The pain funding gap: A database analysis of pain research funding in Canada from 2008-2023

Abstract

Background: One in five Canadians experiences chronic pain, at a cost of $40.3 billion in 2019. Despite this significant burden, there are few effective treatments for pain. This gap has been recognized by Health Canada, which has put forth the Action Plan for Pain in Canada. Advancing our understanding of pain mechanisms and clinical trials to identify novel therapeutics are essential to address this treatment gap. However, it remains unknown whether the recommendations of the Action Plan have increased research investments.

Methods: We investigate research investments in pain by the Canadian Institutes of Health Research (CIHR) based on publicly available data. We performed a systematic database search focused on operating funds from competitions between 2008 and 2023 and tabulated pain funding as a proportion of total CIHR operational funds granted each year. Next, we examined the proportion of pain funding across CIHR institutes aggregated across funding years.

Results: We identified 20,126 operational grants, of which 459 were pain focused. The highest level of pain funding was 3.32% in 2019, and the average (SD) was 2.13% (0.70%). Funding was stagnant from 2008 to 2023 (R ² = 0.10, P = 0.23). The Institute of Musculoskeletal Health and Arthritis allocated the largest proportion of funding to pain research (11.40%). Eight of the 13 institutes allocated less than 1% of their operating funds to pain research.

Interpretation: In sum, CIHR pain research funding does not match the socioeconomic burden posed by pain. We propose three action items to improve pain research funding and to ultimately relieve the burden of pain in Canada.

Keywords: Canadian Institutes of Health Research; Pain; acute pain; chronic pain; funding; operational funds; research.

Figure 1.

Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagrams of CIHR-funded operating grants from 2008 to 2023. (a) Grants from all areas of health research and (b) pain-focused research based on the CIHR Funding Decisions Database. All grants underwent primary screening for location of funding (grants held in Canada), program family (operational grant funding), and secondary screening (based on keywords). Pain grants also underwent manual screening in the secondary screening stage.

Figure 2.

Percentage of CIHR operating grants allocated to pain research for 2008 to 2023. Pain funding is shown in red, and total funding is shown in blue. Both pain funding and total funding are measured on the left y axis. Percentage of total funding that represents pain funding is shown in yellow and is measured on the right y axis. The dashed orange line represents the date of the Action Plan for Pain in Canada.

Figure 3.

Percentage of annual CIHR operational funding for pain research. Pain funding (as a percentage of total operational funds) increased at a slope of 0.047%/year, with an R² = 0.10, P = 0.23. The line of best fit (solid line) and 95% confidence intervals (dashed lines) are plotted.

Figure 4.

Operating activities funded through each CIHR institute aggregated from 2008 to 2023. Pain funding is shown in red, and total funding is shown in blue. Both pain funding and total funding (in billions of Canadian dollars) are measured on the left y axis. The proportion of pain funding to total operational funding (in percentages) is shown in yellow and is measured on the right y axis. Unable to Allocate indicates all grants that lack institute specific funding. IA = Institute of Aging; ICR = Institute of Cancer Research; ICRH = Institute of Circulatory and Respiratory Health; IG = Institute of Genetics; IGH = Institute of Gender and Health; IHDCYH = Institute of Human Development, Child and Youth Health; IHSPR = Institute of Health Services and Policy Research; III = Institute of Infection and Immunity; IIPH = Institute of Indigenous People’s Health; IMHA = Institute of Musculoskeletal Health and Arthritis; INMD = Institute of Nutrition, Metabolism and Diabetes; INMHA = Institute of Neurosciences, Mental Health and Addiction; IPPH = Institute of Population and Public Health.