These three pieces are placeholder reflections, written in a plausible voice as a starting point for the page. They're meant to be replaced with Dr. Shanthanna's own musings whenever he's ready to write them.
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On growing older with pain, not despite it
We spend a great deal of professional effort trying to eliminate pain, and comparatively little asking what a good life looks like alongside it. In the pain clinic, I see this tension every week — patients who have been told, implicitly or otherwise, that the goal is a pain score of zero. For many of my older patients, that goal isn't realistic, and chasing it can crowd out the things that actually matter: walking to see a grandchild, sleeping through the night, gardening for twenty minutes without needing to sit down.
Some of the most meaningful conversations I have aren't about a new medication or injection. They're about function — what a patient wants to be able to do, and how we get closer to that, even if the pain itself doesn't fully go away. Our research into quantitative pain measurement grew directly out of these conversations: the numbers we track in a study should reflect the things patients actually care about, not just the things that are easy to measure.
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What Bangalore taught me before medicine did
Long before I understood the pharmacology of an anesthetic, I understood what it meant to make someone comfortable. That's a lesson from home, not from a textbook. I left Bangalore for what was meant to be a one-year fellowship. Fifteen years on, Hamilton is where I've built a research career, but the instinct that got me here — a fairly stubborn need to understand why something works, not just that it does — hasn't changed since medical school in India.
Moving between two health systems, two training cultures, and honestly two very different paces of life gives you a useful kind of double vision. You stop assuming that the way things are done here is the only reasonable way to do them. I try to bring that same skepticism to the evidence itself — asking not just "does this work" but "for whom, and under what circumstances," which is a very Bangalore way of asking a very McMaster question.
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The humility that evidence-based medicine demands
Systematic reviews have a way of humbling you. You go looking for a clear answer to a clinical question, and more often than you'd like, what you find is a handful of small, poorly designed studies pointing in slightly different directions. Writing guidelines — which has become a larger part of my work in recent years — means being honest about that uncertainty rather than papering over it with confident-sounding language.
I think this is especially important in pain medicine, where the temptation to overstate what we know is strong, precisely because patients are suffering and want answers. The most useful thing a guideline can do is tell a clinician, clearly, where the evidence is solid and where it genuinely isn't — and to leave room for judgment in between. That, more than any single finding, is probably the most durable contribution a career in clinical research can make.