Dr. Clarke has contributed significantly to establish a rational, empirical approach to the “Great Opioid Debate,” an article in the British Medical Journal (Impact factor: 16.3) on prolonged opioid use after major surgery. The study is the largest of its kind, based on more than 39,000 patients who had undergone major elective surgery. The data show that ~3% of patients continue to use opioids 3 months after surgery. Dr. Clarke argues that pain - not ‘addiction’ - is likely the main culprit in the continued use of opioids. Regardless of one’s position in the current debate on the use and abuse of opioids for chronic pain, his research group brings a welcomed, rational, data-driven approach to the problem.
Dr. Clarke has also published an invited review in the Canadian Journal of Anesthesia reviewing the current state of knowledge on the genetics of chronic post-surgical pain. The manuscript, published in March 2015, reviews what is known about the genetic variation in the many genes that increase the risk for developing chronic post-surgical pain. The paper discusses pharmacogenomic approaches to chronic post-surgical pain management as well as personalized, mechanism-based pain treatments.
Dr. Clarke's team has also developed a world-first Transitional Pain Service. The statistics are clear: moderate to severe chronic postsurgical pain occurs in upwards of 10% of patients after major surgery. This is a world-wide problem. They have assembled a multidisciplinary team of health care professionals with expertise in chronic pain mechanisms and management. Under his leadership, The Transitional Pain Service, funded by the Ontario Ministry of Health and Long-term Care, aims to be proactive in optimizing pain control in at-risk patients who have undergone major surgery so that they do not go on to develop chronic postsurgical pain. He has recently published a manuscript in the Journal of Pain Research which templates the Transitional Pain Research Program for others to emulate.