We are pleased to announce the appointment of Dr. Mark Ware, pain physician and clinician scientist, as the Director of the Alan Edwards Pain Management Unit at the McGill University Health Centre (MUHC), Alan Edwards Chair in Clinical Pain and Tenured Associate Professor in the Department of Family Medicine, Faculty of Medicine and Health Sciences (FMHS), McGill University, effective May 1, 2023.
For over 20 years, Dr. Ware has been working to evaluate patient-driven questions concerning the safe and effective control of pain and its consequences. This led him to studying the use, safety and effectiveness of medicines derived from cannabis (cannabinoids), as well as efforts to understand the potential role of complementary and integrative approaches to pain management. From 2001 to 2018, while on faculty at McGill in the departments of Anesthesia and Family Medicine, Dr. Ware was deeply involved in the development of pain education curricula, and in the teaching of pain management to students, residents and health professionals from a wide range of disciplines. He has also collaborated extensively with local, provincial and national population-based studies of the impact of pain with a view to optimizing clinical approaches. His work has been funded by the CIHR, FRQ-S and range of philanthropic and industry sponsors.
From 2007-2018 Dr. Ware was the Executive Director of the non-profit Canadian Consortium for the Investigation of Cannabinoids (CCIC), and in 2016 he served as the vice-chair of Canada’s Task Force on the legalization and regulation of cannabis in Canada. The Task Force report formed the basis of the Cannabis Act which became law in 2018. In July 2018, Dr. Ware took a leave of absence from McGill to become the Chief Medical Officer for the Canopy Growth Corporation. During this time he undertook director training in corporate governance from the Rotman School of Management.
Please join us in welcoming Dr. Ware back to the Department of Family Medicine and congratulating him on his reappointment.
We sat down with Dr. Ware to talk about the latest breakthroughs in pain medicine, the priorities in his new role, and the personal motivations behind his work.
Why become a pain expert? Why is it important to you?
The importance of learning how to improve pain care comes directly from the need in the Canadian population for better understanding and management of chronic pain. 1 in 5 adult Canadians lives in and with chronic pain. This comes at a huge cost to society, both directly and indirectly, including loss of work and disruptions to the patient’s social structures and quality of life. There are many ways to better approach pain management, and it’s important that we have an academic presence alongside patient advocacy to lead and guide better pain control.
How would you define chronic pain?
Everybody knows what pain feels like; we have all experienced it and it is part of life. But most of us experience pain as a reaction to something, usually some traumatic event. It is an important signal that teaches us that something has gone wrong, and it commands and deserves our attention. Chronic pain is defined as pain that persists beyond the typical period of healing (which is somewhat arbitrarily defined as 3 to 6 months), and that means it is no longer serving the ‘alerting’ purpose that it had at the beginning. Chronic pain has become a disease all by itself, and with that comes an incredible array of other complications, including psychological impacts and social limitations.
Do you often see mental health coincide with chronic pain?
There is an important concept in understanding the impacts of chronic pain, which is essentially thinking of it as a triad: pain, mood, and sleep. Pain may be thought of as a mainly physical symptom, but as pain persists, the overlay of mood factors such as anxiety and depression and impacts on sleep become very important. The combination of pain, mood and sleep disorders all contribute to what can be an insurmountable challenge for a patient living with chronic pain.
What have been the main breakthroughs in the field of pain medicine in the last 10 years?
There has been an increasing realization in the last couple of decades that there isn't one single approach to treating pain, but that it requires a unified approach using multiple different modalities. It requires a highly personalized response to each individual patient, drawing from pharmacological, physical and psychological approaches. The breakthroughs have been recognizing the importance of this interdisciplinary approach to managing patients with chronic pain; the challenge is integrating them in a public health system with limited capacity. One of my goals as the Director and Chair is to emphasize and support our ability to offer patients truly interdisciplinary pain management at many levels of the health care system so that they are getting the maximum benefit of these approaches.
Is our healthcare system adapted to work collaboratively in a multi-disciplinary way?
That’s a good question! What is particularly exciting for me about taking this position now is that here in Quebec, there is tremendous momentum towards organizing pain management services along the corridor of care so that we have better approaches to chronic pain from primary and secondary care through to the tertiary institutions like the Alan Edwards Pain Management Unit. There is clearly political will and interest in organizing and supporting these services, so I think the timing is fantastic. The Quebec government put out a 5 year action plan for chronic pain in 2021, and in the same year the federal government published a Task Force report on pain in Canada. These templates serve as tremendous models for working with government, patients and community partners to strengthen and improve access and approaches to improve pain management.
Can you tell us about the Alan Edwards Pain Management Unit?
The Alan Edwards Pain Management Unit is one of the oldest pain clinics in Canada. It was founded many years ago by Ron Melzack who was a pioneer in pain psychology with the support of a philanthropic businessman, Alan Edwards, who recognized the importance of improving our approach to pain management. Over several decades, the clinic has grown to be what it is today: a truly multidisciplinary team including physicians, both specialists and family doctors, psychologists, physical therapists, our administrative team, and other allied health professionals who are all here to see and help patients referred to us from the community with chronic pain. We have a mandate to coordinate and improve the care of patients living with chronic pain in our region. We also have a leadership role as the Center of Expertise in Chronic Pain for our McGill RUISSS (réseaux universitaires de santé et des services sociaux) community.
Does the unit carry out pain research or is it mostly clinical care?
It's both. We believe that high quality research is an important way to improve and advance our understanding of pain. To achieve this, we work closely with the Alan Edwards Centre for Research on Pain at McGill University which a world-leading center for basic science and translational pain research. We have our own strong clinical research team, led by Dr Marc Martel, so we can attempt to translate some of the findings from the basic science team into clinical approaches and better our understanding of pain. We also work with our patients to identify new areas of research that we can develop with our basic science colleagues. It’s really a two way street, from bench to bedside and back. We also have to take the knowledge we gain from research out to patients and health care practitioners, so that is a third arm of our work.
Are you excited about coming back to McGill?
I am extremely excited. This feels like coming back home, and my colleagues at the pain clinic here have been welcoming and patient with me as I come back up to speed! My colleagues in the pain community across Canada have also been supportive and encouraging; we have a very strong network of support across Canada and our Unit is not alone in the challenges we face. This is a fantastic time to be coming back into the pain management field because not only are there initiatives at the provincial level in Quebec, but also on a national level, there is a Canadian pain strategy which has just been published in collaboration with senior leadership in pain management and persons with lived experience across the country. We have an opportunity to engage with these broader efforts to improve the management and delivery of care for chronic pain patients, so our timing is excellent.
What goals would you like to achieve in your new role?
I think the first step is to realize that, like many other clinical units, we've just gone through a very difficult period with COVID, pandemic reorganization, leadership changes and transitions of the way we deliver healthcare to virtual and hybrid models. I am coming into a clinical unit that has been deeply affected by these changes but which continues to deliver high quality care. My first job essentially is to better understand the team and their concerns, identify the opportunities, place our unit in the context of provincial and national pain initiatives, and work with my colleagues here to build a strategy that enhances our strengths and identifies what we need to fix and how.
That is going to require us all really working as a unit, and for me to understand the people and the opportunities that we have here. Over the next three to six months, I will develop a strategic approach to how the clinic can advance as a center of expertise and excellence and how we can improve our teaching, research, and clinical mission.
What does your work mean to you personally?
This work for me is truly a calling. As a very privileged family physician with an appreciation of the needs of patient living with chronic pain, I feel compelled to try to do what I can to improve their lives, to improve the quality of service that we offer to them, and to give them access to the effective tools and opportunities that we know exist already. As somebody with skills in coordinating, managing and bringing people along on a shared journey, I think it's very exciting. I am motivated to position our Unit and McGill University at the forefront of pain medicine in the world. It is a mission for me, and I am very, very fortunate to have this chance to serve our community.