Few people enjoy talking about, or even thinking about, chronic pain.
But Siobhan Schabrun has made it her life’s work to study this pressing challenge in health care.
“Chronic pain is a massive global health burden. It also has an economic burden that is second only to cancer,” Schabrun noted.
And in human cost, it is one of the most pervasive – and limiting – of medical issues. It hampers mobility and impedes daily activity, disrupts mental health and affects quality of life.
“Pain is the single most common reason for seeking medical attention. Yet we don’t really talk about it much and we know very little about it,” she said.
Why does one person with a back injury resume regular activities quickly, for example, while another will suffer pain long after the tissue itself seems to have healed? And can the brain be retrained to detect and tolerate pain in a different way?
Schabrun is the new William and Lynne Gray Endowed Research Chair in Mobility and Activity, and professor at Western’s school of physical therapy in the Faculty of Health Sciences.
The unique role is made possible by a $2.5-million donation from William and Lynne Gray to St. Joseph’s Health Care Foundation, Western University and St. Joseph’s Health Care London. The gift to create the chair is part of a larger $7.5-million commitment the Grays previously made to St. Joseph’s, which established The Gray Centre for Mobility & Activity, located at Parkwood Institute.
The only centre of its kind in Canada, the Gray Centre for Mobility and Activity is advancing mobility and rehabilitation treatment and prevention solutions through research, education delivery and worldwide collaborations to improve the lives of those living with disease, disability or injury.
Western has provided an additional $2.5 million from the university’s matching chairs program to create a $5-million endowment for the chair, which will fund the position in perpetuity.
The gift also reflects a health sciences signature theme of researching mobility and aging that affect people through all stages of their lives.
“The big-picture vision and opportunities that the Gray gift provides are so exciting,” Schabrun said. “It provides us with an opportunity to tackle some of the big challenges, including integrating hospitals, research academics, training and people who are working on the clinical front line so that we don’t have such a huge gap between when we produce research and when we actually start delivering care in the clinic. That clinical space in that research space, I think is really the way of the future.”
Problem-solving persistent pain
Schabrun’s research program is focused on understanding, treating and preventing chronic pain so that people can resume normal life activities.
“Given the scale of the problem, it’s remarkable that all of our treatments for chronic pain are almost completely ineffective. We have nothing to offer these people who are suffering quite markedly with chronic pain. And that has led us down a path of prescribing of opioids – it’s something we’ve relied on purely because we have so little else – and that has generated its own health problems.”
One reason chronic pain has been neglected as a study area is that clinicians often can’t find much structurally wrong with patients’ muscles, bones or joints. “That led us many, many years ago to sort of label it as a kind of psychiatric condition, malingering, which was an extraordinarily unfortunate way of dealing with what is a very widespread and disabling problem.”
Schabrun is now tackling the issue with neuroscience.
“Pain is a threat detector for the body, so when your brain says,’ ‘Aha, there’s pain,’ it’s because it thinks there’s something wrong, there’s a threat to the tissues and it sends out pain signals to inhibit activity that will do further damage. For some people, though, we think the brain is sending threat detection – ‘there’s pain, something is wrong, high alert’ – when the tissues are in fact not in danger. We believe there’s some maladaptive wiring going on.”
That, in turn, leads Schabrun and her colleagues down two paths:
- To identify biomarkers that could allow them to predict who will have a poor outcome and then, to intervene early with that group of people so that acute pain doesn’t turn into activity-limiting chronic pain; and
- To develop treatments that target the neuroscientific mechanisms of pain through non-invasive brain stimulation.
Schabrun is researching the impact of transcranial magnetic stimulation – a painless, non-invasive process that jumpstarts specific brain activity and cause specific neurons to fire to dampen the pain response.
“We’re interested in knowing whether this technique, particularly in combination with traditional therapies, can help undo some of this maladaptive rewiring and potentially either intervene in the transition from acute to chronic pain or assist with the treatment of pain once it becomes chronic,” she said.
Both routes are relatively new in the chronic-pain field.
They build on work Schabrun began while in Australia, where she trained as a physiotherapist before completing a PhD in neuroscience at The University of Adelaide in 2009.
She took post-doctoral training in pain neuroscience at The University of Queensland and in 2014 received a Fulbright scholarship to further her interest in the neuroplasticity of pain. In 2018, she moved to Neuroscience Research Australia and in 2020 received the Ulf Lindblom Award as outstanding young clinical investigator in the field of pain.
In London, Ont., as Gray research chair, she will build a team of summer research students, graduate and post-doctoral students, in addition to working with hospital and health sciences colleagues.
She said discovery science is gratifying, and she is enthused about mentoring and building stronger connections between clinical staff and research.
“I find the part around being able to make a meaningful change in the lives of people who suffer with chronic pain gratifying. The patient perspective is really important. For too long, researchers have done research that is interesting and important, but not necessarily informed by the views of the people who will deliver the treatments or the people who will ultimately be receiving them. One of the challenges over the next few years and a big part of my role will be finding solutions to some of these barriers that really stop that integration.”