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

{"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":"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":"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":"Synthetic cannabinoid for the treatment of severe chronic noncancer pain in children and adolescents.","authors":"Naiyi Sun,&nbsp;Natasha Cunha,&nbsp;Shawnee Amar,&nbsp;Stephen Brown","doi":"10.1080/24740527.2022.2132138","DOIUrl":"https://doi.org/10.1080/24740527.2022.2132138","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of chronic pain in children and adolescents is high. In some patients, it can be severe and refractory to conventional treatment options. There is increasing interest in the use of cannabinoids for therapeutic purposes in children and adolescents. Nabilone, a synthetic cannabinoid, is approved in Canada for the treatment of nausea and vomiting associated with chemotherapy. It can also be used off label for treatment of chronic pain.</p><p><strong>Aims: </strong>This study aims to characterize the use of nabilone for severe chronic pain in a pediatric population.</p><p><strong>Methods: </strong>This is a retrospective cohort study of patients 18 years or younger who were prescribed nabilone for chronic pain in a tertiary multidisciplinary pediatric chronic pain clinic between July 1, 2013, and June 30, 2017.</p><p><strong>Results: </strong>During the 4-year study period, we screened the charts of 507 patients and identified a total of 28 patients (5.5%) who were treated with nabilone as part of their chronic pain treatment. Common indications for nabilone treatment include mixed neuropathic/nociceptive pain, abdominal pain, neuropathic pain, and spasticity. In all patients, nabilone was prescribed as an adjunctive treatment. Seven patients (25%) reported a slight improvement in pain symptoms. Side effects were reported by 21.4% of patients. The most common reported side effects were sedation and cognitive slowing.</p><p><strong>Conclusions: </strong>Adjunctive treatment with nabilone may improve pain symptoms in a subset of pediatric chronic pain patients. Further research investigating the long-term safety and efficacy of nabilone in the treatment of chronic pain in children is needed.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":" ","pages":"225-231"},"PeriodicalIF":2.4,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9707533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40556969","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":"Extension for Community Healthcare Outcomes (ECHO) Chronic Pain & Opioid Stewardship in Northwestern Ontario: A Thematic Analysis of Patient Cases.","authors":"Patricia A Poulin,&nbsp;Yaadwinder Shergill,&nbsp;Adrian Grebowicz,&nbsp;Inês Almeida,&nbsp;Rosemee Cantave,&nbsp;Bryan MacLeod,&nbsp;Tim Larocque,&nbsp;Donna Garstin,&nbsp;Sarah F Fitzgerald,&nbsp;Joshua A Rash","doi":"10.1080/24740527.2022.2126754","DOIUrl":"https://doi.org/10.1080/24740527.2022.2126754","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain (CP) is a debilitating disease that reduces quality of life, decreases productivity, and has become a primary cause of health care resource consumption. Despite this, many Canadian family physicians have received little formal education in managing CP, making it one of the most challenging areas of practice in primary care. Project Extension for Community Healthcare Outcomes Chronic Pain & Opioid Stewardship St. Joseph's Care Group (Project ECHO-SJCG) is an evidence-based educational program connecting community-based health care providers (HCPs) with an interprofessional team by videoconference to learn about management of CP in rural, remote, and underserved areas.</p><p><strong>Aims: </strong>To explore key learning points from cases presented at Project ECHO-SJCG, identify and analyze themes and improve future sessions of continuing professional development for HCPs.</p><p><strong>Methods: </strong>We completed a thematic analysis of forty cases and key learning points using the constant comparison method. We also summarized descriptive statistics for patient and provider characteristics.</p><p><strong>Results: </strong>Forty cases were presented by 31 HCPs, who received suggestions focused on assessment and diagnosis, pharmacological and non-pharmacological pain symptom management, interventional management, attention to biopsychosocial factors, and appropriate referral to other HCPs.</p><p><strong>Conclusion: </strong>Project ECHO-SJCG cases allow HCPs to gain a broad knowledge base to evaluate and manage CP in their practice. Identified themes highlight common gaps in HCPs' knowledge and will guide future sessions.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":" ","pages":"211-224"},"PeriodicalIF":2.4,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9707544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40546579","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 State of Patient Engagement among Pain Research Trainees in Canada: Results of a National Web-Based Survey.","authors":"Kyle Vader,&nbsp;Perri R Tutelman,&nbsp;Delane Linkiewich,&nbsp;Catherine Paré,&nbsp;Alice Wagenaar-Tison,&nbsp;Kathryn A Birnie,&nbsp;Christine T Chambers,&nbsp;Kathleen Eubanks,&nbsp;Nader Ghasemlou,&nbsp;Janet Gunderson,&nbsp;Maria Hudspith,&nbsp;Therese Lane,&nbsp;Jordan Miller,&nbsp;Dawn P Richards","doi":"10.1080/24740527.2022.2115879","DOIUrl":"https://doi.org/10.1080/24740527.2022.2115879","url":null,"abstract":"<p><strong>Background: </strong>Patient engagement (PE) in research refers to partnering with people with lived experience (e.g., patients, caregivers, family) as collaborators in the research process. Although PE is increasingly being recognized as an important aspect of health research, the current state of PE among pain research trainees in Canada is unclear.</p><p><strong>Aims: </strong>The aims of this study were to describe perspectives about and experiences with PE among trainees conducting pain research in Canada, to identify perceived barriers and facilitators, and to describe recommendations to improve its implementation.</p><p><strong>Methods: </strong>A cross-sectional web-based survey (English and French) was administered to trainees at any level conducting pain research at any Canadian academic institution.</p><p><strong>Results: </strong>A total of 128 responses were received; 115 responses were complete and included in the final analysis. The majority of respondents identified as women (90/115; 78.3%), in graduate school (83/115; 72.2%), and conducting clinical pain research (83/115; 72.2%). Most respondents (103/115; 89.6%) indicated that PE is \"very\" or \"extremely\" important. Despite this, only a minority of respondents (23/111; 20.7%) indicated that they \"often\" or \"always\" implement PE within their own research. The most common barrier identified was lack of knowledge regarding the practical implementation of PE, and understanding its positive value was the most commonly reported facilitator. Recommendations for improving the implementation of PE were diverse.</p><p><strong>Conclusions: </strong>Despite viewing PE as important in research, a minority of pain research trainees regularly implement PE. Results highlight perceived barriers and facilitators to PE and provide insight to inform the development of future training and other enabling initiatives.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":" ","pages":"185-194"},"PeriodicalIF":2.4,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9586693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40666304","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":"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}