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

[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.

Hemophilia is a bleeding disorder characterized by recurrent bleeding into muscles and joints. Many people with hemophilia experience multiple traumatic painful bleeding episodes, meaning that pain is often a significant problem for people with hemophilia, with a potentially high prevalence of posttraumatic stress and posttraumatic stress disorder symptoms. Current pain treatments are often ineffective and do not consider pain memories, which are experienced by almost half of people with posttraumatic stress disorder and which has not been explored in people with hemophilia. To fill this gap, 14 semistructured interviews with men with hemophilia were completed between November 2022 and January 2023 to explore their lived experiences of pain relating to their hemophilia. Data were analyzed using reflexive thematic analysis. Three overarching themes were constructed from the data: "trauma histories," "pain management," and "impact on the present." Findings show that pain experienced by people with hemophilia is complex and does include a memory element for many individuals. Pain memories are clear and vivid and include visual, somatic, and emotional elements in intricate detail. Pain can also be experienced in the present when experiencing a pain flashback, and pain in the present can be a trigger to recalling and re-experiencing pain memories from the past. Self-taught active dissociation from pain, imagery, and distraction were described as useful pain management strategies. Findings from this study have implications for clinicians and service providers because current pharmacological and physical pain management techniques may be ineffective when pain memory is involved. Future interventions should consider how pain management is advanced for people with hemophilia and how hemophilia services become trauma informed.

Background: Opioid use disorder (OUD) is a growing public health concern in North America, often coexisting with chronic noncancer pain (CNCP). Managing both conditions presents unique challenges, highlighting the need for evidence to guide decision making.

Aim: The study aimed to conduct a systematic review that summarizes evidence on the efficacy, effectiveness, and safety of opioid analgesics alone or in combination with opioid agonist therapy (OAT) to manage CNCP in people with OUD or with a history of OUD.

Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL and AMED from inception to July 2023 for randomized studies and up to January 2025 for non-randomized studies that explored the efficacy, effectiveness, and safety of opioids for people living with chronic pain and current or prior OUD. We assessed the risk of bias in included studies, evaluated the quality of evidence using the GRADE approach, and provided a narrative summary of treatment effects.

Results: Our search identified 15,988 unique citations, of which six observational studies were deemed eligible to inform safety outcomes for review, while no observational studies or RCTs met the eligibility criteria for efficacy or effectiveness outcomes. The likelihood of suicidality was twice as high in CNCP patients with OUD receiving long-term opioid analgesics compared to those without OUD (absolute risk increase: 127; 95% CI: 36 to 249 more participants with suicidality in 1,000 participants; moderate certainty evidence). Compared to opioid analgesics alone, the risk of fatal opioid-related overdose may decrease in patients with CNCP and OUD who receive both opioid analgesics and OAT (absolute risk reduction: 60; 95%CI: 18 to 94 fewer deaths in 1,000 participants; low certainty evidence).

Conclusions: There is a paucity of evidence to inform practice and policy regarding opioid analgesic prescribing amongst people with OUD. Existing evidence suggests that such prescribing is associated with a higher risk of suicidality, while the use of OAT together with opioid analgesics in this population may be protective against fatal overdose. Further observational and trial research is needed to clarify the benefits and harms of opioid analgesics for CNCP patients with OUD.