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A diverse team of researchers from the University of Toronto is exploring the impact of sociocultural and psychological factors on post-surgical pain – specifically how changes to gender identity and body image contribute to an individual’s pain experience.

The study, supported by the Social Sciences and Humanities Research Council of Canada’s New Frontiers in Research Fund, will focus on transgender men and cisgender women who undergo surgical mastectomies.

Research has shown that a significant proportion of cisgender women – almost 40 per cent – develop post-mastectomy persistent pain, while transgender men who undergo gender affirming surgery, which 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 S. 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.”

Working with co-principal investigators Massieh Moayedi, assistant professor at the Faculty of Dentistry, Cassandra Lord, assistant professor in the department of historical studies at U of T Mississauga, and Emory Potter, co-applicant and a nurse practitioner at Women’s College Hospital, Dale hopes to use this unique opportunity to study both populations, creating 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 patients who have undergone mastectomies are known to experience a lot of pain, some of it chronic, there is little known about how body image and body dysmorphia may be implicated in the pain experience as a source of stress.

“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 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. The approach seeks to determine whether, and how, changes to body image and gender alignment contribute to the development of persistent post-surgical pain.

One in five Canadians suffer from chronic pain, according to the . The impact is significant and can affect every aspect of a person’s life – from cognition to relationships and employment. Those who experience persistent pain also see an overall decline in their health and quality of life.

The study is exploratory, but researchers suspect that differing experiences of pain will emerge for both transgender men and cisgender women, and that this knowledge will aid in the development of sophisticated approaches to proactively address the needs of both populations.

“The equity piece is important because we know that research indicates that trans people are often estranged or scared of seeking help in health-care settings,” says Dale.

By pulling these individuals into this study, he adds, researchers will be able to try to reverse the gap in trans people’s presence and inclusion in health research, so that they can benefit from evidence-informed treatment.