Three or four times a day, staff in neonatal intensive care units across the country prick the heels of their tiny, premature patients to draw blood.
Weighing about three pounds each, these premature babies don’t yet have the fully developed coping mechanisms they need to deal with the pain they encounter when blood is drawn for critical tests. As a result, they often suffer throughout their first few weeks of life.
In addition to the endless tests, these premature infants are also sometimes hooked up to ventilators or are intubated—with tubes down their throats to help them breathe. For a baby that should still be tucked in the warm, safe environment of its mother’s womb, the medical procedures they must endure—as many as 14 a day—deliver continuous pain.
At McGill University, Celeste Johnston is working with colleagues on a new Multicentre Pain Research Initiative to find ways to alleviate that pain. “About 8 percent of babies in Canada are born prematurely, so we’re not talking about a tiny number,” says Johnston, the James McGill Professor and Associate Director for Research at the McGill School of Nursing. In particular, Johnston is exploring ways to alleviate the pain of premature babies without using drugs. That’s because they’re concerned about the long-term effects of pharmaceuticals on babies that are still developing.
So what’s the first clue in their hunt for pain relief? Researchers already know that the presence of the mother decreases the response to pain that these fragile infants exhibit. As a result, they’re looking at a simple and effective solution known as “kangaroo care”—placing babies and mothers skin to skin, enfolded in a blanket, while staff members prick the babies’ heels or do other tests. The approach seems to work. But what if the mother has left the hospital after giving birth and tests on the infant need to continue in her absence? “If the mother can’t be there to do kangaroo care, we’re doing this study where we tape the mother’s voice as if it’s going through fluid,” says Johnston. That mimicry is intended to give the babies the familiar sound of their mother’s voice, as they would have heard it when they were safe in her amniotic fluid.
Relieving the pain of premature infants is just one of the projects under way through the Multicentre Pain Research Initiative. Researchers at McGill University’s Centre for Research on Pain, Laval University, and the University of Montreal have formed an alliance to examine the nature and problem of pain in all its forms—including the countless forms of pain encountered by the ever-growing population of seniors. They’ve created the Quebec Pain Research Initiative, a network of researchers operating around facilities funded by the CFI. Through these initiatives, researchers are exploring a number of topics including the basic models of pain transmission, imaging approaches for tracking the flow of pain throughout the body, and assessing pain associated with sleep disturbance or with burn patients.
“When I began (this research) 20 years ago, it was a taboo topic to work on pain,” says Yves De Koninck, scientific director of the Quebec Pain Research Initiative and the project ‘s leader. “In our macho society, we tend to spread the belief that if you tough out your pain, you will grow stronger and be more resistant to pain.”
The medical community’s attitude towards pain has shifted along with the research, says De Koninck. Instead of seeing it as a symptom of something else, medical professionals are now beginning to recognize that pain is a problem in itself and, in fact, the most debilitating factor in many of the illnesses they treat.
Pain is sometimes referred to as the silent epidemic of our time. In fact, according to research studies around the world, pain is the single most common cause of disability that impairs the quality of life. Between 10 percent and 50 percent of the general population have suffered from chronic pain during their lives. In Canada, the National Population Health Survey of 1994-95 indicated that 3.9 million Canadians over the age of 15 suffer chronic pain. The impact of pain—lost work, visits to hospitals and clinics, and medication cost—is estimated at an average of $10,000 to $14,000 for each of those 3.9 million people.
Infants whose pain is not treated—like those Celeste Johnston is studying—are more likely to have a difficult recovery from surgery. They’re also more likely to go on to develop chronic pain. In fact, research now suggests that the more pain people endure, the more susceptible they become to chronic pain. As a result, understanding the sources of pain, the basic mechanisms of pain transmission, and ways to treat and alleviate pain is critical for improving the quality of life for millions of Canadians. It’s also crucial for relieving the socio-economic costs to our society.
“Pain has not really been recognized as a problem in itself until just recently,” says Yves De Koninck, project leader for a new Multicentre Pain Research Initiative based in Quebec. “Historically, Canada has played a leadership role in the field of pain research.”
The multicenter Pain Research Initiative and the Quebec Pain Research Initiative are working with pharmaceutical companies, particularly AstraZeneca, a leading pharmaceutical company based in London and Sweden, to develop new analgesics to relieve pain. Pain control is one of the seven areas that AstraZeneca specializes in. One of their objectives has been to set up clinics with different patient populations—whether in burn units, neonatal units, or pain labs across Quebec—with standard psycho-physical testing equipment. The clinics allow researchers to use the same basis for comparison when quantifying, measuring, and characterizing pain in all the different groups.
For AstraZeneca to successfully carry out its own research into analgesics that it can then sell to relieve pain, the company relies on its partnership with a number of universities and with the McGill Centre for Research on Pain says Andy Dray, chief scientist at AstraZeneca.
AstraZeneca donated $100,000 to help match the Canada Foundation for Innovation’s contribution to the Multicentre Pain Research Initiative, and recently added another $50,000 to help finance research. The company has also contributed to the Quebec initiative and has contributed an Industrial Chair in Pain Research. “We are funding or sponsoring each of these, because we believe that—particularly for McGill—they have a unique concentration of world experts in pain research and management,” says Dray. “It’s a tremendous wealth of expertise and information.” AstraZeneca has its own pain research centre in Montreal, with about 100 researchers. But because the site is small, it performs only basic discovery work and relies on partnerships with universities and hospitals for clinical work. The company situated itself in Montreal to take advantage of McGill’s historical strengths in understanding pain mechanisms, says Dray. By funding and sponsoring research that facilitates these partnerships, AstraZeneca is moving towards its goal to become the global leader in pain control, he says. And that’s a growing market as the population ages.
In addition, through the program Valorisation Recherche Québec, the Province of Quebec has contributed another $2 million through an operating grant for the facilities. The funds will strengthen research collaborations and support salaries.