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

Background: Chronic musculoskeletal (MSK) pain disproportionately affects Indigenous Peoples, and rural/remote communities face significant barriers in accessing care. La Loche, a Dene/Métis community in northern Saskatchewan, has limited access to specialized chronic pain management services and specialized health providers.

Aims: The aim of this needs assessment was to gain insight into the community's priorities, strengths, and concerns regarding chronic MSK pain management. Community engagement and relationship building were essential to ensure that cultural protocols were respected and community worldviews were accurately represented.

Methods: A community-directed needs assessment was conducted in collaboration with local health care providers and community members. To ensure appropriate representation of community-led priorities, reflexive thematic analysis was utilized and rooted within interpretive description and informed by community-based participatory research and Two-Eyed Seeing. Open discussions were conducted in person, over the phone, or via Zoom in a semistructured format. Thirteen individuals were interviewed (eight community members, five health care professionals).

Results: Interviews conducted with community members and health care providers were analyzed separately. Both yielded the same four major overarching themes: (1) impact of pain on daily living, (2) barriers limiting access to care and the understanding of pain between health care provider and patient, (3) systemic oppression and negative experiences with health care, and (4) strength-based solutions.

Conclusions: Five recommendations were developed to promote culturally safe and patient-centered environments for chronic MSK pain communication and future care delivery: (1) person-centered and community-directed care, (2) clinic model and staffing requirements, (3) practitioner education and awareness, (4) community education and awareness, and (5) community resources.

Background: Negative perceptions of psilocybin and challenges of participant enrollment may represent barriers to conducting a randomized controlled trial examining psilocybin for chronic neuropathic pain.

Aim: Prior to trial initiation, we aimed to examine patient attitudes toward the trial via a prospective preference assessment.

Methods: Twenty-six patients with chronic neuropathic pain participated in a prospective preference assessment comprising quantitative (survey) and qualitative (interview) components. Content analysis was used to inductively and deductively identify factors that would motivate or discourage participation in the proposed trial. Demographics, clinical characteristics, and perceptions of psilocybin were collected to explore differences in characteristics between patients who were willing and unwilling to participate.

Results: Survey results showed that most participants (76.9%) were willing to participate in the PEACE-PAIN trial. "Willing" participants reported higher prior psychedelic use (75%) as compared to the "maybe willing" (0%) and "not willing" participants (0%). Interviews indicated that the top two factors that motivated participation included the need for new treatment options (31.7%) and benefits to personal pain management (31.7%). The top two discouraging factors included practical difficulties of research participation (16.7%), and adverse events associated with psilocybin (16.7%).

Conclusions: The PEACE-PAIN trial study design is supported by patient survey responses but may benefit from modifications, namely incorporating thorough discussions of the current evidence for efficacy, safety, tolerability, and approaches to address adverse effects of psilocybin. Additionally, the interest in participation by individuals with prior psychedelic use holds important methodological implications for the inclusion/exclusion criteria of the trial.

Introduction: Because patients with chronic pain are complex, with significant medical and psychiatric comorbidities, referrals to specialty pain clinics are often necessary. The present study explores the quality of information submitted and the profile of referring physicians associated with rejected patient referrals by a community pain clinic.

Methods: A retrospective cross-sectional study was conducted on a series of consecutive new patient referrals rejected by a noninterventional community pain clinic (November 2021-June 2022). Data were collected on the reasons for rejected referrals and physicians responsible for these referrals using the public database of the College of Physicians and Surgeons of Ontario.

Results: During the study period, 120 new referrals made by 99 physicians (88% primary care providers, or PCPs; male : female ratio 1:1.2; 53% Canadian university graduates) were rejected because of inadequate information (62%) or because they were inappropriate (38%). Only 46% of the rejected referrals were resubmitted within a median of 7 days (range 0-96 days) and accepted. Half of the non-resubmitted referrals could have been accepted if the referring provider had sent in the missing information.

Conclusion: A significant number of referrals to our pain clinic (primarily from PCPs) are rejected for mainly avoidable reasons. The process of rejected referrals and resubmissions requires 92 to 126 h of additional staff time/year. Without additional health care resources, our study highlights simple but effective improvements in the referral process that could facilitate patient care, avoid unnecessary delays, and decrease possible sources of patient complaints.

Background: Loneliness, the perception that one's social relationships do not meet the desire for social connection, is a risk factor for poor mental and physical health. Adolescents with chronic pain experience higher rates of peer loneliness which persists over time. Previous studies used a single loneliness measure, limiting our understanding of the nature of their loneliness. This study describes the types of peer loneliness (intimate, relational, and collective) experienced by these adolescents and the impact that peer loneliness has on pain-related outcomes.

Methods: A cross-sectional online survey was completed by 128 Canadian adolescents aged 12-18 years who experienced pain for at least 3 months. Validated measures captured demographics, pain-related characteristics, types of peer-related loneliness, measures of social well-being, and mental and physical health outcomes.

Results: Friedman's tests of z-scores indicate that participants equally experienced dyadic, relational, and collective peer loneliness. MANCOVA revealed that those who identify as Black were lonelier after controlling for socioeconomic status. Multiple regression showed that loneliness was a robust predicter of worse scores on social well-being and mental health outcomes with males and females equally impacted by loneliness. Despite moderate correlations between loneliness and pain interference and pain intensity, loneliness did not predict school absences, suggesting that loneliness' influence on physical pain outcomes may be temporally earlier (e.g. contribute to pain chronification).

Conclusions: Peer loneliness among adolescents with chronic pain negatively impacts their social well-being and mental health outcomes. Interventions addressing loneliness to target all three types of peer loneliness may be key to improving pain-related outcomes.

Background: Over the past two decades, the prevalence of chronic pain has significantly increased globally, with approximately 20% of the world's population living with pain. Although quantitative measures are useful in identifying pain prevalence and severity, qualitative methods, and especially arts-based ones, are now receiving attention as a valuable means to understand lived experiences of pain. Photovoice is one such method that utilizes individuals' own photography to document their lived experiences.

Aims: The current study utilized an arts-based method to explore immigrant Indian women's chronic pain experiences in Canada and aimed to enhance the understanding of those experiences by creating a visual opportunity for them to share their stories.

Methods: Twelve immigrant Indian women captured photographs and participated in one-on-one interviews exploring daily experiences of chronic pain.

Results: Women's photographs, and description of these photographs, provided a visual entry into their lives and pain experiences. Three themes emerged from our analysis: (1) bodies in pain, (2) traversing spaces including immigration, and (3) pain management methods. Findings revealed that women's representations of pain were shaped by a clash between culturally shaped gender role expectations and changing gender norms due to immigration processes. The use of photovoice visually contextualized and represented pain experiences, proving to be a valuable tool for self-reflection.

Conclusions: This research uncovers the multifaceted nature of chronic pain and identifies the influence of immigration, gender, and social relations on the exacerbation of pain in immigrant Indian women.

Background: Until recently, treatments for chronic pain commonly relied on in-person interventions, and despite more hybrid care options today, capacity for delivery remains challenged. Digital programs focusing on the psychosocial aspects of pain may provide low-barrier alternatives.

Aims: Through a randomized controlled trial, we investigated the effectiveness of a multimodal mobile application.

Methods: Participants (n = 198; 82% women, mean age = 46.7 [13.1] years; mean pain duration 13.6 [11.2] years) with nonmalignant chronic pain were randomized to either a 6-week intervention (n = 98) or a wait-listed usual care group (n = 100). The intervention involved regular engagement with a user-guided mobile application (Curable Inc.) informed by the biopsychosocial model of pain that included pain education, meditation, cognitive behavioral therapy, and expressive writing. The co-primary outcomes were pain severity and interference at 6 weeks.

Results: We observed significant improvements in the intervention group compared to the control group with estimated changes of -0.67 (95% confidence interval [CI] -1.04 to -0.29, P < .001, d = 0.43) and -0.60 (95% CI -1.18 to -0.03, P = .04, d = 0.27) for pain severity and interference, respectively. There were significant improvements across secondary outcomes (Patient-Reported Outcome Measurement Information System pain interference; pain catastrophizing; anxiety, depression; stress). Frequency of app use was correlated with improved pain interference (P < .001) and pain catastrophizing (P = 0.018), and changes from baseline persisted in the intervention group at 12 weeks (P < .05).

Conclusions: A short-term mobile app intervention resulted in significant improvements across physical and mental health outcomes compared to wait-listed usual care.

Background: Living with chronic pain as a young adult (YA) can impact the physical, emotional, social, cognitive, and role function domains of life. Once YAs receive care for their specialist chronic pain care they are expected to self-navigate a complex health care system to transition to community-based care (i.e. primary care). Inadequate discharge planning may increase the unique difficulties YAs face in self-management, which may lead to adverse health outcomes, suboptimal discharge, and a need to reaccess care.

Aims: The purpose of this qualitative study is to explore how YAs with chronic pain define a successful discharge transition from a health service delivery model of specialized chronic pain services setting to self-management in a community setting (i.e. primary care) and contextual factors that promote discharge success.

Methods: This qualitative study included young adults with chronic pain. Data were obtained through semistructured interviews, which were transcribed verbatim and analyzed using inductive content analysis.

Results: Ten participants identified that successful discharge includes the following considerations: (1) acknowledging the tension between moving forward and looking back, (2) a collaborative discharge process, and (3) the need for ongoing, relevant resources and support.

Conclusion: This study provides a deeper understanding of how YAs with chronic pain characterize success in the discharge transition from specialized chronic pain services to community self-management. Our findings highlight the importance of provider-patient collaboration during the discharge planning process to develop a patient-centered self-management plan that incorporates community resources tailored to the needs of the individual to promote an optimal discharge.

[This retracts the article DOI: 10.1080/24740527.2022.2088027.].