Timothy H. Wideman’s research while affiliated with McGill University and other places

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Publications (92)


When pain overwhelms the self: A phenomenological study of a new mode of suffering, based on adults’ recollections of their worst pain episodes
  • Article
  • Full-text available

May 2025

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129 Reads

Journal of Pain

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Mael Gagnon-Mailhot

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Timothy H. Wideman

Suffering is a foundational yet understudied construct within the field of pain. There is general agreement that pain-related suffering involves disruption to one’s sense of self. The selfhood literature characterizes two inter-related modes of self-experience. One mode entails in-the-moment experiences that shape one’s stream of consciousness; another involves self-reflective thoughts about the past or expected future, related to self-narratives and identity. The field’s current conceptualization of pain-related suffering is exclusively anchored to the latter, self-reflective mode of experience. Our past work argues that this framing fails to account for pain’s immediate, disruptive impact and denies the potential for suffering among individuals without self-reflective capacities (e.g. infants). The purpose of this theoretically-informed, phenomenological study was to explore a new potential way by which people living with pain can suffer. We conducted in-depth, qualitative interviews with 12 adults across Canada living with various pain conditions. Interviews focused on understanding the moment-to-moment experiences of their worst episodes of pain. Results revealed important accounts of pain that overwhelmed thoughts and self-reflective capacities and disrupted foundational aspects of self-experience, including senses of agency, bodily ownership and time. Participants reported that these experiences were incapacitating, dehumanizing and dissociating. The findings are remarkably similar to first-hand accounts of torture and support a new mode of pain-related suffering that does not require self-reflection and is characterized by an immediate, disruptive impact on one’s sense of self. Findings will inform the development of the first theoretically-informed and evidence-based definition of pain-related suffering and help advance pain theory and practice. Perspective: This qualitative phenomenological study characterizes how pain can radically transform one’s in-the-moment sense of self. Results reveal a new mode of pain-related suffering that does not require self-reflection. This supports the expansion of traditional understandings of suffering, exclusively anchored to self-reflection, to now include two inter-related modes of pain-related suffering.

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Figure 1. Study procedures and measures. EMA, ecological momentary assessment; MEPLO, movement-evoked provocation test for low back pain in older adults. 51
Bivariate associations with movement-evoked pain.
Psychological and immunological associations with movement-evoked low back pain among older adults

April 2025

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7 Reads

PAIN Reports

Introduction Low back pain (LBP) is a leading global factor in disability among older adults. Movement-evoked pain (MEP) is potentially an important mediator in the disability pathway but is predominantly tested in the laboratory. Objectives We aimed to explore MEP in the natural environment (“daily” MEP) and its correlation with laboratory MEP, along with potential psychological and immunological influences. Method Thirty-five older adults with persistent LBP attended a single laboratory session. Pain catastrophizing, pain-related fear of movement, and pain self-efficacy were measured by questionnaire. Resting inflammation and inflammatory reactivity to painful movement were evaluated using serum interleukin-6, tissue necrosis factor alpha, and C-reactive protein (CRP). Laboratory MEP was defined by aggregate pain intensity with a movement provocation test. Daily MEP was measured for the next 7 days using ecological momentary assessment. Results Laboratory MEP was strongly correlated with daily MEP ( ρ = 0.780, P = <0.001). C-reactive protein (Hedges [ g ] = 0.266) and interleukin-6 (g = 0.433) demonstrated small to moderate reactivity to painful movement. After controlling for age and multimorbidity, pain catastrophizing and pain self-efficacy explained 24% to 37% variance in laboratory and daily MEP. Resting inflammatory markers were not associated with MEP; however, C-reactive protein reactivity to painful movement explained 19% to 25% variance in laboratory and daily MEP. Conclusion Preliminary indication is that laboratory and daily MEP may be proxy measures for one another, and that MEP is influenced by psychological and immunological factors. Future studies will aim to (1) validate findings among older adults with persistent LBP and (2) for clinical phenotyping, clarify complex relationships among psychological and immunological factors with disability pathway components like MEP.


Developing consensus among people living with pain on what health professionals should know about their lived experiences

April 2025

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47 Reads




Effects of physical exercise training on chronic low back pain are mediated by changes in frontostriatal connectivity and gene expression [PREPRINT]

December 2024

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121 Reads

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1 Citation

Chronic low back pain is a prevalent and debilitating condition that can be difficult to resolve. One effective approach is physical exercise training. This study investigates the hypothesis that exercise training normalizes immune-brain interactions that cause pain exacerbation and perpetuation. Fifty-seven participants with chronic low back pain were randomized into a 14-week exercise training program or a wait-list control condition. Exercise training led to significant reductions in pain and disability. Brain imaging analyses revealed decreased nucleus accumbens and medial prefrontal cortex (NAc-mPFC) connectivity, suggesting a normalization of reward circuitry. Gene expression analysis in immune cells indicated that exercise training produced changes in biological pathways related to immune function, stress, and inflammation. In alignment with the hypothesis, the observed changes in NAc-mPFC connectivity and gene expression were found to mediate the effects of exercise training on chronic low back pain.


Study selection flow chart
“How can we help you?”: results of a scoping review on the perceived needs of people living with chronic pain regarding physiotherapy

BMC Health Services Research

Background Physiotherapy is effective to reduce pain and improve the quality of life of people living with chronic pain. To offer high-quality physiotherapy services, these services must be patient-centred and respond to patients’ needs. However, few studies seem to target patients’ perceived needs, whereas more studies tend to focus on needs assessed by healthcare experts, which are not always in line with patients’ perceived needs. In addition, people living with chronic pain are often faced with several health inequities and may have varied perceived needs depending on their personal conditions. To offer services that truly meet patients’ needs, it is therefore crucial to understand these needs. This scoping review aims to identify and map the perceived needs of people living with chronic pain towards physiotherapy services. Methods To conduct this review, we followed the six stages framework proposed by Arksey and O’Malley. We searched four databases (Medline, Embase, CINHAL and APA PsycINFO) as well as the grey literature. We included all studies describing the needs, demands, preferences or expectations of adults living with chronic pain towards physiotherapy. We then performed an inductive thematic analysis of the results and discussion sections of these studies to identify the perceived needs. Once those needs were identified, we mapped them into the seven dimensions of the patient-centred healthcare delivery framework. Results Our review included 96 studies. Various perceived needs were identified through the thematic analysis, such as the needs for an empathetic relationship; for a clear, adapted and supervised exercise program; and for personalized treatment. Our mapping into the patient-centred healthcare delivery framework showed that most studies reported needs associated with the dimensions of interpersonal care, individualized healthcare and professional care. Needs associated with the other dimensions of the framework (access; coordination and continuity; services and facilities; data and information) were less frequently mentioned. Conclusions The results of this review have enabled us to identify and better understand multiple needs perceived by people living with chronic pain regarding physiotherapy services. The perceived needs identified through this scoping review were mapped within the seven dimensions of the Patient-centred healthcare delivery framework.





Citations (66)


... 5,13 Adverse childhood experiences have been identified as a risk factor for chronic pain and adverse health outcomes, with multiple retrospective population-based studies demonstrating a significant number of adults with chronic pain and high impact pain reporting a history of ACEs. 5,6,15,20,33,34 Possible mechanisms connecting childhood adversity to future pain development include the dysregulation of Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. ...

Reference:

Adverse childhood experiences and multisite pain among adolescents in the United States
European Journal of Psychotraumatology ISSN: (Print) ( Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis

... Moreover, previous studies mostly tested resting inflammation and not inflammatory change after painful stimuli (also known as "reactivity") 34,35 ; though a recent casecontrol analysis found IL-6 reactivity was associated with MEP in younger and middle-aged adults with LBP. 64 It is important to examine inflammatory reactivity in older adults due to previous findings of dysregulation, such that circulating inflammation increased substantially with experimentally induced pain. 12,26,50 To this end, our working hypothesis is that older adults experience a similar inflammatory reactivity to painful movement. ...

Are biomarkers associated with sensitivity to physical activity?

European journal of pain (London, England)

... Non-pharmacological rehabilitation management in cases of vertebral fractures was also applied via virtual medicine amid COVID-19 pandemic depending on fracture's stability, and individual medical and surgical profile of co-morbidities [41][42][43]. It generally includes pain medication, physiotherapy, and manual therapy, educational components with respect to lifestyle intervention, diet, daily habits, and physical exercise, both a theoretical training and mindfulness/medical yoga for the subjects with stable fractures, with an adjustment depending on short and long term plan for osteoporosis and associated fractures [42][43][44]. ...

Non-pharmacological management of osteoporotic vertebral fractures: health-care professional perspectives and experiences
  • Citing Article
  • July 2023

... A thorough understanding of these relationships is essential for developing effective management strategies to improve sleep and, consequently, the well-being of RA patients. [27] Further research is warranted to elucidate the mechanisms involved and optimize treatment approaches. On this basis, we again validated that advanced age, female, and high BMI are all risk factors for OA, which is consistent with previous reports. ...

A Preliminary Examination of the Effects and Mechanisms of Cognitive Behavioral Therapy for Insomnia on Systemic Inflammation Among Patients with Knee Osteoarthritis
  • Citing Article
  • May 2023

International Journal of Behavioral Medicine

... PPT is a static measure of pain that reflects the basal state of pain perception, while TSP is a dynamic measure of sensitivity that refers to the perception of increasing pain in response to repeated, stable stimuli (Uddin and MacDermid 2016). Further, these procedures have shown excellent within-session and relative reliability (Mailloux et al. 2021;de Oliveira et al. 2023) in people with and without chronic LBP. ...

Within-Session Test-Retest Reliability of Pressure Pain Threshold and Mechanical Temporal Summation in Chronic Low Back Pain
  • Citing Article
  • March 2023

Clinical Journal of Pain

... 22,24,39,44 Findings also align with a recent study in middle-aged adults with LBP, in whom pain catastrophizing to painful movement influenced daily pain and mood. 60 At the same time, recent prospective geriatric LBP studies have shown that MEP predicts 1 year disability but psychological distress does not. 23,24 Also, despite its specificity, pain-related fear of movement demonstrated the weakest association with MEP of the 3 psychological factors. ...

Task-based measures of sensitivity to physical activity predict daily-life pain and mood among people living with back pain
  • Citing Article
  • March 2023

European journal of pain (London, England)

... In accordance with the international consensus on the management of vertebral fractures [81], an individualized, guided training program should be initiated as soon as the level of pain subsides or after medical clearance (around 4-12 weeks after the vertebral fracture)initially, if necessary, in a relieved position. Fracture healing (around the 12th week after fracture) is the time to start a multimodal training program (progressive strength training, functional training, balance training). ...

International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures
  • Citing Article
  • February 2023

Osteoporosis International

... Long term considerations with respect to osteoporotic vertebral fractures should be regarded at multiple levels. The condition associates back pain, impairment of daily activities and sleep, psychological stress, reduced social wellbeing and affected quality of life [45]. Prolonged immobilization might aggravate further bone loss [46]. ...

Non-pharmacological management of osteoporotic vertebral fractures: Patient perspectives and experiences

... Te efect of isometric maneuvers in these patients remains unclear. Patricio et al. [30] found that an isometric wrist fexion exercise caused a signifcant increase in PPTs on the lumbar erector spinae (ES) region in subjects with LBP, but the same subjects did not show changes in PPTs after an isometric back extension from a seated position. Nevertheless, the work of Gajsar et al. [23] showed exercise-induced hypoalgesia in healthy participants caused by the Biering-Sorensen maneuver on the areas of the back and hip extensor muscles and highlighted the importance of future studies testing its efect in patients with LBP. ...

Assessment of exercise‐induced hypoalgesia in chronic low back pain and potential associations with psychological factors and central sensitization symptoms: A case‐control study
  • Citing Article
  • December 2022

Pain Practice

... Further, disruption to one's sense of self, which characterizes suffering, is a key factor in distinguishing pain from pain-related suffering. 1,2 To oversimplify the selfhood literature, self-experiences of adults can be categorized into two inter-related modes of experience. 3,4 One mode entails in-the-moment experiences that shape one's stream of consciousness. ...

Moving Closer to An Inclusive Definition of Pain-related Suffering and Targeted Care
  • Citing Article
  • November 2022

Journal of Pain