Dr. Clarke is the director of Pain Services and the medical director of the Pain Research Unit at the Toronto General Hospital. He is appointed to the Institute of Medical Sciences at the University of Toronto and is a graduate of the Royal College Clinician Scientist Program. His research interests include identifying novel acute pain treatments following major surgery, identifying the factors involved in the transition of acute postsurgical pain to chronic pain, studying the genetics of acute and chronic pain after surgery, and identifying risk factors associated with continued opioid use and poor health related quality of life after major surgery as well as the efficacy of hyperbaric medicine. Over the past five years he has authored 47 peer reviewed manuscripts.
Areas of Expertise (8)
University of Toronto: Ph.D., Institute of Medical Sciences 2013
University of Toronto: Fellow of The Royal College of Physicians of Canada, Anesthesiology Residency Program 2008
University of Toronto: M.D., Medicine 2003
University of Toronto: M.S., Behavioural Neuroscience 1998
Western University: B.S. (Hons.), Physiology and Psychology 1996
- University of Toronto Department of Anesthesia : Assistant Professor
Media Appearances (5)
No quick fix to society’s opioid crisis
Early one morning, while leaving my downtown Toronto home, I heard the quiet crying of a young woman lying in the alleyway. I saw a tourniquet and needle on the ground, her valuables scattered in disarray. I stopped and offered to take her to a centre where she could get help...
Chronic pain costs are high to Ontario health care system and to individual patients
In a paper titled, "Chronic postsurgical pain and persistent opioid use following surgery: the need for a transitional pain service," published on-line July 6, 2016 in Pain Management, a team led by Dr. Hance Clarke, Medical Director of the Pain Research Unit at Toronto General Hospital (TGH), University Health Network (UHN), estimated that about 15 per cent of complex postoperative pain patients develop moderate to severe chronic, post-surgical pain, have significant disability, and continue to use opioids for pain relief long-term...
Toronto hospital has unique strategy to reduce opioid abuse
Nearly 13 per cent of patients in Canada are already on an opioid for a chronic pain diagnosis — a risk factor for chronic post-surgical pain that costs more than HIV, heart disease and cancer combined annually, said Dr. Hance Clarke, director of the transitional pain service. "Pain is a silent epidemic," he added.
Clarke said he tries to get patients to separate pain relief from their dependency on painkillers.
"If you're telling me today that your pain is nine out of 10 and your pain was nine out of 10 [back] 25 years ago … the effectiveness is gone. So let's start looking at solutions and how we move forward. And Michael [Satok Wolman] was strong enough to say that he does have an issue here, let me try something different, and now he's been able to change his course," he said...
Opioid crisis: Pain specialist calls on government to fix holes in system
CBC The Current
Dr. Hance Clarke, director of Toronto General Hospital's Transitional Pain Program, believes it's time the government addresses the opioid crisis. He says the system has created this crisis, and it's failing patients living with pain...
Toronto General Hospital program uses new methods to prevent pain killer addictions after surgery
Dr. Hance Clarke, medical director of the pain research unit at Toronto General Hospital, believes doctors can do more to prevent patients from developing chronic and debilitating pain after surgery.
He heads a new program — one he says is a world-first — that helps patients manage severe post-surgical pain using a range of traditional and alternate therapies, including acupuncture, exercise, psychological techniques and non-opioid pain medications.
The program is unique in that it provides follow-up care for surgical patients after they are discharged from hospital.
“We do a good job of dealing with pain in hospital, but those regiments don’t continue beyond the hospital stay,” says Clarke, director of the new transitional pain service at Toronto General Hospital, a part of University Health Network...
Objective: To systematically review the evidence of pre-operative exercise, known as ‘prehabilitation’, on peri- and postoperative outcomes in adult surgical populations.
Gabapentin is increasingly being used for the treatment of postoperative pain and a variety of psychiatric diseases, including chronic anxiety disorders. Trials have reported mixed results when gabapentin has been administered for the treatment of preoperative anxiety. We tested the hypothesis that gabapentin 1,200 mg vs placebo would reduce preoperative anxiety in patients who exhibit moderate to high preoperative anxiety.
Many clinical trials have demonstrated the effectiveness of gabapentin and pregabalin administration in the perioperative period as an adjunct to reduce acute postoperative pain. However, very few clinical trials have examined the use of gabapentin and pregabalin for the prevention of chronic postsurgical pain (CPSP). We (1) systematically reviewed the published literature pertaining to the prevention of CPSP (≥2 months after surgery) after perioperative administration of gabapentin and pregabalin and (2) performed a meta-analysis using studies that report sufficient data. A search of electronic databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, IPA, and CINAHL) for relevant English-language trials to June 2011 was conducted.
The classic definition of preemptive analgesia requires 2 groups of patients to receive identical treatment before or after incision or surgery. The only difference between the 2 groups is the timing of administration of the drug relative to incision. The constraint to include a postincision or postsurgical treatment group is methodologically appealing, because in the presence of a positive result, it provides a window of time within which the observed effect occurred, and thus points to possible mechanisms underlying the effect: the classic view assumes that the intraoperative nociceptive barrage contributes to a greater extent to postoperative pain than does the postoperative nociceptive barrage. However, this view is too restrictive and narrow, in part because we know that sensitization is induced by factors other than the peripheral nociceptive barrage associated with incision and subsequent noxious intraoperative events. A broader approach to the prevention of postoperative pain has evolved that aims to minimize the deleterious immediate and long-term effects of noxious perioperative afferent input. The focus of preventive analgesia is not on the relative timing of analgesic or anesthetic interventions, but on attenuating the impact of the peripheral nociceptive barrage associated with noxious preoperative, intraoperative, and/or postoperative stimuli. These stimuli induce peripheral and central sensitization, which increase postoperative pain intensity and analgesic requirements. Preventing sensitization will reduce pain and analgesic requirements. Preventive analgesia is demonstrated when postoperative pain and/or analgesic use are reduced beyond the duration of action of the target drug, which we have defined as 5.5 half-lives of the target drug. This requirement ensures that the observed effects are not direct analgesic effects. In this article, we briefly review the history of preemptive analgesia and relate it to the broader concept of preventive analgesia. We highlight clinical trial designs and examples from the literature that distinguish preventive analgesia from preemptive analgesia and conclude with suggestions for future research.
Moderate to severe pain after total knee arthroplasty often interferes with postoperative rehabilitation and delays discharge from hospital. The present study examined the effects of a four-day postoperative gabapentin (GBP) regimen versus placebo on opioid consumption, pain scores and knee flexion, as well as adverse effects, after total knee arthroplasty.