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

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.

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.