Why do Canadian Veterans need the Chronic Pain Centre of Excellence (CPCoE)

The Veterans Affairs Canada (VAC) Life After Service Studies (LASS)* program of research was designed to enhance understanding of the transition from military to civilian life and ultimately improve the health of Veterans in Canada.

The LASS 2016 found that 40.8% of Veterans suffered from chronic pain and that the incidence of chronic pain had risen since 2013. The results showed that Veterans in the sample group were twice as likely to have chronic pain compared to the equivalent Canadian population.

read report*
Report from the Chairman of the Board
“With Veterans selecting and shaping the research projects that receive funding, the CPCoE is following the example set by the Chronic Pain Network with patient-oriented research.”
Dr. Jonathan BramsonBoard Chair
The Chronic Pain Centre of Excellence for Canadian Veterans
Report from the Chair of the Advisory Council of Veterans
“I am proud to say the Advisory Council of Veterans (ACV) is a very dynamic and energetic team providing valued insight in guiding the CPCoE research efforts to help improve quality of life for Veterans and their families.”
Tom Hoppe MSC, MB, CD, MA.Chair
CPCoE Advisory Council for Veterans

The CPCoE’s Board of Directors oversees the operations and financials of the CPCoE as a not-for-profit. The Board of Directors includes Veterans, industry leaders, and chronic pain experts from McMaster University Faculty of Health Sciences and Hamilton Health Sciences Corporation.

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Establishment of the CPCoE

The CPCoE was established to conduct research and help improve the well-being of Canadian Armed Forces (CAF) Veterans, and their families, suffering from chronic pain. At the core of all CPCoE activities is the principle of Veteran engagement. Consultation and engagement with Veterans, including an Advisory Council for Veterans to advise on research priorities—has been a priority since the organization’s inception. This ongoing engagement helps the CPCoE to develop a deeper understanding of the day-to-day challenges Veterans, and their families, face because of their experiences with chronic pain. These lived experiences are used to shape research that will have a genuine impact on the well-being of Veterans and their families.

Report from the Chief Scientific Officer
“The process of transition from active service to Veteran status has been described by some Veterans as contributing to challenges that they face as civilians. We have initiated discussions amongst research teams in Canada to begin the process of identifying the best processes around transition.”
Dr. Norm BuckleyChief Scientific Director
The Chronic Pain Centre of Excellence Research
Research Priorities

Since its launch, the CPCoE has collaborated directly with Veterans living with chronic pain, and their families, to establish its research priorities. Under the direction of Dr. Jason Busse, a qualitative review was conducted to determine what research was important to Canadian Veterans. One-on-one interviews were conducted with Veterans across five provinces who reported pain that began during their service. Results showed the following research priorities:

  • Pain care in the military
  • Post-operative care in the military
  • Coordination of services through VAC
  • Military to civilian transition
  • Primary care provider access outside the military
  • Knowledge of pain among civilian healthcare providers
  • Holistic care and patient knowledge
  • Effective strategies for chronic pain management

A cross-sectional review is underway to define the ranking of these established priorities. In conjunction, the CPCoE met with its ACV in September 2020 to discuss their goals for research. Based on their responses, the CPCoE built its 2020-2021 research plan.

Current Research

Foundational Research

McMaster University
Dr. Jason Busse, Associate Professor, Anesthesia & Health Research Methods, Evidence, and Impact, McMaster University

i) Rapid Recommendations
The MAGIC project has partnered with the British Medical Journal (BMJ) to create BMJ Rapid Recommendations (Rapid Recs) for areas in which there is a high potential of informing optimal clinical practice. The process begins by identifying an urgent clinical issue or new potentially practice-changing evidence, conducting systematic reviews of benefits, harms, and patients’ values and preferences, and using the findings to inform a focused clinical practice recommendation. To date, a Rapid Rec has been completed on medical cannabis and cannabinoids for chronic pain. Additionally, the CPCoE has embarked on a Rapid Rec for management of chronic pain from temporomandibular disorders (TMDs).

ii) Review of the Seven Domains of Well-being
VAC has established Seven Domains of Well-being that are important to facilitate understanding of Veterans’ well-being:

  1. Health
  2. Life Skills & Preparedness
  3. Finances
  4. Social Integration
  5. Cultural & Social Environment
  6. Housing & Physical Environment
  7. Employment or Other Meaningful Activity

To identify the optimal ways to measure each of these constructs, the CPCoE has committed to conducting further research on these Domains. In September 2020, the ACV participated in an exercise to rank the Domains in terms of order of importance for research. The Domain of Health was ranked number one. As such, an overview of reviews exploring measurement of well-being has been completed, and a systematic review of tools to measure the Domain of Health among community populations is underway.

iii) Review of Institute for Clinical Evaluative Sciences (ICES) Data
ICES data is a specific area of administrative health data research that tracks all healthcare utilization in the province of Ontario. Because Veterans access civilian healthcare services post-discharge from the CAF, ICES data includes a Veteran identifier. The CPCoE has engaged with ICES to use their data to inform patterns of care among Ontario Veterans living with chronic pain.

Evaluation of Online Pain Services

McMaster University
Dr. Victoria Borg Debono, Assistant Professor, Department of Health Research Methods, Evidence, and Impact, McMaster University

This project aims to study the impacts of offering virtual pain services to Canadian Veterans.

With the onset of COVID-19, many pain clinics have had to quickly shift their in-person programs to online delivery formats. Given the far-reaching implications of virtual care services, the CPCoE’s network of interdisciplinary pain clinics across Canada are being surveyed to understand the processes for setting up virtual appointments, ease of access, challenges/barriers, e-platforms used, resource implications, patient satisfaction, and clinical impact. Findings will be used to support the implementation of virtual pain care services for Veterans across Canada.

Evaluation of Community Pain Clinic Infrastructure

CHANGEpain Clinic Inc.
Dr. Brenda Lau, Founder and Medical Director, and Dr. Emmanuel Abreu, Research Director, CHANGEpain Clinic Inc.

This project aims to evaluate community-based pain clinic infrastructure that influences the care experience for Veterans living with chronic pain.

CPCoE recognizes the important role that community-based pain clinics play in the lives of Veterans. CHANGEpain Clinic Inc., a community-based pain clinic in Vancouver, British Columbia, is undertaking this research to evaluate community-based clinic infrastructure, resources, and processes, and the impact they have on overall patient satisfaction. Findings will be used to optimize the care experience for Veterans at community-based pain clinics across Canada.

Design of a Veteran Self-Education Platform

Healthcare Human Factors, University Health Network
Jennifer Rosart, Associate Director, Strategy and Design, Healthcare Human Factors, University Health Network

This project aims to design a self-managed education platform for Veterans living with chronic pain.

Self-education is an important component of chronic pain management. Committed to building an education platform that is truly impactful, the CPCoE is giving Veterans an active voice in designing a platform that will deliver value to them and their families. Context labs have been held with Veterans and their families to gain insights into the Veteran support system. Content has been co-created through interviews with Veterans, their families, clinicians, and subject matter experts. Once complete, this education platform will help Veterans to understand, track, and manage their chronic pain.

Intergenerational Transmission of Chronic Pain in Canadian Veterans and their Children

University of Calgary
Dr. Melanie Noel, Associate Professor of Clinical Psychology, Department of Psychology, University of Calgary

This project aims to study the intergenerational transmission of chronic pain in children of Canadian Veterans.

Chronic pain and associated mental health issues are prevalent in the Veteran population, which places Veterans’ children at heightened risk for the development of pain problems that could potentially persist into adulthood. To date, only one empirical study (conducted in the United States) has examined pain in offspring of Veterans. Given this scarcity, there is a critical need for empirical research to understand the mechanisms underlying the intergenerational risk for chronic pain. This project will characterize and establish the prevalence of pain in Canadian Veterans and their children and provide an in-depth understanding of their pain experience. Findings will be used to help inform future generations on how to manage chronic pain transmission among Veterans and their children.

Identifying Differences in Chronic Pain Treatment Based on Sex and Gender in Canadian Veterans

Western University
Dr. Joy MacDermid, Associate Professor, School of Physical Therapy/Department of Psychiatry, Western University

This project aims to evaluate the impact of sex and gender on chronic pain management in Canadian Veterans.

Sex and gender influence the types of injuries that active-duty military personnel incur, their treatment needs, and responses. While some research on sex and gender differences in pain management is emerging for the general population, there has been little research specific to military personnel and Veterans. This research will examine to what extent current research on pain in Veterans considers sex and gender differences, understand the unique experiences of women Veterans, and analyze the differences in treatment responses between men and women Veterans. Findings will be used to support best practices for chronic pain management programs to be inclusive of the differences in needs and responses of men and women Veterans.

Veterans Cannabis Therapy Outcome Registry (VECTOR)

Hamilton Health Sciences
Dr. Vikas Parihar, Assistant Clinical Professor, Department of Anesthesia, McMaster University

This project aims to develop a registry focused on Canadian Veterans who use cannabis for medical purposes.

As reported by VAC, from 2020 to 2021, a total of 15,369 Veterans were reimbursed for a total of 14,463,796 grams, or $119,264,105 worth, of cannabis. Given the prevalence of cannabis use among Canadian Veterans, it is imperative to study the usage of, and potential outcomes associated with, cannabis for Veterans living with chronic pain. This registry will feature Canadian Veterans using cannabis for medical purposes who are funded, or seeking funding, by VAC. It will identify the primary reason/indication for cannabis use; the types, forms, and quantities used; and the impact on pharmaceutical and/or non-pharmaceutical treatments already in place. Findings will be used to understand the potential outcomes associated with cannabis usage as it pertains to chronic pain and mental health comorbidities, which will help to inform Veterans and healthcare practitioners when considering cannabis as part of chronic pain management.

Characterization of the Landscape of Veteran Pain Clinics

The Pain and Wellness Centre
Dr. Angela Mailis, Director, The Pain and Wellness Centre

This project aims to characterize Veterans’ pain services nationally.

The CPCoE provides research, training, and education for interdisciplinary teams to improve the delivery of evidence-based pain care across the country. An important component of this research, training, and education is understanding the pain services provided to Veterans nationally. Through this study, the CPCoE’s network of interdisciplinary clinics are being surveyed to collect data about their organizational and clinical activities associated with treating Veterans. Findings will be used to understand the landscape of chronic pain management services and identify potential opportunities and/or barriers to improve those services across Canada.

What do Canadian Veterans have to say about the CPCoE?
“My involvement with the CPCoE gave me the opportunity to share my story, and hopefully impact other Veterans in sharing theirs. The CPCoE made me feel understood, supported, and like they were truly on my side. The CPCoE’s genuine commitment to Veterans’ well-being is self-evident.”
Written and Narrated by Michelle Bourdon
Michelle Bourdon
“My dog is the best reminder to get outside and get moving throughout the day. I also have a daily yoga practice, including slow, gentle yoga, yin yoga and breath awareness (evenings), and guided meditation (iRest). I have a few specific strengthening exercises that I do to help manage my pain, mostly exercises that target the back and core. In the summer I like to swim and sit outside and read. Living in the country has really helped me slow down and appreciate things that I never noticed before because I was always so busy and distracted.”
Dawn Herniman
“My name is Conrad Heegsma. I am a CAF Veteran. I have been suffering with chronic pain most of my adult life. I have found that a combination of Physiotherapy, Massage Therapy and Chiropractor have helped me the most. I also use medical cannabis to help with pain control. Most other medications have minimal results [for me].”
Conrad “Curt” Heegsma
“The CPCoE is a wealth of information for those dealing with chronic pain. The CPCoE provides educational services to Veterans that not only offer an understanding of pain, but a network of other Veterans who are dealing with the same pain as you. The online webinars show me that I am not alone, there are many of us out there suffering and there are things we can do to manage pain during our daily lives.”
Derek Speirs
Veterans and their families
Veterans Affairs Canada Case Managers
Health Care Professionals
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Impact: What has the CPCoE Accomplished?
  • Recruited and engaged with the ACV and Scientific Advisory Board
  • Recommended framework to VAC on requirements for interdisciplinary pain management centres in Canada
  • Completed qualitative study on Veteran research priorities
  • Commenced multiple research projects across diverse topic areas
  • Engaged with partner organizations, including the Canadian Institute for Military and Veteran Health Research, the Centre of Excellence, the Centre of Excellence on Post-Traumatic Stress Disorder, and the United States Departments of Veterans Affairs and Department of Defense on their innovative approach to pain management
new partnerships formed with other research entities
people reached through 5 hosted education sessions/webinars
Fiscal Year 2020-2021
VAC Contribution Agreement
$ 4,022,517
Research & Informatics
$ 5 88,198
$ 7 49,694
$ 2,684,625
$ 4,022,517

Chronic Pain Centre of Excellence for Canadian Veterans

McMaster Innovation Park
Suite 413A – 175 Longwood Road South
Hamilton, ON L8P 0A1
T: 1-833-644-HOPE (4673)