeraatkar addressed early knee osteoarthritis pain phenotypes and chronic pain in long COVID, respectively.

The symposium closed with final reflections from Dr. Buckley, reiterating the value of collaborative, interdisciplinary approaches in pain research. As the IPRC continues to drive knowledge translation and innovation, events like this reinforce McMaster’s role as a leader in pain research, both in Canada and around the world.

Keynote Speakers over the years include:

• Dr. Manon Choinière

University of Montreal

• Dr. Mike Salter

University of Toronto

• Dr. Matthew Chan

Chinese University of

• Dr. Jane Quinlan

University of Oxford

• Dr. Karen Davis

University of Toronto

• Dr. Brice Gaudilliere

Stanford University

Pictured Above: Dr. Peter Emary and Dr. Bruce Fligg at the Pain

Education and Outreach

Annual Research Day

On June 25, 2025, the Institute for Pain Research and Care (IPRC) hosted its Annual Research Day at the Royal Botanical Gardens’ Rock Garden. This year’s event brought clinicians, scientists, and trainees together to exchange knowledge and explore new directions in pain research, including a shared goal to improve care for those most at risk of being left behind in the healthcare system.

The afternoon began with lunch and an informal networking session, setting the stage for a series of presentations rooted in both scientific evidence and social relevance.

Dr. Mike Noseworthy opened the session with research on brain imaging to identify how individuals process pain differently. His goal: to pave the way for personalized assessment strategies that move beyond the “one-size-fits-all” approach, which is particularly important for patients whose pain has historically been dismissed or misunderstood.

Next, Dr. Mike McGillion presented findings from the FORESITE study, which examines how coping styles, pain beliefs and gender-based expectations contribute to chronic

post-surgical pain after cardiac surgery. His work highlighted how social context and identity can influence medical outcomesespecially in older adults and those recovering from complex procedures.

Joining virtually, Dr. Emile Tompa spoke about the IDEA initiative (Inclusive Design for Employment Access), which promotes workplace inclusion through co-design with persons living with disabilities. His talk underscored the need for systemlevel changes that recognize chronic pain as both a health and social issue - one that disproportionately affects marginalized workers.

After a short break, Dr. Jason Busse outlined his work on predictors of chronic pain after fracture surgery. His COPE trial is testing whether online cognitive behavioural therapy (CBT) can reduce long-term pain by addressing psychological risk factors early, making it more accessible for people in rural or under-served communities.

The day concluded with an innovation spotlight: Akil Siva and Jialiang (Kevin) Hu introduced the RF-Surge, a

T-adapter for radiofrequency ablation that allows for more precise and comfortable procedures. The device was designed with patient experience in mind, particularly those who have not benefited from conventional treatments.

These efforts highlight the ongoing work across the country to make pain care more accessible, inclusive and evidence-informed. Collectively, they underscore a growing commitment to identifying and addressing the inequities and systemic obstacles faced by vulnerable and underserved populations - groups that are often at greater risk for developing chronic pain and less likely to receive

Pictured Above: Dr. Mike McGillion discusses findings from the FORESITE study at the

Partnerships & Collaborations

Centre for Medicinal Cannabis Research

The Michael G. DeGroote Centre for Medicinal Cannabis Research (MGD CMCR) is an international leader in cannabis research. A partnership between McMaster University and St. Joseph’s Healthcare Hamilton, the Centre leverages world-class scientists and expertise in evidence-based medicine to advance the science of medical cannabis. The Centre investigates cannabis like any other drug, systematically evaluating both its potential benefits and harms. Since its launch in 2017, the Centre has brought together over 50 McMaster faculty to advance this mission.

In 2024, the Centre expanded its knowledge translation initiative called BudTalks. We created a website [https://budtalks.ca] and now offer high-quality printed materials to help people understand specific areas of cannabis research. The first two booklets completed are *Cannabis Use and Older Adults* and *Cannabis Use Disorder*. The guide for older adults presents easy-to-understand, reliable, sciencebased information to help seniors make decisions about their cannabis use. The second booklet targets people experiencing negative outcomes from cannabis use and discusses how the brain is affected and how to reduce or

In 2024, CMCR launched the website for its BudTalks and has covered topics such as cannabis use in older adults and cannabis use disorder.

stop problematic use.

On the clinical research side, 2024 saw the completion of data collection on two pilot clinical trials. The first, led by Drs Anthony Adili, Kim Madden and Jason Busse, examined CBD for reducing persistent post-surgical pain after knee replacement. The second, led by Dr. Benicio Frey, examined CBD and a CBD/ THC mix for treating insomnia in people with depression. Next steps include pursuing funding for a definitive trial of CBD to prevent persistent pain after knee replacement.

2024 also saw several trainees publish landmark works. For example, Dr.

Amanda Doggett published articles on label accuracy of legal oral cannabis oil products in Ontario, and on Canadian cannabis legalization’s impact on emerging adults. Dr. Andre McDonald published on cannabis legalization and opioid-related deaths. Other trainee work included a review of cannabis versus opioids for chronic non-cancer pain (Haron Jeddi), a study on values and preferences in medical cannabis for chronic pain, and a systematic review on adolescent cannabis use and academic achievement (Olsen Chan).

To learn more about BudTalks, visit: budtalks.ca

Partnerships & Collaborations

Chronic Pain Centre of Excellence for Canadian Veterans

The Chronic Pain Centre of Excellence for Canadian Veterans (CPCoE) continues to value its strong partnership with the Michael G. DeGroote Institute for Pain Research and Care (IPRC), whose foundational role helped establish the CPCoE’s guiding principles—particularly the commitment to engaging Veterans with lived experience in research. That principle remains central to the CPCoE’s identity. This past year, the CPCoE adopted a formalized research priority-setting process grounded in the James Lind Alliance model. Veterans, clinicians, and policymakers were invited to submit topics of concern, which were then carefully reviewed by the Advisory Council for Veterans (ACV). The resulting research priorities reflect the real-world needs of Veterans living with chronic pain and will shape the Centre’s scientific direction over the coming years.

In fiscal year 2024–2025, the CPCoE funded 14 new research projects, bringing the total number of active projects focused on chronic pain in Veterans to 76. To date, the CPCoE has partnered with 30 research institutions across Canada, the United States, and Australia— demonstrating the scale and reach of its collaborative network.

The conference's theme was Pathways to Impact for Research Related to Veterans Living with Chronic Pain. The workshop convened a diverse group of Veterans, researchers clinicians, policymakers and other interest holders to exchange ideas and strengthen collaboration.

The CPCoE also made significant strides in knowledge mobilization this year, working closely with researchers to translate evidence into accessible, usable formats. Recent initiatives include its Annual Workshop in Halifax and its collaboration with Research Impact Canada. Also, the CPCoE Knowledge Mobilization team contributed to the design and delivery of a global KMb course: MobilizeU; as well as RIC’s bi-annual “Knowledge Mobilization Forum.”

As we look ahead, the IPRC and CPCoE remain aligned in their shared mission: to improve the

lives of Veterans living with chronic pain. Through evidence-based research, inclusive engagement, and a growing network of partners, the CPCoE continues to deliver on its vision of Veteran-first, equity-driven research that serves those who are often under-served or overlooked.

To learn more about the CPCoE visit: http://veteranschronicpain.ca

Partnerships & Collaborations

Chronic Pain Network: Knowledge Mobilization & Implementation Science

Over the past year, the Chronic Pain Network (CPN) has continued advancing its vision of changing the way pain is managed in Canada.

A major highlight was the launch of Pain Connect, a new online platform designed to bring together researchers, policymakers, clinicians, and people living with pain. Pain Connect strengthens opportunities for engagement and knowledge exchange, ensuring that patient voices remain central to shaping pain research and care.

CPN also supported the second National Indigenous Clinicians Gathering, held in Membertou and Eskasoni First Nations in Nova Scotia. This gathering created a space for Indigenous clinicians, traditional knowledge keepers, and community to help set national hurt and healing research priorities for Indigenous children and youth. Dr. Chelsea Gabel, the Scientific Director for CIHR’s Institute of Indigenous Peoples’ Health presented about the national landscape of Indigenous health research and how to access funding specific to Indigenous-led research.

CPN, along with CPS and the Health Standards Organization, is also partnering with the Michael G. DeGroote Institute for Pain Research and Care on the development of a national adult pain standard. This standard will provide

The second National Indigenous Clinicians Gathering brought together Indigenous health leaders to guide the future of pain research and care for Indigenous children and youth.

a shared framework to guide pain care across Canada and will be developed into an assessment standard, so that it is included in the Accreditation Canada process for healthcare delivery organizations.

CPN participated in a meeting with Government of Ontario policymakers to discuss strategies for improving and supporting pain care in the province.

Another key initiative this year has been the network impact evaluation, which is currently underway. This evaluation is engaging members and partners across Canada to reflect on CPN’s influence since its inception. The process will help capture successes,

identify areas for growth, and inform the next phase of the Network’s work.

Together, these milestones demonstrate CPN’s ongoing commitment to collaboration, equity, and impact. By connecting communities, amplifying patient voices, and advancing standards of care, the Network is shaping a future where pain is better understood and more effectively managed across Canada.

Stay connected and informed by visiting our newly updated website: https://cpn-rdc.ca/

Partnerships & Collaborations

At McMaster and Around the World

This year, Dr. Andrea Darzi was appointed as the Assistant Director of the National Pain Centre. In addition to her work through the Department of Anesthesia, Dr. Darzi also holds an appointment with the Department of Health Research Methods, Evidence and Impact—reflecting the deeply collaborative and interdisciplinary nature of the Centre’s work.

The National Pain Centre (NPC) and the Institute for Pain Research and Care (IPRC) are distinct but closely aligned organizations that prioritize inclusivity and collaboration at every level. Whether it’s through shared faculty appointments, cross-departmental research, copresentations at research events or inter-institutional projects, the NPC and IPRC work across disciplines and borders to advance pain care, research and education. This commitment is reflected not only through collaborations at McMaster University, but across Canada and around the world.

One of the Centre’s greatest strengths is its team’s cultural and linguistic diversity. With researchers fluent in multiple languages and trained across different health systems, the NPC is uniquely positioned to interpret and engage with research literature from around the world, removing

The Institute for Pain Research & Care produced 114 publications in 2024, with most collaborations taking place within McMaster University. Extensive collaboration also occurred across Canada and internationally, reflecting the Institute’s strong national partnerships and global connections. The visualization depicts clusters of co-authorships, where each node represents a publication and proximity indicates the strength of collaborative relationships.

traditional barriers to evidence access and broadening the global relevance of its work. Our publications have appeared in policy-informing publications from the Norwegian Institute of Public Health, Canada’s Drug Agency, the Government of Canada, the UK Government and the World Health Organization.

In 2024, Institute for Pain Research and Care members saw more than 110 publications, collaborating with more than ___ individuals and institutions globally.

work is MAGICapp, a web-based platform used to develop and share clinical guidelines in accessible, transparent formats. By publishing guidelines through MAGICapp, the Centre helps ensure that its research is more usable and understandable to clinicians, policymakers, and the public - both in Canada and around the world.

In addition to working with academic institutions like the University of Liverpool, the National Pain Centre is also engaged with international organizations focused on evidence dissemination. A key partner in this

“With support from the Institute for Pain Research & Care and the ongoing work of the National Pain Centre to produce high-quality, evidence-based guidelines that shape policy worldwide, meaningful progress is being made toward improving access and quality of care for people living with pain.”

- Dr. Jason Busse Director, National Pain Centre

Institute for Pain Research & Care

Seed Grants

Graduate Studentships

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

BMJ Rapid Recommendation: spinal decompression with or without fusion surgery for degenerative lumbar spondylolisthesis

Primary Investigator: Maura Marcucci, update

Recipient: : Arnav Agarwal, BSc, MD

Start Date: 2021

Supervisor: Dr. Jason Busse

Brief Overview and Progress to Date

Two systematic reviews -- one on randomized trial evidence regarding benefits and harms, and a second on observational data regarding harms -- have been completed. These reviews will inform a practice guideline on whether chronic back pain due to stenosis (narrowing of the spinal canal) should be managed with surgical decompression alone or decompression plus fusion.

The guideline panel has been selected. Financial and intellectual conflicts have been reviewed and the panel has been approved by MAGIC and the BMJ, who collectively oversee the guideline process. Introductory panel meetings to determine the clinical question (PICO) and associated analyses for the guideline have been completed. Next panel

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 arthroplasty. The quantitative part is a cohort study of patients who 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 cognitive dysfunction. We just closed the study with the completion of the 1-year follow-up for the last participant. We recruited 93 participants, of whom, 67 completed the 1-year visit. 30 participants consented to the biomarkers evaluation. We obtained extension of the project timeline (at the same funding). We are currently cleaning the database for analyses for the first publication. Given the disruption due to the pandemics we decided to put the qualitative component of the study (which would explore expectations and lived experience with surgery) on hold.

meetings to review evidence and move from evidence to recommendations are planned.

The ultimate goal of the research is to incorporate the latest available evidence to develop trustworthy guidelines regarding the management of lumbar spinal stenosis. Next steps include the finalization of the two systematic reviews and completion of the Evidence-to-Decision pathway to develop recommendations for the guideline are pending.

“IPRC funding has enabled me to have protected time and resources to progress the project. I am very grateful to have funding support for this work.”

- Arnav Agarwal

Institute for Pain Research & Care

Seed Grants Seed Grants

Graduate Studentships

Who

Susceptible

to Developing CPSP? A High-Throughput

Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Understanding the mechanisms that underpin the development of chronic postsurgical pain after minimally invasive thoracic surgeries; predicting risk using neurophysiology and predictive modeling

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Recipient: Stevie Foglia,

BSc

Supervisor:

Dr. Harsha Shanthanna & Dr. Aimee Nelson

Brief Overview and Progress to Date

Chronic postsurgical pain (CPSP) is defined as pain persisting for at least three months after surgery without other explanations. Following thoracic surgery, CPSP occurs in 30–50% of patients and is linked to depression, anxiety, and reduced quality of life. Current risk factors for CPSP remain inconclusive. The primary motor cortex (M1) is central in pain modulation, and transcranial magnetic stimulation (TMS) and electroencephalography (EEG) provide noninvasive tools to assess excitatory and inhibitory circuits within M1 that may be linked to the genesis of CPSP. The goal of this research is to explore differences in the association of GABAergic inhibition and corticospinal excitability among patients who develop CPSP as compared to those who do develop CPSP in a cohort of patients having thoracic surgery.

We have received HiREB ethics (17806). To date, 124 patients have been screened, 81 have been surgery eligible, and 21 patients have been enrolled in total.

The goal of the research is to identify biological predictors for the occurrence of CPSP. This information will help clinicians determine, prior to surgery, if a patient is at greater risk of developing CPSP. Furthermore, the biomarkers identified to predict CPSP outcomes can be used to inform mitigation strategies before surgery, ultimately improving healthcare outcomes for individuals following their procedures.

Next steps include completion of data collection by May 2026, conference presentation in Fall 2026 and publication Summer 2026.

“IPRC funding has been instrumental in supporting my doctoral studies, allowing me to focus on my passion: chronic pain research.”

- Stevie Foglia

Institute for Pain Research & Care

Seed Grants

Pain Fellowship

Impact of Chiropractic Care on Opioid Use for Non-Cancer Spinal Pain: A Systematic Review and Pilot Cluster Randomized Controlled Trial

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Primary Investigator: Maura Marcucci, update

Recipient: Peter Emary, DC, PhD

Start Date: 2021

Supervisor: Dr. Jason Busse

Brief Overview and Progress to Date

In our systematic review we found that receipt of chiropractic care is associated with lower odds of receiving prescription opioids and initiating long-term opioid use among patients with non-cancer spinal pain, particularly when chiropractic care is provided earlier vs later. However, the evidence supporting these findings is only very low certainty, as it was informed by observational studies. As such, we’ve initiated a feasibility randomized controlled trial (RCT) of chiropractic care added to usual medical care, versus usual medical care alone, for adults prescribed opioid therapy for chronic spinal pain at 4 Ontario community health centres (CHCs). These patient populations have traditionally been excluded from clinical trial research; however, we now have a mechanism in place to conduct this research through Clinical Trials Ontario (CTO). We’ve registered our first 2 CHCs with CTO and are aiming to begin trial initiation and participant recruitment at these sites in December 2025. We plan to register the 2

additional CHCs with CTO in the coming months.

Next steps include conducting further research on the impact of chiropractic care on opioid use, and the costeffectiveness of chiropractic care for managing spinal pain. Accordingly, I am planning a series of definitive RCTs to measure the effectiveness of chiropractic care on: (1) opioid tapering among patients receiving high-dose opioids for chronic spinal pain, (2) opioid tapering among patients being managed for opioid use disorder, and (3) opioid diversion in opioid-naive patients with acute or chronic spinal pain. In these studies, I will also be evaluating the cost-utility of integrating chiropractic with medical care in Canadian CHCs. In partnership with Dr. Sheila Sprague and the Surgical Methods Centre at McMaster University, we have a framework in place for conducting intra- and interprovincial clinical trials and writing successful research grants to support and expand this work.

“The work I have completed over these past two years, including ongoing related projects, would not have been possible without my IPRC fellowship.”

- Peter Emary

Institute for Pain Research & Care

Seed Grants Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Advanced controlled transcranial magnetic stimulation to modulate neural plasticity and alleviate pain in diabetic neuropathy and use of a new TMS technology that aims to reduce pain symptoms in diabetic neuropathy

Primary Investigator: Aimee Nelson, PhD

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Co-Investigator: Harsha Shanthanna, MD, PhD

Start Date: 2024

Brief Overview and Progress to Date

The overarching goal of the proposed research is to assess the effects of a 5-day cTMS stimulation protocol on measures of pain, neuroplasticity, and somatosensory function in individuals with pDN. The specific aims of this study in pDN are to: (1) Investigate the effects of a 10-day cTMS intervention on pain symptoms. We hypothesize that cTMS will produce analgesic relief that will be associated with changes in neuroplasticity and somatosensory function compared to sham. Importantly, the effect of real and sham cTMS will be explored within individuals; and (2) To explore the feasibility of the 10-day cTMS intervention. This will inform the utility of cTMS interventions in future treatments studies. In addition, the patient perceived change from the intervention will be assessed to improve the patient experience for future studies.

To date, we have recruited 22 participants, 15 are completed and 3 are in the midst of data collection and 4 have dropped out of the study.

We are seeking a new therapeutic treatment for individuals with painful diabetic neuropathy. We anticipate that positive outcomes will benefit people with lived experience.

Next steps include completing collection and analysis by October 2026. We will publish these results in a journal and a conference presentation at that time.

“IPRC funding has allowed for the opportunity to test cutting-edge brain stimulation technology as a potential therapy for individuals living with painful diabetic neuropathy.”

- Aimee Nelson

Institute for Pain Research & Care

Seed Grants

The validation of a proposed mechanism for statin-induced myalgia in vivo

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Primary Investigator: Irena Rebalka, PhD

Primary Investigator: Maura Marcucci, update

Start Date: 2024

Start Date: 2021

Brief Overview and Progress to Date

Statins impair mitochondrial respiration within skeletal muscle, increasing ROS production and glutamate extrusion, which may cause myalgia. To expand understanding of the relationship between statins, oxidative stress, and glutamate, this aim validated these effects within the skeletal muscle microenvironment following local statin administration in vivo. Results are being compiled for a short report. Briefly, atorvastatin in its lactone form altered skeletal muscle amino acid flux after only 90 minutes of perfusion, suggesting a rapid response to oxidative stress and dysregulated calcium handling. This study provides evidence for a mechanistic link to statin-induced myalgia, early alterations within muscle and differences between lactone and acid forms.

Next steps include expansion through a five-year NSERC

Discovery Grant and a one-year NSERC Discovery Launch Supplement for Early Career Researchers, awarded with pilot data from this seed grant. Several publications are in preparation to advance this program. Future directions aim to enable faster initiation of targeted treatment plans for musculoskeletal pain, with potential to lessen pain, reduce analgesic dependence, improve quality of life, and decrease the burden of musculoskeletal pain on the Canadian healthcare system.

This seed grant has also supported additional projects in pain research. One ongoing study examines the incidence, prevalence, and risk factors of musculoskeletal pain in individuals with type 1 diabetes.

“Funds to support a co-op student led to being named the 2024 Science Co-op Employer of the Year. Exciting preclinical findings contributed to the award of a five-year NSERC Discovery Grant and NSERC Discovery Launch Supplement. This IPRC Seed Grant has truthfully boosted my career.” - Irena Rebalka

Institute for Pain Research & Care

Seed Grants Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Impact of Chiropractic Care on Opioid Use Among Adults with Chronic Non-Cancer Spinal Pain: A Pilot Cluster Randomized Controlled Trial (RCT)

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Jason Busse, DC, PhD 2024

Brief Overview and Progress to Date

Results of several uncontrolled studies suggest that integration of chiropractic services into primary care centres may reduce reliance on opioids for chronic pain.

We will conduct a cluster-randomized, 2-arm, data analystblinded feasibility trial of chiropractic care added to usual medical care, versus usual medical care alone, on opioid use among patients with chronic non-cancer spinal pain. We will recruit four community health centres in Ontario, Canada and enroll 25 adult patients with active opioid prescriptions (≥50 mg morphine equivalents daily) for chronic non-cancer spinal pain. Each centre (cluster) will be allocated to provide either: (1) eight-week ongoing usual medical care plus chiropractic care, or (2) 8-week ongoing usual medical care alone. Our primary aim will be to estimate

recruitment rates at individual centres and completeness of data collection and follow-up of participants to inform the feasibility of a definitive trial. The ultimate goal of this trial is to establish the feasibility of a definitive trial.

“Funding from the IPRC allowed for the project to be launched. It also has supported the efforts of a post-doctoral fellow.”

- Jason Busse

Institute for Pain Research & Care

Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Development of a risk prediction model for chronic postsurgical pain after breast cancer surgery: An individual patient data meta-analysis

Wang, PhD

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Co-Investigators: James Khan, MD, Jason Busse, DC,

PhD, Behnam Sadeghirad, PharmD, MPH, PhD, Malahat Khalili, PhD, Nicole Hodgson, PhD & Lehana Thabane, PhD

Brief Overview and Progress to Date

Start Date: 2024

Brief Overview and Progress to Date

Breast cancer is the most common cancer among women worldwide. Almost one in two breast cancer patients develops chronic post-surgical pain (CPSP), and one in four develops moderate-to-severe pain, significantly impacting the quality of life. Our aim is to develop a novel risk prediction model of CPSP after breast cancer surgery, using a systematic review and individual patient data (IPD) meta-analysis.

To date, systematic reviews have been completed, screening 54,957 references and preliminarily identifying 3,444 eligible studies, including randomized controlled trials and observational studies. Two ethics approvals have been secured from HiREB: one for the development of a core predictor set for CPSP and another for the IPD meta-analysis. Currently, an International Network is being established, and an international data repository encompassing approximately 1,000,000 patient records is being built. In addition, a three-year

CIHR Operating Grant totaling $600,000 has been awarded.

We are currently developing a core predictor set based on surveys of clinical experts, continuing our outreach to investigators to build a collaborative network and data repository, assessing risk of bias of eligible studies using a validated tool, and preparing to conduct a one-stage individual participant data (IPD) meta-analysis, and development of a risk prediction model for chronic postsurgical pain (CPSP) following breast cancer surgery, potentially accompanied by a related IT product. A comprehensive knowledge translation (KT) plan has been established, and end-of-project dissemination will be carried out in partnership with provincial, national, and international knowledge users, patient partners, and other stakeholders to co-create and share findings across Canada and globally.

“IPRC funding was instrumental in initiating our international collaboration and IPD repository, leading to a CIHR grant, and advancing a validated CPSP risk prediction model to enhance breast cancer care.”

Institute for Pain Research & Care

Seed Grants Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

A Randomized Sham-Controlled Trial of Transcranial Direct Current Stimulation and Yoga for People with Knee Osteoarthritis: A Pilot and Feasibility Study

Primary Investigator: Maura Marcucci, update

Lisa Carlesso, PT, PhD

Co-Investigators: Siobhan Schabrun, PhD & Guillaume Leonard, PhD

Start Date: 2021

Start Date: 2024

Brief Overview and Progress to Date

This study is a pilot and feasibility double blinded RCT of yoga and transcranial direct current stimulation with immediate and 3 month follow up. Since January 2025, 20 participants have been recruited (11 from McMaster University, 9 from University of Western Ontario). There were delays with ethics and contracts at the Sherbrooke site, thus, Sherbrooke will run in September 2025. From the 20 participants, 1 participant withdrew due to a scheduling conflict. 16 participants completed the immediate follow-up and 3 have completed the 3 month follow-up. We will continue to recruit for fall 2025, winter 2026 and spring 2026 if necessary. We will then publish the results. We hope to reach our primary feasibility outcome of 90% follow up at immediate and 3 months. There

has been no adverse events reported. The tDCS and the yoga are well tolerated by participants.

Upon completion of the trial, results will be published and shared with the Arthritis Society, our participants and local networks, such as the IPRC and MIRA.

The ultimate goal of the project is to be able to conduct a full scale trial which, if effective, could lead to a new clinical treatment option for people with Knee OA. tDCS is currently used in clinical practice by PTs in Quebec but not in Ontario.

“We had a $100k grant from the Arthritis Society that was not enough to carry out the project so the extra funding from the IPRC has been critical to its completion.”

- Lisa Carlesso

Institute for Pain Research & Care

Seed Grants

Past Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Assessing pain-related maladaptive functional behaviors in chronic disabling low back pain with cognitive functional therapy approach

Luciana

Macedo, PhD

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Co-Investigator: Ney Meziat, PhD

Start Date: 2023

Brief Overview and Progress to Date

Cognitive functional therapy (CFT) has become the most promising approach for the management of CLPB given high quality evidence demonstrating moderate/large effect sizes. CFT aims to address modifiable multidimensional biopsychosocial aspects of disabling CLBP including painrelated functional behavior (motor response to pain, threat of pain, and /or pain-related distress). These behaviors are characterized by slower, stiffer, less variable movements and an inability to relax the back muscles during functional tasks. According to the CFT approach, pain-related functional behaviors can be classified into control impairments and movement impairment. However, few studies have evaluated the reliability or validity of the subclassifications such as if subclassifications are associated with measurable movement impairments which is the objective of our study.

The goal of the research is to test the validity and reliability of a classification system that is widely used in clinical practice and research. The results of our study will potentially either confirm the validity of current practice or will put in question what is currently done. This may require some community discussions and may lead to new intervention.

We are currently completing data collection for the study. We have collected data on 56 of our required sample of 75 with a few additional already booked for data collection. We expect completion of recruitment by end of summer. Afterwards we will complete data analysis.

“Without the funding our project would not be possible. This allowed not only for the conduct of our project but also the 1 year visit of an international professor from Brazil expert in CFT. This has been invaluable for our group. There are also multiple graduate students involved in this project.”

- Luciana Macedo

Institute for Pain Research & Care

Seed Grants Seed Grants

Past Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Application of photo-biomodulation as part of multimodal analgesia to improve pain relief and wound healing for patients having elective C section: a randomized controlled trial

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Primary Investigator: Harsha

Start Date: 2023

Shanthanna, MD, PhD

Brief Overview and Progress to Date

Caesarean sections (CS) are the most common inpatient surgical procedure performed in Canada and are associated with moderate to severe pain in most women, especially in the first two days. Significant pain after CS not only causes maternal distress but interferes with neonatal bonding and furthermore predisposes a woman for persistent pain and postpartum depression (PPD). Multimodal analgesia is limited by a maximum dose to be used and may not be effective in all patients. Hence, there is an important need to look for non-pharmacological options. The combination of low-level LASER therapy and LEDs (photobiomodulation, PBMT) has been used in many musculoskeletal conditions and in some acute pain conditions. Despite known potential and safety, there have not been any well-designed and large RCTs to assess the benefits of PBMT on postsurgical pain after CS. We undertook this RCT primarily to evaluate

the effect of PBMT as part of a multimodal analgesia on post-surgical pain burden using pain scores with movement after CS.

Recruitment has finished, and we are still collecting 6-week and/or 3-month data on the remaining patients in the study.

The study aims to evaluate the effectiveness of PBMT as part of existing multimodal analgesia, so that it can be demonstrated as appropriate for clinical use. This may result in improved maternal satisfaction and wound healing; decrease the use of perioperative opioids; potentially influence a decrease in the incidence of postpartum depression and persistent pain; and overall lead to better postoperative outcomes thereby decreasing healthcare costs.

“The funding from IPRC has enabled us to assess the benefits of PBMT on postsurgical pain after CS, which has not previously been investigated.”

- Harsha Shanthanna

Institute for Pain Research & Care

Seed Grants

Past Seed Grants

A

systematic review and individual patient data (IPD) meta-analysis of perioperative prognostic factors associated with chronic pain after total knee arthroplasty and development of

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

a risk prediction model

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Primary Investigator:

Start Date: 2023

Behnam Sadeghirad, PharmD, MPH, PhD

Brief Overview and Progress to Date

Chronic post-surgical pain (CPSP) is a significant and prevalent complication with important impacts on patient function and quality of life. Our objective is to design and develop an international repository of individual patient data for perioperative prognostic factors of CPSP after TKA, and develop and validate a prediction model for the development of CPSP after knee replacement. We have identified eligible studies through systematic search of multiple electronic databases. Mac-PROSPER initiative research group has developed a manuscript protocol for IPD meta-analysis to develop our proposed risk prediction model, submitted for publication. Our group now has received letters of support from several research groups and collaborators to provide access to data from over 22,000

patients, and with commitments from members of our research team to invite colleagues to join our initiative and share data from additional eligible studies, we anticipate this figure to increase substantially.

Mac-PROSPER initiative has developed a data storage, security, and governance framework for the project to plan for the sustainability of the proposed international data repository using McMaster University Dataverse, a secure encrypted server with multifactor authentication that facilitates data storage and sharing. Next steps include working to further develop our data repository of prognostic factors of CPSP after knee replacement.

“IPRC funding enabled us to achieve key milestones, and to expand its scope. It also accelerated our planning stage, resulting in impactful outcomes to build an international initiative.”

- Behnam Sadeghirad

Institute for Pain Research & Care

Seed Grants Seed Grants

Past Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Controllable Pulse-Parameter Transcranial Magnetic Stimulation to alleviate pain in Fibromyalgia

Nelson, PhD

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Co-Investigator: Harsha Shanthanna, MD & Eugene Maida,

Start Date: 2023

Brief Overview and Progress to Date

The goal of this study is the investigate the short and longterm effects of a two-week intervention of Active versus Sham cTMS in individuals with fibromyalgia. The primary objective is to investigate the effects of a two-week intervention of active versus sham cTMS on perceived pain intensity. The second and third objectives are to investigate the effects of this intervention on quality of life and symptoms of fibromyalgia, respectively.

To date, we have completed testing 26 participants with fibromyalgia, five are in the midst of intervention and we are pursuing the recruitment of three additional individuals to complete the study.

The goal is to identify a new therapeutic approach to assist people living with fibromyalgia. There is controversy in the literature about brain stimulation helping fibromyalgia. We are testing a novel form of brain stimulation.

We will complete this study by October 2026, and present the data at a conference and publish a manuscript.

“The funding by IPRC has made a positive impact in the lives of our participants who have expressed hope for new possible therapies to improve the quality of their lives.”

- Aimee Nelson

Institute for Pain Research & Care

Seed Grants

Past Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Pilot Study of Association of BIOmarkers and Neuropathic Pain with Intercostobrachial Nerves Sparing in breast surgery to improve Persistent post-surgical pain-an International RandomizEd

controlled trial (BIO-INSPIRE)

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Primary Investigator: Harsha Shanthanna, MD, PhD

Start Date: 2021

Brief Overview and Progress to Date

The burden of persistent post-surgical pain (PPSP) after breast cancer surgery is significant, with prevalence reported as high as 60%. PPSP is associated with increased rates of depression and anxiety, decreased function, and reduced quality of life and places an immense strain on limited healthcare resources. PPSP after breast cancer surgery has been shown to be strongly associated with damage to ICBN, causing neuropathic pain. There is substantial preclinical evidence linking neuro-inflammation with the development of neuropathic pain. This study assesses the feasibility of assessing the association of cytokine biomarkers and neuropathic pain in the Intercostobrachial Nerve Sparing in breast cancer surgery

to reduce Persistent post- surgical pain: A Randomized Controlled Pilot Trial (INSPIRE) trial of women with invasive breast cancer randomized to ‘intercostobrachial nerve (ICBN) preservation’ versus ‘standard surgery.’

We have collected biomarker data and the clinical part of the study is complete. Next steps will be to analyze data.

“Identification of biomarkers to correlate with the development of neuropathic pain allows us to identify individuals at risk for development of PPSP at an early stage and potentially focus treatment strategies to patients at risk.”

- Harsha Shanthanna

Institute for Pain Research & Care

Seed Grants Seed Grants

Past Seed Grants susceptible to developing CPSP? A high-throughput clinical proteomics-based approach for the prediction susceptibility

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Fei Geng, PhD

Brief Overview and Progress to Date

decline in ≥50 years old who are longitudinally pain of

project focuses on understanding why some patients develop chronic postsurgical pain (CPSP) after total knee arthroplasty (TKA), while others recover without long-term pain. Osteoarthritis is the leading cause of disability mid-to-late life, and although most patients report relief following TKA, up to 34% experience CPSP. Current evidence suggests that protein-level changes—particularly in inflammatory and immune pathways—play a critical role in the transition from acute to chronic pain. By applying high-throughput clinical proteomics and bioinformatics, our research seeks to uncover predictive molecular “pain signatures” that can stratify patients into susceptible, transitional, and resilient groups.

last We recruited 93 of whom, 67 consented the database for analyses for the first publication. Given to

The ultimate goal of this research is to identify and validate proteomic “pain signatures” that can reliably predict which

patients are at risk of developing chronic postsurgical pain (CPSP) following total knee arthroplasty. By establishing a biomarker-based framework for early risk stratification, we aim to transform how pain is predicted, prevented, and managed in surgical populations.

Next steps include: disseminating findings through peerreviewed publications, conference presentations, and workshops targeting both the clinical pain research community and orthopedic surgeons; developing accessible summaries and infographics for patients and caregivers to improve awareness of CPSP risk factors and potential predictive tools; and engaging with interdisciplinary forums (e.g., pain societies, arthritis networks) to integrate proteomic biomarkers into broader chronic pain research and practice guidelines.

“IPRC funding enabled the successful discovery and validation of proteomic pain signatures, supported patient recruitment and sample analysis, and provided the foundation for advancing our µChip-on-chip diagnostic platform.”

- Fei Geng

Institute for Pain Research & Care

Seed Grants

Past Seed Grants

Topicals for Osteoarthritis Pain In Knee Surgery (TOPIKS): A Pilot Randomized Controlled Trial

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Primary Investigator: Maura Marcucci, update

Harsha Shanthanna, MD, PhD

Start Date: 2021

Brief Overview and Progress to Date

Up to 50% of patients experience persistent postoperative pain after total knee arthroplasty (TKA). Due to harms associated with opioids and oral NSAIDs, we plan to investigate topical agents to treat postoperative pain among patients undergoing TKA. We hypothesize that topical NSAIDs will provide adequate pain control and opioid-sparing effects. Additionally, previous studies have shown that topical cannabidiol (CBD) may improve pain and decrease inflammation, but more clinical studies are needed. We also hypothesize that topical CBD in addition to standard pain management will result in better pain control and a reduction in opioid use compared to standard care alone.

This will be a 3-group parallel randomized pilot trial. We will use a 3-group design for efficiency, e.g. to conserve time and resources by comparing the two active treatment arms to a shared control group rather than conducting two separate trials. This design will also allow us to have

direct evidence comparing the efficacy and safety of the two topical medications.

The overall aim of this study is to improve patient care by improving pain management and decreasing opioid use. The results of this study will provide valuable information regarding the opioid-sparing effects of topical pain medications. Given the Canadian government’s focus on the opioid crisis as a research priority, this pilot trial has the potential to lead to a large-scale multicentre definitive trial that is fundable at the national level.

Next steps include sourcing a suitable licensed supplier for topical CBD.

“The funding from IPRC has enabled us to assess the benefits of topical CBD on postsurgical pain after TKA.”

- Harsha Shanthanna

Institute for Pain Research & Care

Seed Grants Seed Grants

Past Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Patient-Reported Characteristics and Management of Chronic Pain in Canada: A Cross-sectional Survey

Jason Busse, DC, PhD

Primary Investigator: Maura Marcucci, update

Start Date: 2021

2020

Brief Overview and Progress to Date

decline in ≥50 years old who are longitudinally pain of

last We recruited 93 of whom, 67 consented

We acquired 770 completed surveys, predominantly from women (90%) between the ages 35 and 65 years (76%) who had been living with chronic pain for ≥15 years (51%). Respondents were more likely to endorse frequent use of cannabis after developing chronic pain, and less likely to endorse frequent physical activity. Approximately half of respondents (52%) reported no support from a health care professional for their chronic pain. Past treatment included use of pain clinics (96%), physiotherapy (69%), opioids (56%), complementary and alternative medicine (47%), cannabis (42%), psychotherapy (35%), and interventional procedures (22%); however, current use of any of these modalities was significantly lower (ORs ranged from 0.32 to 0.06).

the database for analyses for the first publication. Given to

Most respondents indicated that treatment to date had resulted in ≤40% pain relief (55%) and ≤40% functional improvement (56%) and were either dissatisfied (29%) or strongly dissatisfied (24%) with treatment results. The aim of this survey is to inform future research. Next steps include publishing results.

“Funding from the Institute for Pain Research & Care allowed this project to be completed. It helped fund a pain fellow to lead the study.”

- Jason Busse

Institute for Pain Research & Care

Seed Grants

Past Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Opioid Reduction in Orthopedic Surgery (OREOS): A feasibility randomized controlled trial in total knee replacement patients

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Harsha Shanthanna, MD, PhD 2022

Brief Overview and Progress to Date

This project consisted of a 2-arm parallel-design feasibility RCT of 100 patients. Patients were randomized to intervention or usual care. The overarching influence of this research will be to support the evaluation and implementation of a coordinated approach to clinical care, to improve pain control and reduce harms, with an emphasis on patientcentred care and shared decision making. The results of this trial will ideally reduce patients’ persisting pain and opioid use and hence improve their satisfaction and quality of life. If successful, the trial helps to facilitate important decisions for different stakeholders involved in perioperative care to implement team care paradigms

The feasibility study has now been completed. We are in the process of starting the full multi-centre study.

“Support from the IPRC provided the foundation we needed to complete our feasibility trial and move forward with a larger multi-centre study aimed at improving pain management and patient outcomes.”

- Harsha Shanthanna

Institute for Pain Research & Care

Seed Grants Past Seed Grants

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

An investigation into the effectiveness of a new Transitional Pain Service (TPS) on opioid cessation after a broad range of surgeries done at Hamilton Health Sciences (HHS) and its affiliated hospitals

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Primary Investigator: James Paul, DC, PhD

Start Date: 2019

Brief Overview and Progress to Date

Hospitals affiliated with Hamilton Health Sciences (HHS) have adopted the Transitional Pain Service (TPS) model of care. Drawing on data from the Acute Pain Service (APS), TPS, and chronic pain clinic, this retrospective study aims to identify factors that contribute to chronic post-surgical pain (CPSP) and prolonged opioid use, while also assessing the impact of TPS on reducing opioid dependence across the Hamilton-Niagara region.

While most existing research focuses primarily on the incidence and predictors of CPSP, few have evaluated— on a large scale—whether TPS is more effective than conventional pain management in helping patients discontinue opioid therapy. Findings from this study will

strengthen the evidence base for TPS as a best-practice model for CPSP prevention, opioid reduction, and for understanding the evolving role of pain specialists in addressing the opioid crisis.

This study has been adapted to reach out to patients as outpatients as it was discovered that the majority of the TPS patients were seen as inpatients after surgery and most did not come back to the chronic pain clinic for their follow-up. To that end we developed an online questionnaire that will be sent to all the patients to collect the study outcomes. This is underway and we hope to have some study outcomes soon.

“IPRC Funding has provided us with the resources we needed to develop the tools necessary to evaluate our Transitional Pain Service to see if it’s achieving its objective of providing high quality analgesia to our complex pain patients.”

- James Paul

Institute for Pain Research & Care

Seed Grants Past Seed Grants

Who

Susceptible

to Developing CPSP?

A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Feasibility of a definitive trial to evaluate the effect of cannabinoid oil, versus placebo, on PPSP and functional outcomes in patients undergoing TKA

Primary Investigator: Maura Marcucci, update

Start Date: 2021

Jason Busse, DC, PhD

Brief Overview and Progress to Date

We completed a pilot randomized controlled trial (RCT) of cannabidiol (CBD) to prevent chronic post-surgical pain (CPSP) after total knee replacement (TKA). We enrolled 37 patients, and at 6-months follow-up, 25% in the placebo arm (4 of 16) reported CPSP, and 14% in the CBD arm (2 of 14). There were 27 adverse events in the CBD group and 45 in the placebo group, most of which were gastrointestinal.

The aim of this research is to inform the feasibility of a definitive trial. Next steps are to publish our trial and apply for funding to support a definitive RCT.

“Support from the IPRC facilitated our trial and has positioned our team to move forward with a definitive trial.”

- Jason Busse

Institute for Pain Research & Care

Seed Grants Past Catalyst Grants with MIRA

Quantitative Measurements of Chronic Pain

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

Primary Investigator: Matiar Howlader,

B.Eng, PhD

Primary Investigator: Maura Marcucci, update

Start Date: 2023

Start Date: 2021

Brief Overview and Progress to Date

Chronic pain (CP) is increasingly recognized as a chronic disease comparable to cancer or diabetes, with profound impacts on quality of life, disability, and healthcare costs. In Canada, CP accounts for more than $15 billion annually—over 10% of health expenditures. Current assessments rely on selfpain scales, which are subjective, prone to bias, and often fail to capture underlying pathophysiology. This leads to misdiagnosis, suboptimal treatment, and disability. Objective, biomarker-based approaches are urgently needed to improve diagnosis, personalize treatment, and reduce the burden of CP.

Progress to date includes several electrochemical sensing platforms. An IL-6 sensor was created using a MIP-based design on AuNP-modified SPCEs, achieving high selectivity (imprinting factor 11.2), sensitivity of 3.48 µA/log(pg·mL ¹), and a detection limit of 1.74 pg·mL ¹. A glucose sensor was fabricated as a dualamplified AuNP/CuO platform with a linear detection range of 2–397 µM, validated in human saliva. For H₂O₂ detection, a

green-synthesized AgNP/SPCE platform offered high sensitivity (20,160 μA·mM⁻¹·cm⁻²) and was validated in urine. Glutamate sensors based on hybrid MIP copolymers (RC+oPD, oPD+PPy) were also developed. NaOH treatment (50 mM, 3 minutes) removed templates without damaging polymer films; however, reproducibility challenges remain. Ongoing efforts address polymer thickness, incomplete template removal, and nonspecific adsorption.

Planned milestones include: Integration of IL-6, glucose, H₂O₂, and glutamate sensors into a multiplexed POCT platform; Pilot testing in 10 patients with chronic low back pain, correlating saliva and blood biomarker levels with pain scores and treatment response; Exploration of THC and CBD biomarker signatures in CP modulation; and development of continuous monitoring through microfluidics for clinical and home use.

This project will deliver a low-cost, portable, and noninvasive biosensing system for CP.

“IPRC funding enabled pioneering work on MIP-based IL-6, glucose, H2O2, and glutamate sensing for chronic pain, generating critical insights that shaped sensor optimization strategies and informed future directions despite technical challenges.”

- Matiar Howlader

Institute for Pain Research & Care

Past Catalyst Grants with MIRA

Repetitive transcranial magnetic stimulation and augmented reality sensorimotor training to treat chronic neck pain: a feasibility study

Primary Investigator: Aimee Nelson, PhD

Co-Investigator: Harsha Shanthanna, MD, & Zhen Goa, MD

Start Date: 2022

Brief Overview and Progress to Date

Chronic neck pain (CNP) reduces quality of life and is a leading cause of disability. Current treatments offer limited relief with potential side effects. Augmented reality sensorimotor training (ARST) may overcome limitations of virtual reality by promoting targeted cervical movements. This feasibility study paired repetitive transcranial magnetic stimulation (rTMS) with ARST in 10 CNP participants over four weeks. Both REAL and SHAM rTMS groups improved in pain, neck disability index, and range of motion without adverse events. Greater pain reduction was observed in REAL at two weeks post-intervention. Findings support the feasibility and potential of rTMS + ARST, warranting larger trials.

To date, we have recruited 15 participants, 4 are ongoing and the remaining are completed.

The goal of this research is to obtain data to enable a larger trial to understand the longevity of the effects and the need for maintenance. It is intended to inform our future research. Data collection will be completed by December 2025.

“IPRC funding has allowed a very novel, and potentially impactful technology-based approach to be tested as an alternative therapeutic to benefit individuals living with chronic neck pain.”

- Aimee Nelson

Institute for Pain Research & Care

Seed Grants

Past Catalyst Grants with MIRA

Who is Susceptible to Developing CPSP? A High-Throughput Clinical Proteomics-Based Approach for the Prediction of Susceptibility

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, update

Start Date: 2021

Primary Investigator: Maura

Marcucci, MD, MSc

Start Date: 2021

Brief Overview and Progress to Date

The ArthroCaP project was a mixed methods study exploring the association between chronic post-surgical pain and cognitive decline in patients ≥50 years old undergoing total arthroplasty, bringing together experts from three Faculties and six Departments. We faced challenges implementing the study during the pandemic but eventually recruited 93 participants; 30 consented to provide blood samples for a biomarkers substudy. Given initial disruptions, we obtained a project extension and decided to put the qualitative component on hold to focus on completing the 1-year followup. We completed this last year, but changes in the study team (I transitioned to a Part-Time position; the fellow completed her PhD) affected the timeline for data cleaning and analysis.

Older adults undergoing major noncardiac surgery are at increased risk of accelerated cognitive decline. The mechanisms are only partially understood. Some evidence

links chronic pain with higher long-term risk of cognitive impairment. Up to 30% of major joint arthroplasty patients experience long-term pain, representing a population of interest. Our research will evaluate and provide a mechanistic understanding of the association between chronic postsurgical pain and postoperative cognitive dysfunction, and identify possible biomarkers to help predict patients at risk for adverse outcomes.

We are now finalizing data cleaning and aim to complete analyses and the main manuscript by year-end for submission to a peer-reviewed journal (helped by the possibility of co-funding and co-supervising the same fellow in a new Postdoc role). Last year, we applied to the RSJH Research & Innovation Collaboration Grant to support biomarker analyses but were unsuccessful. We continue to seek additional funding.

“This funding has been instrumental to start working with researchers with an interest in Aging from other Faculties and with other perspectives and expertise to bring in my program.”

- Maura Marcucci

Institute for Pain Research & Care

Past Catalyst Grants with MIRA

Feasibility study to assess the added value of Integrated Musculoskeletal BioFeedback Device (IMBED) combined with neuromuscular exercise and education (GLA-DTM) to decrease chronic pain in older adults with osteoarthritis.

Primary Investigator: Pasqualina Santaguida, PhD

Co-Investigators: Qiyin Fang, PhD & Stuart Phillips, PhD

Start Date: 2020

Brief Overview and Progress to Date

Our project was divided into two phases. Phase 1 focused on developing technology to capture movements for assisting participants and clinicians working with lower extremity osteoarthritis. We created a system to record muscle activity and motion (IMBED) but found it unsuitable for group exercise settings. We then switched to an AI-based technology and collaborated with the manufacturer to adapt it for specific exercise and mobility functions. Early user testing with patients and clinicians found MOTRACK acceptable.

Phase 2 piloted the feasibility of MOTRACK with two patient groups. However, refinements are ongoing, and more user testing is needed. We continue to improve the device based on clinician and participant feedback and plan to seek additional funding to evaluate MOTRACK’s utility in group settings.

Our goal is to find a simple, affordable technology to capture motion during exercise (including functional activities) and provide useful feedback to clinicians and participants. We also aim to monitor functional movements beyond classes, including athome exercise and mobility.

We’re still refining the core technology and adding features. New design elements include a smart TV-guided exercise program with real-time pain recording (via voice input), large on-screen exercise guidance, and predefined anatomical regions.

We’re also collaborating with industry partners interested in adapting the technology for applications such as sports injury rehabilitation reporting and recording.

“The funding of this project has allowed us to truly move forward with finding the best way to monitor exercise of older adults with less intrusive technology.”

- Pasqualina Santaguida

Director

Norm Buckley

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

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

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

Mike Salter

Professor, Departments of Physiology and Institute for Medical Sciences and Faculty of Dentistry, University of Toronto

Executive Members

Jason Busse

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

Luciana Macedo

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

Ian Gilron

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

Ian Rodger

Professor Emeritus, Department of Medicine, McMaster University

Lisa Carlesso

Associate Professor, School of Rehabilitation Sciences, McMaster University

Mark Lema

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

Eleni Hapidou

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

Michael McGillion

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

Gurmit Singh

Professor Emeritus, Department of Pathology and Molecular Medicine, McMaster University

James Paul

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

Florentina Miftodi

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

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

Philip J. Devereaux

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

Mohit Bhandari

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

Laura Katz

Assistant Clinical Professor (PT), Department of Psychiatry and Behavioural Neurosciences, McMaster University; Psychologist, Community Practice

Andrea Darzi

Assistant Professor, Department of Anesthesia, Assistant Professor, Department of Health Research Methods, Evidence and Impact; Assistant Director, Michael G. DeGroote National Pain Centre,McMaster University

Joy MacDermid

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

Kim Madden

Research Director, St. Joseph’s Healthcare, Hamilton

Randi McCabe

Professor, Department of Psychiatry and Behavioural Sciences, McMaster University

Tara Packham

Assistant Professor, School of Rehabilitation Sciences, McMaster University

Louis Schmidt

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

Dena Zeraatkar

Assistant Professor, Department of Anesthesia, McMaster University

Staff

Brandon Van Dam

Managing Director, Chronic Pain Network, McMaster University

Jessica Bottomley

Administrative Assistant, Chronic Pain Network, McMaster University (Maternity Leave)

Irena A Rebalka

Assistant Professor, Pathology and Molecular Medicine, McMaster University

Harsha Shanthanna

Associate Professor, Department of Anesthesia, McMaster University

Aimee Nelson

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

Behnam Sadeghirad

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

Li Wang

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

Rachel Couban

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

Rachel Roy

Knowledge Broker, Chronic Pain Network, McMaster University

Megan Groves

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

Sandra Rodwell

Administrative Assistant, Chronic Pain Network, McMaster University

“As a trainee in the IPRC network, I’ve found the sessions incredibly supportive and productive. In one session, I had the opportunity to practice presenting my work and learn how to give and receive constructive feedback from peers. I also appreciate the online Trainee Hub, which offers clear information on funding opportunities, networking and practical tips.”

- Kian Torabiardakani Trainee, Institute for Pain Research & Care

Mission

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

Michael G. DeGroote Institute for Pain Research & Care - 2025 Annual Report

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