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Exploring the relationship between gender, body image and pain

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In the last two decades, biomedical researchers have been paying increasingly more attention to how sex and gender can inform one's pain experience. With this approach, it is now possible to investigate the impact of anatomical changes and body image satisfaction at the same time in a specific surgical context. In this current exploratory study funded by the New Frontiers Research Fund, we investigate the pain experiences of ciswomen, transgender men and nonbinary individuals undergoing mastectomies and top surgery. Through our research, we aim to understand how gender identity and body image satisfaction contribute to post-surgical pain. Our goal is to improve surgical outcomes and provide better pain management for all groups.

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Source: Canadian Institutes of Health Research, the Institute of Gender and Health

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But why is this a worthwhile research question? 

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Chronic pain literature shows that pain is impacted by biological, psychological and social factors. However, studying one of these domains in isolation, or with a much greater emphasis, can lead to unsatisfactory pain management paradigms and incomplete knowledge about how pain is generated and maintained. Persistent post-surgical mastectomy pain has been shown to impact women for years after surgery, and is accompanied by high rates of body image dissatisfaction. Whereas, a limited number of studies have shown that transmen need little pain management in the acute post-surgical phase. We can see that people with different gender identities can undergo similar surgical procedures, and face divergent pain and outcomes. However, these patient groups have not been studied at the same time before, which limits our scientific insights. Furthermore, there is little to no data on transmen and nonbinary people's pain experiences after gender affirming top surgery. 

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We believe that our gender-informed research on how post-surgical pain and body image satisfaction might interact with each other will generate novel knowledge that can guide clinical care, and provide insights on biological and psychological mechanisms related to pain.  

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This study has been reviewed by the Women's College Hospital's Research Ethics Board (9 November 2023, REB#: 2021-0079-B). There are no direct benefits to you for participating, however, we hope to improve surgical outcomes for patients in the future based on our scientific findings. Participation in this study is voluntary. Inquiries about the study can be directed to the graduate student leading the project, Batu Kaya, using the form at the bottom of this page or by sending an email to genderpain@utoronto.ca

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THE TEAM

Principal Investigators​

Massieh Moayedi, PhD, Faculty of Dentistry, University of Toronto 

R. Cassandra Lord, PhD, Historical Studies, University of Toronto, Mississauga 

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Co-Investigators

Emery Potter, NP-PHC, MN, Transition Related Surgery, Women’s College Hospital 

Craig Dale, PhD, Bloomberg School of Nursing, University of Toronto 

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Graduate Student

Batu Kaya, Collaborative Program in Neuroscience, University of Toronto

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WHO CAN PARTICIPATE

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​Definitions

We provide some key definitions below to address the gender identity terms we use in our inclusion and exclusion criteria. These definitions are provided by the Canadian Institutes of Health Research.  

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  • Cisgender refers to a person whose gender identity corresponds with the sex they were assigned at birth

  • Nonbinary refers to a person whose gender identity does not align with a binary understanding of gender such as man or woman

  • Transgender refers to a person whose gender identity does not correspond with the sex they were assigned at birth

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Inclusion Criteria

  • Ciswomen undergoing cancer-related prophylactic simple or double mastectomy, with or without immediate reconstruction

  • Transgender men and non binary individuals undergoing gender affirming mastectomy, i.e., top surgery

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​Exclusion Criteria

  • Younger than 18 years old

  • Pregnancy

  • MRI contraindications

  • Diabetes, immune disorders, HIV/AIDS

  • History of stroke

  • Uncontrolled neurological and/or psychiatric disorders (e.g., Parkinson's, Huntington's, Alzheimer's, epilepsy; bipolar disorder, schizophrenia)

  • Nonbinary and transgender men undergoing prophylactic mastectomy

  • History of chronic pain disorders (e.g., fibromyalgia, irritable bowl syndrome)

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If you are unsure about your eligibility, we encourage you to use the form at the bottom of the page to send Batu Kaya a message to discuss further. 

STUDY VISITS

We have two aims in this study. The graduate student spearheading the project, Batu Kaya, will determine which aim you are eligible for. A typical study visit will comprise of the items below: 

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Aim 1 

  • Pre-surgical visit: From a month to a week prior to surgery​

    • Online interview with a social worker on Microsoft Teams (1-1.5 hours)​

    • Sensory testing at the Moayedi Lab (123 Edward Street, Suite 501; 1-1.5 hours)

    • Brain imaging at the University of Toronto's neuroimaging facility (325 Huron Street; 1.5 hours)

    • Online questionnaires (60-90 minutes)

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  • One-week post-surgical visit:

    • Online questionnaires (60-90 minutes)​

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  • Post-surgical visit: From four to six months after surgery

    • Online interview with a social worker on Microsoft Teams (1-1.5 hours)​

    • Sensory testing at the Moayedi Lab (123 Edward Street, Suite 501; 1-1.5 hours)

    • Brain imaging at the University of Toronto's neuroimaging facility (325 Huron Street; 1.5 hours)

    • Online questionnaires (60-90 minutes)

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Aim 2 

  • Pre-surgical visit: From a month to a week prior to surgery​​

    • Sensory testing at the Moayedi Lab (123 Edward Street, Suite 501; 1-1.5 hours)

    • Brain imaging at the University of Toronto's neuroimaging facility (325 Huron Street; 1.5 hours)

    • Online questionnaires (60-90 minutes)

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  • One-week post-surgical visit:

    • Online questionnaires (60-90 minutes)​

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  • Post-surgical visit: From four to six months after surgery

    • Sensory testing at the Moayedi Lab (123 Edward Street, Suite 501; 1-1.5 hours)

    • Brain imaging at the University of Toronto's neuroimaging facility (325 Huron Street; 1.5 hours)

    • Online questionnaires (60-90 minutes)

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Goals for Each Aim 

Aim 1 is focused on pain experiences of patients navigating the healthcare system, and body image expectations and outcomes throughout the surgical process.

 

Aim 2 will be carried out to reveal the biological underpinnings of the pain and body image circuits in the brain, and the potential interactions between these two circuits in patients who develop persistent post-surgical pain.

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We will analyze data from both aims in tandem to elucidate the biological, psychological and sociological contributors to mastectomy-related persistent post-surgical pain.

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REIMBURSEMENT

For Aim 1, we will reimburse you $90 for the pre-surgical, and $110 for the post-surgical visit. 

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For Aim 2, we will reimburse you $60 for the pre-surgical, and $80 for the post-surgical visit. 

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Under both aims, and for each visit, we will reimburse you up to $100 each time to cover your travel expenses. This travel stipend is in addition to the study participation reimbursement. We will provide taxi chits to travel between the neuroimaging facility and the Moayedi Lab.  

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METHODS

Neuroimaging refers to the use of magnetic resonance imaging (MRI) to study the central nervous system and its involvement in pain. Your MRI visits will take place at the University of Toronto's neuroimaging facility ToNI at your convenience.

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Questionnaires will be made available to you on REDCAP--a secure online database. This way, you can complete the questionnaires from the comfort of your home. You will be asked to reflect on your gender identity, body image satisfaction, pain sensations and more. 

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Sensory testing will be carried out using a battery of standardized tests called QST. We are interested in measuring your sensation and pain thresholds to cold, warm and mechanical stimulation. 

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CONTACT US TO PARTICIPATE

Please leave us a message using the form, and we will follow up with you shortly to discuss your eligibility for the study. If you prefer, you can email us directly at genderpain@utoronto.ca

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As emails are not secure, please do not include sensitive information in your message. 

Thanks for submitting!

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