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

Background: Regular viewing of dim green light has been shown to reduce the pain associated with migraine, fibromyalgia, and post-surgery.

Aim: The present study examined whether visual exposure to ambient green light could also alleviate osteoarthritis (OA) pain.

Methods: Nineteen patients diagnosed with moderate to severe knee OA pain were exposed to dim white light (6.57 ± 1.00 lux) for 1-2 hours per day for 10 weeks. Following a 2-week wash-out period, patients then received green light treatment (wavelength = 525 nm, 6.82 ± 0.78 lux) for 1-2 hours per day for a further 10 weeks. The primary outcome measure was changes in arthritis disability score as measured by the Western Ontario and McMaster University Arthritis Index (WOMAC) questionnaire. Secondary outcomes included patient-reported changes in pain intensity, pain disability, and patient global satisfaction.

Results: With green light therapy (GLT), average WOMAC scores decreased from 44.1 ± 17.5 at baseline to 32.5 ± 16.2 whereas white light therapy (WLT) had no significant effect on arthritis disability scores (39.6 ± 15.3). While both WLT and GLT reduced pain intensity, the analgesic effect of green light was significantly greater. Pain interference scores were lower following GLT whereas WLT had no effect on this parameter. The Patient's Global Impression of Change was significantly improved over baseline with both WLT and GLT.

Conclusion: Daily exposure to ambient green light had a beneficial effect on OA knee pain. The neural pathways between the visual system and central pain modulation regions requires further investigation.

Background: With the increasing use of medical cannabis (MC), there is growing evidence suggesting that MC may be an effective therapeutic for chronic sleep, pain, and anxiety conditions. However, further evaluation is warranted to evaluate the heterogeneous patient outcomes of authorized cannabis treatment.

Aims: To assess the effectiveness of authorized cannabis on pain, sleep duration, anxiety, and depression in patients presenting to clinics over a 6-month time period.

Methods: This long-term prospective observational multicenter study utilized data from adult Canadian patients in the Medical Cannabis Real-World Evidence study. With physician guidance, patients were able to choose from Health Canada-verified MC products via a national pharmacy platform. Validated questionnaires were administered at Weeks 0, 6, 12, and 24 to assess pain interference (PROMIS, 6-30), pain score (NPRS, 0-10), sleep duration, anxiety (GAD-7, 0-21), depression (PHQ-9, 0-27), and quality of life (EQ-5D-3 L, 0-10). Outcomes were analyzed using descriptive statistics and generalized estimating equations models as both a per-protocol and intention-to-treat basis.

Results: Improvements in pain, anxiety, depression, and QoL were observed from Baseline to Week 24. Decreases were observed in PROMIS Pain Interference - 4.6 (CI - 6.02 to - 3.17, n = 137), Numeric Pain Rating Scale - 1.19 (CI - 1.7 to -0.68, n = 137), General Anxiety Disorder-7 - 2.24 (CI - 3.5 to - 0.99, n = 139), Patient Health Questionnaire-9 depression -2.79 (CI - 4.29 to -1.3, n = 141), and EQ-5D-3 L - 0.56 (CI -0.96 to -0.16, n = 139).

Conclusions: At Week 24, outcomes in chronic pain, anxiety, depression, and quality of life improved. Although 85% of patients in our study had an MC indication for pain, no outcomes met their minimal clinically significant thresholds at Week 24. These observations align with existing evidence, yet there remains some discrepancies in the current literature. Our findings highlight the need for future studies to characterize MC administration, dose, and specific product relationships.

Missing value imputation is a routine step in biomedical data analysis, yet techniques are often not tailored to specific datasets. We propose a systematic framework for selecting imputation methods customized for the unique characteristics of cross-sectional numerical data, with a focus on pain-related biomedical research. This approach generates artificial "diagnostic" missing values by randomly removing entries, allowing for direct assessment of reconstruction accuracy across various algorithms. We introduce two novel classes of diagnostic reference methods: pseudo or "poisoned" imputation methods, which intentionally introduce bias into the imputation, and "calibrating" imputations, which inject controlled random noise for objective evaluation. The framework was tested on synthetic datasets and four biomedical datasets, primarily focusing on pain-related data, employing 29 different imputation methods. Quantitative outputs, including root median square deviation (RMSD), median difference (MD), relative bias, and method categorization, facilitate a comprehensive assessment of imputation quality. The framework consistently identifies the most suitable imputation technique for each dataset, revealing that multivariate methods generally outperform univariate approaches. Benchmarking against poisoned and calibrated references establishes quantifiable thresholds for acceptable imputation errors, while also identifying instances where reliable imputations are unattainable. This systematic framework offers practical and reproducible guidelines for imputing missing values in biomedical contexts, particularly in pain research. By empowering researchers to make informed decisions about imputation, the framework enhances data integrity and the robustness of subsequent analyses. Its model-agnostic nature allows for the integration of various imputation methods, with an automated implementation available in the open-source R package "opImputation."

[This corrects the article DOI: 10.1080/24740527.2025.2486835.].

The incidence of liver disease is projected to increase significantly by 2030, affecting 1.5 billion of the global population and approximately 3 million in Canada. With various etiologies, the progression of liver disease to cirrhosis varies from months, years, or decades. Experiencing pain can severely debilitate a person living with this condition. However, there is limited qualitative evidence to understand the subjective pain experience of individuals with cirrhosis. Understanding this experience with cirrhosis is crucial for providing comprehensive, person-centered care. The aim of this study was to qualitatively explore the multidimensional experience of pain for persons with cirrhosis. A qualitative descriptive approach was used, recruiting participants from a hepatology clinic in Toronto in 2021. Participants completed a Brief Pain Inventory Short Form questionnaire and a semistructured interview. Data analysis was guided by Hsieh and Shannon's stepwise directed content analysis. Fifteen interviews were conducted with adults (mean age: 54 years, 53% men, 47% women) with cirrhosis, most unable to work, with approximately half married/partnered. Participants reported diverse physical symptoms including visceral and musculoskeletal pain, often described as a constant experience. Psychologically, pain contributed to significant fatigue and emotional distress, affecting self-care and daily activities. Socioculturally, pain disrupted social interactions and financial stability, intensifying reliance on support systems. Participants reported limited effectiveness of pharmacological interventions, reliance on mindfulness and rest, and frustration with unmet pain management needs. These interrelated themes collectively impaired quality of life and independence. Exploring the multidimensionality of pain for persons with cirrhosis provides valuable insights to address the gaps in current pain management strategies.

Background: The Pain Education in Physiotherapy (PEP) competency profile provides a structured framework for integrating pain management competencies into Canadian physiotherapy (PT) curricula. Despite widespread endorsement, the integration of pain management competencies into PT curricula remains inconsistent. Identifying the barriers and enablers to implementation is essential for developing strategies that support students in achieving these competencies.

Objective: This study explored factors influencing the implementation of the PEP competency profile in Canadian PT programs and identified key challenges and opportunities for improving integration.

Methods: A qualitative description study was conducted using five focus groups with 23 participants, including pain educators and program directors from 13 entry-level PT programs in Canada. Data were analyzed using the Consolidated Framework for Implementation Research to identify multilevel barriers and facilitators.

Results: Participants recognized the value of the PEP competency profile in enhancing pain education but highlighted three key challenges: (1) a lack of structured guidance for teaching and assessment, (2) an overreliance on faculty champions rather than systemic institutional support, and (3) the absence of rigorous assessment approaches. Participants expressed uncertainty about integrating competencies within existing curricula, emphasizing the need for national collaboration, faculty development, and shared resources. The iterative, decentralized nature of curriculum change further complicated efforts to achieve consistent integration.

Conclusion: Sustainable implementation of the PEP competencies requires structured guidance, institutional commitment, and adapted assessment strategies. Addressing these barriers through national-level collaboration, accreditation alignment, and faculty support is critical to ensure that PT graduates develop the necessary competencies for high-quality pain management.

Patients with chronic pain that cannot be explained by tissue abnormality may be accused of symptom amplification and at worst malingering. This is particularly relevant in the medicolegal setting where legal decisions are highly dependent on objective and validated information, conditions mostly lacking in the setting of chronic pain. When evaluations are conducted by assessors less familiar with current knowledge of pain mechanisms, subjective complaints of pain and associated symptoms such as fatigue and cognitive difficulties, are at risk of being misinterpreted leading to bias and stigmatization. In this commentary we will highlight some of the pitfalls that erroneously lead to a biased assessment of pain severity including failure to pay attention to psychological state and sociocultural influences, application of poorly reliable physical maneuvers, and use of neurocognitive testing of intentional cognitive dysfunction as a surrogate for dishonesty in pain and functional impairment report. Concerns about misinterpretation of exaggeration in persons with chronic pain are highlighted by recent report of symptom exaggeration in up to two thirds of those attending for an independent medical evaluation. Directives to help the medical assessor to provide pertinent information that will assist the courts in reaching a fair decision are discussed, with emphasis on need for a comprehensive assessment of biosocial factors, contextual variables and nonphysical evidence.

Background: Understanding the experiences of parents of adolescents with chronic pain is crucial in creating a better experience for all involved throughout the adolescent's chronic pain journey. However, limited qualitative research has explored the experiences of parents of adolescents with chronic pain.

Aims: This qualitative study explored the lived experiences of parents of adolescents with chronic pain, with a focus on the impact of chronic pain on their child and family life. Methods: We conducted 12 semi-structured interviews with parents of adolescents with chronic pain receiving care through a pain management program. Data were transcribed and analyzed using inductive thematic analysis.

Results: Seven key themes were generated and divided into two groups: (1) adolescent and (2) family (including both parents and siblings). Groups were determined based on whether the theme referred to the effect of chronic pain on the adolescent or the caregiver or family. The adolescent group included four themes: (1) physical, (2) psychological, (3) social interaction, and (4) school functioning. The family group included three themes: (1) disruption to daily life, (2) emotional, and (3) relationship dynamics.

Conclusions: This study provides a deeper understanding of the negative effect chronic pain can have on adolescents and family life. Our findings call for interventions to mitigate the physical, psychological, and social impact of chronic pain on adolescents. Family level interventions are also needed to support families of adolescents with chronic pain. More research is needed to explore adolescents' own views of their experiences with chronic pain.

Canada's advancements in pain research, characterized by innovative education, clinical care, and trainee-led scholarship, offer valuable insights for the Global South. This article examines key initiatives highlighted in a recent Canadian Journal of Pain special issue, including multidisciplinary approaches, patient-centered care, and the development of accessible pain assessment tools. By contextualizing these innovations within the Philippine healthcare landscape, the article explores challenges such as limited access, cultural perceptions of pain, and under-resourced pain management systems. Emphasizing the importance of narrative-driven and culturally sensitive methodologies, it advocates for integrating indigenous knowledge and community participation into pain research and care. Furthermore, the article underscores the critical role of nurturing early-career researchers and fostering cross-sector collaboration to build sustainable pain research ecosystems. Ultimately, this reflection invites Global South countries to adapt and co-create pain science innovations, contributing to a more inclusive and globally connected understanding of pain management. The article serves as a call to reimagine pain research that bridges local realities with global expertise, fostering equitable health outcomes across diverse populations.