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For some, she was known as a "Holy Terror," a "Bulldozer," the "Tiger Lady" or the "Energizer Bunny."
Regardless of the nickname, all would agree they were due to Dr. Angela Mailis' tireless drive to find treatments for patients with chronic pain.
After nearly 34 years at Toronto Western Hospital (TWH), 25 of which she was the director of the Krembil Neuroscience Centre's Pain Program she founded, Dr. Mailis bid farewell to UHN at the end of December.
However, Dr. Mailis likes to paraphrase a country tune to describe her departure: "You can take the girl out of academia, but you can't take academia out of the girl."
So, although leaving UHN, Dr. Mailis is continuing her work, taking her expertise to the community. She's created the
Pain and Wellness Centre in Vaughan – the first community-based academic clinic in Ontario which serves as a teaching and research facility, and provides interdisciplinary pain care to the GTA and beyond.
The new clinic is the result of the years she spent building a treatment program for pain from the ground up as a clinician, researcher and patient advocate, and will continue to work closely with the UHN pain program.
Dr. Mailis' fascination with pain and its treatment is rooted in the early years she spent in her home country of Greece. It was at family gatherings that she noticed there were different perceptions of pain, and that people dealt with their pain differently.
Contrasting perceptions of pain
"I noticed that siblings on my father's side of the family never talked about pain and never complained about their symptoms," recalls Dr. Mailis of her family. "But on my mother's side, brothers and sisters would sit around the kitchen table comparing medications and discussing their pain and other health complaints."
This contrasting experience made Dr. Mailis very curious, and she maintained this interest through the years of her residency program in Physical Medicine and Rehabilitation at the University of Toronto (U of T.) It also became a cornerstone of her medical career – motivating her to establish a dedicated program for pain management.
But the road to founding a focused medical program for pain treatment wasn't a smooth one. Though several disciplines including neurosurgery, orthopaedics, anaesthesia and psychiatry had an interest in treating pain, Dr. Mailis was the specialist they all relied on to create a program that would accommodate this patient population.
"Coordinating all these people was not an easy task and, in the early days, I was on my own without any residents or fellows for support," says Dr. Mailis. "I was running several outpatient clinics, conducting research for my Master's degree, and gave birth to two sons. It was a busy, busy time."
"A program dedicated to pain was a novel approach back then, I didn't have funding to ensure the program would keep going, and I had to do my best with the resources I had."
Bringing pain to the forefront of health care
In 1990, Dr. Mailis' hard work and sacrifice paid off: Ontario's Ministry of Health and Long-term Care (MOHLTC) agreed to fund the program which provided the staff and resources necessary for continued clinical and research output. The funding has been maintained to this day – a fact Dr. Mailis notes as one of her accomplishments as director.
She is confident that funding will continue under the direction of Dr. John Flannery at Toronto Rehab (TR), with whom she organized the merging of the Comprehensive Pain Program with the new and expanded Comprehensive Inter-professional Pain Program.
"Stable funding, no matter how limited, is the basis of great academic medicine to establish best practices, clinical care, research and education in any discipline," she says.
The following years saw Dr. Mailis publish extensively in peer reviewed journals and become nationally and internationally known for her clinical research. On the home front, she worked to change the scene of chronic pain management. She collaborated with provincial and national organizations such as the Canadian Pain Society and the College of Physicians and Surgeons in Ontario (CPSO) to develop guidelines for best practices in the field.
For more than 10 years, she chaired the non-profit organization ACTION Ontario for education and advocacy on behalf of pain patients. She lent her expertise as an advisor to a number of pain related committees organized by the MOHLTC, one of which led to the original Comprehensive Pain Strategy framework that has served to reformat pain care in the province.
"I actually never had a role model until a couple of years ago," says Dr. Mailis. "I've realized I aspire to be like Hazel McCallion, the immortal former mayor of Mississauga.
"At 94, she still has the schedule that a 30-year-old would have trouble keeping up with."
Understanding chronic pain
And, all this work has served to greatly change society's understanding of pain.
"Our understanding of pain has progressed exponentially since I started working in this field in 1982," says Dr. Mailis. "The biggest realization has been that chronic pain costs immensely in terms of public money, human suffering, and lost productivity – and this will only get worse as our society ages."
"But, in Ontario, the Ministry has really been putting sizeable funding and resources to address this issue through family health teams, academic programs like the one at UHN and providing long-distance education to healthcare practitioners across the province," she adds. "Soon we hope to see chronic pain management taken out of the hospital setting and into community centres which is a huge but needed change.
"And I'm very proud to have been part of the process in getting there."
Like with most of her career, Dr. Mailis is one of the first to blaze the trail in shifting pain care from the hospital to the community through her clinic.
It's this headstrong independence and passion for all she does, that makes it easy to picture her climbing on her beloved Harley trike – or getting in her Jeep Wrangler in the winter.
"They are bothraw, rough, strong, and very loud, like me!" But Dr. Mailis isn't leaving us behind. "I will continue to be indefinitely connected to UHN by 'the belly button.'"