A diverse team of researchers from the University of Toronto have been awarded a grant from the New Frontiers Research Fund (NFRF) to explore the impact of sociocultural and psychological factors on postsurgical pain. The researchers are specifically investigating the contribution of changes to gender identity and body image on an individual’s pain experience.
The study will focus on transgender men and cisgender women who undergo surgical mastectomies. Research has shown that a significant proportion of cisgender women, almost 40%, develop post-mastectomy persistent pain, while transgender men who undergo gender affirming surgery, which also includes a mastectomy, report little to no postsurgical pain and require very little medication.
“Cisgender women who undergo a mastectomy, may experience more pain because of a negatively perceived body image, on top of surgical recovery and a potential cancer diagnosis,” says Craig Dale, assistant professor at the Lawrence Bloomberg Faculty of Nursing, a pain expert, and a co-applicant on the study. “For transgender men, there may be a sense of relief following surgery, which might differently impact their post-surgical pain, but often they must pay out of pocket for this surgery, which can make follow-up and pain management difficult.”
Dale, alongside principal investigators, Massieh Moayedi assistant professor at the Faculty of Dentistry, Cassandra Lord, assistant professor at the Department of Historical Studies at U of T Mississauga and Emory Potter, co-applicant and Nurse Practitioner at Women’s College Hospital, hope to use this unique opportunity to study both populations, to create a multi-faceted understanding of pain that looks beyond traditional therapies and informs new approaches to pain prevention and treatment.
“There is still some stigma around people with persistent pain, and they are not always believed when reporting pain in their health care encounters,” says Dale. “This can have long-term negative impacts on these individuals who may find it difficult to seek help for their pain in future.”
While statistics show that the population of patients who have undergone mastectomies are known to experience a lot of pain, some of it being chronic, there is little known about how body image and body dysmorphia as a source of stress may be implicated in that pain experience.
“There is emerging evidence that body perception disturbances – or mismatches between the body itself and how we perceive our bodies, contribute to some complex pain disorders,” says Dentistry’s Moayedi. “This study can help us find new treatment strategies and targets to treat the pain disorders.”
To examine the pain experience, the research team will use MRIs and pain assessments to compare the brain, pain sensitivity, gender identity and body image of patients before and after surgery. This will determine whether and how changes to body image and gender alignment contribute to the development of persistent post-surgical pain.
According to the Canadian Pain Task Force, 1 in 5 Canadians suffer from chronic pain. The impact is significant, and can affect every aspect of a person’s life, from cognition to relationships, and employment. Those who experience this kind of persistent pain also see an overall decline in their health and quality of life.
While this exploratory study is considered high-risk because the team of researchers do not yet know what they might encounter, they suspect that differing experiences of pain will emerge for both transgender men and cisgender women, and this knowledge will provide a sophisticated way forward in proactively addressing the needs of both these populations.
“The equity piece is important, because we know that research indicates that trans people are often estranged or scared of seeking help in healthcare settings,” says Dale. By pulling these individuals into this study, he says, researchers will be able to try and reverse the gap in trans people’s presence and inclusion in health research, so that they can benefit from evidence-informed treatment.
With this opportunity to focus on gender and health, this collaborative U of T-led research will have the potential to address long-term, the direction of patient support for pain, which is often invisible to most people.