Open House - Faculty of Health Sciences

Michael G. DeGroote
Institute for Pain Research and
Care
Open House
INFORMATION BOOKLET
6 November, 2008
Geraldo’s at LaSalle Park, Burlington
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Illness is the doctor to whom we pay most heed:
To kindness, to knowledge we make promises; only pain we obey
Proust
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Table of Contents
The Michael G. DeGroote Institute for Pain Research and Care
4
A Tribute to Mr. DeGroote
5
National Pain Awareness Week
6
Open House Poster
7
Vision
8
Mission
9
Environmental Scan
10
Leadership
11
Osteoarthritis Pain Research
13
Peripheral Neuropathic Pain Research
16
Central Post-stroke Pain Research
20
Rheumatoid Arthritis Pain Research
23
Bone Cancer Pain Research
25
Low Back Pain Research
29
Iconic Pain Assessment Tool
32
Technical Support for the Research Group
35
Community Alliances for Health Research and Knowledge Translation in Pain
37
Funding Sources
42
Community Outreach – Health Care Professionals
43
Community Outreach – Chronic Pain Patients
46
McMaster as a Centre of Culture of Pain Research
48
External Academic Collaborations
50
Industry Collaborations
51
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The Michael G. DeGroote Institute for Pain Research and Care is a researchintensive centre of excellence on pain mechanisms, diagnosis and management,
where innovation and change are guiding principles. By providing optimal
conditions, the Institute fast-tracks transformative research from discovery to
development of new treatments and therapies for chronic pain. The Institute is a
driving force for generating new knowledge and for translating this knowledge to
all stakeholders, including patients, health care professionals, the commercial
sector, the public and policymakers. Innovation in education is a cornerstone to
build capacity for future research. As innovators and pioneers, we in the Michael
G. DeGroote Institute for Pain Research and Care boldly expand the frontiers of
understanding, diagnosing and managing chronic debilitating pain. The ultimate
goal is a world in which chronic pain can no longer be debilitating.
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A TRIBUTE TO MR. DEGROOTE
Since its inception in 2003, the Institute for Pain Research and Care
has engaged in groundbreaking basic research, initiated
interdisciplinary collaborations, offered medical education
opportunities and organized community outreach projects.
Undoubtedly, much of this urgent work would not be possible
without the generosity and insight of Michael G. DeGroote. We
sincerely thank Mr. DeGroote for his unwavering commitment to
the goal of understanding, and ultimately, overcoming chronic
pain.
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National Pain Awareness Week
“A large part of the problem is that chronic pain is so poorly understood.
Scientists around the world are working to remedy this problem, and
Canadians are world leaders in this field.”
Honourable Senator Yves Morin, introducing a Private Member’s Bill in the Canadian
Senate, declaring the first week of November each year as Pain Awareness Week.
28 October, 2004.
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Vision
The Michael G. DeGroote Institute for Pain Research and Care is a research-intensive
centre of excellence on pain mechanisms, diagnosis and management, where innovation
and change are guiding principles. By providing optimal conditions, the Institute fasttracks transformative research from discovery to development of new treatments and
therapies for chronic pain. The Institute is a driving force for generating new knowledge
and for translating this knowledge to all stakeholders, including patients, health care
professionals, the commercial sector, the public and policymakers.
Innovation in
knowledge translation and exchange is a cornerstone, to build capacity for future research.
As innovators and pioneers, we in the Michael G. DeGroote Institute for Pain Research
and Care boldly expand the frontiers of understanding, diagnosing and managing chronic
debilitating pain. The ultimate goal is a world without suffering from chronic pain.
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Mission
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taking ownership of central post-stroke pain
-
creating a new paradigm in the conceptualization and perception of chronic pain –
it must be recognized as a distinct disorder, deserving, in fact demanding, direct
treatment and management by pain specialists
-
recruiting leaders in areas of pain research of strategic importance to the evolution
of the Institute
-
providing outstanding research facilities to promote cutting-edge research
-
forging, fertilizing and facilitating initiatives in pain research and care at
McMaster and more broadly throughout Canada
-
establishing living collaborations and partnerships with all relevant academic and
non-academic stakeholders for mutual advancement
-
building a network for integrated action among members and partnered
stakeholders
-
developing novel interventions to treat chronic pain
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promoting evolution of improved approaches to management of chronic pain
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enhancing knowledge transfer to and application by all receptor communities
-
generating and preserving sound operational principles to optimize investments in
the Institute
-
leading innovation in knowledge translation and exchange
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attracting, training and retaining the very best of successive generations of young
investigators
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reaching out to the community to enhance understanding of chronic pain and its
management
-
leading local, provincial and federal initiatives in pain research and care
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representing needs of consumers to policymakers, in partnership with consumer
and advocacy groups
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Environmental scan
Pain is a necessary part of our normal physiology. It prevents tissue damage and causes
behavioural and physiological changes to facilitate tissue repair. However, for an
unfortunate few, pain can create debilitating unbearable suffering. For the majority, pain
is not a medical challenge. For the few it is. Pain is heterogeneous in terms of aetiology,
mechanisms and temporal characteristics, making it difficult to study other than through a
multidisciplinary approach focussed on selected types of pain. Also, it is clear that there
is no “magic bullet” to treat all types of pain. What is needed is to understand that
different types of pain exist (Woolf & Salter, 2000), the distinguishing properties of each
type (Schulz & Woolf, 2002) and an understanding of the mechanisms underlying each
type (Hunt & Mantyh, 2001; Decosterd et al, 2004). If we are to develop novel
interventions to treat chronic pain it is imperative to find the specific molecular targets of
different pains (Honore et al., 2000). Concepts of mechanisms also need to be partnered
with emerging views from genetics, genomics and proteomics of pain (Mogil &
McCarson, 2000; Mogil, 2004). Demographics indicating an ageing population
accentuate this need for innovative interventions to treat chronic pain (Gibson & Farrell,
2004); as the mean population age increases, the incidence of chronic diseases such as
rheumatoid arthritis, osteoarthritis, diabetes and others, all sharing the symptom of
debilitating chronic pain, are expected to skyrocket, and with them the need for effective
pain management (Ferrell, 2004).
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Leadership
James L. Henry, Ph.D.
Scientific Director
Dr. Henry, a neurophysiologist who has
worked throughout his career to understand
underlying mechanisms of chronic pain, is the
inaugural scientific director of the Michael G.
DeGroote Institute for Pain Research and Care
at McMaster University. He also holds an
endowed chair in central pain.
Joining McMaster in January 2005 as a
professor in the departments of Psychiatry and
Behavioural Neurosciences and Anesthesia, he
is also renowned for important advancements
in basic science of pain, his strong record of
leadership, and his training of young
investigators.
Dr. Henry earned his doctorate in physiology from the University of Western Ontario in
1972 and received postdoctoral fellowships from the Canadian Medical Research Council
and Le Conseil de la recherche en santé du Québec. In 2000 he was awarded the
Millennium Distinguished Career Award of the Canadian Pain Society.
From 1977 to 2002 he was a professor in the Department of Physiology at McGill
University. He established both the McGill Centre for Research on Pain and the Quebec
Pain Research Initiative which networks pain researchers and clinicians across Quebec.
From 2002 to 2004, he was professor and chair of the Department of Physiology and
Pharmacology at the University of Western Ontario.
His research has a focus on control systems within the central nervous system. He is
world renowned for his pioneering discovery, in 1975, that the peptide, substance P, is a
regulator of synaptic transmission in central pain pathways, specifically in the region of
the first sensory synapse in the spinal cord and brain stem. This discovery opened a new
field of research into the neurochemistry of pain mechanisms and led him to propose a
chemical specificity theory of pain that replaced previous theories of pain and which
persists unchallenged today.
His awards over the past ten years include the Millennium Distinguished Career Award
of the Canadian Pain Society (2000), the Raymond W Houde Memorial Award of the
Eastern Pain Society, New York (2006) and the Gunn-Loke Lecture, Multidisciplinary
Pain Center, University of Washington (2008).
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Dr. Panju is the first medical director of McMaster
University ’s Michael G. DeGroote Institute for Pain
Research and Care. He has also been appointed to the
Medard DeGroote Chair in Medicine. He is the
Vice Chair (Clinical), Department of Medicine
at McMaster University. He is a co-lead for
Chronic Disease Management and Prevention
for Local Health Integrated Network.
Akbar Panju, M.D.
Medical Director
Dr. Panju, who is both a professor of medicine
for McMaster’s Faculty of Health Sciences and
has completed ten years as chief of medicine for
Hamilton Health Sciences, has a particular
interest in the mechanisms and treatment of
pain, in addition to his interests in cardiology
and thrombosis.
Trained as a physician in Britain, Dr. Panju
came to Canada in 1975 and worked as a family
physician for five years in the Ontario
communities of Ignace, Thunder Bay and Cambridge, before completing a residency in
internal medicine with further training in cardiology and thrombosis at McMaster
University in 1984.
Dr. Panju has been a faculty member at
McMaster since 1986 and his abilities as an
instructor have been reflected in teaching
awards he has received from students,
medical residents and his academic peers.
Stroke Central Pain, and he is a pastpresident of the Canadian Society of
Internal Medicine.
For the pain institute he will create and
coordinate an international database and
In 2003, he received the national Osler
registry for patients suffering with thalamic
Award from the Canadian Society of
and central pain. A key focus of the Michael
Internal Medicine, as an individual who
G. DeGroote Institute for Pain Research and
exemplified the best in medicine. Previously Care will be ensuring a collaborative
he earned the John C. Sibley Award from approach in national and international
McMaster’s Faculty of Health Sciences for research in pain.
his outstanding contribution to health
“The Michael G. DeGroote Institute for
sciences education and research.
Pain Research and Care will be a hub and
Dr. Panju says his interest in pain was
magnet to attract individuals of national and
kindled by a challenging patient with
international stature in pain research
thalamic pain. His investigation made it
activity,” he says.
clear that there has been very little research
His responsibilities will include
being done in the field of thalamic and
coordinating pain services locally and
central pain.
regionally and building the institute’s
partnership with Hamilton Health Sciences.
His research has focused on chest pain,
cardiology, thrombosis and general internal His recent research has focussed on
medicine. He has over 50 publications to evaluating a thermal grill instrument for
his credit, including contributions to book management of different types of chronic
pain.
chapters and co-editing a book on Post
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Osteoarthritis Pain Research
Artist depiction of life with osteoarthritis pain.
Osteoarthritis – what is it?
•
•
Osteoarthritis is a degenerative joint disease and is the most prevalent form of
arthritis
Osteoarthritis is the leading cause of disability (MMWR Morb Mortal Wkly Rep.
50 (7): 120–5)
What is its impact?
• approximately 10% of Canadian adults are afflicted with osteoarthritis (Health
Canada, 2003).
• pain is reported to be what causes patients with OA to seek medical attention
(Creamer et al., 1998)
• the primary goal of current management of the patient with OA remains
control of pain along with improvement in function and health-related quality
of life (Felson, 2005)
• there is poor correlation of OA pain with radiographic and other signs in OA,
such as loss of cartilage and bony changes (Lethbridge-Cejku et al., 1995)
• effectiveness of existing drug therapies for OA pain is poor, with only
moderate effectiveness (Wieland et al., 2005)
• patients with OA are faced, then, with limited treatments that have a known
mechanistic basis of action
• significant resources are being applied to limiting cartilage loss and alterations
in bone structure, but until recently, there has been little basic science
investigation focused on understanding the mechanisms underlying the
initiation and the maintenance of the pain of OA
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What are we contributing?
• studies to address the lack of mechanism-based treatments
• several mechanisms of OA pain have been proposed, but none accounts for
o lack of correlation of functional and structural change
o referred nature of OA pain
o loss of proprioception
• we have established a unique animal model of OA pain
o confirmed in histological, anatomical, imaging and physiological
studies
• have found that joint use exacerbates joint pathology
• have identified changes in gene expression in OA knee
• studying changes in gene expression in sensory neurones
• recording from spinal nociceptive neurones
o data indicate that the spinal substrate of nociception undergoes loss of
buffering capacity
• recording from primary afferent neurones
o data indicate that the primary pathology is not in normally nociceptive
neurones, but that large diameter non-nociceptive neurones undergo a
phenotypic change and relay a ‘pain’ signal to spinal nociceptive
neurones
• on the basis of our results we are proposing a new hypothesis of OA pain: that
encompasses all symptoms associated with OA and departs from all earlier
hypotheses on mechanisms of OA pain
• involved in commercial development of novel compounds for treatment of
OA pain
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Who is involved?
This project is being carried out by Dr. Qi Wu , Dr. Kiran Yashpal and Yufang Wang, as
well as collaborators Drs. Aexander Ball, Heather Arnett, Frank Beier and David
Holdsworth.
Dr. Qi Wu received an M.D. degree in 1997 and an M.S, Anaesthesiology in 2000, from
the Second Military Medical University, Shanghai, China. In 2005 he joined a graduate
programme at McMaster and is currently a senior Ph.D. student running
electrophysiological experiments on dorsal root ganglion neurones.
Three-dimensional reconstruction of micro-computed tomographic images
of an osteoarthritic knee from a model animal.
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Peripheral Neuropathic Pain Research
“Pain is a major healthcare problem in Europe. Although acute
pain may reasonably be considered a symptom of disease or
injury, chronic and recurrent pain is a specific healthcare
problem, a disease in its own right”
European Federation of IASP Chapters
“Ten years following the initial neck injury I painted this self-portrait; a study in the
unceasing coldness that set in after surgery and the continuing awareness of the area of
surgery, a self-consciousness about the resulting scar and the residual pain. This is
despair and resignation combined with a determination that saw me through many years
of surgeries and pain and treatment yet to come. ”
Courtesy of the PAIN Exhibit and www.PainExhibit.com
© 2007 Chronic Pain Visual Arts Project. All Rights
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Peripheral neuropathic pain – what is it?
•
•
peripheral neuropathic pain is due to damage or dysfunction to the peripheral
nervous system
types of peripheral neuropathic pain include: painful diabetic neuropathy, postherpetic neuralgia, post-amputation pain, HIV-related neuropathies,
chemotherapy-related neuropathies, complex regional pain syndrome, traumatic
and compressive nerve injuries, nerve tumours including neuromas, trigeminal
neuralgia, syringomyelia, failed back surgery syndrome, traumatic brachial plexus
injury,
What is its impact?
•
•
•
•
as much as 7% to 8% of the of the population is affected by neuropathic pain and
in 5% it may be severe
neuropathic pain is associated with a number of other comorbdities, including
depression, sleep disorder and development of other types of pain, and is a major
contributor to absenteeism and decreased productivity at work
neuropathic pain is relatively refractory to medical treatment, with only 50% of
patients achieving even modest pain relief
mechanisms underlying peripheral neuropathic pain are unknown
What are we contributing?
• studies undertaken to address the lack of mechanism-based treatments
• we have been running a unique animal model of peripheral neuropathic pain
• measuring influence of neuronal dysfunction on pathology of peripheral tissues
• reflex testing using standard tests of
o tactile hypersensitivity
o mechanical hyperalgesia
o cold place preference test
o differential weight-bearing test
• recording from spinal nociceptive neurones
o data indicate that the spinal substrate of nociception undergoes increased
excitation to noxious and innocuous stimuli
• recording from primary afferent neurones
o data indicate that the primary pathology is not in normally nociceptive
neurones, but that large diameter non-nociceptive neurones undergo a
phenotypic change and relay a ‘pain’ signal to spinal nociceptive neurones
• mechanisms implicated specifically from our studies indicate substance P and
other structure-related chemical pathways in peripheral neuropathic pain
• on the basis of our results we are proposing a new hypothesis of neuropathic pain
that pain is due to mechanisms that evolve over days, giving a therapeutic window
of “a golden day and a silver week”, after which the pain will be difficult to treat
• involved in commercial development of novel compounds for treatment of
peripheral neuropathic pain
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Who is involved?
This project is being carried out by Liliane Dableh, YongFang Zhu, Yufang Wang and
Dr. Kiran Yashpal as well as collaborators Drs. Alexander Ball and Steve Bain.
Liliane Dableh received her B.Sc. at the University of Toronto, with a specialization in
Physiology and a minor in Life and Environmental Physics. She completed her M.Sc.
under the supervision of Dr. James Henry, at McGill University. She is currently
completing her Ph.D. in Dr. Henry’s lab at McMaster University. Her research is focused
on early intervention after nerve injury as a means to prevent the development of
neuropathic pain.
YongFang Zhu is currently in her second year of the Ph.D. Medical Sciences
program at McMaster University. She has previously completed a Master’s degree
in Biochemistry and Biomedical Science as well as Bachelor’s degrees in Biology
and Computer Science. Yong Fang is very proud to be working for the Pain
Institute and is working hard to become an excellent electrophysiologist.
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Artist rendering of peripheral neuropathic pain
Courtesy of the PAIN Exhibit and www.PainExhibit.com
© 2007 Chronic Pain Visual Arts Project. All Rights
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Central Post-stroke Pain Research
A wretched soul, bruised with adversity,
We bid be quiet when we hear it cry;
But were we burdened with like weight of pain,
As much or more would we ourselves complain
The Comedy of Errors, Act 2, Scene.1, 34-7.
Self-portrait by artist with central post-stroke pain
From: http://www.painonline.com
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Central post-stroke pain – what is it?
CPSP occurs from stroke or cerebrovascular accident that injures the sensory thalamus or
specific sensory pathways (spino-thalamo-cortical pathways)
What is its impact?
•
•
•
•
•
•
•
CPSP develops in 8% of stroke victims
burning seems to be the commonest descriptor of pain
most patients have more than one kind of pain
pain is moderate to severe at least in 50% of victims
appears immediately after stroke in more than 1/3 of patients, up to 12 months
later in half, 2 years in 9.5% and more than 2 yrs in 4.5%
accompanied by sensory abnormalities
o hypoesthesia
o hyperesthesia
o paresthesiae
o dysesthesiae
limited success with traditional neuropathic pharmacotherapy and opioids as well
as deep brain stimulators
What are we contributing?
•
•
•
•
•
•
•
•
we have established the first animal model of CPSP
have plotted the time course of development of tactile and cold hypersensitivity,
confirming parallel to the human condition
have measured the time course of apoptosis following stroke in the sensory
thalamus
have measured the time course of necrosis following stroke in the sensory
thalamus
have measured the time course of vascular permeability following stroke in the
sensory thalamus
have identified the changes in vascularization of the brain following stroke in the
sensory thalamus
have implicated nitric oxide synthase in early stages of CPSP
involved in commercial development of novel compounds for treatment of central
post-stroke pain
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Who is involved?
This project is being carried out by Dr. Kiran Yashpal, Vasek Pitelka and Yufang Wang,
as well as collaborators Drs. David Holdsworth and Jose Nobrega.
Kiran Yashpal is an Academic Research Scientist at the Pain Institute. She obtained her
PhD from the Montreal Neurological Institute at McGill University. She received a
postdoctoral fellowship from the Canadian Heart and Stroke Foundation to study with Dr.
Remi Quirion at McGill. She is best known for her behavioural and physiological reflex
studies in rodent models of acute and chronic pain, as well as her work on the functional
neuroanatomy of pain pathways. She recently designed an animal model of central poststroke pain.
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Rheumatoid Arthritis Pain Research
Rheumatoid arthritis – what is it?
•
rheumatoid arthritis is a painful inflammatory joint disease attributed to a
systemic autoimmune disorder that causes the immune system to attack the joints
– the cause is unknown
What is its impact?
•
•
•
•
reported to affect approximately 1 % of the adult population worldwide
pain is a major disabling factor, leading to:
o limitations on quality of life
o additional chronic health problems
o substantial consumption of health care resources
o loss of productivity in the workplace
there is no known cure for RA although some disease-modifying drugs are
available
there are currently limited treatments for RA pain
What are we contributing?
• studies to address the lack of mechanism-based treatments
•
measuring neuronal influence on pathology of peripheral joint tissue
•
recording from spinal nociceptive neurones
o hyperexcitability of spinal nociceptive neurones
o joint movement causes long-lasting excessive response to synaptic inputs
mechanisms-based research
o implicates nitric oxide synthase mechanisms in RA pain
o implicates cycooxygenase mechanisms in RA ain
o implicates growth factors in RA pain
involved in commercial development of novel compounds for treatment of RA
pain
•
•
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Who is involved?
This project is being carried out by Julie Mudryk and Dr. Kiran Yashpal.
Julie Mudryk recently completed an undergraduate degree in Health Sciences at the
University of Ottawa. She is now pursuing a Master’s degree in the Medical Sciences
program at McMaster under the supervision of Dr. Kiran Yashpal and Dr. James L.
Henry. Her project involves the elucidation of nociceptive mechanisms and associated
therapeutic treatments in rheumatoid arthritis.
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Bone Cancer Pain Research
“The act of verbally expressing pain is a necessary prelude to the collective task of
diminishing pain.”
Elaine Scarry
Artist rendering of diffuse pain
Courtesy of the PAIN Exhibit and www.PainExhibit.com
© 2007 Chronic Pain Visual Arts Project. All Rights
Bone cancer pain – what is it?
•
•
•
•
•
•
bone cancer pain most commonly occurs when tumors originating in breast,
prostate, or lung metastasize to long bones, spinal vertebrae, and/or pelvis
bone pain is commonly the first symptom of bone metastases and may lead to
tests that will confirm the diagnosis
primary and metastatic cancers involving bone account for an estimated 40,000
new cancer cases per year in Canada
>70% of patients with advanced breast or prostate cancer have skeletal metastases
pain resulting from bone cancer can dramatically impact an individual’s quality of
life
generally two major components to bone cancer pain
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•
•
•
o an early dull ache or throbbing in character, usually ongoing and increases
in severity over time
o a later breakthrough or incident pain occurs either spontaneously, with
intermittent exacerbations of pain, or by movement of the cancerous bone
- one of the most serious and highly debilitating sequelae of cancer and
one of the most difficult cancer pains to treat
radiotherapy remains the cornerstone for the treatment of bone cancer pain, it is
most effective for the symptomatic treatment of local bone pain but is
accompanied by severe adverse effects
control of breakthrough pain can be problematic because doses required are
usually high and accompanied by adverse side effects such as severe cognitive
impairment, sedation, and constipation
little is known about the mechanisms that generate and maintain this pain
What is its impact?
•
•
•
bone cancer pain significantly impacts quality of life
costs of metastatic bone disease are estimated at 17% of total oncology
expenditures
metastatic bone disease imposes a significant impact on the health care delivery
system
What are we contributing?
•
•
•
Dr. Gurmit Singh has established a unique animal model of bone cancer pain in
which we are investigating mechanisms of pain
as one of the first research groups to focus specifically on mechanisms of the pain
associated with bone metastasis we are measuring nociceptive scores and
administering analgesic agents to determine how this model parallels the human
condition
future studies will focus on the chemical basis of altered nociceptive mechanisms
and the phenotypic changes that occur in sensory pathways
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Who is involved?
This project is being carried out by Paolo De Ciantis, Dr. Kiran Yashpal and Dr. Gurmit
Singh.
Paolo De Ciantis obtained an Honours Bachelor of Science degree from the University
of Toronto majoring in Life Science (Human Biology) and Sociology. He is currently
completing a Master of Science degree in the Medical Sciences Graduate Program at
McMaster under the co-supervision of Dr. Gurmit Singh and Dr. James L Henry. His
time as a graduate student has been divided between research and extracurricular
activities such as Co-president for the Health Science Graduate Student Federation
(HSGSF) and sitting on the Graduate Policy and Curriculum Committee.
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Dr, Gurmit Singh is a full professor in McMaster’s Department of Pathology &
Molecular Medicine and an associate member of the departments of Biochemistry and
Biology. A member of various international science societies, he has published over 100
papers and edited 3 books. He holds grants from National Institute of Health (US),
Canadian Institute of Health Research, Canadian Breast Cancer Alliance, Cancer
Research Society, and Ontario Cancer Research Network. His research focuses on
experimental therapeutics with an emphasis on breast and prostate cancer. He was
recruited to become the Juravinski Cancer Centre’s first Career Scientist in 1984 and
initiate the Terry Fox Laboratories at McMaster with Dr. Bill Orr. He became Director of
Research in 1993, and a Senior Scientist for Cancer Care Ontario in 1996.
Page 28 of 52
Low Back Pain Research
“To experience pain is to have certainty; to hear about pain is to have doubt.”
Elaine Scarry
Low back pain
Low back pain – what is it?
•
•
back pain arises from trauma to the back or a disorder such as arthritis
o a sports injury
o work around the house or in the garden
o sudden jolt such as a car accident
o other stress on spinal bones and tissues
nearly everyone at some point has back pain that interferes with work, routine
daily activities, or recreation
Page 29 of 52
What is its impact?
•
•
•
•
•
•
•
back pain is the most common cause of job-related disability
back pain is the second most common neurological ailment
back pain costs the Canadian economy an estimated $5 billion annually
treatment involves using analgesics, reducing inflammation, restoring proper
function and strength to the back, and preventing recurrence of the injury
bed rest is NOT recommended for back pain
may be due to stress or pressure on dorsal roots
pain may be associated with
o loss of bowel or bladder control
o pain when coughing
o progressive weakness in the legs
What are we contributing?
•
•
•
•
•
•
we have recently established a unique derangement animal model of low back
pain
have developed novel tests to measure low back pain in the rat
o algometer-monitored vocalization
o movement-induced hypersensitivity
o side-to-side progression test
movement-induced hypersensitivity confirms parallel to the human condition
histological approach to identify structural changes associated with the model
imaging to identify structural changes associated with the model
studying mechanisms underlying hypersensitivity
Page 30 of 52
Who is involved?
This project is being carried out by Prateek Kalani, Dr. Kiran Yashpal, Vasek Pitelka and
collaborator Dr. Howard Vernon.
Prateek Kalani is presently enrolled in his fourth year of undergraduate studies in the
(Honours) Bachelor of Health Sciences Program at McMaster University. He is currently
undertaking a thesis project under the supervision Drs. Yashpal and Henry, studying and
evaluating an animal model of lower back pain in rats.
Page 31 of 52
Iconic Pain Assessment Tool
It is said that few die from pain; yet many die in pain and even more live in pain.
What is the Iconic Pain Assessment Tool?
• unlike other major health disorders, there is a general lack of objective
measures for pain, particularly chronic pain
• we are reliant on translation tools for the accurate and efficient
interpretation of patient experience, which must operate within a userfriendly framework and demonstrate the properties of validity,
reliability, and patient adherence
• an ideal pain assessment instrument should:
o provide a quantitative measure for analysis
o capture the different qualitative dimensions of pain
o be free from reliance on linguistic competence
o be related to the patient’s disease experience
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REFERENCES
McMahon E. (2006). The challenge of visualizing pain: a web-based educational module and
iconic pain assessment tool targeted towards patients with central post-stroke pain. Master’s
Research Paper. Biomedical Communications, University of Toronto.
McMahon E, Wilson-Pauwels L, Henry JL, Jenkinson J, Sutherland B, Brierley M, BFA.
The iconic pain assessment tool: facilitating the translation of pain sensations and
improvising patient-physician dialogue. J Biocommunication (in press), 2008.
What are we contributing?
• The Iconic Pain Assessment Tool (IPAT) was designed in 2006 by
Emilie McMahon, a former graduate student in the Department of
Biomedical Communication at the University of Toronto, cosupervised by Dr. Henry
• Features of the IPAT: freely accessible on the World Wide Web,
facilitates the assessment of pain quality, intensity and location, four
assessments available over the diurnal cycle, completed templates can
compiled into a longitudinal record of pain status
• Central Hypothesis states that the IPAT is a valid and reliable
instrument for the assessment of persistent pain
• Pilot Study: designed to assess the face and content validity of the
IPAT
• Validation Study: intended to demonstrate the properties of criterion
and construct validity, test-retest reliability and patient adherence
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Who is involved?
This project is being carried out by Chitra Lalloo and Dr. James L. Henry.
Chitra Lalloo completed her undergraduate studies in the Bachelor of Health Sciences
Program at McMaster University in May 2008. She is currently pursuing a Master’s
degree in the Medical Sciences Program under the supervision of Dr. James Henry. Her
project involves the assessment and validation of an iconic pain assessment tool in a
population of neuropathic pain patients. Chitra’s research is supported by the Alexander
Graham Bell Canada Graduate Scholarship (NSERC).
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Technical support for the research group
Sheila Bouseh, Senior technician, received a BSc. from Trinity College in Hartford, CT
with a double major in Neuroscience and Psychology and a minor in Human Rights. She
currently manages the Institute’s main laboratory.
Vasek Pitelka, Senior technician, oversees the laboratory at the University of Western
Ontario and plays a leading role in several of the projects on-going at McMaster.
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Elsa Mammen received a BSc. from Bharathiar University in India, majoring in
Microbiology. She is a graduate of the Biotechnology diploma program at Centennial
College in Scarborough. She is the newest member of the Henry lab, working as a
research assistant.
Yu Fang Wang graduated from Shanghai Medical University in China with training as a
nephrologist. She has been performing morphology work including
immunohistochemistry and histochemistry for more than ten years since coming to
McMaster University. She is currently working on dorsal root ganglion (DRG) and brain
tis sues with Laser Scanning Confocal Microscopy in Dr. Henry’s lab.
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Community Alliances for Health Research and Knowledge
Translation in Pain
This is a research project in knowledge translation funded by the CIHR Institute of
Musculoskeletal Health and Arthritis and the CIHR Institute of Neuroscience Mental
Health and Addiction.
Clause 4 of Bill C-13, the CIHR Act of the Canadian Parliament states:
“The objective of the CIHR is to excel, according to internationally accepted standards
of scientific excellence, in the creation of new knowledge and its translation into
improved health for Canadians, more effective health services and products and a
strengthened Canadian health care system …”
Research generating knowledge in pain is attempting to understand mechanisms,
complexities, incidence and prevalence, the personal, social and economic costs, etc.
While much remains to be learned, at the same time we must recognize that we are much
further ahead than we were 20 years ago, even 10 years ago. An important question,
though, is how much this mounting knowledge is being applied to those who suffer
debilitating pain, which is the presumed end-purpose of knowledge generation. This is
the entry point for ‘knowledge translation‘, the term widely used to refer to the process of
research use, or the application of knowledge to receptor communities. More formally,
knowledge translation at CIHR is defined as the exchange, synthesis and ethically sound
application of research findings within a complex set of interactions among researchers
and knowledge users - to accelerate the capture of the benefits of research for Canadians
through improved health, more effective services and products, and a strengthened health
care system.
Canada, the Canadian health care system, Canadian society and the Canadian economy
are in dire need of application of knowledge translation and exchange to debilitating pain.
In fact, a national strategy is needed to promote implementation of research findings,
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application and appraisal of clinical practice guidelines, and uptake of decision support
tools by health care practitioners and decision-makers.
What we are doing about it?
CAHR-pain is a Canadian research network funded by the Canadian Institutes of Health
Research to provide knowledge translation to receptor communities in the area of pain.
The six themes are each led by internationally-recognized leaders in the field, and you are
invited to learn about what each theme has as its research objectives, who the participants
are in each research theme, what the respective receptor communities are, what the longterm objectives are and how these will be carried out. This information is available by
clicking on the respective section of this web site.
The overarching impact from the outputs of this CAHR is to promote and sustain a
balanced portfolio of curiosity-based and needs-based research, which along with
existing knowledge will be mobilized and applied for the benefit of Canadians, the health
system and the economy.
The value-added of the CAHR is as follows:
• Creation of a unified stakeholder voice to make recommendations for public and
voluntary sector policy development to address the huge burden of chronic pain
• Creation of the defensible case for research-community interactions in this
domain to ensure that reliable knowledge addresses burden by being socially
robust
• Enhancement of the funding base supporting operations and, on this basis,
potential for leverage from the public purse, for incremental funding
Chronic pain as a chronic disease
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The burden of chronic diseases is tremendous, and traditional methods of healthcare
delivery are unsuitable for addressing these needs. Chronic disease management has
emerged as a new strategy for chronic disease care. Chronic disease management in the
clinical setting is defined as an organized, proactive, multi-component, patient-cantered
approach to healthcare delivery that involves all members of a defined population who
have a specific disease entity (or a subpopulation with specific risk factors). Care is
focused on, and integrated across the entire spectrum of the disease and its complications,
the prevention of comorbid conditions, and relevant aspects of the delivery system.
Essential components include identification of the population, implementation of clinical
practice guidelines or other decision-making tools, implementation of additional patient-,
provider-, or healthcare system-focused interventions, the use of clinical information
systems, and the measurement and management of outcomes.
The European Federation of IASP Chapters (International Association for the Study of
Pain) views chronic pain as a disease, and they have successfully lobbied the European
Parliament to declare chronic pain as a disease.
“Pain is a major healthcare problem in Europe. Although acute
pain may reasonably be considered a symptom of disease or
injury, chronic and recurrent pain is a specific healthcare
problem, a disease in its own right”
Who is involved?
The following are key leaders in the CAHR-pain initiative:
Theme I – Drs. Sandra LeFort and Shirley Solberg, Memorial University of
Newfoundland, Dr. Thomas Hadjistavropoulos, University of Regina.
Theme II - Drs. Judy Watt-Watson, Judith Hunter, Michael McGillian and Leila Lax,
University of Toronto.
Theme III – Dr. Allan Gordon, University of Toronto.
Theme IV – Dr. Paul Taenzer, University of Calgary and Dr. Saifee Rashiq, University of
Alberta.
Theme V – Drs. Joy MacDermid, Linda Woodhouse, Patricia Solomon, McMaster
Theme VI – Dr. John Lavis, McMaster.
Special Advisers – Dr. Linda Li, University of British Columbia, Dr. Peter Tugwell,
University of Ottawa, and Drs. Anthony Levinson and Jean-Eric Tarride, McMaster.
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An overview of the mandates of the respective Research Themes is as follows:
CAHR-pain will build capacity integrating community through to decision, as a state of
readiness to partner with process to improve the quality of life of those living with the
burden of chronic pain. At a national meeting in 2006 that included academics, clinician
researchers, pain management professionals, patients, epidemiologists, experts in KT,
health economists and industry representatives, it was agreed that to make meaningful
progress action must be taken to address the quality care gap for the one in five
Canadians suffering chronic pain. This initiative will create a favourable environment to
drive innovation in KT directed at improving measurable outcomes through six Research
Themes within three operating principles.
Research Theme 1 – “From the Ground Up: Alliances to Address Chronic Pain in the
Community”. This Theme will engage communities of chronic pain sufferers and
families, providers of health care and relevant organizations in participatory action
research to explore the chronic pain experience, the interface of chronic pain
patients/families with the health system, the needs of people with chronic pain, and
perspectives about client, provider and system expectations regarding care. We will
conduct an in-depth review of the scientific, policy and lay literature to identify existing
resources and emerging technologies for both patients and providers of care, and best
practice and models of community-based care for chronic pain
Research Theme 2 – “E-learning interprofessional pain curriculum for pre-licensure
health science students”. The overall objective is to improve the health of Canadians
who are experiencing pain, through the development and evaluation of an E-learning pain
curriculum for pre-licensure health science students in universities across Canada. This
study will be developed to: develop an E-learning pain curriculum for pre-licensure
health science students; evaluate its transferability to pre-licensure health science students
in selected universities across Canada; develop KT strategies for implementation of this
curriculum in each site, including facilitator training; implement a pilot study to evaluate
the final curriculum product.
Research Theme 3 – “Preceptorship Programmes in Pain Management - Longitudinal
Evaluation of Pain Management Education in Medical Trainees through Undergraduate
and Post Graduate Programs and Creating Pain Management Clinics Practicing EvidenceBased Standards of Care”. The present research project is to: intervene at different levels
of the career development of physicians and other health care practitioners to measurably
improve the skills and competencies in pain management both locally and nationally;
measure the impact of our various preceptorship programs on the physicians that we
educate, particularly in the field of Pain and Addiction; demonstrate that pain clinics can
follow acceptable standards of care and document that these standards of care were
influenced by this training.
Research Theme 4 – “Partnering with the Alberta HTA Chronic Pain Ambassador
Programme”. The project team is committed to evaluating the impact of the
“Ambassador Workshop KT Strategy” on: provider knowledge of evidence-based
assessment and treatment strategies; provider clinical practices/activities when working
with patients with these symptoms; patient outcomes. The results of the initial study will
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be used to plan a two group cluster randomized trial and additional cluster randomized
controlled trials comparing the Ambassador program to other promising knowledge
translation strategies.
Research Theme 5 – “Integrating Evidence into Effective Collaborative Practice to
Enhance Quality of Life”. The objective is to apply innovative KT strategies engaging
the chronic pain community to effectively mobilize explicit and tacit knowledge to assist
those living with chronic pain to attain the best possible quality-of-life. We will develop
and evaluate: a push-out technology (MacPlus-P) to capture and push-out the best
evidence on management of chronic pain to clinicians, patients and policy makers; a
Community of Practice approach to mobilizing the tacit knowledge required to
implement best practice in chronic pain management (including community-based and
knowledge developed in our Themes / groups).
Research Theme 6 – “Engaging in Knowledge Translation Through Deliberative
Processes”. The project team proposes: to develop and test a simple tool to describe and
evaluate key elements of deliberative processes that bring together public policymakers,
health system managers, clinical leaders, consumer group representatives and others to
discuss key challenges in responding to chronic pain (e.g., goals, group composition, and
group process); and to conduct formative evaluations of all deliberative processes and
after two and four years a summative evaluation of a concerted effort to match key design
elements to particular contexts.
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The research listed in this booklet was made possible through
funding from the following:
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Community Outreach – Health Care Professionals
“Who understands pain, knows medicine”
–Sir William Osler
Rationale:
Pain imposes a heavy burden on health care services across the board. The 1994-1995
National Population Health Survey indicated that 3.9 million Canadians, or 17% of the
population over the age of 15, suffer chronic pain. Sadly, though training in pain
management is barely alluded to in most health professional training programmes
(veterinarian trainees are reported to average five times more training than the average
for physician trainees). Although 40-65% of visits to family physicians have a pain
component, patients typically report that communication with doctors is poor. In a study
that attempted to quantify the total cost of chronic non-cancer pain to the Irish economy
in 1995, a study from a sample of 95 patients estimated that chronic pain had already cost
the economy £1.9 million by the time of their referral to a multidisciplinary pain clinic.
A reportedly high use of specialist care by chronic pain patients has been attributed to the
absence of a functioning primary care gate-keeping system for patient selection.
Management of low back pain in a cohort of general practitioners in Ireland was not
consistent with European clinical guideline recommendations and it was found that most
of the costs incurred by the National Health Services were attributable to physician nonadherence. The information in this paragraph is presented in detail in Henry, Pain
Research & Management (in press) 2008.
Clearly, knowledge translation to health care professionals remains a high priority if we
are to address the needs of those who live with chronic pain.
Goals:
The principal goal of the community outreach to health care professionals is to address
the gap between evidence and practice. A secondary goal is to create visibility and
credibility of the Michael G. DeGroote Institute for Pain Research and Care as a leader in
continuing health education in chronic pain.
What are we contributing?
This initiative is addressing knowledge translation to family physicians, specialists,
nurses, nurse practitioners, physiotherapists, pharmacists and other interested
professionals. In particular, Continuing Health Education Courses are being held to
address issues facing health care professionals vis a vis chronic pain management.
Topics in these courses have covered early and effective assessment, dealing with the
complex patient, use and abuse of opioids in pain management, focus on rehabilitation
and life habits, cannabinoids as drug or weed, the multidisciplinary approach to pain
management, addiction and drug-seeking vs. the bone fide need, alternative approaches to
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pain management, interrelation of the family physician and the pain clinic, nonpharmacological approaches to pain management, interprofessional interaction, etc.
To carry out this programme a series of continuing health education events has been held
each year since the first year of the National Pain Awareness Week in 2005.
Participation in these courses has consistently drawn 80 to 110 from across the health
care spectrum. Distinguished speakers have been attracted to the Hamilton/Burlington
area nationally and internationally to provide fertilisation of local health care
professionals with new and advancing ideas.
The annual Academic Pain Day poster for 2008 is found on the next page.
In addition, continuing health education courses have been offered during the Global Day
Against Pain, as declared collectively by the World Health Organization and the
International Association for the Study of Pain (IASP).
Other continuing health education courses have been held at other times throughout the
year.
These events have been made possible largely through industry partners and the Ontario
Pain Foundation, which was established to promote educational activities in the local
community.
These events and courses have been organized and run by Dr. Kiran Yashpal and Dr.
James L. Henry.
In 2006 the Michael G. DeGroote Institute for Pain Research and Care held an two and a
half day international meeting in Toronto on central neuropathic pain. This attracted the
thought leaders on central neuropathic pain from around the world. Funding was
provided from the IASP as that year’s IASP Research Symposium, as well as funding
from a number of industry partners. Attendance included mainly researchers and
physicians and the programme provided an update on mechanisms, diagnosis and
management of central neuropathic pain, particularly central post-stroke pain. The
proceedings were published as a book and circulated widely by the IASP Press.
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Community Outreach – Chronic Pain Patients
“Knowing is not enough; we must apply.
Willing is not enough; we must do.” - Goethe
“This sculpture symbolizes being trapped by chronic pain. The
rebar represents a prison and I am attempting a desperate escape
by pushing my face through the bars but there is never an escape.”
Courtesy of the PAIN Exhibit and www.PainExhibit.com
© 2007 Chronic Pain Visual Arts Project. All Rights
Rationale:
In 2005 a patient support group was established in the Hamilton/Burlington area. The
first thought of doing so came from a chronic pain patient performance in Toronto, based
on stories of patients who were associated with the Wasser Pain Management Centre in
Mount Sinai Hospital in Toronto, directed by Dr. Allan Gordon. It was apparent that
patients needed to express themselves, they had stories to tell and they gained benefit
from being and working together.
It became clear that traditional health care delivery was important and critical to these
patients and that self-management courses were also important. However, beyond these
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it appeared to us that socializing with peers was also important. This is not offered by
other resources and it was decided to establish the local group. To achieve this, we set up
a vehicle to fund these activities, the Ontario Pain Foundation; with a Board of Directors
and an accounting firm to ensure compliance, the OPF functions to promote educational
activities in the local communities. Reference to some of these activities is made in the
previous section on CHEs.
Goals:
The principal goal of this initiative is to create community alliances for health research
and knowledge translation in pain, engaging all stakeholders with an interest in chronic
pain. A secondary goal is to create visibility for the Michael G. DeGroote Institute for
Pain Research and Care as a community leader in the cause against chronic pain.
What are we contributing?
Initially, we worked with the Chronic Pain Association of Canada to incorporate
established principles to set up a support group with a catchment area including Hamilton
and Burlington, although some patients have come from Kitchener/Waterloo, Brampton,
Mississauga and the Niagara/St. Catharines area.
The group has monthly meetings, on Tuesday nights. Each event includes a period of
social networking. In addition, meetings include invited speakers of special interest to
chronic pain patients. Past speakers have included topics such as the physician approach
to chronic pain, physiotherapy for chronic pain, principles of nutrition to lessen the
burden of pain, principles of tai chi for those who suffer chronic pain, massage therapy
for pain, natural healing approaches to lessen pain, the ins and outs of pharmaceuticals
for pain, a programme in self-management for chronic pain, the science behind pain,
traditional Chinese medicine for chronic pain, etc. Many meetings also have
entertainment to lighten the atmosphere.
In addition, the group is assembling stories of what it is to live with chronic pain and of
their experiences with the health care system, the legal system, the insurance system as
well as family and friends.
An annual Public Forum is also held. In this case, in addition to the social networking
there are invited speakers and exhibits of community organizations that relate to chronic
pain. For example, this year invited speakers include the President of the Canadian Pain
Coalition, the national organization of support groups and chronic pain sufferers, and a
physician who also suffers chronic pain. Community organizations include those
offering services to chronic pain sufferers.
The Ontario Pain Foundation has also sent representatives of this support group to the
Annual Meeting of the Canadian Pain Society to interact with a broader community of
stakeholders and to bring back their own experiences to the group.
These activities have been organized by Drs. Kiran Yashpal and James L. Henry.
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McMaster as a Centre of Culture of Pain Research
The generous gift to McMaster from Mr. DeGroote gave birth to the possibility of
creating a world-class pain institute. To create such an institute it has been necessary to
introduce to McMaster and Hamilton Health Sciences a culture of pain research. None
had existed before. An advantage was that previous models existed at the time in
Toronto and Montreal, and recruitment of the Scientific Director brought direct
experience with creating a culture of pain research and a track record of success in doing
so.
In particular, a strategy was pursued to generate this culture from existing strengths. For
example, the CIHR project on Community Alliances in Health Research, CAHR-pain,
has enlisted the following researchers at McMaster in a unique blend of expertise,
creating a McMaster team of 8 researchers to include Drs. Brian Haynes, John Lavis,
Anthony Levinson, Joy Macdermid, Patty Solomon, Jean-Eric Tarride, Linda
Woodhouse.
In addition, a number of other research projects have been launched to create a pain
research culture from existing strengths. These include the following McMaster
researchers.
Dr. Alexander Ball is collaborating on immunohistochemical studies on
intracellularly-labelled dorsal root ganglion neurones in an entirely unique
technical approach to understanding mechanisms of the pain of osteoarthritis.
Drs. Norm Buckley and Akbar Panju – To 2007 I co-supervised a graduate
student to develop an internet-based pain assessment tool for central post-stroke
pain. This tool is found at the following URL:
http://www.emiliemcmahon.ca/mrp.html - together with Drs. Buckley and Panju,
we completed a research project, beginning with a summer student project last
summer, to determine the most appropriate receptor community for this tool and
then to refine the tool for these end users and monitor its uptake and effectiveness
for patients and managers of central post-stroke pain. Ultimately, this tool will be
broadened for application to other types of chronic pain.
Dr. Margaret Fahnestock has been collaborating on a study of the involvement
of brain-derived neurotrophic factor (BDNF) in mechanisms of altered
nociceptive mechanisms in the spinal cord of our animal model of osteoarthritis.
Dr. Jan Huizinga is collaborating on a highly technical and unique project. In
this case, we will be recording intracellularly from single dorsal root ganglion
neurones and classifying these neurones in terms of their electrophysiological and
physiological properties. Each neurone will be individually filled by intracellular
injection of a cellular marker. The ganglion will be removed, the neurones
dispersed and the filled neurone will be extracted. This neurone will then be
analyzed using RT-PCR to determine changes in expression, particularly of ion
channel species. This is because of some unique observations we have made that
have led to a new and transformative hypothesis that explains how osteoarthritis
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pain is brought about and how this type of pain remains refractory to medical
treatment. The plan is to carry out pilot experiments and submit a joint grant
application for this project.
Dr. Wolfgang Kunze is collaborating on another highly technical and unique
project. We will be recording intracellularly from single dorsal root ganglion
neurones and classifying these neurones in terms of their electrophysiological and
physiological properties. Each neurone will be individually filled by intracellular
injection of a visible dye, the ganglion removed and placed into an in vitro
recording chamber. The neurone will then be re-visualized and recorded from
using patch clamp technology to determine the ion species underlying the changes
in excitability and neuronal properties identified in our osteoarthritis model. The
plan is to carry out pilot experiments and submit a joint grant application for this
project.
Dr. Carl Richards – Our collaboration focuses on molecular mechanisms of
inflammation and pain in osteoarthritis, using our derangement rat model of
osteoarthritis. Based on some of our recent data, our laboratory is proposing that
the pain of osteoarthritis arises from a demyelination process in peripheral nerve
fibres, and this collaboration is directed at determining the role of cytokines and
cytokine receptors in this process, including the breakdown of the connective
tissue matrix that insulates these fibres and also provides the basis for saltatory
conduction in these fibres, and that shares a symbiotic metabolic relationship with
nerve fibres.
Dr. Gurmit Singh is collaborating on a study on an animal model of bone cancer
pain. The project involves running physiological nociceptive reflex tests on these
animals and running unique operant behavioural tests to measure the level of pain
experienced. This model will be used to identify novel targets for development of
new and effective treatment of bone cancer pain. A new graduate student has
been taken on for this project.
Dr. Linda Woodhouse is collaborating on a study to develop a unique animal
model of axial pain. Most animal models pertain to distal pains, yet the most
common of the debilitating pains is axial. In this study we are expanding on the
joint derangement of the osteoarthritis model and modifying an existing spine
immobilization model to create a flexible derangement model of vertebral pain.
This study also involves Dr. Kiran Yashpal as well as Drs. Barry Sessle and
James Hu, of the University of Toronto, and Dr. Howie Vernon, of the Canadian
Memorial Chiropractic College. The plan is to carry out pilot experiments and
submit a joint grant application for this project.
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External Academic Collaborations
Beyond the direct benefits of collaborations with research laboratories at other research
centres, the Michael G. DeGroote Institute for Pain Research and Care is gaining
widespread visibility as an eminent centre in this field. The following collaborations
have on-going research projects on pain mechanisms.
•
Dr. Heather Arnett, Amgen Corp., Seattle WA, USA – gene expression analysis
in dorsal root ganglion neurones in an animal model of osteoarthritis
•
Dr. Steve Bain, University of Washington, Seattle WA, USA – changes in bone
structure in an animal model of neuropathic pain
•
Dr. Frank Beier, University of Western Ontario – gene expression analysis in
knee structures in an animal model of osteoarthritis
•
Dr. Jean-Paul Collet, University of British Columbia, and Dr. Mark White,
Canadian Institute for the Relief of Pain and Disability, Vancouver - a pilot
randomized controlled trial assessing the effectiveness of intramuscular
stimulation to treat chronic low back pain associated with peripheral neuropathy
•
Drs. Allan Gordon and Judy Watt-Watson, University of Toronto – learning
preferences in continuing health education courses
•
Dr. David Holdsworth, Robarts Research Institute, London ON – imaging the
time course and development of structural change in an animal model of
osteoarthritis
•
Dr. Myron Levin, University of Colorado, Denver CO, USA – neuronal
subpopulations involved in herpes zoster activation and generation of postherpetic neuralgia
•
Dr. Ed Lui, University of Western Ontario physiological studies on effects and
on mechanisms of action of ginseng in animal models of pain and of
inflammation
•
Dr. Saifee Rashiq, University of Alberta, and Dr. Mark Ware, McGill University
– clinical study on intramuscular stimulation intervention on clinical signs of neck
torticollis
•
Dr. Hee-Jeong Im Sampen, Rush University Medical Center, Chicago IL, USA –
a prospective clinical study, “Dynamic Interactions Between Joint And Spinal
Cord Neurons In Knee Joint Pain”
•
Dr. Howard Vernon, Canadian Memorial Chiropractic College, Toronto, and Dr.
Barry Sessle, University of Toronto – sensory-motor changes in an animal model
of facet joint derangement, studies directed to mechanisms of axial pains
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Industry Collaborations for Drug Development and Drug
Testing
Knowledge translation includes the application of fundamental knowledge to new
techniques, methodologies, as well as new therapeutic approaches and tools. On-going
collaborations on research projects as well as on product efficacy and development have
been established with a number of industry partners, including:
¾ Amgen Corp. – osteoarthritis pain
¾ Merck Frosst – painful diabetic neuropathy
¾ NeurAxon Inc. – central post-stroke pain
¾ Pfizer Canada – neuropathic pain
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