Comprehensive Pain

Patient Population
The Comprehensive Pain Program (CPP) at Toronto Western Hospital evaluates 650 new patients and about 1,500 follow-up patients yearly.

The majority of patients suffer from neuropathic pain or suspected neuropathic pain. However, a substantial number suffer from a multiplicity of malignant and non malignant pain disorders. The CPP is the most comprehensive diagnostic and treatment center in the country and referrals come from within the GTA, the province and nationally.

Education
The CPP is the training site for Physical Medicine, Anesthesia and other subspecialty program residents. The ambulatory program serves as an Ambulatory Clinic site for undergraduate medical students and a Pain Fellowship program has been in place for 14 years. The CPP is a premier research/clinical training site for provincial, national and international trainees and visitors.

Research
CPP researchers have published unique research tools that advance the understanding of the mechanisms and management of neuropathic pain. These include the pioneering use of barbiturates for discrimination of central versus peripheral contributions in neuropathic pain and the establishment of algometric pain pressure thresholds as a quantitative instrument for deep pain. Research into the physiological and psychological effects of non specific treatment effects and on the psychophysiological basis of hysteria are further research interests. Areas of ongoing research activity include:

• Human Neuropathic Pain: syndromes (epidemiology and demographics, genetic predisposition, causation), effects of drugs, personality profiles, quantitative measurements, functional imaging, genetic research

• Chronic Pain Syndromes: intractable pain beyond healing time of injury and in the absence of obvious ongoing nociception (mechanisms, psychobiological model, functional imaging)

• Painful clinical syndromes: epidemiology, mechanisms, treatment response

• Placebo/nocebo effects: mechanisms, pathophysiology, personality profile

• Chronic pain and health care utilization/costs: demographics, epidemiology

• Educational research: development of guidelines, learning instruments in chronic pain

• Evidence-based medicine, literature reviews/ meta-analysis: member of the Cochrane collaboration (UK).