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

{"title":"A Scoping Review of Gaps Identified by Primary Care Providers in Caring for Patients with Chronic Noncancer Pain.","authors":"Virginia McEwen, Mihal Michelle Esterlis, R Gianni Lorello, Abhimanyu Sud, F Marina Englesakis, Anuj Bhatia","doi":"10.1080/24740527.2022.2145940","DOIUrl":"10.1080/24740527.2022.2145940","url":null,"abstract":"<p><strong>Introduction/aim: </strong>Primary care providers (PCPs), who provide the bulk of care for patients with chronic noncancer pain (CNCP), often report knowledge gaps, limited resources, and difficult patient encounters while managing chronic pain. This scoping review seeks to evaluate gaps identified by PCPs in providing care to patients with chronic pain.</p><p><strong>Methods: </strong>The Arksey and O'Malley framework was used for this scoping review. A broad literature search was conducted for relevant articles on gaps in knowledge and skills of PCPs and in their health care environment for managing chronic pain, with multiple search term derivatives for concepts of interest. Articles from the initial search were screened for relevance, yielding 31 studies. Inductive and deductive thematic analysis was adopted.</p><p><strong>Results: </strong>The studies included in this review reflected a variety of study designs, settings, and methods. However, consistent themes emerged with respect to gaps in knowledge and skills for assessment, diagnosis, treatment, and interprofessional roles in chronic pain, as well as broader systemic issues including attitudes toward CNCP. A general lack of confidence in tapering high dose or ineffective opioid regimes, professional isolation, challenges in managing patients with CNCP with complex needs, and limited access to pain specialists were reported by PCPs.</p><p><strong>Discussion/conclusions: </strong>This scoping review revealed common elements across the selected studies that will be useful in guiding creation of targeted supports for PCPs to manage CNCP. This review also yielded insights for pain clinicians at tertiary centers for supporting their PCP colleagues as well as systemic reforms required to support patients with CNCP.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2145940"},"PeriodicalIF":2.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9980640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10848879","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":"\"We survived the pandemic together\": The impact of the COVID-19 pandemic on Canadian families living with chronic pain.","authors":"Tieghan Killackey, Sabine Soltani, Melanie Noel, Kathryn A Birnie, Manon Choinière, M Gabrielle Pagé, Lise Dassieu, Anaïs Lacasse, Chitra Lalloo, Patricia Poulin, Samina Ali, Krista Baerg, Marco Battaglia, Fiona Campbell, Vina Mohabir, Fareha Nishat, Rachel Kelly, Tatiana Lund, Ariane Isaac-Bertrand, Myles Benayon, Isabel Jordan, Jennifer Stinson","doi":"10.1080/24740527.2022.2157251","DOIUrl":"10.1080/24740527.2022.2157251","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric chronic pain is a significant problem in Canada, affecting one in five youth. This study describes the impact of the pandemic on the experiences of Canadian families living with chronic pain through interviews with youth living with chronic pain, parents, and siblings.</p><p><strong>Methods: </strong>Employing a qualitative descriptive design, in-depth semistructured interviews were completed with Canadian youth living with pain, as well as parents and siblings. Participants were not required to be related. Interviews were analyzed using a reflexive thematic analysis approach.</p><p><strong>Results: </strong>Forty-four interviews were completed with 14 parents, 19 youth with chronic pain, and 11 siblings from across the country. Three key themes were developed: (1) absorbing and shifting: the toll of the pandemic on the family system (e.g., loss of coping mechanisms, shifting roles to respond to the pandemic), (2) social ambiguity and abandonment (e.g., social sacrifice and abandonment by the health care system), and (3) building community resilience: familial adaptation to the pandemic (e.g., family cohesion, confidence, and self-management).</p><p><strong>Discussion/conclusions: </strong>Youth, parents, and siblings reported that the pandemic impacted coping strategies across the family system. These results outline the challenges youth experienced managing their pain and overall health throughout the pandemic and the resilience built within families during this time. Going forward, it would be relevant to examine how racialized and structurally marginalized youth with chronic pain and their families experienced the pandemic. Future research should examine how unexpected benefits of the pandemic (e.g., increased confidence and self-management) may be sustained into the future.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 2","pages":"2157251"},"PeriodicalIF":2.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10693281","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":"Preliminary clinical testing to inform development of the Critical Care Pain Observation Tool for Families (CPOT-Fam).","authors":"Anmol Shahid,&nbsp;Bonnie G Sept,&nbsp;Victoria S Owen,&nbsp;Corson Johnstone,&nbsp;Rameiya Paramalingam,&nbsp;Stephana J Moss,&nbsp;Rebecca Brundin-Mather,&nbsp;Karla D Krewulak,&nbsp;Andrea Soo,&nbsp;Jeanna Parsons-Leigh,&nbsp;Céline Gélinas,&nbsp;Kirsten M Fiest,&nbsp;Henry T Stelfox","doi":"10.1080/24740527.2023.2235399","DOIUrl":"https://doi.org/10.1080/24740527.2023.2235399","url":null,"abstract":"<p><strong>Introduction: </strong>Many patients in the intensive care unit (ICU) cannot communicate. For these patients, family caregivers (family members/close friends) could assist in pain assessment. We previously adapted the Critical Care Pain Observation Tool (CPOT) for family caregiver use (CPOT-Fam). In this study, we conducted preliminary clinical evaluation of the CPOT-Fam to inform further tool development.</p><p><strong>Methods: </strong>For preliminary testing, we collected (1) pain assessments of patients in the ICU from family caregivers (CPOT-Fam) and nurses (CPOT) and determined the degree of agreement (kappa coefficient, κ) and (2) collected openended feedback on the CPOT-Fam from family caregivers. For refinement, we used preliminary testing data to refine the CPOT-Fam with a multidisciplinary working group.</p><p><strong>Results: </strong>We assessed agreement between family caregiver and nurse pain scores for 29 patients. Binary agreement (κ) between CPOT-Fam and CPOT item scores (scores ≥2 considered indicative of significant pain) was fair, κ = 0.43 (95% confidence interval [CI] 0.18-0.69). Agreement was highest for the CPOT-Fam items ventilator compliance/vocalization (weighted κ = 0.48, 95% CI 0.15-0.80) and lowest for muscle tension (weighted κ = 0.10, 95% [CI] -0.17 to 0.20). Most participants (<i>n</i> = 19; 69.0%) reported a very positive experience using the CPOT-Fam, describing it as \"good\" and \"easy-to-use/clear/straightforward.\" We iteratively refined the CPOT-Fam over five cycles using the data collected until no further revisions were suggested.</p><p><strong>Conclusion: </strong>Our preliminary clinical testing suggests that family involvement in pain assessment in the ICU is well perceived. The CPOT-Fam has been further refined and is now ready for clinical pilot testing to determine its feasibility and acceptability.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 2","pages":"2235399"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10311100","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":"The Efficacy of Graded Motor Imagery and Its Components on Phantom Limb Pain and Disability: A Systematic Review and Meta-Analysis.","authors":"Katleho Limakatso,&nbsp;Aidan G Cashin,&nbsp;Sam Williams,&nbsp;Jack Devonshire,&nbsp;Romy Parker,&nbsp;James H McAuley","doi":"10.1080/24740527.2023.2188899","DOIUrl":"https://doi.org/10.1080/24740527.2023.2188899","url":null,"abstract":"<p><strong>Introduction: </strong>Graded Motor Imagery (GMI) is a non-invasive and inexpensive therapy used to treat Phantom Limb Pain (PLP) by sequentially activating motor networks in such a way that movement and pain are unpaired. The objective of this systematic review was to critically appraise relevant data on the efficacy of GMI and its components for reducing PLP and disability in amputees.</p><p><strong>Methods: </strong>We searched 11 electronic databases for controlled trials investigating GMI and its components in amputees with PLP from inception until February 2023. Two reviewers independently screened studies and extracted relevant data. Study-level data were entered using the inverse variance function of the Review Manager 5 and pooled with the random effects model.</p><p><strong>Results: </strong>Eleven studies with varying risk of bias were eligible. No eligible study considered left/right judgement tasks in isolation. Studies showed no effect for imagined movements, but positive effects were seen for GMI [weighted mean difference: -21.29 (95%CI: -31.55, -11.02), I²= 0%] and mirror therapy [weighted mean difference: -8.55 (95%CI: -14.74, -2.35, I²= 61%]. A comparison of mirror therapy versus sham showed no difference [weighted mean difference: -4.43 (95%CI: -16.03, 7.16), I²= 51%].</p><p><strong>Conclusion: </strong>Our findings suggest that GMI and mirror therapy may be effective for reducing PLP. However, this conclusion was drawn from a limited body of evidence, and the certainty of the evidence was very low. Therefore, rigorous, high-quality trials are needed to address the gap in the literature and inform practice.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2188899"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10193907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10194074","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":"Chronic Pain: A Case Application of a Novel Framework to Guide Interprofessional Assessment and Intervention in Primary Care.","authors":"Jay Reaume","doi":"10.1080/24740527.2023.2228851","DOIUrl":"https://doi.org/10.1080/24740527.2023.2228851","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a complex condition that poses challenges in assessment and treatment. Primary care teams, especially in rural areas, may have a role in managing this population, providing interprofessional care to optimize patient outcomes. Tools are needed to aid these clinicians in assessing chronic pain.</p><p><strong>Aims: </strong>The aim of this article is to present the case application of a clinical reasoning framework proposed by Walton and Elliott, which is used to identify drivers of chronic pain in a 61-year-old male patient with a remote history of spinal injury. Furthermore, it aims to demonstrate that an interprofessional, individualized intervention strategy can improve patient outcomes.</p><p><strong>Methods: </strong>This case took place in a multidisciplinary primary care team in rural northern Ontario, Canada. An assessment was completed by the author, including collection of the patient's history, a medication review, and the use of multiple validated patient-reported outcome measures (PROMs), all of which were used in applying the framework.</p><p><strong>Results: </strong>Three relevant drivers of his pain experience were identified: central nociplastic, cognitive/belief, and emotional/affective. A pharmacist and social worker then used multimodal interventions to address these drivers, which yielded improvements in scores on multiple validated pain measures but also improved the patient's self-reported quality of life.</p><p><strong>Conclusions: </strong>A clinical reasoning framework can provide a basis for identifying drivers of chronic pain during assessment and guide primary care clinicians to targeted interventions. Broader applications of this framework by primary care providers could serve to increase capacity for managing chronic pain in Canada.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2228851"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/42/UCJP_7_2228851.PMC10376912.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10197693","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":"Continuing professional development needs in pain management for Canadian health care professionals: A cross sectional survey.","authors":"Craig M Dale,&nbsp;Iacopo Cioffi,&nbsp;Christine B Novak,&nbsp;Franklin Gorospe,&nbsp;Laura Murphy,&nbsp;Deepika Chugh,&nbsp;Judy Watt-Watson,&nbsp;Bonnie Stevens","doi":"10.1080/24740527.2022.2150156","DOIUrl":"https://doi.org/10.1080/24740527.2022.2150156","url":null,"abstract":"<p><strong>Background: </strong>Continuing professional development is an important means of improving access to effective patient care. Although pain content has increased significantly in prelicensure programs, little is known about how postlicensure health professionals advance or maintain competence in pain management.</p><p><strong>Aims: </strong>The aim of this study was to investigate Canadian health professionals' continuing professional development needs, activities, and preferred modalities for pain management.</p><p><strong>Methods: </strong>This study employed a cross-sectional self-report web survey.</p><p><strong>Results: </strong>The survey response rate was 57% (230/400). Respondents were primarily nurses (48%), university educated (95%), employed in academic hospital settings (62%), and had ≥11 years postlicensure experience (70%). Most patients (>50%) cared for in an average week presented with pain. Compared to those working in nonacademic settings, clinicians in academic settings reported significantly higher acute pain assessment competence (mean 7.8/10 versus 6.9/10; <i>P</i> < 0.002) and greater access to pain specialist consultants (73% versus 29%; <i>P</i> < 0.0001). Chronic pain assessment competence was not different between groups. Top learning needs included neuropathic pain, musculoskeletal pain, and chronic pain. Recently completed and preferred learning modalities respectively were informal and work-based: reading journal articles (56%, 54%), online independent learning (44%, 53%), and attending hospital rounds (43%, 42%); 17% had not completed any pain learning activities in the past 12 months. Respondents employed in nonacademic settings and nonphysicians were more likely to use pocket cards, mobile apps, and e-mail summaries to improve pain management.</p><p><strong>Conclusions: </strong>Canadian postlicensure health professionals require greater access to and participation in interactive and multimodal methods of continuing professional development to facilitate competency in evidence-based pain management.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2150156"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9872952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9194725","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":"\"You have to believe the patient\": What do people with fibromyalgia find helpful (and hindering) when accessing health care?","authors":"Ria K Nishikawara,&nbsp;Izabela Z Schultz,&nbsp;Lee D Butterfield,&nbsp;John W Murray","doi":"10.1080/24740527.2023.2176745","DOIUrl":"https://doi.org/10.1080/24740527.2023.2176745","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia (FM) is a complex, still poorly understood, and difficult-to-treat chronic pain condition for which many people struggle to find adequate care.</p><p><strong>Aims: </strong>This study investigated the research question, \"What do people accessing health care services for fibromyalgia perceive as helpful, hindering, and absent but desired?\" with the aim of identifying clear, implementable changes for clinical practice.</p><p><strong>Materials and methods: </strong>This study used the enhanced critical incident technique (ECIT), a qualitative research method that focuses on helping, hindering, and desired factors, to explore the health care experiences of 14 individuals (12 women and 2 men) diagnosed with FM.</p><p><strong>Results: </strong>Using qualitative data analysis, results identified three categories of health care experiences: (1) systemic navigation, including financial and economic security; accessibility, flexibility, and continuity of care; and diversity of treatment options; (2) clinician-patient alliance, including invalidation and prejudice; therapeutic bond; and clinician-patient alignment on treatment plan; and (3) patient self-management strategies, including information-seeking and education, self-advocacy, social supports, symptom management strategies, and other coping strategies. Participants tended to conceptualize their health care concerns as a multilayered systemic problem.</p><p><strong>Conclusions: </strong>Participants described a medical system they perceived as poorly equipped to support their needs and tended to invalidate their health concerns. Helping experiences tended to be the result of unique efforts on the part of individual clinicians. Findings emphasize the importance of recognizing the complexities and psychological impact of pain, trusting clinician-patient relationships, multidisciplinary/interdisciplinary care within a biopsychosocial framework, and improved education and awareness around psychosocial aspects of FM and effective management of chronic pain.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 2","pages":"2176745"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9639608","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":"Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery.","authors":"Mandy M J Li,&nbsp;Don Daniel Ocay,&nbsp;Cynthia L Larche,&nbsp;Kelsey Vickers,&nbsp;Neil Saran,&nbsp;Jean A Ouellet,&nbsp;Céline Gélinas,&nbsp;Catherine E Ferland","doi":"10.1080/24740527.2022.2156332","DOIUrl":"https://doi.org/10.1080/24740527.2022.2156332","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain cannot be measured accurately among many children with intellectual and developmental disabilities, resulting in underrecognition or delay in recognition of pain. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool that has been widely validated in critically ill and postoperative adults.</p><p><strong>Aims: </strong>The objective of this study was to validate the CPOT for use with pediatric patients able to self-report and undergoing posterior spinal fusion surgery.</p><p><strong>Methods: </strong>Twenty-four patients (10-18 years old) scheduled to undergo surgery were consented to this repeated-measure, within-subject study. To examine discriminative and criterion validation, CPOT scores and patients' self-reports of pain intensity were collected prospectively by a bedside rater before, during, and after a nonnociceptive and nociceptive procedure on the day following surgery. Patients' behavioral reactions were video recorded at the bedside and retrospectively viewed by two independent video raters to examine interrater and intrarater reliability of CPOT scores.</p><p><strong>Results: </strong>Discriminative validation was supported with higher CPOT scores during the nociceptive procedure than during the nonnociceptive procedure. Criterion validation was supported with a moderate positive correlation between the CPOT scores and the patients' self-reported pain intensity during the nociceptive procedure. A CPOT cutoff score of ≥2 was associated with the maximum sensitivity (61.3%) and specificity (94.1%). Reliability analyses revealed poor to moderate agreement between bedside and video raters and moderate to excellent consistency within video raters.</p><p><strong>Conclusions: </strong>These findings suggest that the CPOT may be a valid tool to detect pain in pediatric patients in the acute postoperative inpatient care unit after posterior spinal fusion.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2156332"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9980602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10848874","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":"Ultrasound-guided repetitive pulsed peripheral magnetic stimulation provides pain relief in refractory glossopharyngeal neuralgia: A case report.","authors":"James S Khan,&nbsp;Duncan Westwood,&nbsp;Massieh Moayedi","doi":"10.1080/24740527.2022.2157250","DOIUrl":"https://doi.org/10.1080/24740527.2022.2157250","url":null,"abstract":"<p><strong>Aims: </strong>Repetitive peripheral magnetic stimulation (rPMS) is a novel nonpharmacological treatment modality. This noninvasive approach can stimulate peripheral nerves to provide analgesia through neuromodulation. We report the first case of ultrasound-guided rPMS to treat a case of severe refractory glossopharyngeal neuralgia.</p><p><strong>Methods: </strong>A 70-year-old female with an 8-year history of glossopharyngeal neuralgia reported refractory pain unresponsive to pharmacological and interventional treatments. After consenting to treatment, the patient received high-frequency rPMS in three different sessions using intermittent theta burst stimulation below motor thresholds. rPMS was applied over the skin directed at the glossopharyngeal nerve identified using ultrasound guidance. Session 1 included 20 min of continuous treatment, session 2 included 40 min of treatment (two 20-min treatments separated by a 10-min break), session 3 included 40 min of treatment (similar to Session 2) repeated daily for 5 days. Pre- and postintervention pain levels were collected with a daily 1-week pain diary and pain questionnaires.</p><p><strong>Results: </strong>Session 1 led to an immediate 30% decrease in pain after treatment. Session 2 led to a 75% decrease in pain immediately after treatment that remained reduced for approximately 2 days. Session 3 produced complete pain relief immediately after treatment and remained lower for 5 days after treatment and returned to baseline levels at 1 week.</p><p><strong>Conclusion: </strong>rPMS provided immense but temporary relief in a severe case of refractory glossopharyngeal neuralgia. Further work is needed to determine the most effective regimen to treat complex pain disorders in the head and neck.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2157250"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9888447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9198009","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":"Views on and experiences with medicinal cannabis among Canadian veterans who live with pain: A qualitative study.","authors":"David P Storey,&nbsp;Natalie R Keeler-Villa,&nbsp;Nick Harris,&nbsp;Jennifer Anthonypillai,&nbsp;Gregory K Tippin,&nbsp;Vikas Parihar,&nbsp;Joshua A Rash","doi":"10.1080/24740527.2023.2232838","DOIUrl":"https://doi.org/10.1080/24740527.2023.2232838","url":null,"abstract":"<p><strong>Background: </strong>During fiscal year 2021-2022, Veterans Affairs Canada (VAC) reimbursed 18,388 veterans for medicinal cannabis at a cost of $153 million. Yet, it is not known whether the reimbursement program is producing a net benefit for veterans.</p><p><strong>Aims: </strong>This study investigated the views and experiences Canadian that veterans who live with pain have about medicinal cannabis use, including its use for the management of chronic pain, poor sleep, and emotional distress.</p><p><strong>Methods: </strong>Twelve Canadian veterans who live with pain-eight men, four women; split across four focus groups-were recruited to participate in a semistructured discussion around their experiences with medicinal cannabis use.</p><p><strong>Results: </strong>Using inductive thematic analysis, seven broad categories were identified: (1) cannabis use behaviors, (2) reasons for cannabis use, (3) outcomes from cannabis use, (4) facilitators of cannabis use, (5) barriers to cannabis use, (6) stigma around cannabis use, and (7) questions and concerns about cannabis use.</p><p><strong>Conclusions: </strong>Most veterans initiated cannabis use to manage the symptoms of preexisting medical and/or mental health conditions. Despite some negative side effects, most veterans reported improvements in their overall quality of life, sleep, relationships, mood, and pain. Concern remains around the discrepancy between veterans' qualitative reports of beneficial outcomes from medicinal cannabis use and equivocal findings around the benefit-to-harm ratio in the wider literature. Currently, the VAC reimbursement program remains challenged by unclear indication for which veterans, with what condition(s), at what dose, and in what form medical cannabis is most beneficial.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"7 1","pages":"2232838"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244515","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}