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

{"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}

{"title":"Clinical Innovation Poster Abstracts","authors":"D. Anghelescu, Heidi Meeks, Michael J Frett, Latika Puri, N. Alberts, M. Bordeleau, J. Vollert, M. Backonja, Serge Marchand","doi":"10.1080/24740527.2022.2088026","DOIUrl":"https://doi.org/10.1080/24740527.2022.2088026","url":null,"abstract":"St. Jude Children’s Research Hospital, Pediatric Medicine, Memphis, Tennessee, United States; St. Jude Children’s Research Hospital, Pediatric Medicine, Memphis, Tennessee, United States; St. Jude Children’s Research Hospital, Pediatric Medicine, Memphis, Tennessee, United States; Loma Linda University, Pediatrics, Loma Linda, California, USA; Concordia University, Psychology, Montreal, Quebec, Canada","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"6 1","pages":"A45 - A59"},"PeriodicalIF":2.4,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46486177","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":"Research Poster Abstracts","authors":"","doi":"10.1080/24740527.2022.2088027","DOIUrl":"https://doi.org/10.1080/24740527.2022.2088027","url":null,"abstract":"","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"6 1","pages":"A60 - A180"},"PeriodicalIF":2.4,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41526137","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":"Symposia Abstracts","authors":"Nader Ghasemlou, Bradley Kerr, Vivianne Tawfik","doi":"10.1080/24740527.2022.2088025","DOIUrl":"https://doi.org/10.1080/24740527.2022.2088025","url":null,"abstract":"Symposium Abstract: Females are disproportionately affected by chronic pain compared to males, with a higher prevalence of pain conditions including arthritis, migraine and fibromyalgia, among others. Seminal work from various laboratories has shown that differing inflammatory responses underlie some of the sexual dimorphism observed in the regulation of pain. While it is now clear that interactions between the nervous and immune systems are critical mediators of both acute and chronic pain responses, the underlying molecular and cellular mechanisms controlling these differences remain poorly understood. We will present evidence from our respective laboratories showing how sexually dimorphic responses in neuroimmunity help control pain using models of multiple sclerosis (Dr. Bradley Kerr), complex regional pain syndrome (Dr. Vivianne Tawfik), and in the baseline control of nociception (Dr. Nader Ghasemlou). Abstract Activated myeloid-lineage cells, macrophages peripherally and microglia centrally, contribute to the acute-to-chronic pain transition, however, the details on the timing and possible sex-specificity of such involvement remains a matter of debate. For example, there is evidence that CNS microglia may contribute to chronic pain only in males. In this talk I will discuss data from my laboratory using complementary pharma-cologic and transgenic approaches in mice to more specifically manipulate myeloid-lineage cells using a model of the pain condition, complex regional pain syndrome. I will discuss a novel spatiotemporal transgenic mouse line, Cx3CR1-Cre ERT2 -eYFP;TLR4 fl/fl (TLR4 cKO) that we used to specifically knock out toll-like receptor 4 (TLR4), only in microglia and no other myeloid-lineage cells. Using this transgenic mouse, we find that early TLR4 cKO results in profound improvement in chronic, but not acute, allodynia in males, with a significant but less robust effect in females. In contrast, late TLR4 cKO results in partial improvement in allodynia in both sexes, suggesting that downstream cellular or molecular TLR4-independent events may have already been triggered. I will further discuss new data using a transgenic mouse that allows for microglia-specific depletion, Cx3CR1-Cre ERT2 -eYFP;iDTR lox-STOP-lox (microglia cKO). We performed microglial depletion at multiple time points after peripheral injury and see the most striking decrease in mechanical allodynia in males and females when depletion is performed several weeks after injury. Overall, Symposium Abstract: Observing the pain of brings about a cascade of biological and psychological in the self For caregivers and loved ones of individuals in pain, the ability to adaptively manage these reactions is closely related to the ability to provide appropriate pain assessment and pain management behaviours. This three-part symposium examines the psychological, physiological, and neural responses of individuals observing their loved ones as they undergo a range of painful exp","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"6 1","pages":"A4 - A44"},"PeriodicalIF":2.4,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60130137","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":"Plenary Abstracts","authors":"","doi":"10.1080/24740527.2022.2088024","DOIUrl":"https://doi.org/10.1080/24740527.2022.2088024","url":null,"abstract":"This presentation will focus upon our understanding of how pain is processed in the developing spinal cord and brain. The neurobiological, mechanistic approach provides (i) pre-dictive and testable theories of early life pain from age-appropriate animal models using new technologies and (ii) a scientific framework for better measurement & treatment of pain in infants and children. Pain is learned in infancy – and so discoveries in this area are relevant to us all.","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"6 1","pages":"A1 - A3"},"PeriodicalIF":2.4,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60130128","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":"The development of a stakeholder-endorsed national strategic plan for advancing pain education across Canadian physiotherapy programs.","authors":"Timothy H Wideman, Geoffrey Bostick, Jordan Miller, Aliki Thomas, André Bussières, David Walton, Yannick Tousignant-Laflamme, Lisa Carlesso, Judith Hunter, Kadija Perreault, Barbara Shay","doi":"10.1080/24740527.2022.2056006","DOIUrl":"10.1080/24740527.2022.2056006","url":null,"abstract":"<p><strong>Background: </strong>The Canadian Pain Task Force recently advanced an action plan calling for improved entry-level health professional pain education. However, there is little research to inform the collaboration and coordination across stakeholders that is needed for its implementation.</p><p><strong>Aims: </strong>This article reports on the development of a stakeholder-generated strategic plan to improve pain education across all Canadian physiotherapy (PT) programs.</p><p><strong>Methods: </strong>Participants included representatives from the following stakeholder groups: people living with pain (<i>n</i> = 1), PT students and recent graduates (<i>n</i> = 2), educators and directors from every Canadian PT program (<i>n</i> = 24), and leaders of Canada's national PT professional association (<i>n</i> = 2). Strategic priorities were developed through three steps: (1) stakeholder-generated data were collected and analyzed, (2) a draft strategic plan was developed and refined, and (3) stakeholder endorsement of the final plan was assessed. The project was primarily implemented online between 2016 and 2018.</p><p><strong>Results: </strong>The plan was developed through five iterative versions. Stakeholders unanimously endorsed a plan that included five priorities focusing on uptake of best evidence across (1) national PT governance groups and (2) within individual PT programs; (3) partnering with people living with pain in pain education; (4) advocacy for the PT role in pain management; and (5) advancing pain education research.</p><p><strong>Conclusion: </strong>This plan is expected to help Canadian stakeholders work toward national improvements in PT pain education and to serve as a useful template for informing collaboration on entry-level pain education within other professions and across different geographic regions.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"6 1","pages":"21-32"},"PeriodicalIF":2.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ec/ad/UCJP_6_2056006.PMC9176229.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10380948","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}