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

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.

Background: There is a growing interest in understanding the long-standing tension between subjective experience and objective measurement, with a focus on better understanding personal or lived experience. However, quantitative pain measurement is itself a complicated practice that is rarely examined. The method does not exist in a vacuum but along a historical trajectory that we believe to be worth unpacking.

Aims: We seek to highlight (1) the problematics associated with a systemic reliance on quantitative tools that are themselves validated via statistical methods; (2) what alternatives already exist, regardless of their logistical shortcomings; and (3) the actual and possible consequences of continuing a trajectory of data-based pain rating.

Methods: We present historical and contemporary case studies through theoretical frames that help the reader understand the social construction of pain as a phenomenon whose quantification has been justified with statistical approaches.

Results: Relying on quantitative data for a pain rating that is perceived as more valid, reliable, and efficient-a triad that has come to represent the ideal pain measurement instrument-risks entrenching both patient/participant and clinician/researcher in systems of computation and control. This is detrimental to society's most vulnerable populations.

Conclusions: Patients, practitioners, and social scientists all have an opportunity to reframe their understanding of pain measurement as medical practice to build more equitable spaces in pain medicine.

Background: Chronic pain is progressively receiving attention as a universal public health priority. It is anticipated that there will be an increase in the prevalence of chronic pain in the coming years, particularly among youth. Chronic pain can be stressful and have a significant impact on young people and their family.

Aims: The aim of this systematic review was to synthesize the best available qualitative evidence on the coping experiences of youth living with chronic pain and to note whether there were any differences in their coping experiences.

Methods: A multi-database search was conducted including child development and adolescent studies. CINAHL, MEDLINE, PsycINFO, Embase, and Scopus were searched for eligible English-language articles from inception to December 2023. Out of 1625 article titles and abstracts screened for eligibility, 280 articles underwent full-text screening, with 20 ultimately meeting all inclusion criteria. We conducted a thematic analysis of data extracted from the 20 reviewed articles.

Results: We arrived at two synthesized findings. A Different Way of Being considers the experience of being a youth with chronic pain. Learning to Get By looks at the coping strategies youth use to manage their chronic pain and involved youth using self-directed strategies, as well as relying on external supports.

Conclusions: It is apparent from these synthesized findings that youths' lives have been significantly impacted by chronic pain. Findings from this study can be used to support the care and well-being of youth living with chronic pain.

Background: The Life After Service Study (LASS) suggests that the absolute prevalence of chronic pain among Canadian veterans, defined as pain lasting 3 months or longer, increased by 10% from 2016 to 2019.

Aims: We explored the association of year of survey administration, sociodemographic characteristics, military service, and health-related factors with the prevalence of chronic pain among Canadian veterans.

Methods: We analyzed 2016 and 2019 LASS data and built a multivariable regression model to explore factors associated with chronic pain. Measures of association are reported as adjusted odds ratios (ORs) and absolute risk increases (ARIs).

Results: The 2016 LASS (73% response rate; 3002 of 4121) reported a 41.4% prevalence of chronic pain, and the 2019 LASS (72% response rate; 2630 of 3671) reported a 51.5% prevalence of chronic pain among Canadian veterans. Respondents who completed the 2019 LASS were more likely to endorse an anxiety or related disorder, mood disorder, probable posttraumatic stress disorder, and traumatic brain injury. In our adjusted regression model, year of survey administration was not associated with chronic pain (OR = 1.08, P = 0.8); however, we found large associations with obesity class 1 (body mass index [BMI] = 30.0-34.9; OR = 3.66; 95% confidence interval [CI] 1.46-9.17; ARI 27%), obesity class 2 (BMI = 35.0-39.9; OR = 8.10; 95% CI 1.67-39.3; ARI 47%), mood disorder (OR = 3.20; 95% CI 1.49-6.88; ARI 24%), and an anxiety or related disorder (OR = 4.53; 95% CI 1.28-16.0; ARI 33%).

Conclusions: The increase in chronic pain among Canadian veterans from 2016 to 2019 appears confounded by increased comorbidities associated with chronic pain among responders in 2019.

Background: Health care providers often struggle to treat patients with chronic pain. One potential solution is to facilitate access to programs and tools that develop patients' skills and confidence in managing their own care.

Aims: This study aimed to describe the uptake of the Chronic Pain Self-Management Program (CPSMP) in Eastern Ontario and evaluate the effectiveness of the program in the acquisition of knowledge, confidence, and skills required to manage chronic pain, as measured by the Patient Activation Measure (PAM).

Methods: Using data routinely collected through the CPSMP between December 2017 and May 2023, we conducted a descriptive analysis of the number of participants each year, their gender, and their age distributions. We conducted a longitudinal analysis of the change in PAM score between participants' first (baseline) and last (follow-up) day in the program.

Results: Overall, 1023 individuals enrolled in the CPSMP during the study period, with enrollments peaking in 2018 and remaining stable thereafter. There was a higher proportion of females compared to males (69%, n = 709) and 50- to 59-year-olds compared to other ages. Of the 1023 participants enrolled, 151 completed PAM surveys at baseline and follow-up (15%), of which 69% experienced an increase of at least 4 points on the PAM (104/151).

Conclusion: Most participants were female and aged 50 to 59 years old. Among a sample of participants with available longitudinal data, the CPSMP demonstrated promising effectiveness at equipping participants with the knowledge, skills, and confidence to manage their pain. Replication in a larger representative sample is warranted.

Background: Pain is an individual and subjective experience that places a burden on individuals to convince others they have pain. Brain imaging technologies can potentially inform pain management but raise neuroethical questions.

Aims: We examined the degree of endorsement and concerns of adults in Canada with chronic pain regarding the use of brain imaging to detect and treat chronic pain in six areas: new brain imaging technologies, brain data privacy, stigma, treatment, objective representations of pain, and dismissing pain self-reports.

Results: An online survey was completed by 349 Canadian adults living with chronic pain. Most respondents were open to using brain imaging for diagnostics, prediction, and therapeutic decision making (>90%). More than half of respondents felt that a brain scan would give them more confidence in their diagnosis and treatment plans and that health care providers would be more likely to believe they had chronic pain. However, they worried that brain scans could be used to dismiss their pain self-report. Most respondents felt there were policies to protect their brain data, but 40% were concerned about privacy and brain scan use against them by their employers/insurers. Although most respondents felt that a brain scan could represent their pain and suffering, 80% disagreed that their pain is only real if seen in a brain scan.

Conclusions: People with chronic pain recognize the potential benefits of brain imaging but are concerned about data security and dismissal of their self-reported pain. Our data align with previous recommendations to use brain imaging as an adjunct to pain self-reports but not as a replacement for the same.