HHS doctors, patients lead research into high rates of chronic pain among Canadian veterans
Hundreds of Canadian veterans, including many treated for chronic pain at the Hamilton Health Sciences (HHS) Michael G. DeGroote Pain Clinic, continue to serve their country by taking part in leading-edge research funded by the Chronic Pain Centre of Excellence for Canadian Veterans (CPCoE), a national, independent, not-for-profit research centre based at the McMaster Innovation Park in west-end Hamilton. The CPCoE research centre was established by Veterans Affairs Canada with HHS and McMaster University as stakeholders. It is Canada’s only research centre specializing in veterans’ chronic pain and its mission is to improve the well-being of veterans and their families. Since opening in 2020, the CPCoE has funded more than 60 studies in Canada, the United States, the United Kingdom and Australia including at HHS and McMaster University. In this two-part series we share more about the CPCoE and the pain clinic, and introduce three veterans involved in leading-edge research aimed at improving the quality of life for their retired comrades.
Soldiers of Misfortune
While 20 per cent of Canada’s population is affected by chronic pain, this jumps to 40 per cent for male veterans and 50 per cent for female veterans. It’s not surprising given the nature of their work, says Dr. Ramesh Zacharias, chief executive officer of the CPCoE.
Along with his work at CPCoE, Zacharias, a pain management specialist, also sees patients including veterans once a week at the HHS Michael G. DeGroote Pain Clinic, located at HHS McMaster University Medical Centre. It’s the largest academic, university-affiliated pain clinic in Canada and the largest pain clinic nationally for treating veterans with chronic pain. More than half the patients he cares for at the pain clinic are veterans.
Chronic pain is more common in veterans, largely due to wear and tear on their bodies over many years of training and service, says Zacharias. “They’re carrying heavy packs, jumping in and out of tanks, loading heavy cargo, and sometimes sleeping on dirt floors. That’s the job and they know what they signed up for but unfortunately it comes with the burden of chronic, long-term pain for many.”
Half of female veterans experience chronic pain, often due to ergonomics because military equipment has traditionally been designed for larger male bodies.
Mental health challenges such as post-traumatic stress disorder (PTSD) are also tied to chronic pain for both male and female veterans, says Zacharias. “Studies show that 60 per cent of veterans with chronic pain also have mental health concerns, and 63 per cent of people with mental health concerns have chronic pain. It’s two sides of the same coin. You can’t separate the two.”
Pain management program connects vets to research
Veterans learn about research opportunities through avenues including the Michael G. DeGroote Pain Clinic and its five-week intensive pain management program.
“Our pain clinic stands at the forefront of excellence, blending interdisciplinary expertise to deliver cutting-edge, patient-centered care while driving innovative research that transforms pain management practices,” says Dr. Eugene Maida, the pain clinic’s medical director.
The third-party funded intensive pain manage program is offered in a group format, year round, and is available through Veterans Affairs, the Workers’ Safety and Insurance Board, and insurance companies for motor vehicle accidents. About 60 per cent of participants are veterans and the rest are civilians.
The program includes fitness and education classes, tai chi, yoga, and sessions on breathing, relaxation and mindfulness. There are also sessions on understanding pain, such as the science of pain, the importance of pacing yourself in daily activities, self-talk, communication, sleep, grief and loss, and medication.
The team supporting program participants includes a physician/pain specialist, a psychologist, a psychometrist, a physiotherapist, pharmacist, social worker, dietitian and occupational therapists, all with expertise in chronic pain management. Sessions help patients understand that while their pain is a chronic condition that won’t go away, it can be managed better.
Program graduates include Cameron Kowalski, a retired RCMP officer with chronic pain who now works as director of operations for the CPCoE. “It’s the greatest experience I’ve had for treatment,” says Kowalski, of Hamilton, who shares more about his patient experience and commitment to pain management research in part two of this series along with veterans John Brown of Dorchester and Helene Le Scelleur of Quebec.
Collecting research data
Patients in the pain management program fill out a detailed questionnaire at the beginning and end of the five-week program to assess any changes or improvements in pain level, perceived pain-related disability, overall functioning, and mood. Completed questionnaires are entered into a database and different ethically-approved research projects are undertaken to evaluate the program’s effectiveness.
So far, the growing database contains feedback from more than 150 participants, including veterans. Many of these veterans also volunteer to participate in research studies funded by the CPCoE.
Research findings are used to promote evidence-based best practices for veterans and the health-care professionals treating them, as well as researchers and case managers with Veterans Affairs Canada.
Veterans interested in participating in the five-week pain management program are encouraged to speak with their Veterans Affairs case manager. Veterans wanting more information on research opportunities can join CPCoE’s mailing list.
The following studies are currently underway and include HHS pain clinic patients, doctors and staff. All studies are supported by HHS and the CPCoE.
- Intensive Six-Month Follow-Up Study: (77 participants, veterans and civilians). Patients who completed the five-week pain management program are surveyed six months later to rate their pain and various pain-related outcomes, so this can be compared to their earlier feedback. This study is ongoing. The principal investigator is HHS psychologist Eleni Hapidou. The research coordinator is Jennifer Anthonypillai.
- Veterans Cannabis Therapy Outcome Registry: (VECTOR) study: (200 participants, veterans only). This study surveys veterans who use medical cannabis to better understand its usefulness in managing chronic pain, mental health issues and sleep. Principal investigators are HHS psychologist Dr. Greg Tippin and HHS clinical pharmacist Dr. Vikas Parihar.
- Cannabis Use Disorder Identification Test Review Study: (22 participants, veterans and civilians). This study is assessing problematic cannabis use such as overuse and dependence. Tippin is the principal investigator.
- Pelvic Pain Retrospective Study: (50 participants, veterans and civilians). This study involves reviewing medical histories of female pain clinic patients who have participated in the five-week program to compare incidence of pelvic floor dysfunctional symptoms and disorders. The principal investigator is physiotherapist Adria Fransson and co-investigators are Hapidou and Anthonypillai.
- Examples of interventional research include:
- Epidural steroid injections: (65 participants, veterans and civilians). This study looks at the effectiveness of corticosteroid injections in helping patients manage pain from spinal stenosis, when the space inside the backbone is too small, putting pressure on the spinal cord and nerves. The principal investigator is Dr. Vladimir Djuric, a pain clinic doctor.
- Peripheral Nerve Stimulation Study: (57 participants, veterans and civilians). This study is assessing the therapeutic effect of image-guided pulsed radiofrequency in treating nerve pain. The principal investigator is Dr. Akil Siva, an interventional pain specialist.