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

Background: Exploring regional variation in opioid use for pain among long-term care (LTC) residents may help identify modifiable factors associated with suboptimal prescribing practices.

Aims: We aimed to compare recent trends in prevalent opioid use and higher risk prescribing among LTC residents in Ontario and Alberta, and to examine variation in opioid trends across resident subgroups within each province.

Methods: Utilizing comparable linked clinical and health administrative databases for LTC residents (aged >65) in each province, we examined trends in monthly use of any opioid, specific drug types and formulations, high daily doses (≥90 Morphine Equivalents), and concurrent use with a benzodiazepine or gabapentinoid. Prevalence ratios comparing change in opioid measures, overall and across resident subgroups, from the first (March 2015) to last study (March 2022) months were estimated using age-sex adjusted log-binomial regression models.

Results: Opioid prevalence (any, select types, long-acting formulations, high daily doses) was consistently higher among Ontario residents whereas concurrent use with a benzodiazepine or gabapentinoid was higher among Alberta residents. Overall use remained stable in Ontario but increased by 23% in Alberta LTC. In both provinces, there were significant decreases in higher risk opioid prescribing over time, including concurrent use with benzodiazepines, but also significant increases in the concurrent use with gabapentinoids and tramadol use (Alberta only).

Conclusions: Although both provinces showed trends toward more appropriate opioid use in LTC, the factors driving observed provincial differences in opioid prescribing and the rise in concurrent opioid and gabapentinoid use among residents, warrant further investigation.

Introduction: Chronic pain is a global challenge resulting in substantial healthcare costs. Despite its prevalence, gaps in pain management education persist across health professions education programs. Developing an assessment to evaluate student competency in pain management is essential to identify and address the potential impact of these disparities on learning outcomes. This study describes the development and initial evaluation of the Pain Education in Physiotherapy (PEP) competency assessment, aimed at assessing student level of competency in pain management across entrylevel physiotherapy (PT) programs.

Methods: The assessment was developed using the DeVellis process, incorporating integrated knowledge translation principles and ongoing partner engagement. A steering group guided the creation of case-based multiple choice questions (MCQs) and simulation-based stations to assess competencies for pain management at different levels of Miller's Pyramid. Initial evidence supporting the validity argument was gathered from PT students in their final semester of education (n = 146 for MCQs; n = 53 for simulations).

Results: Twenty-eight MCQ items and three simulation-based stations were selected. The MCQ component showed moderate internal consistency (α = 0.65), and the simulation-based assessments demonstrated moderate internal consistency (α = 0.63) with good interrater reliability (ICC_2,1 range: 0.73-0.86).

Discussion: The PEP assessment incorporates case-based MCQs and simulation-based assessment stations to address critical interpersonal skills such as communication and empathy, often overlooked in traditional written assessments. This approach fills gaps in pain management education and provides a more comprehensive assessment tailored to PT needs.

Conclusion: This assessment represents an important advancement in the assessment of pain management competencies. Its rigorous development process, partner engagement, and promising initial evaluation underscore its potential to identify gaps in pain education and help improve outcomes related to PT education.

Introduction: We evaluated gendered risks and the associations between demographics, anxiety, and depressive symptoms, military sexual trauma (MST), and severe pain in Canadian military personnel and veterans.

Methods: A cross-sectional sample of 328 veterans and military members with chronic pain completed confidential surveys, including demographics, disability, pain location, and intensity, as well as a Patient Health Questionnaire (PHQ-4). We evaluated gendered exposures (rates, odds ratios), associations between MST and severe pain (logistic regression), and associations with pain severity and PHQ-4 (linear regression), adjusting for age, race, and education.

Results: We found high levels of chronic pain and disability for women and men (6.8 or 6.9/10), PHQ-4 scores (6.6 or 6.2/12), and SANE scores (11% or 10%). Women reported higher exposure to MST (e.g. 69% for sexual harassment, 76% for emotional abuse) than men (8% and 13%). Odds of severe pain were not gendered (OR = 1.05). Physical abuse (β = 1.09, p = .030) and gender discrimination (β = 1.10, p = .033) were associated with higher PHQ-4 scores. Sexual harassment was not independently associated (OR = 1.57, p = .354) with chronic pain, but was associated with increased anxiety and depressive symptoms (β = 1.06, p = .016). Higher PHQ-4 scores were significantly associated with higher pain scores (β = 0.18, p < .001).

Conclusions: MST exposures are much more common among women, but the associations of MST with severe pain and PHQ-4 scores are similar across genders. Differences in operational trauma and occupational trauma may influence occupational stress injuries and chronic pain.

Background: Understanding pain disparities is critical for fostering health equity and guiding effective health policies. However, little is known about racial/ethnic disparities in pain among adults in Canada.

Aims: We provide a comprehensive analysis of racial/ethnic disparities in pain among Canadian adults, focusing on two dimensions of pain - frequent pain and interfering pain.

Methods: We use two-wave cross-sectional data collected in 2020 and 2022 from a representative sample of 4,637 adults aged 18 and older residing in Canada. We calculate the prevalence of pain among White, Black, East/Southeast Asian, South Asian, Indigenous, Multiracial, and "Other" groups and estimate relative differences adjusted for key covariates in a multivariable framework.

Results: The data reveal large and statistically significant pain disparities; specific patterns, however, vary across the two pain outcomes and by gender. Indigenous Canadians have relatively high prevalence of both frequent pain (38.4%) and interfering pain (27.8%), while East/Southeast Asian Canadians have the lowest prevalence of both (8.2% and 14.4%, respectively). Black Canadians have a relatively low prevalence of frequent pain (16.9%) but a very high prevalence of interfering pain (27.8%). Covariates are associated with pain levels but less so with the racial/ethnic patterns in pain.

Conclusions: Our analysis highlights substantial racial/ethnic disparities in pain prevalence among Canadian adults. Further research is essential to better understand the root causes of the observed disparities and ultimately improve the lives of Canadians living with pain.

Background: Health care provider (HCP) implicit bias can impact health outcomes for youth with sickle cell disease (SCD).

Aims: : The aim of this study was to evaluate the feasibility, acceptability, and preliminary impact of an individuation and perspective-taking (IPT) intervention to decrease implicit bias and improve pain treatment clinical decision making in pediatric SCD HCPs.

Methods: This mixed methods pilot randomly assigned HCPs (N = 36) to an intervention (n = 17) or control condition (n = 19). Implicit and explicit bias measures were administered pretreatment and 3 months postintervention. Differences were analyzed using repeated measures analyses of variance. HCP ratings of virtual patient vignettes depicting Black and White youth with SCD or cancer pain were used to assess differential clinical decision making based on race and diagnosis and analyzed using hierarchical linear mixed model analysis. Focus groups with intervention participants were analyzed using thematic analysis.

Results: No significant differences in scores on bias measures across time, condition, or the Condition × Time interaction were found (all P < 0.05). Significant differences in HCP ratings were found between types of HCPs (P < 0.001), but no effects were attributable to condition, time, virtual patient race, or diagnosis. Ten themes were extracted regarding the intervention's format, structure, and content.

Conclusions: This study is the first to evaluate an IPT intervention in pediatric SCD HCPs. HCPs deemed the intervention feasible, acceptable, and impactful and suggested areas for improvement. Future research should refine the intervention to incorporate greater patient involvement and skills practice to improve health outcomes for this underserved population.

Background: One in five Canadians experiences chronic pain, at a cost of $40.3 billion in 2019. Despite this significant burden, there are few effective treatments for pain. This gap has been recognized by Health Canada, which has put forth the Action Plan for Pain in Canada. Advancing our understanding of pain mechanisms and clinical trials to identify novel therapeutics are essential to address this treatment gap. However, it remains unknown whether the recommendations of the Action Plan have increased research investments.

Methods: We investigate research investments in pain by the Canadian Institutes of Health Research (CIHR) based on publicly available data. We performed a systematic database search focused on operating funds from competitions between 2008 and 2023 and tabulated pain funding as a proportion of total CIHR operational funds granted each year. Next, we examined the proportion of pain funding across CIHR institutes aggregated across funding years.

Results: We identified 20,126 operational grants, of which 459 were pain focused. The highest level of pain funding was 3.32% in 2019, and the average (SD) was 2.13% (0.70%). Funding was stagnant from 2008 to 2023 (R ² = 0.10, P = 0.23). The Institute of Musculoskeletal Health and Arthritis allocated the largest proportion of funding to pain research (11.40%). Eight of the 13 institutes allocated less than 1% of their operating funds to pain research.

Interpretation: In sum, CIHR pain research funding does not match the socioeconomic burden posed by pain. We propose three action items to improve pain research funding and to ultimately relieve the burden of pain in Canada.

Background: Individuals who experience social marginalization, such as transgender and gender-diverse (TGD) youth, have increased risk for poor health outcomes, including chronic pain. A better understanding of the impact of chronic pain in these populations would improve treatment and aid in reducing health care disparities. Our retrospective review of clinical data examined psychosocial correlates of pain in TGD and cisgender youth with chronic pain.

Aims: The study aim was to explore differences in psychosocial variables between TGD and cisgender youth with chronic pain. In alignment with the minority stress model, we hypothesized worse pain and pain-related disability, poorer quality of life, and more internalizing symptoms in TGD patients. The secondary aim was to explore associations among psychosocial variables in TGD and cisgender youth.

Methods: Data were collected from 140 youth (48 TGD, 92 cisgender) evaluated in pediatric pain clinics. Independent samples t-tests examined group differences in pain intensity, functional disability, quality of life, pain catastrophizing, and internalizing symptoms. Bivariate correlations were conducted for each group, and differences in the strength of correlations were evaluated using Fisher r-to-z. Institutional review board (IRB) approval was obtained for all study procedures at each participating institution prior to extraction of retrospective clinical data (Indiana 240 University IRB Protocol No. 12506, The Ohio State University College of Medicine IRB Protocol No. 16-00937). Informed consent was not required or obtained due to the retrospective nature of the study.

Results: Cisgender patients reported worse pain intensity, whereas TGD patients reported lower quality of life and more internalizing symptoms. In the combined sample, pain intensity was correlated with worse functional disability, poorer quality of life, and more catastrophic thinking. No group differences in the strength of correlations were found.

Conclusions: Results suggest that for TGD youth with chronic pain, internalizing symptoms and quality of life are important targets for treatment and improvement.

Background: Indigenous Peoples in Canada experience health disparities, including higher rates of chronic pain. Many report distrust of the health system due to factors such as racial discrimination. A lack of appreciation and respect for Indigenous knowledges further contributes to feelings of alienation. In 2022-2023, we offered the first Project Extension for Community Healthcare Outcomes (Project ECHO) Indigenous Chronic Pain and Substance Use Health (ICP&SU) to health care providers interested in improving chronic pain care with and for Indigenous Peoples in Canada. The program reflects a Two-Eyed Seeing approach weaving together Indigenous and Western approaches to chronic pain and substance use health care.

Aims: We describe the development and implementation of Project ECHO ICP&SU.

Methods: Following guidance from the project Elder, we use storytelling, centered around the metaphor of weaving, to discuss the conception and implementation of Project ECHO ICP&SU. We also describe our engagement in sharing circles and ceremonies to share stories, knowledges, and lessons learned.

Results: With strong Anishinaabe leadership, the program was implemented as intended and reached 121 health care professionals. Lessons learned included an overt recognition of the influence of different structures and institutions on programs and for a culturally safer development and evaluation frameworks for future Project ECHOs to improve care with and for Indigenous Peoples.

Conclusions: Project ECHO can be a vehicle to enact Truth and Reconciliation Calls to Action through weaving relationships and knowledges to create culturally safer institutions and practices to improve chronic pain, substance use health, and wellness, with and for Indigenous Peoples.