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Cardinal É, Bilodeau K, Lebeau J, Aubin M, Guiné J, Dutey-Harispe O, Delage J, Caron-trahan R, Véronneau J, Landry M, Ogez D. Cultivating Comfort: Examining Participant Satisfaction with Hypnotic Communication Training in Pain Management. J Multidiscip Healthc 2024; 17:2973-2987. [PMID: 38948391 PMCID: PMC11213529 DOI: 10.2147/jmdh.s463738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
Context One in four Canadians experiences chronic pain, yet insufficient services and restrictions surrounding prevailing treatments result in inadequate management and significant negative consequences for these individuals. Previous work indicates that hypnotic communication represents a promising complementary treatment; however, training protocols for healthcare professionals are underdeveloped and understudied. Aim To evaluate the level of satisfaction for a training program on hypnotic communication in pain management clinics. Design Qualitative study. Methods Six health professionals who first completed the hypnotic communication training participated in 30 minutes virtual semi-structured interviews. These testimonials allowed them to elaborate on their user experience and potential areas for improvement. Thematic analysis using qualitative data management software NVIVO was conducted on the interview data. Results Two themes emerged from the interviews. 1) Satisfaction: Participants expressed satisfaction on various structural aspects of the training, including the provided materials, atmosphere, training structure, presentation modalities, practical workshops, acquired knowledge, trainer quality, and training duration. 2) Areas for Improvement: Five main improvement suggestions were identified (providing more material; more practical workshops, more concrete and adapted; testimonials from former patients; follow-up training meeting; and continuing education). Implications for the Profession and/or Patient Care and Conclusion The results improved the training program to help minimized inherent biases related to this technique, cut associated costs, and identify reasons that would explain its underutilization among medical professionals in Quebec. Our work highlights that healthcare professionals in chronic pain management clinics (eg, respiratory therapists, nurses) can incorporate this simple hypnotic communication technique into their usual care and contribute to the well-being of patients. Impact This study aimed to address the lack of training protocols for healthcare professionals, that are underdeveloped and understudied. The main findings on participant' satisfaction and the areas of improvement for the training will help the refinement of the training to better suit healthcare professional's needs in hospitals and chronic pain facilities.
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Affiliation(s)
- Éloïse Cardinal
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Karine Bilodeau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Faculty of Nursing Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Julie Lebeau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Faculty of Nursing Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Maryse Aubin
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Joséphine Guiné
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Odile Dutey-Harispe
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Julie Delage
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Rémi Caron-trahan
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Jade Véronneau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Mathieu Landry
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - David Ogez
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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Kaseweter K, Nazemi M, Gregoire N, Louw WF, Walsh Z, Holtzman S. Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era. BMC Health Serv Res 2023; 23:1131. [PMID: 37864210 PMCID: PMC10588239 DOI: 10.1186/s12913-023-10157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent and disabling condition which is often undertreated and poorly managed in the community. The emergence of COVID-19 has further complicated pain care, with an increased prevalence of chronic pain and mental health comorbidities, and burnout among physicians. While the pandemic has led to a dramatic increase in virtual health care visits, the uptake of a broader range of eHealth technologies remains unclear. The present study sought to better understand physicians' current needs and barriers in providing effective pain care within the context of COVID-19, as well as gauge current use, interest, and ongoing barriers to eHealth implementation. METHODS A total of 100 practicing physicians in British Columbia, Canada, completed a brief online survey. RESULTS The sample was comprised of physicians practicing in rural and urban areas (rural = 48%, urban = 42%; both = 10%), with the majority (72%) working in family practice. The most prominent perceived barriers to providing chronic pain care were a lack of interdisciplinary treatment and allied health care for patients, challenges related to opioid prescribing and management, and a lack of time to manage the complexities of chronic pain. Moreover, despite expressing considerable interest in eHealth for chronic pain management (82%), low adoption rates were observed for several technologies. Specifically, only a small percentage of the sample reported using eHealth for the collection of intake data (21%), patient-reported outcomes (14%), and remote patient monitoring (26%). The most common perceived barriers to implementation were cost, complexity, and unfamiliarity with available options. CONCLUSIONS Findings provide insight into physicians' ongoing needs and barriers in providing effective pain management during the COVID-19 pandemic. Despite the potential for eHealth technologies to help address barriers in pain care, and strong interest from physicians, enhanced useability, education and training, and funding are likely required to achieve successful implementation of a broader range of eHealth technologies in the future.
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Affiliation(s)
- Kimberley Kaseweter
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
| | - Mark Nazemi
- Clinical and Wellbeing Solutions, Thrive Health Inc, 200 - 116 West Hastings Street, Vancouver, BC, V6B 1G8, Canada
| | - Nina Gregoire
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - W Francois Louw
- Department of Family Practice, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Bill Nelems Pain and Research Centre, 309-2755 Tutt St, Kelowna, BC, V1Y 0G1, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
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Patton M, Carlson LE, Noel M, Palermo T, Forster V, Cho S, Schulte F. Internet-Delivered Cognitive Behavioral Treatment for Chronic Pain in Adolescent Survivors of Childhood Cancer: Protocol for a Single-Group Feasibility Trial. JMIR Res Protoc 2023; 12:e45804. [PMID: 37526959 PMCID: PMC10427928 DOI: 10.2196/45804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND There are over 500,000 survivors of childhood cancer in North America alone. One in 4 survivors experiences chronic pain after treatment has been completed. Youths with chronic pain report increased anxiety, depression, activity limitations, and sleep disturbances. An 8-week web-based cognitive behavioral treatment for chronic pain (Web-Based Management of Adolescent Pain [WebMAP]) has demonstrated a reduction in pain in youths but has not yet been explored in survivors. OBJECTIVE The objectives of this study are to (1) test the feasibility and acceptability of WebMAP for a sample of survivors with chronic pain and their parents; (2) assess the acceptability of WebMAP using qualitative interviews; (3) assess WebMAP's effect on activity limitations, pain intensity, depression and anxiety symptoms, and sleep disturbances; and (4) assess WebMAP's effect on parent pain catastrophizing and parental response to their child's pain. METHODS A single-arm mixed methods pre-post intervention study design will be used. Participants will be 34 survivors and at least one of their parents or caregivers. Inclusion criteria are (1) a cancer history, (2) current age of 10-17 years, (3) >2 years post treatment or >5 years post diagnosis, (4) pain present over prior 3 months impairing >1 area of daily life and occurring >1 time per month, and (5) computer access with broadband internet. Survivors will complete a pretreatment questionnaire, which will include the following: the Child Activity Limitations Interview, the pain intensity Numerical Rating Scale, Patient-Reported Outcomes Measurement Information System (PROMIS)-Pain Interference, Anxiety, Depression, Insomnia Severity Index, and Adolescent Sleep Wake Scale. Parents will complete the Pain Catastrophizing Scale-Parent Version and the Adult Responses to Child Symptoms. Upon completion of pretreatment questionnaires (T0), survivors will begin WebMAP. After the 8-week intervention, survivors will complete the same measures (T1), and at 3-month follow-up (T2). Posttreatment interviews will be conducted to determine acceptability. Feasibility will be assessed via recruitment and retention rates. Treatment engagement will be measured by number of modules completed. Pre-post outcome data will be assessed using linear mixed models. Qualitative data will be analyzed using thematic analysis. Patient partners will be involved in study design, recruitment, interpretation of results, and knowledge translation. RESULTS This study has been funded in January 2022. Data collection started in May 2022 and is projected to end in August 2023. We have enrolled 10 participants as of December 2022. CONCLUSIONS Investigating whether WebMAP is useful to survivors will be an important step in improving pain management in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT05241717; https://clinicaltrials.gov/ct2/show/NCT05241717. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45804.
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Affiliation(s)
- Michaela Patton
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Linda E Carlson
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Tonya Palermo
- Seattle Children's Research Institute, Seattle, WA, United States
| | | | - Sara Cho
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Fiona Schulte
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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Jovey RD, Balon J, Mabee J, Yake J, Currer C, Vadgama G, Jomy J, Hong KY, Patel M, Busse JW. Patients Response to Interventional Care for Chronic Pain Study (PRICS): A Cross-Sectional Survey of Community-Based Pain Clinics in Ontario, Canada. Cureus 2023; 15:e37440. [PMID: 37182006 PMCID: PMC10174670 DOI: 10.7759/cureus.37440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Non-image guided injection treatments ("nerve blocks") are commonly provided in community pain clinics in Ontario for chronic non-cancer pain (CNCP) but remain controversial. AIM We explored patients' perspectives of nerve blocks for CNCP. METHODS We administered a 33-item cross-sectional survey to patients living with CNCP pain attending four community-based pain clinics in Ontario, Canada. The survey captured demographic information and asked about patient experiences with nerve blocks. RESULTS Among 616 patients that were approached, 562 (91%) provided a completed survey. The mean age of respondents was 53 (SD 12), 71% were female, and the majority (57%) reported living with CNCP for more than a decade. Fifty-eight percent had been receiving nerve blocks for their pain for >3 years, 51% on a weekly frequency. Since receiving nerve blocks, patients self-reported a median improvement in pain intensity of 2.5 points (95% CI -2.5 to -3.0) on an 11-point numeric rating scale and 66% reported stopping or reducing prescription medications, including opioids. The majority who were not retired (62%) were receiving disability benefits and were unable to work in any capacity. When asked what impact cessation of nerve blocks would have, most employed patients (52%) reported they would be unable to work, and the majority indicated their ability to function across multiple domains would decrease. CONCLUSION Our respondents who received nerve blocks for CNCP attribute important pain relief and functional improvement to this intervention. Randomized trials and clinical practice guidelines are urgently needed to optimize the evidence-based use of nerve blocks for CNCP.
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Affiliation(s)
- Roman D Jovey
- Department of Pain Management, NeuPath Health Inc, Mississauga, CAN
| | - Jeffrey Balon
- Department of Pain Management, NeuPath Health Inc, Ottawa, CAN
| | - Joanne Mabee
- Department of Clinical Research, NeuPath Health Inc, Toronto, CAN
| | - Julie Yake
- Department of Information Systems, NeuPath Health Inc, London, CAN
| | | | - Geeta Vadgama
- Regional Director, NeuPath Health Inc, Mississauga, CAN
| | - Jane Jomy
- Department of Health Research Methods, Temerty Faculty of Medicine, University of Toronto, Toronto, CAN
| | - Ker-Yung Hong
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, CAN
| | - Mansi Patel
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, CAN
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, CAN
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Ten-year mixed-method evaluation of prelicensure health professional student self-reported learning in an interfaculty pain curriculum. Pain Rep 2022; 7:e1030. [PMID: 36128043 PMCID: PMC9478270 DOI: 10.1097/pr9.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/21/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction: Student perspectives on interprofessional pain education are lacking. Objectives: The purpose of this study was to evaluate ratings of knowledge acquisition and effective presentation methods for prelicensure health professional students attending the University of Toronto Centre for the Study of Pain Interfaculty Pain Curriculum (Canada). Methods: A 10-year (2009–2019) retrospective longitudinal mixed-methods approach comprising analysis and integration of quantitative and qualitative data sets was used to evaluate 5 core University of Toronto Centre for the Study of Pain Interfaculty Pain Curriculum learning sessions. Results: A total of 10, 693 students were enrolled (2009–2019) with a mean annual attendance of 972 students (±SD:102). The mean proportion of students rating “agree/strongly agree” for knowledge acquisition and effective presentation methods across sessions was 79.3% (±SD:3.4) and 76.7% (±SD:6.0), respectively. Knowledge acquisition or presentation effectiveness scores increased, respectively, over time for 4 core sessions: online self-study pain mechanisms module (P = 0.03/P < 0.001), online self-study opioids module (P = 0.04/P = 0.019), individually selected in-person topical pain sessions (P = 0.03/P < 0.001), and in-person patient or interprofessional panel session (P = 0.03). Qualitative data corroborated rating scores and expanded insight into student expectations for knowledge acquisition to inform real-world clinical practice and interprofessional collaboration; presentation effectiveness corresponded with smaller session size, individually selected sessions, case-based scenarios, embedded knowledge appraisal, and opportunities to meaningfully interact with presenters and peers. Conclusion: This study demonstrated positive and increasing prelicensure student ratings of knowledge acquisition and effective presentation methods across multifaceted learning sessions in an interfaculty pain curriculum. This study has implications for pain curriculum design aimed at promoting students' collaborative, patient-centered working skills. See commentary: Trouvin A-P. “Ten-year mixed method evaluation of prelicensure health professional student self-reported learning in an interfaculty pain curriculum”: a view on pain education. PAIN Rep 2022;7:e1031. Students attending learning sessions at the University of Toronto Interfaculty Pain Curriculum (2009–2019) in Toronto, Canada, self-report high ratings of knowledge acquisition and effective presentation methods.
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Etheridge T, Bostick GP, Hoens AM, Holly J, Ippersiel P, Bobos P, Arumugam V, Woods S, Gielen S, Woznowski-Vu A, Campbell N. Barriers to Physiotherapists’ Use of Professional Development Tools for Chronic Pain: A Knowledge Translation Study. Physiother Can 2022. [DOI: 10.3138/ptc-2020-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherapy Association that serves physiotherapists who have an interest in better understanding and managing patients’ pain. The PSD developed evidence-based resources for its members with the goal of improving patient care by supporting professional development. However, online metrics tracking access to these resources indicated that access was low. The purpose of this study was to identify the barriers PSD members encountered to the use of PSD resources and to recommend interventions to address these barriers guided by the Theory and Techniques Tool (TTT). Method: We distributed an online survey to PSD members across Canada. We used the TTT, a knowledge translation tool, to guide the design of the questionnaire and identify actionable findings. Results: Response rates from 621 non-student members and 1,470 student members were 26.9% and 1.4%, respectively. Based on the frequency of practicing physiotherapists’ ( N = 167) agreement with items in the TTT, the primary barriers to use of the PSD resources were forgetting that the resources were available and forgetting to use them. Conclusions: The TTT can be used to identify barriers to use of professional development tools.
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Affiliation(s)
- Tori Etheridge
- Centre for Neurology Studies, Surrey, British Columbia, Canada
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
| | - Geoff P. Bostick
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Alison M. Hoens
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet Holly
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Patrick Ippersiel
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Pavlos Bobos
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Vanitha Arumugam
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- Pain Management Program, St. Joseph Health Care, London, Ontario, Canada
| | | | | | - Arthur Woznowski-Vu
- Pain Science Division, Canadian Physiotherapy Association, Ottawa, Ontario, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Ten years of interfaculty pain curriculum at the University of Toronto: impact on student learning. Pain Rep 2021; 6:e974. [PMID: 34870057 PMCID: PMC8635288 DOI: 10.1097/pr9.0000000000000974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/08/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. The University of Toronto Interfaculty Pain Curriculum has significantly improved students' pain knowledge and ability to develop interprofessional care plans over the period 2009 to 2019. Introduction: Delivery of interprofessional pain education for prelicensure healthcare professionals is strongly recommended to advance a workforce ready for collaborative practice and to improve the quality and outcomes of pain care. Objectives: We report a 10-year (2009–2019) longitudinal evaluation of a 20-hour undergraduate Interfaculty Pain Curriculum (IPC) delivered to students in the Faculties of Dentistry, Nursing, Pharmacy, and Medicine (also including the Departments of Physical Therapy, Occupational Therapy and Physician Assistant) at the University of Toronto, Canada. The IPC follows a constructivist approach to facilitate interactive and multifaceted learning. Methods: Evaluation methods based on the Kirkpatrick model were used to appraise changes in participating students' pain knowledge and beliefs and their ability to collaboratively develop an interprofessional pain management plan. Results: A total of 10,693 students participated over the 10-year study period. The mean annual attendance was 972 students and participation to the program increased significantly over the years. Overall, the IPC was effective in improving students' mean pain knowledge and beliefs scores; however, the mean knowledge score gains were negatively correlated with time, likely related to increased uniprofessional pain education. Although an increasing trend in mean interprofessional pain management plan scores was observed, the scores were not significantly correlated with time. Conclusions: The interactive and multifaceted IPC is consistently effective in improving knowledge and beliefs and interprofessional pain management care plan development among participating student cohorts. Future inquiry is required to better understand the mechanisms behind student learning in interprofessional pain education to enhance pain curriculum development and delivery.
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8
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Linde LD, Bent LR, Dickey JP, Kumbhare DA, Srbely JZ. Exploring the effect of capsaicin-induced central sensitization on the upper limb nociceptive withdrawal reflex threshold. Exp Brain Res 2021; 239:3405-3415. [PMID: 34505162 DOI: 10.1007/s00221-021-06216-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
The nociceptive withdrawal reflex (NWR) threshold is commonly employed in the lower limb to assess clinical and experimentally induced pain. However, no studies to date have investigated changes in spinal nociception in the upper limb, via the NWR threshold, following experimentally induced central sensitization (CS). We tested the hypothesis that experimentally induced CS of the C5-C6 spinal segment significantly reduces NWR thresholds in muscles of the upper limb. Upper limb NWR thresholds from 20 young, healthy adults were assessed by applying noxious electrical stimuli to the right index finger and recording muscle activity from the biceps brachii (BI), triceps brachii (TRI), flexor carpi ulnaris (WF), and extensor carpi radialis longus (WE) muscles via surface electromyography. Topical cream (either 0.075% capsaicin, or control) was applied to the C5-C6 dermatome of the lateral forearm (50 cm2). NWR thresholds were compared at baseline, and four 10-min intervals after topical application. WF muscle NWR thresholds were significantly reduced in the capsaicin session compared to control, while TRI muscle NWR thresholds were significantly reduced 40 min after capsaicin application only (p < 0.05). There were no significant differences for BI or WE muscle NWR thresholds. We observed poor to moderate test-retest reliability for all upper limb NWR thresholds, a key contributor to the selective reduction in NWR thresholds among muscles. Accordingly, while our findings demonstrate some comparability to previously reported lower limb NWR studies, we concurrently report limitations of the upper limb NWR technique. Further exploration of optimal parameters for upper limb NWR acquisition is needed.
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Affiliation(s)
- Lukas D Linde
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
| | - Leah R Bent
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - James P Dickey
- School of Kinesiology, Western University, London, ON, Canada
| | - Dinesh A Kumbhare
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - John Z Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
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Thacker L, Walsh RM, Shinyoung Song G, Khan HA, Parmar P, Vance KT, Grant G, Mesaroli G, Hunter J, Vader K. Exploring physiotherapy practice within hospital-based interprofessional chronic pain clinics in Ontario. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:96-106. [PMID: 34189393 PMCID: PMC8210862 DOI: 10.1080/24740527.2021.1905508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Chronic pain affects one in five persons and is a leading contributor to years lived with disability and high health care costs. In 2016, the government of Ontario increased public funding for pediatric and adult hospital-based interprofessional chronic pain clinics (HICPCs) in Ontario, Canada, expanding the role of physiotherapy in chronic pain management in the province. This role has yet to be described in the literature. Aim: The aim of this study was to explore physiotherapy practice within HICPCs in Ontario. Methods: We conducted an interpretive description qualitative study based on semistructured interviews with physiotherapists employed in pediatric and adult HICPCs in Ontario. Interviews were audio recorded, transcribed verbatim, and reviewed for accuracy. We analyzed interview data using thematic analysis. Results: Ten physiotherapists who practiced in pediatric and adult HICPCs (n = 4 pediatric; n = 6 adult) in Ontario were interviewed between February and April 2020. We constructed five themes related to physiotherapy practice in this setting. Themes included (1) contributing a functional lens to care; (2) empowering through pain education; (3) facilitating participation in physical activity and exercise; (4) supporting engagement in self-management strategies; and (5) implementing a collaborative approach to whole-person care. Conclusions: Our results illuminate how physiotherapy practice within HICPCs in Ontario focuses on providing a collaborative and whole-person approach to care, with an emphasis on supporting patients to increase their functional capacity by promoting engagement in active chronic pain management strategies.
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Affiliation(s)
- Linnea Thacker
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Robert M Walsh
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Hammad A Khan
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Prem Parmar
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin T Vance
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Grant
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Giulia Mesaroli
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada
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10
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Bhatia A, Kara J, Janmohamed T, Prabhu A, Lebovic G, Katz J, Clarke H. User Engagement and Clinical Impact of the Manage My Pain App in Patients With Chronic Pain: A Real-World, Multi-site Trial. JMIR Mhealth Uhealth 2021; 9:e26528. [PMID: 33661130 PMCID: PMC7974758 DOI: 10.2196/26528] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/14/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic pain imposes a large burden on individuals and society. A patient-centric digital chronic pain management app called Manage My Pain (MMP) can be used to enhance communication between providers and patients and promote self-management. Objective The purpose of this study was to evaluate the real-world engagement of patients in urban and rural settings in Ontario, Canada with the MMP app alongside their standard of care and assess the impact of its usage on clinical outcomes of pain and related mental health. Methods A total of 246 participants with chronic pain at a rural and 2 urban pain clinics were recruited into this prospective, open-label, exploratory study that compared the use of MMP, a digital health app for pain that incorporates validated questionnaires and provides patients with summarized reports of their progress in combination with standard care (app group), against data entered on paper-based questionnaires (nonapp group). Participants completed validated questionnaires on anxiety, depression, pain catastrophizing, satisfaction, and daily opioid consumption up to 4.5 months after the initial visit (short-term follow-up) and between 4.5 and 7 months after the initial visit (long-term follow-up). Engagement and clinical outcomes were compared between participants in the two groups. Results A total of 73.6% (181/246) of the participants agreed to use the app, with 63.4% (111/175) of them using it for at least one month. Individuals who used the app rated lower anxiety (reduction in Generalized Anxiety Disorder 7-item questionnaire score by 2.10 points, 95% CI –3.96 to –0.24) at short-term follow-up and had a greater reduction in pain catastrophizing (reduction in Pain Catastrophizing Scale score by 5.23 points, 95% CI –9.55 to –0.91) at long-term follow-up relative to patients with pain who did not engage with the MMP app. Conclusions The use of MMP by patients with chronic pain is associated with engagement and improvements in self-reported anxiety and pain catastrophizing. Further research is required to understand factors that impact continued engagement and clinical outcomes in patients with chronic pain. Trial Registration ClinicalTrials.gov NCT04762329; https://clinicaltrials.gov/ct2/show/NCT04762329
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Affiliation(s)
- Anuj Bhatia
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jamal Kara
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | | | - Atul Prabhu
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gerald Lebovic
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, Unity Health Toronto, Toronto, ON, Canada
| | - Joel Katz
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.,Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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11
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Gyurcsik NC, Tupper SM, Brittain DR, Brawley LR, Cary MA, Ratcliffe-Smith D, Blouin JE, Marchant MG, Sessford JD, Hellsten LAM, Arnold BE, Downe P. A proof-of-concept study on the impact of a chronic pain and physical activity training workshop for exercise professionals. Scand J Pain 2021; 21:112-120. [PMID: 33035194 DOI: 10.1515/sjpain-2020-0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/05/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Physical activity is essential for long-term chronic pain management, yet individuals struggle to participate. Exercise professionals, including fitness instructors, and personal trainers, are preferred delivery agents for education and instruction on chronic pain, physical activity, and strategies to use adherence-promoting behavioral skills. However, exercise professionals receive no relevant training during certification or continuing education opportunities to effectively support their participants living with chronic pain. Based on the ORBIT model for early pre-efficacy phases of development and testing of new behavioral treatments, the present Phase IIa proof-of-concept study was conducted. The purpose was to examine the impacts of a newly developed chronic pain and physical activity training workshop on psychosocial outcomes among exercise professionals. Outcomes included knowledge and attitudes regarding chronic pain, attitudes and beliefs about the relationship between pain and impairment, and self-efficacy to educate and instruct participants with chronic pain. METHODS Forty-eight exercise professionals (M age=44.4±11.0 years) participated in a three-hour, in-person workshop that was offered at one of four different locations. Participants completed pre- and post-workshop outcome assessment surveys. RESULTS Mixed MANOVA results comparing time (pre- versus post-workshop) by workshop location (sites 1 to 4) illustrated a significant within-subjects time effect (p<0.001). All outcomes significantly improved from pre- to post-workshop (p's<0.001), demonstrating large effect sizes (partial eta-squared values ranging from 0.45 to 0.59). CONCLUSIONS Findings offer early phase preliminary support for the effectiveness of the chronic pain and physical activity training workshop for exercise professionals. Based on ORBIT model recommendations, findings warrant future phased testing via a pilot randomized clinical trial as well as testing for impacts that trained professionals have on activity adherence among their clients living with chronic pain. Eventual workshop adoption by exercise professional certification organizations would ensure widespread and sustainable access to qualified exercise professionals to help individuals engage in physical activity. By increasing the capacity of available exercise professionals to deliver effective support, active individuals could better manage their chronic pain and live well.
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Affiliation(s)
- Nancy C Gyurcsik
- University of Saskatchewan, College of Kinesiology, 87 Campus Drive, Saskatoon, SK, Canada
| | - Susan M Tupper
- Pain Quality Improvement and Research for the Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Danielle R Brittain
- University of Northern Colorado, College of Natural and Health Sciences, Greeley, CO, USA
| | - Lawrence R Brawley
- University of Saskatchewan, College of Kinesiology, 87 Campus Drive, Saskatoon, SK, Canada
| | - Miranda A Cary
- University of British Columbia, School of Health and Exercise Science, Kelowna, BC, Canada
| | - Don Ratcliffe-Smith
- University of Saskatchewan, College of Kinesiology, 87 Campus Drive, Saskatoon, SK, Canada
| | - Jocelyn E Blouin
- University of Saskatchewan, College of Kinesiology, 87 Campus Drive, Saskatoon, SK, Canada
| | - Mackenzie G Marchant
- University of Saskatchewan, College of Kinesiology, 87 Campus Drive, Saskatoon, SK, Canada
| | - James D Sessford
- University of Saskatchewan, College of Kinesiology, 87 Campus Drive, Saskatoon, SK, Canada
| | | | - Bart E Arnold
- University of Saskatchewan, College of Kinesiology, 87 Campus Drive, Saskatoon, SK, Canada
| | - Pamela Downe
- University of Saskatchewan, Department of Archaeology and Anthropology, Saskatoon, SK, Canada
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12
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Brown CO, Uy J, Singh KK. A mini-review: Bridging the gap between autism spectrum disorder and pain comorbidities. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:37-44. [PMID: 33987518 PMCID: PMC7942773 DOI: 10.1080/24740527.2020.1775486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Pain is a complex neurobiological response with a multitude of causes; however, patients with autism spectrum disorder (ASD) often report chronic pain with no known etiology. Recent research has been aimed toward identifying the causal mechanisms of pain in mouse and human models of ASD. In recent years, efforts have been made to better document and explore secondary phenotypes observed in ASD patients in the clinic. As new sequencing studies have become more powered with larger cohorts within ASD, specific genes and their variants are often left uncharacterized or validated. In this review we highlight ASD risk genes often presented with pain comorbidities. Aims This mini-review bridges the gap between two fields of literature, neurodevelopmental disorders and pain research. We discuss the importance of the genetic landscape of ASD and its links to pain phenotypes. Results Among the numerous genes implicated in ASD, few have been implicated with varying severities of pain comorbidity. Mutations in these genes, such as SCN9A, SHANK3, and CNTNAP2, lead to altered neuronal function that produce different responses to pain, shown in both mouse and human models. Conclusion There is a necessity to use new technologies to advance the current understanding of ASD risk genes and their contributions to pain. Secondly, there is a need to power future ASD risk genes associated with pain with their own cohort, because a better understanding is needed of this subpopulation.
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Affiliation(s)
- Chad O Brown
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.,Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada.,Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Jarryll Uy
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.,Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Karun K Singh
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.,Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
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13
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Sud A, Nelson MLA, Cheng DK, Armas A, Foat K, Greiver M, Hosseiny F, Katz J, Moineddin R, Mulsant BH, Newman RI, Rivlin L, Vasudev A, Upshur R. Sahaj Samadhi Meditation versus a Health Enhancement Program for depression in chronic pain: protocol for a randomized controlled trial and implementation evaluation. Trials 2020; 21:319. [PMID: 32264945 PMCID: PMC7140371 DOI: 10.1186/s13063-020-04243-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background Despite the high prevalence of comorbid chronic pain and depression, this comorbidity remains understudied. Meditation has demonstrated efficacy for both chronic pain and depression independently, yet there have been few studies examining its effectiveness when both conditions are present concurrently. Furthermore, while meditation is generally accepted as a safe and effective health intervention, little is known about how to implement meditation programs within or alongside the health care system. Methods We will conduct a hybrid type 1 effectiveness–implementation evaluation. To measure effectiveness, we will conduct a randomized controlled trial comparing Sahaj Samadhi Meditation and the Health Enhancement Program in 160 people living with chronic pain, clinically significant depressive symptoms, and on long-term opioid therapy. Changes in depressive symptoms will be our primary outcome; pain severity, pain-related function, opioid use, and quality of life will be the secondary outcomes. The primary end point will be at 12 weeks with a secondary end point at 24 weeks to measure the sustainability of acute effects. Patients will be recruited from a community-based chronic pain clinic in a large urban center in Mississauga, Canada. The meditation program will be delivered in the clinical environment where patients normally receive their chronic pain care by certified meditation teachers who are not regulated health care providers. We will use a mixed-methods design using the multi-level framework to understand the implementation of this particular co-location model. Discussion Results of this hybrid evaluation will add important knowledge about the effectiveness of meditation for managing depressive symptoms in people with chronic pain. The implementation evaluation will inform both effectiveness outcomes and future program development, scalability, and sustainability. Trial registration ClinicalTrials.gov: NCT04039568. Registered on 31 July 2019.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Michelle L A Nelson
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Darren K Cheng
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Alana Armas
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | | | - Michelle Greiver
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, North York General Hospital, Toronto, ON, Canada
| | | | - Joel Katz
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ronnie I Newman
- Research and Health Promotion Department, Art of Living Foundation (North America), Saint-Mathieu-du-Parc, QC, Canada.,Lifelong learning Institute, Health Professions Division, Nova Southeastern University, Davie, FL, USA
| | - Leon Rivlin
- Rivlin Medical Group, Mississauga, ON, Canada.,Emergency Medicine, Humber River Hospital, Toronto, ON, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Neuroscience, Western University, London, ON, Canada.,Geriatric Mood Disorders Lab, Lawson Health Research Institute, Parkwood Institute of Mental Health Care, London, ON, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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14
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Nowakowski ME, McCabe RE, Busse JW. Cognitive behavioral therapy to reduce persistent postsurgical pain following internal fixation of extremity fractures (COPE): Rationale for a randomized controlled trial. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2019; 3:59-68. [PMID: 35005420 PMCID: PMC8730643 DOI: 10.1080/24740527.2019.1615370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Approximately half of all patients who undergo surgical repair of extremity fractures report persistent postsurgical pain (PPSP) at 1-year post-surgery. Psychological factors such as anxiety, depression, catastrophization, poor coping, high somatic complaints, and pessimism about recovery are risk factors for the development of PPSP. It is possible that interventions such as cognitive behavior therapy (CBT) that target psychological factors may reduce the incidence of PPSP in this population. Aims: The current report reviews the role of psychological factors in the development of PPSP and discusses the rationale and protocol development for a multi-site randomized-controlled trial investigating the effectiveness of CBT in reducing PPSP in patients with surgically treated extremity fractures.
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Affiliation(s)
- Matilda E. Nowakowski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Chronic Pain Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Randi E. McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Jason W. Busse
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
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15
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Rice K, Ryu JE, Whitehead C, Katz J, Webster F. Medical Trainees' Experiences of Treating People With Chronic Pain: A Lost Opportunity for Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:775-780. [PMID: 29140917 PMCID: PMC5929494 DOI: 10.1097/acm.0000000000002053] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Evidence suggests that physicians' opinions about patients with chronic pain become progressively negative over the course of medical training, leading to decline in empathy for these patients. Few qualitative studies have focused on this issue, and thus the experiences shaping this process remain unexplored. This study addressed how medical trainees learn about chronic pain management through informal and formal curricula. METHOD This study adopted a constructive qualitative approach informed by the theoretical lens of the hidden curriculum. Thirteen open-ended interviews were conducted with medical students and residents at various training stages; interviewees had experience treating patients with chronic pain, shadowing the care of these patients, or both. Interviews elicited information about stage of medical training, general descriptions of work, and concrete experiences of managing patients with chronic pain. All interviews were collected in Toronto between June and August 2015. RESULTS Most interviewees described the management of chronic pain as challenging and unrewarding and attributed this at least in part to their perception that pain was subjective. Trainees also recounted that their inability to cure chronic pain left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value. CONCLUSIONS Specifically because chronic pain is subjective and incurable, listening and communication become crucial for patient care. Instead of sheltering trainees, medical educators should be offered the opportunity to reflect on the skills that are required to provide patient-centered care for this population. This approach has the potential to greatly benefit both trainees and patients.
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Affiliation(s)
- Kathleen Rice
- K. Rice is a postdoctoral fellow, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jae Eun Ryu
- J.E. Ryu is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- C. Whitehead is director and scientist, Wilson Centre, University Health Network, associate professor, Department of Family and Community Medicine, University of Toronto, vice president for education, Women’s College Hospital, and BMO Financial Group Chair, Health Professions Research, University Health Network, Toronto, Ontario, Canada
| | - Joel Katz
- J. Katz is professor and Canada Research Chair in Health Psychology, Department of Psychology, York University, Toronto, Ontario, Canada
| | - Fiona Webster
- F. Webster is associate professor, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, scientist, Wilson Centre, University Health Network, and academic fellow, Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
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16
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Loh E, Guy SD, Craven BC, Guilcher S, Hayes KC, Jeji T, Joshi P, Kras-Dupuis A, Laramée MT, Lee J, Mehta S, Noonan VK, Mings EJ, Salter M, Short C, Bassett-Spiers K, White B, Wolfe DL, Xia N. Advancing research and clinical care in the management of neuropathic pain after spinal cord injury: Key findings from a Canadian summit. Can J Pain 2017; 1:183-190. [PMID: 35005353 PMCID: PMC8730656 DOI: 10.1080/24740527.2017.1385370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/01/2017] [Accepted: 09/25/2017] [Indexed: 11/17/2022]
Abstract
Background: Optimal management of neuropathic pain (NP) is essential to enhancing health-related quality of life for individuals living with spinal cord injury (SCI). A key strategic priority for the Ontario Neurotrauma Foundation (ONF) and Rick Hansen Institute (RHI) is optimizing NP management after SCI. Aims: A National Canadian Summit, sponsored by ONF and RHI, was held to develop a strategic plan to improve NP management after SCI. Methods: In a one-day meeting held in Toronto, Ontario, a multidisciplinary panel of 18 Canadian stakeholders utilized a consensus workshop methodology to (1) describe the current state of the field, (2) create a long-term vision, and (3) identify steps for moving into action. Results: A review of the current state of the field identified strengths including rigourously developed evidence syntheses and practice landscape documentation. Identified gaps included limited evidence on NP hindering recommendation development in evidence syntheses, absence of a national strategy, care silos with limited cross-continuum connections, limited consumer involvement, and limited practice standard implementation. The panel identified key themes for a long-term vision to improve the management of SCI NP in Canada, including establishing an integrated collaborative network; standardized care and outcome evaluation; education; advocacy; and directing resources to innovative solutions. The panel identified the next step as prioritization of areas that will have the greatest impact in a 5-year time frame. Conclusion: A strategic plan outlining a long-term vision to improve management of NP after SCI in Canada was developed and will inform future activities of the sponsors.
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Affiliation(s)
- Eldon Loh
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Stacey D. Guy
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
| | - B. Cathy Craven
- Toronto Rehabilitation Institute, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sara Guilcher
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Keith C. Hayes
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | - Phalgun Joshi
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Anna Kras-Dupuis
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
| | - Marie-Thérèse Laramée
- Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l’Île-de-Montréal and Centre de Recherche Interdisciplinaire en Réadaptation, Montréal, Quebec, Canada
| | - Joseph Lee
- The Centre for Family Medicine, Kitchener, Ontario, Canada
| | - Swati Mehta
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
| | | | | | - Michael Salter
- The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christine Short
- Department of Medicine, Division of Physical Medicine and Rehabilitation Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada
| | | | - Barry White
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Dalton L. Wolfe
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
| | - Nancy Xia
- SCI Ontario, Toronto, Ontario, Canada
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17
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Supporting chronic pain management across provincial and territorial health systems in Canada: Findings from two stakeholder dialogues. Pain Res Manag 2015; 20:269-79. [PMID: 26291124 PMCID: PMC4596635 DOI: 10.1155/2015/918976] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic pain is a serious health problem affecting one in five Canadians. To provide better care for patients affected by chronic pain, there is a need to identify how provinces and territories across the country can strengthen its management. In this report, the authors summarize key findings from two stakeholder dialogues that addressed the support of chronic pain management by health system decisionmakers and across health systems. An overview of examples of the progress that has been made since the dialogues is also provided. BACKGROUND: Chronic pain is a serious health problem given its prevalence, associated disability, impact on quality of life and the costs associated with the extensive use of health care services by individuals living with it. OBJECTIVE: To summarize the research evidence and elicit health system policymakers’, stakeholders’ and researchers’ tacit knowledge and views about improving chronic pain management in Canada and engaging provincial and territorial health system decision makers in supporting comprehensive chronic pain management in Canada. METHODS: For these two topics, the global and local research evidence regarding each of the two problems were synthesized in evidence briefs. Three options were generated for addressing each problem, and implementation considerations were assessed. A stakeholder dialogue regarding each topic was convened (with 29 participants in total) and the deliberations were synthesized. RESULTS: To inform the first stakeholder dialogue, the authors found that systematic reviews supported the use of evidence-based tools for strengthening chronic pain management, including patient education, self-management supports, interventions to implement guidelines and multidisciplinary approaches to pain management. While research evidence about patient registries/treatment-monitoring systems is limited, many dialogue participants argued that a registry/system is needed. Many saw a registry as a precondition for moving forward with other options, including creating a national network of chronic pain centres with a coordinating ‘hub’ to provide chronic pain-related decision support and a cross-payer, cross-discipline model of patient-centred primary health care-based chronic pain management. For the second dialogue, systematic reviews indicated that traditional media can be used to positively influence individual health-related behaviours, and that multistakeholder partnerships can contribute to increasing attention devoted to issues on policy agendas. Dialogue participants emphasized the need to mobilize behind an effort to build a national network that would bring together existing organizations and committed individuals. CONCLUSIONS: Developing a national network and, thereafter, a national pain strategy are important initiatives that garnered broad-based support during the dialogues. Efforts toward achieving this goal have been made since convening the dialogues.
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