As I’m cleared through the daunting security desk, I wonder what goes on in the University of Toronto Centre for the Study of Pain (UTCSP). Inside there are no latex gloves scattered in corridors, no smell of antiseptic, no sound of drills buzzing through the hallway. Relieved, I make my way upstairs. For a place where pain is the name of the game, it’s not so scary after all.
The UTCSP was founded in 1999 in an effort to bring together the large number of pain researchers working in Toronto. It began when five scientists combined forces to operationally function as a centre, and has since grown to include over 60 faculty researchers from U of T and affiliated hospitals.
“There’s a real Canadian history to pain research,” says the centre’s director, Dr. Mike Salter. Some of the world’s foremost scientists in pain include McGill psychologist Ronald Melzack, and psychiatrist Harold Merskey from the University of Western Ontario. Their pioneering work has helped put Canada on the map since the early days of pain research.
Since then, developments in the study of pain have led to a collaborative outlook on how to conduct research in the field. “People were realizing that in order to treat pain effectively, you need to have multiple approaches, and we’ve kept that going here,” says Salter.
The UTCSP is a collaborative project involving the Faculties of Dentistry, Medicine, Nursing, and Pharmacy. According to Salter, “In terms of an academic pain centre that integrates different faculties, there really aren’t any others that do things the way that we do.”
With a mandate of research and education, the UTCSP aims to lead to a better understanding of the mechanisms of pain and its alleviation, and to spread and apply new knowledge.
On the research side, the centre facilitates projects, and helps faculty gain access to funding. It emphasizes an approach to clinical research from multiple angles in a number of disciplines.
The centre’s focus on education has led to the development of programs to instruct undergraduates, graduates, and post-graduates in pain assessment and management. The UTCSP’s flagship program, the Interfaculty Pain Curriculum (formally known as Pain Week), is a weeklong intensive course in pain for undergraduate students in various health disciplines. The program has been very successful, and has included 884 students across faculties.
In light of the centre’s educational mission: what exactly is pain? According to Salter, “there are two very distinct aspects that people often get confused: there’s pain, and there’s something called nociception.”
Nociception is the unconscious detection of potentially tissue-damaging stimuli by the body’s central and peripheral nervous system. It can result from heat, chemicals, or noxious mechanical stimulation, like pinching.
“There’s a really good survival value to be able to detect when the integrity of your body is being impaired somehow,” says Salter. “It’s really important to be able to do that.”
But pain is not that.
Pain is a function of the brain, and unlike nociception, it’s a conscious experience. It involves the integrated activity of various parts of the brain. Its relationship with nociception can be a tricky one. Nociception or noxious stimuli usually cause pain, but the stimulus is not always proportional to the discomfort experienced. Sometimes, pain can even occur without stimuli.
“Where things get a little bit more confused is in situations of chronic pain, where the relationship between tissue damage and the experience that you have is quite variable,” says Salter. In cases like these, minor tissue damage can lead to a big experience of pain, or vice versa.
According to Salter, understanding the nature of pain mechanisms is crucial, considering the huge role that pain plays in everyday life. “Most people outside the field think of pain as a symptom of a disease. But what we’ve come to realize in the field, and with huge amounts of evidence, is that pain is in the brain. But the brain is changed by pain. Or the brain changes pain. So we’re coming to see pain as a series of disorders of the nervous system.
“That’s been one of the things we’re trying to educate people about: that pain isn’t just a symptom of diseases. Pain can be a disease in and of itself, and there are many people that suffer from it.”
Statistics show that 10 to 20 per cent of the population suffers from chronic pain. All too often, people are afraid to talk about their pain problems because they don’t want to be stigmatized, or seen as complainers.
For many pain conditions, there are not very many good therapies, which is why pain is both a major societal and health problem. These problems promise to continue to grow in magnitude because there is a disproportionate representation of pain as people get older. “Unless we do something about it,” says Salter, “pain problems are going to increase with the aging population.”
In light of the challenges facing pain management today, the UTCSP aims to continue facilitating pain research, and to move beyond undergraduate professional education into more translational education for post-graduates, professionals, and continuing medical education. An increased understanding of pain as an economic, ethical, and human problem will also help to establish pain as an important focus for research worldwide.