Leon JR Tourian - Membre du RQRD

Biography

Dr. Leon Tourian is a psychiatrist, clinician-scientist, and medical educator at the McGill University Health Centre (MUHC) and Associate Dean of Postgraduate Medical Education at McGill University. His research focuses on consultation-liaison psychiatry, pain psychiatry, critical care psychiatry, and the integration of mental health within complex medical illness. He collaborates on a longitudinal clinical databank of more than 800 patients at the Alan Edwards Pain Management Unit, studying the interface between chronic pain, psychiatric disorders, and health outcomes. His scholarly work also examines competency-based medical education, postgraduate training, physician professionalism, and health systems innovation. Dr. Tourian has authored numerous peer-reviewed publications, book chapters, and national educational initiatives. He currently serves as Chair of the Royal College of Physicians and Surgeons of Canada Specialty Committee in Psychiatry, where he leads national curriculum and competency standards. He is also President of the Board of Les Impatients, promoting research and knowledge translation on the role of artistic practice in mental health and recovery.

If you had an unlimited budget, what would you do with it?

With unlimited research resources, I would launch a large-scale longitudinal study aimed at disentangling factors that, in clinical practice, are almost always inextricably intertwined: pain itself, centrally acting medications, psychiatric comorbidities, sleep disturbances, and coping strategies. Each of these factors can, on its own, impair cognitive function and daily functioning, but they coexist in the vast majority of people living with chronic pain, making it extremely difficult to distinguish their respective contributions. The fundamental principle of this study would be to treat each participant as their own control. Through intensive and repeated follow-up over time, the natural fluctuations in pain, symptoms, and treatments would allow for an estimation of the specific effect of each of these factors while accounting for the influence of the others. Participants would undergo a comprehensive neurocognitive assessment at baseline and then at regular intervals. At the same time, digital tools used at home and patient-reported measures would continuously track pain intensity, sleep, physical activity, various physiological parameters, medication use, mood, and level of functioning. This observational framework would be supplemented by integrated therapeutic comparisons, enabling an assessment of the differential impact of interventional, pharmacological, and physical therapy approaches to pain, as well as that of structured psychotherapies on cognitive functions, functional disability, and pain-related distress. This approach would go beyond simple prediction to provide a better understanding of the causal mechanisms underlying clinical changes. The analyses would pursue two complementary objectives. The first would be to define different patient phenotypes based on the interaction between pain, medication exposure, substance use, psychiatric comorbidities, catastrophizing, and kinesiophobia. The second would aim to model individual trajectories in order to identify factors that predict improvement, deterioration, or response to treatment, and to determine for which patient profiles these effects are observed. Ultimately, this research program would contribute to the development of truly personalized medicine for chronic pain. It would provide clinicians with a solid scientific foundation for distinguishing the specific effects of pain from those of treatments, mental health disorders, and behavioral factors, while guiding each patient toward the therapeutic approach most likely to benefit them.