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

Background: There is a growing interest in understanding the long-standing tension between subjective experience and objective measurement, with a focus on better understanding personal or lived experience. However, quantitative pain measurement is itself a complicated practice that is rarely examined. The method does not exist in a vacuum but along a historical trajectory that we believe to be worth unpacking.

Aims: We seek to highlight (1) the problematics associated with a systemic reliance on quantitative tools that are themselves validated via statistical methods; (2) what alternatives already exist, regardless of their logistical shortcomings; and (3) the actual and possible consequences of continuing a trajectory of data-based pain rating.

Methods: We present historical and contemporary case studies through theoretical frames that help the reader understand the social construction of pain as a phenomenon whose quantification has been justified with statistical approaches.

Results: Relying on quantitative data for a pain rating that is perceived as more valid, reliable, and efficient-a triad that has come to represent the ideal pain measurement instrument-risks entrenching both patient/participant and clinician/researcher in systems of computation and control. This is detrimental to society's most vulnerable populations.

Conclusions: Patients, practitioners, and social scientists all have an opportunity to reframe their understanding of pain measurement as medical practice to build more equitable spaces in pain medicine.

Background: Chronic pain is progressively receiving attention as a universal public health priority. It is anticipated that there will be an increase in the prevalence of chronic pain in the coming years, particularly among youth. Chronic pain can be stressful and have a significant impact on young people and their family.

Aims: The aim of this systematic review was to synthesize the best available qualitative evidence on the coping experiences of youth living with chronic pain and to note whether there were any differences in their coping experiences.

Methods: A multi-database search was conducted including child development and adolescent studies. CINAHL, MEDLINE, PsycINFO, Embase, and Scopus were searched for eligible English-language articles from inception to December 2023. Out of 1625 article titles and abstracts screened for eligibility, 280 articles underwent full-text screening, with 20 ultimately meeting all inclusion criteria. We conducted a thematic analysis of data extracted from the 20 reviewed articles.

Results: We arrived at two synthesized findings. A Different Way of Being considers the experience of being a youth with chronic pain. Learning to Get By looks at the coping strategies youth use to manage their chronic pain and involved youth using self-directed strategies, as well as relying on external supports.

Conclusions: It is apparent from these synthesized findings that youths' lives have been significantly impacted by chronic pain. Findings from this study can be used to support the care and well-being of youth living with chronic pain.

Background: The Life After Service Study (LASS) suggests that the absolute prevalence of chronic pain among Canadian veterans, defined as pain lasting 3 months or longer, increased by 10% from 2016 to 2019.

Aims: We explored the association of year of survey administration, sociodemographic characteristics, military service, and health-related factors with the prevalence of chronic pain among Canadian veterans.

Methods: We analyzed 2016 and 2019 LASS data and built a multivariable regression model to explore factors associated with chronic pain. Measures of association are reported as adjusted odds ratios (ORs) and absolute risk increases (ARIs).

Results: The 2016 LASS (73% response rate; 3002 of 4121) reported a 41.4% prevalence of chronic pain, and the 2019 LASS (72% response rate; 2630 of 3671) reported a 51.5% prevalence of chronic pain among Canadian veterans. Respondents who completed the 2019 LASS were more likely to endorse an anxiety or related disorder, mood disorder, probable posttraumatic stress disorder, and traumatic brain injury. In our adjusted regression model, year of survey administration was not associated with chronic pain (OR = 1.08, P = 0.8); however, we found large associations with obesity class 1 (body mass index [BMI] = 30.0-34.9; OR = 3.66; 95% confidence interval [CI] 1.46-9.17; ARI 27%), obesity class 2 (BMI = 35.0-39.9; OR = 8.10; 95% CI 1.67-39.3; ARI 47%), mood disorder (OR = 3.20; 95% CI 1.49-6.88; ARI 24%), and an anxiety or related disorder (OR = 4.53; 95% CI 1.28-16.0; ARI 33%).

Conclusions: The increase in chronic pain among Canadian veterans from 2016 to 2019 appears confounded by increased comorbidities associated with chronic pain among responders in 2019.

Background: Health care providers often struggle to treat patients with chronic pain. One potential solution is to facilitate access to programs and tools that develop patients' skills and confidence in managing their own care.

Aims: This study aimed to describe the uptake of the Chronic Pain Self-Management Program (CPSMP) in Eastern Ontario and evaluate the effectiveness of the program in the acquisition of knowledge, confidence, and skills required to manage chronic pain, as measured by the Patient Activation Measure (PAM).

Methods: Using data routinely collected through the CPSMP between December 2017 and May 2023, we conducted a descriptive analysis of the number of participants each year, their gender, and their age distributions. We conducted a longitudinal analysis of the change in PAM score between participants' first (baseline) and last (follow-up) day in the program.

Results: Overall, 1023 individuals enrolled in the CPSMP during the study period, with enrollments peaking in 2018 and remaining stable thereafter. There was a higher proportion of females compared to males (69%, n = 709) and 50- to 59-year-olds compared to other ages. Of the 1023 participants enrolled, 151 completed PAM surveys at baseline and follow-up (15%), of which 69% experienced an increase of at least 4 points on the PAM (104/151).

Conclusion: Most participants were female and aged 50 to 59 years old. Among a sample of participants with available longitudinal data, the CPSMP demonstrated promising effectiveness at equipping participants with the knowledge, skills, and confidence to manage their pain. Replication in a larger representative sample is warranted.

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.