NeuroMatters Researcher Profile – Dr. Eldon Loh
Beginning with this issue, NeuroMatters will feature a profile of those who contribute to improving the understanding of neurotrauma and care for those with spinal cord or acquired brain injury through their research and implementation efforts.
Dr. Eldon Loh, Medical Director of the Spinal Cord Injury Program at the Schulich School of Medicine, Western University, and consulting physiatrist in the Spin Cord Injury and Brain Injury programs at the Parkwood Institute, St. Joseph’s Health Care Centre, London, Ontario. His most recent research efforts have focused on the treatment of neuropathic pain in those living with spinal cord injury. “Clinical Practice Guideline for Managing Neuropathic Pain with Patients who have experienced a Spinal Cord Injury” was published in the summer of 2016 in Spinal Cord. Dr. Loh is a graduate of the University of Western Ontario and completed his residency at the University of Alberta and an interventional pain fellowship at the HealthPointe Medical Centre in Edmonton.
What has been the response to your research into the management of neuropathic pain related to spinal cord injury?
It has been very positive. Neuropathic pain can be a difficult condition to manage after spinal cord injury, and I think clinicians and others appreciate having the guidelines that we developed as a resource to use when optimizing their practice. The guidelines have also highlighted the gaps in neuropathic pain management after spinal cord injury in Canada, and I think we are on a path to improve all aspects of neuropathic pain moving forward, from basic science to the clinic.
What are those next steps for this area of research?
There is really a lack of evidence for many of the treatments that are used in neuropathic pain management. One important example where the evidence really doesn’t exist now is cannabis. Given the current policy directions with respect to the use of cannabis, there is a lot of interest in gathering evidence about the effectiveness of cannabis as a pain management option for those with spinal cord injury. Another area that needs to be better explored is non-pharmacological treatment options. When I discuss neuropathic pain management with people who have spinal cord injury, they often ask about non-pharmacological options that may benefit them. Again, this is an area where evidence is limited.
Why did you choose pain as the area of focus for your research?
Throughout my training I worked closely with mentors who were involved in pain management for many different conditions, not just spinal cord injury. Many of my mentors were also actively engaged in pain management research. I was inspired and motivated by their successes in helping people manage their pain in clinic, particularly if this is something that they have had to deal with for many years. I was also struck by their enthusiasm and desire to improve what they were able to offer in clinic through research. Because of them, I wanted to look at ways to help these patients eliminate pain, if possible, or live more comfortably with pain if it wasn’t feasible.
Can you share your perspectives on how the management of pain improves the lives of those living with SCI?
Neuropathic pain is often chronic and difficult to treat, and can impact people’s lives in a variety of ways. Sleep, mood, participation in rehabilitation, and the ability to perform functional tasks can all be impacted by neuropathic pain. If we can improve someone’s experience of pain, their quality of life and their ability to do the things that they want to do can significantly improve. Sometimes this can be achieved with changes in medication or other treatments, but unfortunately, this doesn’t happen often enough. Many benefit from counselling about how to live with their pain and improve day-to-day functioning. It is very satisfying to be able to assist patients through this process and observe how even a small improvement can lead to positive changes in their lives and their participation in activities of daily living.
What changes would you like to see in the healthcare system that would support pain management initiatives?
There is an urgency for equal access to pain management regardless of where people live in this province. Specialty pain clinics and spinal cord injury clinics tend to be in larger centres, and it can be difficult for people to access either one. In addition, many of these clinics can have extensive waitlists. Better coordination of care between pain clinics and spinal cord injury rehabilitation clinics may allow people living with SCI to access pain management services more efficiently. Funding for treatment, both pharmacological and non-pharmacological, can also be limited. We must advocate for equitable access and funding for different pain management options which can result in significant improvement in quality of life.