Speech from the President: Canadian Pain Research Summit

September 19, 2016

Toronto, Ontario

Thank you, Dorothy [Strachen], for your kind introduction.

Distinguished guests,

I am especially pleased to be with you today to open this summit on pain research, because as some of you know, this is a subject that is very close to my heart.

For too long, pain has been a neglected topic in medicine. It was seen as a symptom, not a disease, and often dismissed as a complaint and not given the attention it deserved.

Yet, according to the Canadian Pain Society, pain is the most common reason for which patients seek health care. And by many metrics, the care received is still today arguably inadequate.

For example, one in five Canadian adults suffers from chronic pain. And while it is estimated that 90% of patients could obtain safe and effective pain relief through currently available treatments, only 50% actually do.

In terms of its impact on the Canadian economy, chronic pain costs Canadians an estimated $43–60 billion per year in health care expenditures and productivity costs – exceeding the combined cost of cancer, heart disease, and HIV.

Pain also leads to depression, reduced productivity at work, and even suicide.

But if pain has long been neglected from a clinical standpoint – I cannot remember having received even an hour of lecture on pain while in medical school – it has long been a topic for research.

And a topic on which Canada has been at the vanguard, from Melzack and Wall's proposal of the Gate Control Theory of Pain in the mid-1960s, to the imaging of brain pain control centers today.

It is in Canada that the famous McGill pain questionnaire was developed by Melzack and Torgerson in the seventies. A questionnaire, incidentally, that is still in use and considered to be one of the most robust pain assessment tools available worldwide today.

Early on, researchers realized that because of the multifaceted components of pain, be they physiological, pathological, clinical or behavioral, pain research necessitated multi-disciplinary approaches. Remember, Melzak was a psychologist and Wall an electrophysiologist!

CIHR's funding reflects this necessity. Indeed, pain research is funded through multiple Institutes, even though predominantly through the Institute of Musculoskeletal Health and Arthritis and the Institute of Neurosciences, Mental Health and Addiction.

Through $16 million annual investments in this area, we support 1,226 pain researchers and trainees from a variety of disciplines, from neuroscience to anesthesiology, from molecular biology to behavioral therapy, from biophysics to pharmacology.

The updated definition of pain proposed by Williams and Craig in the materials circulated prior to the meeting reflects this reality.

And I quote: ‘Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components'

Addressing such a complex issue and ensuring that research evidence is translated into clinical impacts require that we break down silos among disciplines, between professions, and between the different players and jurisdictions. And that we encourage innovative partnerships between the private and public sectors.

Which is why, in addition to leading pain researchers in biomedical, clinical, health systems services, and population health areas, we have gathered here today patients, health care professionals, policy makers, industrial partners, and members of the charitable sector.

People sometimes tend to forget that the mission of CIHR, as set out in the act establishing it, is two-fold: to support the creation of knowledge and to ensure that this knowledge is translated into new treatments and services.

Research on pain has often served as a model in this regard. And, probably because of its subjective components, pain has been one of the first areas of health research to closely involve patients.

It is therefore a subject that quite naturally lends itself to the objectives of the Strategy for Patient-Oriented Research.

Patients who live in pain are often the best poised to address the research questions that require answers urgently. Their perspectives are essential in the establishment of priorities that will drive Canada's pain research agenda. To quote Sir William Osler: "The good physician treats the disease; the great physician treats the patient who has the disease."

No topic in my mind was therefore more suited to the creation of the pan-Canadian SPOR Network on Chronic pain that was announced earlier this year.

This was one of five SPOR networks launched that day, and it's important to note that all of these Networks benefited from widespread collaboration and investments from partner organizations. Indeed, partners invested over $126 million in this suite of networks, more than twice CIHR's investment.

The Chronic Pain Network itself is supported by a combined CIHR-partner investment of more than $23 million. It focuses on delivering real-world impact – improving the health and wellbeing of chronic pain sufferers, and accelerating the translation of pain research evidence into effective care.

In a few moments, we will hear from the network's principal investigator, Dr. Norman Buckley. On behalf of CIHR, I wish to thank him for his leadership in this field.

The objective of this Summit is to foster the development of an evidenced-based pain research agenda. This agenda will be organized and implemented by the summit's steering committee. It will provide guidance for our Institutes when it comes to the development of new large scale funding opportunities.

It is my hope that this summit will also allow us to further deepen cross-sectoral relationships and collaborations which will lead to positive change for patients suffering from pain and reduce the emotional and economic costs it exacts on Canadian society.

I wish you all a productive and inspiring Summit.

Thank you.

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