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

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.

Purpose: The efficacy of Acceptance and Commitment Therapy (ACT) for chronic pain when provided as weekly sessions, is well documented. In scarcely populated areas, the traveling distance may be a barrier to weekly attendance. This study aimed to test the efficacy of a group-based ACT intervention, clustered into three bouts of three consecutive days, separated by 4 weeks.

Patients and methods: A total of 122 patients, recruited from a university hospital pain clinic, were randomized to either a clustered ACT or Treatment As Usual (TAU) provided by the primary health care services. The study had a semi-crossover design. Group effects of ACT versus TAU were assessed 3 months after the start of ACT by using linear mixed models for repeated measures. Outcome measures included pain intensity, health-related quality of life, pain acceptance, catastrophizing, and psychological distress.

Results: A total of 81 patients completed the ACT intervention. No statistically significant effects were observed on the primary outcome variables, pain intensity and health-related quality of life.

Significant group differences in favor of ACT were detected in pain acceptance (modified Cohen`s d = 0.32), including pain willingness (modified Cohen`s d = 0.30) and activity engagement (modified Cohen`s d = 0.23). The treatment effect remained at the 6- and 12-month follow-ups with a trend toward improvement.

Conclusion: A group-based ACT for chronic pain clustered into 3-day bouts may strengthen pain acceptance processes, including pain willingness and activity engagement. Reasons why the intervention did not affect pain intensity and health-related quality of life are discussed.

[This corrects the article DOI: 10.1080/24740527.2024.2425596.].

Introduction: Percutaneous auricular neuromodulation involves implanting electrodes around the ear and administering an electric current. A device is currently available that is cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. This randomized, controlled pilot study aimed to (1) assess the feasibility of a postoperative auricular neuromodulation protocol and (2) provide an estimate of its treatment effects on postoperative pain and opioid consumption.

Methods: Adults undergoing unilateral or bilateral ambulatory breast surgery with anticipated moderate-severe pain and a single-injection paravertebral nerve block(s) received an auricular neuromodulation device (NSS-2 Bridge, Masimo) following surgery. Participants were randomized to 5 days of electrical stimulation or sham in a double-masked fashion.

Results: In the first 5 days, the median pain for those receiving active stimulation (n = 15) was 0 (interquartile range [IQR] = 0, 0.5] versus 1.5 (IQR = 0, 3.8) for the sham group (n = 15, P = 0.084). Concurrently, the median oxycodone use for active stimulation was 0 mg (IQR = 0, 2.5) compared to 0 mg (IQR = 0, 3) for the sham group (P = 0.905). Various secondary outcomes reached statistical significance, including maximum and average daily pain scores.

Conclusions: This pilot study demonstrates that percutaneous auricular neuromodulation is a feasible approach for managing pain in ambulatory surgical procedures and shows potential as an effective analgesic following discharge. Considering its ease of application, absence of systemic side effects, and lack of significant complications, conducting a definitive clinical trial seems justified because the current study was underpowered, which possibly resulted in the lack of statistical significance for the primary outcome.Registry: Clinicaltrials.gov NCT05521516.