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

{"title":"COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals.","authors":"Tieghan Killackey,&nbsp;Melanie Noel,&nbsp;Kathryn A Birnie,&nbsp;Manon Choinière,&nbsp;M Gabrielle Pagé,&nbsp;Lise Dassieu,&nbsp;Anaïs Lacasse,&nbsp;Chitra Lalloo,&nbsp;Sarah Brennenstuhl,&nbsp;Patricia Poulin,&nbsp;Pablo Ingelmo,&nbsp;Samina Ali,&nbsp;Marco Battaglia,&nbsp;Fiona Campbell,&nbsp;Andrew Smith,&nbsp;Lauren Harris,&nbsp;Vina Mohabir,&nbsp;Myles Benayon,&nbsp;Isabel Jordan,&nbsp;Justina Marianayagam,&nbsp;Jennifer Stinson","doi":"10.1080/24740527.2021.1931069","DOIUrl":"https://doi.org/10.1080/24740527.2021.1931069","url":null,"abstract":"<p><p><b>Background</b>: The COVID-19 pandemic presents one of the greatest threats to pediatric pain care seen in generations. Due to public health restrictions, many pediatric pain clinics halted in-person appointments, delaying and disrupting access to care. There is no existing research on the impacts of COVID-19 on pediatric chronic pain care in Canada or the challenges experienced by health care professionals and pain clinics. <b>Aims</b>: The aim of this study was to evaluate the impact of COVID-19 on Canadian pediatric chronic pain care by documenting how health care professionals provided care during the first six months of the pandemic. <b>Methods</b>: Two Canadian online cross-sectional surveys were conducted: one among Canadian pediatric pain clinic directors (Study 1) and another among multidisciplinary pediatric pain health care professionals (Study 2). <b>Results</b>: Responses from 13/13 Canadian pediatric pain clinics/rehabilitation programs indicated that all clinics provided virtual care during the pandemic. No significant changes were reported on the frequency of appointment requests. Most clinics reported no perceived change in patient pain levels (<i>n</i> = 9/13, 69%) or occurrence of pain flares (<i>n</i> = 10/13, 77%). Results from 151 individual health care professionals indicated that the majority (90%) of non-emergency department respondents were providing virtual care. The main challenges of virtual care included technological barriers, financial concerns, infrastructure and logistics, privacy, and clinical challenges. <b>Conclusions</b>: This study documented the impact of the COVID-19 pandemic on pediatric chronic pain care in Canada and highlighted the rapid shift to using virtual solutions. Simultaneously, respondents outlined current challenges and potential solutions to consider in the development of virtual care guidelines and policy in Canada.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"139-150"},"PeriodicalIF":2.4,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1931069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39185228","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 Retrospective Cohort Study of Healthcare Utilization Associated with Paravertebral Blocks for Chronic Pain Management in Ontario.","authors":"George Deng,&nbsp;Michael Gofeld,&nbsp;Jennifer N Reid,&nbsp;Blayne Welk,&nbsp;Anne Mr Agur,&nbsp;Eldon Loh","doi":"10.1080/24740527.2021.1929883","DOIUrl":"https://doi.org/10.1080/24740527.2021.1929883","url":null,"abstract":"<p><p><b>Background</b>: Injections, particularly paravertebral blocks (PVBs), are frequently performed procedures in Ontario, Canada, for the management of chronic pain, despite limited evidence and risk of complications. <b>Aim:</b> This study examines usage patterns of PVBs to evaluate their effects on healthcare utilization and opioid prescribing. <b>Methods:</b> A retrospective cohort study in Ontario using administrative data. Ontario residents receiving their initial PVBs between July 1, 2013 and March 31, 2018 were included. Changes in use of other interventions, physician visits, and opioids were compared to the 12-month periods before and after index PVBs. Data use was authorized under section 45 of Ontario's Personal Health Information Protection Act. <b>Results:</b> 47,723 patients received their initial PVBs in the study period. The rate of index PVBs increased from 1.61 per 10,000 population (2013) to 2.26 per 10,000 (2018). Initial PVBs were performed most commonly by family physicians (<i>N</i> = 25,042), followed by anesthesiologists (<i>N</i> = 14,195). 23,386 patients (49%) received 1 to 9 repeat PVBs in the 12 months after index PVB; 12,474 patients (26.15%) received 10 or more. Use of other nonimage guided interventional pain procedures per patient (mean±SD) increased from 2.19 ± 9.35 to 31.68 ± 52.26 in the year before and after index PVB. Relevant physician visits per patient (mean±SD) also increased from 2.92 ± 3.61 to 9.64 ± 11.77. Mean opioid dosing did not change significantly between the year before and the year after index PVB. <b>Conclusion:</b> PVBs are associated with increases in healthcare utilization and no change in opioid use patterns.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"130-138"},"PeriodicalIF":2.4,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1929883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39185227","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":"Attending work with chronic pain is associated with higher levels of psychosocial stress.","authors":"Greig Adams,&nbsp;Tim V Salomons","doi":"10.1080/24740527.2021.1889925","DOIUrl":"https://doi.org/10.1080/24740527.2021.1889925","url":null,"abstract":"<p><p><b>Background and Aims</b>: Much is known about the impact of pain in terms of medical costs and missed work. Less is known about its associations when individuals are present for work. This study examines \"presenteeism\" by analyzing the psychosocial costs of pain in the workplace, using the 2015 European Working Conditions Survey (EWCS). <b>Methods</b>: We conducted cross-sectional analysis of 2384 individuals with chronic pain and 2263 individuals without pain (matched by age and sex) using data from the 2015 EWCS. We compared groups in terms of the following psychosocial factors: supervisor support, job responsibility, team cohesion, discrimination, threats/abuse, job competency, job reward, sexual harassment, stress, and job security. The groups were also compared in terms of days lost due to illness. <b>Results</b>: People with pain were 64% less likely to view their job as rewarding (odds ratio [OR] = 0.61; 95% confidence interval [CI], 0.57-0.65), 47% more likely to be subjected to threats/abuse in the workplace (OR = 0.68; 95% CI, 0.63-0.73), 30% more likely to report poor supervisor support (OR = 0.77; 95% CI, 0.73-0.82), and 28% more likely to perceive discrimination in the workplace (OR = 0.78; 95% CI, 0.71-0.85). People with pain missed approximately nine more days of work per year than respondents without pain. <b>Conclusions</b>: Chronic pain was associated with lower vocational fulfillment and feelings of being ostracized in the workplace. These findings suggest that the presence of pain in the workplace goes well beyond lost productivity due to absenteeism.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"107-116"},"PeriodicalIF":2.4,"publicationDate":"2021-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1889925","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39041197","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":"Exploring physiotherapy practice within hospital-based interprofessional chronic pain clinics in Ontario.","authors":"Linnea Thacker,&nbsp;Robert M Walsh,&nbsp;Gabriella Shinyoung Song,&nbsp;Hammad A Khan,&nbsp;Prem Parmar,&nbsp;Kaitlin T Vance,&nbsp;Gillian Grant,&nbsp;Giulia Mesaroli,&nbsp;Judith Hunter,&nbsp;Kyle Vader","doi":"10.1080/24740527.2021.1905508","DOIUrl":"https://doi.org/10.1080/24740527.2021.1905508","url":null,"abstract":"<p><p><b>Background</b>: Chronic pain affects one in five persons and is a leading contributor to years lived with disability and high health care costs. In 2016, the government of Ontario increased public funding for pediatric and adult hospital-based interprofessional chronic pain clinics (HICPCs) in Ontario, Canada, expanding the role of physiotherapy in chronic pain management in the province. This role has yet to be described in the literature. <b>Aim</b>: The aim of this study was to explore physiotherapy practice within HICPCs in Ontario. <b>Methods</b>: We conducted an interpretive description qualitative study based on semistructured interviews with physiotherapists employed in pediatric and adult HICPCs in Ontario. Interviews were audio recorded, transcribed verbatim, and reviewed for accuracy. We analyzed interview data using thematic analysis. <b>Results</b>: Ten physiotherapists who practiced in pediatric and adult HICPCs (<i>n</i> = 4 pediatric; <i>n</i> = 6 adult) in Ontario were interviewed between February and April 2020. We constructed five themes related to physiotherapy practice in this setting. Themes included (1) contributing a functional lens to care; (2) empowering through pain education; (3) facilitating participation in physical activity and exercise; (4) supporting engagement in self-management strategies; and (5) implementing a collaborative approach to whole-person care. <b>Conclusions</b>: Our results illuminate how physiotherapy practice within HICPCs in Ontario focuses on providing a collaborative and whole-person approach to care, with an emphasis on supporting patients to increase their functional capacity by promoting engagement in active chronic pain management strategies.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"96-106"},"PeriodicalIF":2.4,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1905508","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39041196","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":"Plenary Abstracts","authors":"","doi":"10.1080/24740527.2021.1914206","DOIUrl":"https://doi.org/10.1080/24740527.2021.1914206","url":null,"abstract":"We have an increasingly robust armoury as to how to stratify neuropathic pain patients according to symptoms, sensory testing and more advanced techniques such as neurophysiology, genetics and functional imaging. These are now being applied at scale both in large collaborative research consortia and in some cases within national health services. In parallel to these technological advances harmonised data collection and storage is enabling advanced multi-modal data analysis and correlation with long term health outcomes. The application of these techniques is helping us to: identify conditions which were not previously understood to have a neuropathic component, identify those individuals at highest risk of neuropathic pain and stratify patients living with neuropathic pain in a clinically meaningful way. I will discuss how these approaches are enhancing our understanding of neuropathic pain with the ultimate goal of not only developing novel treatment strategies but also better targeting of existing treatments to those most likely to respond.","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"A1 - A2"},"PeriodicalIF":2.4,"publicationDate":"2021-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1914206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43992021","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":"K. Birnie, Nader, Ghasemloub, J. Bradley, Kerrc, Linda, Wilhelmd","doi":"10.1080/24740527.2021.1914213","DOIUrl":"https://doi.org/10.1080/24740527.2021.1914213","url":null,"abstract":"","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"A3 - A33"},"PeriodicalIF":2.4,"publicationDate":"2021-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1914213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60129738","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":"Clinical Innovation Poster Abstracts","authors":"Krista, Baergd","doi":"10.1080/24740527.2021.1914216","DOIUrl":"https://doi.org/10.1080/24740527.2021.1914216","url":null,"abstract":"University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan, Canada; University of Saskatchewan, Department of Pediatrics, Saskatoon, Saskatchewan, Canada; University of Saskatchewan, College of Medicine, Clinical Research Support Unit (CRSU), Saskatoon, Saskatchewan, Canada; University of Saskatchewan, Department of Pediatrics, Saskatoon, Saskatchewan, Saskatchewan Health Authority— Saskatoon, Saskatchewan, Canada","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"A34 - A47"},"PeriodicalIF":2.4,"publicationDate":"2021-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1914216","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43731710","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":"Cluster analysis of Canadian Armed Forces veterans living with chronic pain: Life After Service Studies 2016.","authors":"Julian Reyes Velez,&nbsp;James M Thompson,&nbsp;Jill Sweet,&nbsp;Jason W Busse,&nbsp;Linda VanTil","doi":"10.1080/24740527.2021.1898278","DOIUrl":"https://doi.org/10.1080/24740527.2021.1898278","url":null,"abstract":"<p><p><b>Objective</b>: This study explored the heterogeneity of Canadian Armed Forces veterans living with chronic pain to inform service needs planning and research using cluster analysis. <b>Design</b>: We used a national cross-sectional Statistics Canada population survey. <b>Participants</b>: Participants included 2754 Canadian Armed Forces (CAF) Regular Force veterans released from service between 1998 and 2015 and surveyed in 2016. <b>Methods</b>: We used cluster analysis of veterans with chronic pain based on pain severity, mental health, and activity limitation characteristics. We compared clusters for sociodemographic, health, and service utilization characteristics. <b>Results</b>: Of 2754 veterans, 1126 (41%) reported chronic pain. Veterans in cluster I (47%) rarely had severe pain (2%) or severe mental health problems (8%), and none had severe activity limitations. Veterans in cluster II (26%) more often than veterans in cluster I but less often than veterans in cluster III endorsed severe pain (27%) and severe mental health problems (22%) and were most likely to report severe activity limitation (91%). Veterans in cluster III (27%) were most likely to report severe pain (36%) and severe mental health problems (96%), and a majority reported severe activity limitations (72%). There was evidence of considerable heterogeneity among individuals in terms of socioeconomic characteristics, pain characteristics, mental and physical health status, activity limitations, social integration, and service utilization indicators. <b>Conclusions</b>: About half of Canadian veterans living with chronic pain infrequently endorse severe pain or serious mental health issues without severe activity limitations. The other half had more complex characteristics. The heterogeneity of CAF veterans with chronic pain emphasizes the need for support systems that can address variability of needs.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"81-95"},"PeriodicalIF":2.4,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1898278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39041195","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":"\"They think you're trying to get the drug\": Qualitative investigation of chronic pain patients' health care experiences during the opioid overdose epidemic in Canada.","authors":"Lise Dassieu,&nbsp;Angela Heino,&nbsp;Élise Develay,&nbsp;Jean-Luc Kaboré,&nbsp;M Gabrielle Pagé,&nbsp;Gregg Moor,&nbsp;Maria Hudspith,&nbsp;Manon Choinière","doi":"10.1080/24740527.2021.1881886","DOIUrl":"10.1080/24740527.2021.1881886","url":null,"abstract":"<p><p><b>Background</b>: The opioid overdose epidemic has led health care providers to increased vigilance for opioid-related risks in the treatment of chronic non-cancer pain (CNCP). Media have conveyed stigmatizing representations of opioid analgesics. <b>Aims:</b> This study aimed to understand how the opioid overdose epidemic has impacted health care experiences among people living with CNCP in two Canadian provinces (British Columbia, Quebec). <b>Methods:</b> This qualitative study proceeded through 22 semi-structured interviews conducted in 2019. Participants were recruited from a cross-sectional survey examining the effects of the opioid overdose epidemic on individuals with CNCP. We collected in-depth narratives that we analyzed using a thematic framework. The sample included 12 women and 10 men aged 20 to 70 years, with 11 from each province. <b>Results:</b> Several participants described increased difficulty in accessing medical services for pain since the onset of the opioid overdose epidemic. They reported that some physicians urged them to taper opioids regardless of their pain severity and functional limitations. Some participants reported facing discrimination and care denials as they were labeled \"drug-seeking,\" especially in hospital. Depending on their educational resources, they were unequally able to counter providers' stigmatizing behaviors. However, participants described empathetic relationships with providers with whom they had a long-term relationship. Some participants drew distinctions between themselves and the stigmatized status of \"addict\" in ways that reinforced stigma toward people who are dependent on opioids. <b>Conclusions:</b> Health policies and provider education programs aimed at reducing opioid-related stigma are needed to counter detrimental consequences of the opioid overdose epidemic for people living with CNCP.</p>","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"66-80"},"PeriodicalIF":2.4,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2021.1881886","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39041194","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":"Transcutaneous electrical nerve stimulation (TENS): towards the development of a clinic-friendly method for the evaluation of excitatory and inhibitory pain mechanisms.","authors":"Monica Sean,&nbsp;Alexia Coulombe-Lévêque,&nbsp;Matthieu Vincenot,&nbsp;Marylie Martel,&nbsp;Louis Gendron,&nbsp;Serge Marchand,&nbsp;Guillaume Léonard","doi":"10.1080/24740527.2020.1862624","DOIUrl":"https://doi.org/10.1080/24740527.2020.1862624","url":null,"abstract":"ABSTRACT Background: Temporal summation and conditioned pain modulation (CPM) can be measured using a thermode and cold pressor test (CPTest). Unfortunately, these complex and expensive tools are ill-suited for routine clinical assessments. Aims: We aimed to compare the temporal summation and CPM obtained with the thermode + CPTest paradigm to those obtained with a novel paradigm using transcutaneous electrical nerve stimulation (TENS). Methods: We assessed temporal summation and CPM in 29 healthy participants, using two paradigms (random order): TENS, and thermode + CPTest. In the TENS paradigm, both the conditioning stimulus (CS) and the test stimulus (TS) were delivered using TENS; in the thermode + CPTest paradigm, the CS consisted of a CPTest and the TS was delivered using a thermode. We compared the average temporal summation and CPM evoked by the two paradigms. Results: Average temporal summation was similar for both modalities (P = 0.90), and the number of participants showing temporal summation was similar in both paradigms (19 with thermode vs. 18 with TENS; P = 1.00). Average CPM response was larger following the thermode + CPTest than following the TENS (P = 0.005), and more participants showed CPM with the thermode + CPTest paradigm compared to the TENS paradigm (24 vs. 14; P = 0.01). Conclusions: Both paradigms were roughly equivalent in the ability to evoke temporal summation (although response to one modality did not predict response to the other), but the TENS paradigm appeared to be less apt to induce a CPM response than the thermode + CPTest paradigm.","PeriodicalId":53214,"journal":{"name":"Canadian Journal of Pain-Revue Canadienne de la Douleur","volume":"5 1","pages":"56-65"},"PeriodicalIF":2.4,"publicationDate":"2021-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24740527.2020.1862624","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39041193","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}