Leader(s): David WaltonJoy MacDermid, Jim Elliott, Walter Siqueira, Lynn Cooper, Brian Corneil, Eldon Loh, Gordon Good, Siobhan Schabrun, Jordan Miller
Institution(s): University of Western OntarioMcGill UniversityUniversity of British Columbia,Queen’s UniversityNorthwestern University (Chicago), Western Syndey University (New South Wales), University of North Carolina at Chapel HillCanadian Pain CoalitionGordon Good Law Offices
Other Member(s): Bill Aal, David Holdsworth, Douglas Fraser, David Seminowicz, Greg Gloor, Gunter Siegmund, Jim Dickey, Jeff Dixon, Joe Gati, Kevin Shoemaker, Linda Carroll, Marnin Heisel, Paul Tremblay, Samuel McLean, Ruth Lanius, Stan Van Uum, Tim Wideman, Trevor Birmingham. Trainees: Joshua Lee, Sadia Siraj. Research Assistants: Paul Phares, Ryan Power.


Why was the study done?
Chronic pain continues to be a burdensome issue for sufferers, health systems, and their communities. Many experts have endorsed more informed management in the acute pain period and identification of key prognostic/risk factors to prevent the development of chronic pain in the first place. The SYMBIOME project was conducted to collect rich biopsychosocial data on a longitudinal cohort of people recruited in the acute stage of musculoskeletal trauma, and to follow those for 12 months to identify trajectories and predictors of recovery / non-recovery (chronicity) after trauma.

How was the study done?
We recruited participants locally through the Urgent Care Centre of a major hospital. Data were collected as close to a non-catastrophic MSK injury as possible, including biological (blood, saliva, hair, and stool), psychological (distress, depression, threat appraisal, pain and disability) and social (education, gender roles, adult and early life stressors, socioeconomic status) data through self-report or in-person contact. Participants were then followed at 1, 2, 3, 6, and 12 months each time capturing additional data on recovery status using the Brief Pain Inventory as the primary outcome, and work status, healthcare usage, and emotional state as secondary outcomes.

What were the study results?
We recruited 120 acutely injured participants in the first phase of the SYMBIOME study. From those we have identified 3 recovery trajectories, of which ~45% continued to report moderate or greater persistent pain or interference problems at 12 months (Lee et al. 2020). We have further determined that recent life stressors are associated with acute pain but that the association is mediated by the effect of stress on sleep (Walton et al. 2020). Currently under review are manuscripts describing a new panel of blood markers that appear to distinguish high vs. low risk of chronicity, the effect of early life adversity on recovery from adulthood trauma, and further validation of the Traumatic Injuries Distress Scale for risk stratification.

Recent Updates:
Ten publications available, under review, or prepared for submission from the SYMBIOME work.

Last updated: May 2021

Selected Publications:
  • Walton DM, Pourkazemi F, Ghodrati M, Elliott JM. A Mediational Analysis of Stress, Inflammation, Sleep, and Pain in Acute Musculoskeletal Trauma. Clin J Pain. 2020 Mar;36(3):197-202. doi: 10.1097/AJP.0000000000000790. PMID: 31833913.