Canadian Journal of Pain-Revue Canadienne de la Douleur最新文献

{"title":"Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research.","authors":"Louise V Bell,&nbsp;Sarah F Fitzgerald,&nbsp;David Flusk,&nbsp;Patricia A Poulin,&nbsp;Joshua A Rash","doi":"10.1080/24740527.2022.2156331","DOIUrl":"https://doi.org/10.1080/24740527.2022.2156331","url":null,"abstract":"<p><strong>Background: </strong>Balance between benefits and harms of using opioids for the management of chronic noncancer pain (CNCP) must be carefully considered on a case-by-case basis. There is no one-size-fits-all approach that can be executed by prescribers and clinicians when considering this therapy.</p><p><strong>Aim: </strong>The aim of this study was to identify barriers and facilitators for prescribing opioids for CNCP through a systematic review of qualitative literature.</p><p><strong>Methods: </strong>Six databases were searched from inception to June 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias was rated, and confidence in evidence was graded.</p><p><strong>Results: </strong>Twenty-seven studies reporting data from 599 health care providers were included. Ten themes emerged that influenced clinical decision making when prescribing opioids. Providers were more comfortable to prescribe opioids when (1) patients were actively engaged in pain self-management, (2) clear institutional prescribing policies were present and prescription drug monitoring programs were used, (3) long-standing relationships and strong therapeutic alliance were present, and (4) interprofessional supports were available. Factors that reduced likelihood of prescribing opioids included (1) uncertainty toward subjectivity of pain and efficacy of opioids, (2) concern for the patient (e.g., adverse effects) and community (i.e., diversion), (3) previous negative experiences (e.g., receiving threats), (4) difficulty enacting guidelines, and (5) organizational barriers (e.g., insufficient appointment duration and lengthy documentation).</p><p><strong>Conclusions: </strong>Understanding barriers and facilitators that influence opioid-prescribing practices offers insight into modifiable targets for interventions that can support providers in delivering care consistent with practice guidelines.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2156331"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9980668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10848877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unacknowledged Pain and Disenfranchised Grief: A Narrative Analysis of Physical and Emotional Pain in Complex MAiD Bereavement Stories.","authors":"Kristie Serota,&nbsp;Michael Atkinson,&nbsp;Daniel Z Buchman","doi":"10.1080/24740527.2023.2231046","DOIUrl":"https://doi.org/10.1080/24740527.2023.2231046","url":null,"abstract":"<p><strong>Background: </strong>Pain can influence an individual's choice to pursue medical assistance in dying (MAiD) and may also influence how family members experience that decision. Family conflict or discordance surrounding a loved one's MAiD decision can cause unique challenges affecting grief and bereavement, including disenfranchised grief. There is limited knowledge of how individuals with complex MAiD bereavement experiences describe the role of physical and emotional pain in their bereavement stories.</p><p><strong>Aims: </strong>This article explores the role of physical and emotional pain in the stories of family members with complex MAiD bereavement and identifies opportunities to improve care for individuals and families experiencing disagreement around MAiD.</p><p><strong>Methods: </strong>We conducted qualitative interviews and utilized a narrative and ethics of care approach to analyze the data.</p><p><strong>Results: </strong>We conducted <i>N</i> = 12 narrative interviews with participants in three provinces: Ontario, British Columbia, and Alberta. Descriptions of physical pain were used to justify the morality, or immorality, of MAiD in the context of patient suffering. Emotional pain described experiences where participants' feelings about MAiD went unacknowledged by their family or friends, institutions, and sociopolitical environments. We conceptualize this unacknowledged emotional pain as disenfranchised grief and make recommendations to improve care for individuals experiencing complex MAiD bereavement.</p><p><strong>Conclusions: </strong>Experiences of physical and emotional pain leave a lasting impact on family members with complex MAiD bereavement. Health care professionals should continue to improve care for family members following MAiD, especially where there is disagreement or family conflict.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 2","pages":"2231046"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10431743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10198235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signs and symptoms of pediatric complex regional pain syndrome - type 1: A retrospective cohort study.","authors":"Giulia Mesaroli,&nbsp;Logan McLennan,&nbsp;Yvonne Friedrich,&nbsp;Jennifer Stinson,&nbsp;Navil Sethna,&nbsp;Deirdre Logan","doi":"10.1080/24740527.2023.2179917","DOIUrl":"https://doi.org/10.1080/24740527.2023.2179917","url":null,"abstract":"<p><strong>Background: </strong>Complex regional pain syndrome (CRPS) presents with an array of symptoms that can vary from child to child, making it difficult to diagnose and differentiate from other pain conditions such as chronic musculoskeletal (MSK) pain. Thirteen symptoms and signs are outlined in the Budapest criteria for CRPS (developed and validated for adults) but have not been well described in pediatrics.</p><p><strong>Aims: </strong>The aim of this study was to describe the signs and symptoms of pediatric CRPS type 1 (CRPS 1) and determine whether a cluster of symptoms can differentiate CRPS 1 from chronic MSK pain.</p><p><strong>Methods: </strong>A retrospective cohort study of pediatric patients with CRPS 1 and MSK pain in a pediatric pain program was conducted. Descriptive statistics were used to report demographics and pain characteristics. The chi-square test was used to evaluate differences in signs and symptoms between patients with CRPS and MSK pain. A logistic regression model was used to evaluate whether a cluster of symptoms could predict a diagnosis of CRPS 1.</p><p><strong>Results: </strong>The sample included 187 patients (99 with CRPS 1 and 88 with MSK pain); 81% were female with a mean age 14.1 years. The most prevalent CRPS symptoms were hyperalgesia (54%) and allodynia (52%). A cluster of symptoms (hyperalgesia, color changes, and range of motion) predicted the probability of a diagnosis of CRPS 1.</p><p><strong>Conclusions: </strong>A cluster of symptoms may be critical in differentiating pediatric CRPS 1 and MSK pain. Future research is needed to determine if this model is valid in external populations and to explore whether a similar model can differentiate CRPS 1 from other pain conditions (e.g., neuropathic pain).</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2179917"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10116922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A formal evaluation of The Ottawa Hospital Pain Clinic orientation session: A quality improvement project.","authors":"Patricia A Poulin,&nbsp;Louise Bell,&nbsp;Danielle Rice,&nbsp;Yaadwinder Shergill,&nbsp;Sarah Fitzgerald,&nbsp;Rosemee Cantave,&nbsp;Renée Gauthier,&nbsp;Rose Robbins,&nbsp;Cristin Kargus,&nbsp;Susan Ward","doi":"10.1080/24740527.2022.2111993","DOIUrl":"https://doi.org/10.1080/24740527.2022.2111993","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain affects approximately one in every five Canadians and has a substantial impact on psychological well-being, relationships, ability to attend work or school, and overall functioning.The Ottawa Hospital Pain Clinic introduced orientation sessions, with the aim of providing new patients with pain education to help prepare patients for engagement with multimodal pain management strategies. This report summarizes the results of a formative evaluation of the orientation session at The Ottawa Hospital Pain Clinic to determine whether patients perceived the orientation session as beneficial.</p><p><strong>Methods: </strong>Interviews were conducted, transcribed, and then thematically analyzed to understand patients' perspectives on the orientation session. Coding was done by two team members using the constant comparison analyses method with key ideas, concepts, and patterns identified and compared to identify similarities.</p><p><strong>Results: </strong>Between September 6 and October 18, 2019, 18 patients attended an orientation session and 12 consented to participation and completed telephone interviews. The six themes identified included (1) feeling of community, (2) participants feeling heard by providers, (3) appreciation of the holistic approach, (4) availability of community resources, (5) barriers to access, and (6) discordant feelings of preparedness for the physician appointment.</p><p><strong>Conclusion: </strong>Results from this evaluation indicate that the orientation session offered at The Ottawa Hospital Pain Clinic improves chronic pain literacy, reduces feeling of isolation, and instills hope. As such, it appears to be a valuable component of pain clinic programs.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2111993"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9839373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9084835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the roles of depression, pain catastrophizing, and self-efficacy in quality of life changes following chronic pain treatment.","authors":"Landon T Montag,&nbsp;Tim V Salomons,&nbsp;Rosemary Wilson,&nbsp;Scott Duggan,&nbsp;Etienne J Bisson","doi":"10.1080/24740527.2022.2156330","DOIUrl":"https://doi.org/10.1080/24740527.2022.2156330","url":null,"abstract":"<p><strong>Background: </strong>Adults with chronic pain have a lower quality of life (QOL) compared to the general population. Chronic pain requires specialized treatment to address the multitude of factors that contribute to an individual's pain experience, and effectively managing pain requires a biopsychosocial approach to improve patients' QOL.</p><p><strong>Aim: </strong>This study examined adults with chronic pain after a year of specialized treatment to determine the role of cognitive markers (i.e., pain catastrophizing, depression, pain self-efficacy) in predicting changes in QOL.</p><p><strong>Methods: </strong>Patients in an interdisciplinary chronic pain clinic (<i>N</i> = 197) completed measures of pain catastrophizing, depression, pain self-efficacy, and QOL at baseline and 1 year later. Correlations and a moderated mediation were completed to understand the relationships between the variables.</p><p><strong>Results: </strong>Higher baseline pain catastrophizing was significantly associated with increased mental QOL (<i>b</i> = 0.39, 95% confidence interval [CI] 0.141; 0.648) and decreased depression (<i>b</i> = -0.18, 95% CI -0.306; -0.052) over a year. Furthermore, the relationship between baseline pain catastrophizing and the change in depression was moderated by the change in pain self-efficacy (<i>b</i> = -0.10, 95% CI -0.145; -0.043) over a year. Patients with high baseline pain catastrophizing reported decreased depression after a year of treatment, which was associated with greater QOL improvements but only in patients with unchanged or improved pain self-efficacy.</p><p><strong>Conclusions: </strong>Our findings highlight the roles of cognitive and affective factors and their impact on QOL in adults with chronic pain. Understanding the psychological factors that predict increased mental QOL is clinically useful, because medical teams can optimize these positive changes in QOL through psychosocial interventions aimed at improving patients' pain self-efficacy.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2156330"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9980521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10848878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivering Team-Based Primary Care for the Management of Chronic Low Back Pain: An Interpretive Description Qualitative Study of Healthcare Provider Perspectives.","authors":"Kyle Vader,&nbsp;Catherine Donnelly,&nbsp;Therese Lane,&nbsp;Gillian Newman,&nbsp;Dean A Tripp,&nbsp;Jordan Miller","doi":"10.1080/24740527.2023.2226719","DOIUrl":"https://doi.org/10.1080/24740527.2023.2226719","url":null,"abstract":"<p><strong>Background: </strong>Chronic low back pain (LBP) is a prevalent and disabling health issue. Team-based models of primary care are ideally positioned to provide comprehensive care for patients with chronic LBP. A better understanding of primary care team perspectives can inform future efforts to improve how team-based care is provided for patients with chronic LBP in this practice setting.</p><p><strong>Aims: </strong>The aim of this study was to understand health care providers' experiences, perceived barriers and facilitators, and recommendations when providing team-based primary care for the management of chronic LBP.</p><p><strong>Methods: </strong>We conducted an interpretive description qualitative study based on focus group discussions with health care providers from team-based primary care settings in Ontario, Canada. Data were analyzed using thematic analysis.</p><p><strong>Results: </strong>We conducted five focus groups with five different primary care teams, including a total of 31 health care providers. We constructed four themes (each with subthemes) related to experiences, perceived barriers and facilitators, and recommendations to providing team-based primary care for the management of chronic LBP, including (1) care pathways and models of service delivery, (2) team processes and organization, (3) team culture and environment, and (4) patient needs and readiness.</p><p><strong>Conclusions: </strong>Primary care teams are implementing diverse care pathways and models of service delivery for the management of patients with chronic LBP, which can be influenced by patient, team, and organizational factors. Results have potential implications for future research and practice innovations to improve how team-based primary care is delivered for patients with chronic LBP.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2226719"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale, methods, and progress of the ArthroCaP Study: A prospective cohort study exploring the associations between chronic postsurgical pain and postoperative cognitive dysfunction after elective knee or hip arthroplasty","authors":"Maram Khaled, Jocelyn Kuber, Mary Ferber, Praveen Sritharan, Yarden Levy, S. Becker, M. Fahnestock, M. Griffin, K. Madden, H. Shanthanna, M. Marcucci","doi":"10.1080/24740527.2022.2162375","DOIUrl":"https://doi.org/10.1080/24740527.2022.2162375","url":null,"abstract":"ABSTRACT Background Chronic postsurgical pain (CPSP) may increase the risk of postoperative cognitive dysfunction (POCD) directly or by negatively impacting mobility. A comprehensive measure of satisfaction with surgery that accounts for ability to perform activities might be even more strongly associated with POCD. There might be complex mechanisms underlying the interplays between postoperative pain and cognition. Aims The primary objective is to explore whether CPSP at 6 months is associated with POCD (≥2-point decline in the Montreal Cognitive Assessment [MoCA] compared to preoperative) at 12 months. Secondary objectives are to explore the association between satisfaction with surgery and POCD, the role of pain medications (opioids) in the association between CPSP and POCD, the role of patient preoccupation/optimism and coping in determining the effect of pain on cognition, and the hypothesis of neurogenesis interference as an underlying mechanism. Methods We will prospectively recruit ≥100 patients ≥50 years old undergoing elective total knee/hip arthroplasty. Sociodemographic characteristics, comorbidities, frailty, pain, and pain medications will be assessed preoperatively. The Somatic Preoccupation and Coping questionnaire will be administered preoperatively and 4 to 6 weeks postoperative. Pain and the Self-Administered Patient Satisfaction Scale will be measured at 3 and 6 months. MoCA and neuropsychological tests will be administered at baseline, 4 to 6 weeks, and 6 and 12 months. Blood will be longitudinally collected for biomarker analysis. Progress Forty-six participants have been enrolled in the study so far. Conclusion ArthroCaP will provide preliminary data on the association of CPSP and patient satisfaction with POCD and underlying mechanisms. It will inform larger confirmatory and interventional studies to enhance the benefits of surgery.","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47024783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is chronic pain as an autoimmune disease?","authors":"Gurmit Singh","doi":"10.1080/24740527.2023.2175205","DOIUrl":"https://doi.org/10.1080/24740527.2023.2175205","url":null,"abstract":"ABSTRACT Autoimmune diseases frequently occur in females, and a parallel sexually dimorphic suffering is observed in individuals who suffer chronic pain. Though perception and environment influence the chronicity of pain, this review illustrates examples of specific, evolutionarily preserved, physiological parameters that may be responsible and differentially contribute to chronic pain and affect treatment outcomes in females and males. In females, the immune system may be continuously “primed,” potentially due to the presence of two X chromosomes, each bearing a number of genes involved in immune responsiveness. In the event of nerve injury, declining parity rates could be having repercussions via increased rates of chronic pain or less effectiveness to therapies, which may be associated with a heightened immune cell infiltration into damage-associated sites. Additionally, the female hormone estradiol is both neuroprotective and neurodegenerative, with reproductive cycle– and age-dependent outcomes. There is therefore a need to study neuro-immune-endocrine crosstalk in the context of chronic pain. Autoantibodies have been associated to neural antigens with sensory pathway hyperexcitability in patients, and self-antigens need to be identified by damaged nerves remain to be discovered. Specific T cells release pronociceptive cytokines that directly influence neural firing, and T lymphocytes reactivated by specific antigens may elicit neuroprotective effects by secreting factors that support nerve repair. Modulating immune cells could therefore be a mechanism by which nerve recovery is promoted, with sex-specific outcomes. Investigating neuroimmune homeostasis may inform the selection of specific treatment regimens for females or males and hence may improve chronic pain management by recalibrating the influence of the immune system on the nervous system.","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47412693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presurgical rehabilitation program for patients with symptomatic lumbar spinal stenosis: A pilot randomized controlled trial protocol","authors":"Nora Bakaa, D. Gross, L. Carlesso, J. Macdermid, K. Thomas, Florence Slomp, A. Rushton, M. Miciak, R. Smeets, R. Rampersaud, A. Nataraj, B. Drew, Pahuta Markian, D. Guha, A. Cenic, Luciana G Macedo","doi":"10.1080/24740527.2022.2137009","DOIUrl":"https://doi.org/10.1080/24740527.2022.2137009","url":null,"abstract":"ABSTRACT Background Symptomatic lumbar spinal stenosis (SLSS) is the most common diagnosis associated with spine surgery for those over the age of 55 years. There is a lack of quality research on the effectiveness of prehabilitation on pain, function, and quality of life in patients undergoing surgery for SLSS. This pilot randomized controlled trial (RCT) will evaluate the feasibility of an eHealth prehabilitation program for individuals undergoing SLSS surgery, and an embedded longitudinal qualitative study explores the perioperative patient experience and recovery trajectory. Methods Participants (n = 60) undergoing spine surgery for LSS will be randomized into the 8-week electronic health (eHealth) prehabilitation program or minimal intervention. The prehabilitation program will be delivered virtually using synchronous (one-on-one) and asynchronous (independent) sessions by an experienced clinician, consisting of motivational interviewing, exercise (graded activity), education, peer support groups, and a 6-week booster session. Participants in the minimal care group will receive usual care and will have access to educational videos. Primary outcomes will include (1) recruitment, (2) patient adherence, (3) acceptability of program content, (4) acceptability and compliance with study questionnaires, and (5) attrition. Outcomes will be assessed at baseline, after the intervention, and 3 and 12 months postoperatively. We will conduct semistructured interviews alongside the RCT with 12 to 15 participants. Discussion The proposed project will include the feasibility testing of an eHealth LSS prehabilitation program with potential to improve surgical outcomes. Results of this study will provide the foundation for future fully powered multicenter RCTs. Trial Registration clinicaltrials.gov NCT05073081","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45040425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid reduction and enhanced recovery in orthopaedic surgery (OREOS): A feasibility randomized controlled trial in knee replacement patients.","authors":"Sushmitha Pallapothu,&nbsp;Kim Madden,&nbsp;Anthony Adili,&nbsp;Adrijana Krsmanovic,&nbsp;Matilda Nowakowski,&nbsp;Tara Packham,&nbsp;Sidra Shoaib,&nbsp;Lehana Thabane,&nbsp;Jean-Eric Tarride,&nbsp;Daniel Tushinski,&nbsp;Harsha Shanthanna","doi":"10.1080/24740527.2022.2102465","DOIUrl":"https://doi.org/10.1080/24740527.2022.2102465","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasties are the second most common surgery in Canada. Most patients recover well, but 20% or more still suffer from persistent pain and opioid use. Though opioids are an important part of perioperative pain management, their potential for long-term adverse effects is well recognized. Limiting opioids may be insufficient to overcome the issue of opioid overuse. Pain and opioid use are highly linked, so an effective alternative needs to address both issues.</p><p><strong>Objectives: </strong>The principal objective of this pilot trial is to assess the feasibility. The clinical objectives are to determine the effects of a multicomponent care pathway on opioid-free pain control, persisting pain and opioid use, functional knee outcomes, quality of life, and return to function.</p><p><strong>Methods: </strong>We will include adult patients scheduled for primary elective total knee arthroplasty. Patients in the intervention group will undergo a multicomponent intervention pathway that will be facilitated by an intervention coordinator linking each patient and their surgical/ perioperative team. The interventional pathway will include (1) preoperative education on pain and opioid use, (2) preoperative risk identification and mitigation using cognitive behavioral skills, (3) personalized postdischarge analgesic prescriptions, and (4) continued support for pain control and recovery up to 8 weeks. Patients in the control group will receive the usual care at their institution.</p><p><strong>Discussion: </strong>The overarching goal is to implement and evaluate a coordinated approach to clinical care to improve pain control and reduce harms, with an emphasis on patient-centered care and shared decision making.<b>Trial Registration Number:</b> NCT04968132 (informed consent/ research ethics board statement).</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"6 4","pages":"1-2"},"PeriodicalIF":2.4,"publicationDate":"2022-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33496595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}