'The brain may have rewired in such a way that it's causing pain to continue,' suggests researcher
A pioneering research initiative at St. Joseph’s Health Care London is aiming to change the way chronic pain is understood, diagnosed, and treated—an advance with significant implications for health and safety leaders across Canada’s workplaces.
Led by Dr. Siobhan Schabrun, Acting Director and Professor in the School of Physical Therapy at Western University and the William and Lynn Gray Endowed Research Chair in Mobility and Activity at St. Joseph’s, the project is part of a $66 million, 10-year research partnership funded by Ontario’s Workplace Safety and Insurance Board (WSIB). The initiative seeks to make the invisible burden of chronic pain more visible, reduce stigma, and improve outcomes for workers.
Making the invisible visible
Chronic pain, often described as “invisible,” affects one in five Canadians and can persist for months or years after an injury. Dr. Schabrun explains, “Chronic pain is pain that lasts… from three to six months to longer. We might use the word nonspecific. Nonspecific means that we can't find a structural diagnosis for the pain. So we can't see that there's a tumor. We can't see that there's any damage to joints or tissues or ligaments or muscles or anything that might explain why the pain is continuing.”
The research focuses on how the brain and spinal cord can maintain pain even after the original injury has healed. “The brain may have rewired in such a way that it's causing pain to continue, even though whatever the initial injury was to the tissues has healed,” says Dr. Schabrun. “We think in some ways chronic pain can be defined as a neurological condition in its own right.”
New approach for health and safety leaders
For health and safety professionals, the implications are significant. Many workers in heavy industry, construction, and similar sectors experience acute injuries that, for some, develop into chronic pain. Dr. Schabrun notes, “Chronic pain has for a really long time been very poorly understood. For a long time, when pain became chronic and we could no longer see anything wrong with the tissues, we attributed it to psychosocial distress or to a kind of malingering. As research and neuroscience has advanced… it's become clear that the brain itself rewires in response to an initial injury.”
Traditional treatments, she says, often target the site of injury rather than the brain, which may explain why many people do not find relief. The research aims to identify brain markers at the time of injury that could predict who is at risk of developing chronic pain. “A big part of our research looks at this idea of at the time that somebody experiences that acute injury at work… What factors at that time will predispose one person to get better along a normal healing trajectory, or the other person develops this chronic disabling pain?”
Bridging silos and advancing treatment
The WSIB-funded initiative is also breaking down traditional silos between musculoskeletal, mental health, and pain research. “We know that these three things, musculoskeletal health, mental health, and chronic pain, they're all interlinked. Yet traditionally, we tend to study them in silos,” Dr. Schabrun says.
Dr. Aaron Thompson, Chief Medical Officer at the WSIB, emphasizes the importance of recognizing chronic pain as a distinct medical condition. “Chronic pain is not just pain that lasts a long time. It is a unique diagnosis with unique pathophysiology and is often misdiagnosed as a psychological injury,” Thompson says. “There’s a reason people view it like that, but it's a major disservice to the patient because it fails to recognize the pathophysiological basis of the persistent pain.”
Dr. Schabrun’s team is launching a study to track injured workers from the time of acute injury, using advanced brain imaging to identify markers that predict recovery or the development of chronic pain. The research will also test non-invasive brain stimulation as a potential early intervention to prevent the transition from acute to chronic pain.
Reducing stigma and improving outcomes
Beyond treatment, the project aims to reduce the stigma surrounding chronic pain. “One in five Canadians experiences chronic pain. But it's one of these things that we don't talk about very often. We talk about a lot of other things… But chronic pain… it's kind of this invisible condition that so many people are living with, but it's often quite stigmatized and unrecognized,” says Dr. Schabrun.
With its cross-disciplinary approach and focus on early intervention, the research could help health and safety leaders better support workers, reduce long-term disability, and improve quality of life for those living with chronic pain.
