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Tidmarsh LV, Harrison R, Finlay KA. Prehabilitation: The underutilised weapon for chronic pain management. Br J Pain 2024; 18:354-364. [PMID: 39092207 PMCID: PMC11289902 DOI: 10.1177/20494637241250239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Objective Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions. Methods Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed. Results Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention. Conclusions Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.
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Affiliation(s)
- Lydia V. Tidmarsh
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Richard Harrison
- Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading, UK
| | - Katherine A. Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Lynch M. Mission Critical, a Call to Action for Implementation of the Recommendations of the Canadian Pain Task Force. Can J Pain 2024; 8:2346253. [PMID: 38894730 PMCID: PMC11185179 DOI: 10.1080/24740527.2024.2346253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Mary Lynch
- FRCPC, Founder (Pain Medicine) Royal College Physicians and Surgeons, Canada
- Department of Anesthesia, Pain Management and Perioperative Medicine, Psychiatry and Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
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DeSouza A, Wang D, Wong JJ, Furlan AD, Hogg-Johnson S, Macedo L, Mior S, Côté P. Characteristics of Canadians Living With Long-Term Health Conditions or Disabilities Who Had Unmet Rehabilitation Needs During the First Wave of the COVID-19 Pandemic: A Cross-sectional Study. Am J Phys Med Rehabil 2024; 103:488-493. [PMID: 38112669 DOI: 10.1097/phm.0000000000002388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE This study aimed to describe the characteristics associated with unmet rehabilitation needs in a sample of Canadians with long-term health conditions or disabilities during the first wave of the COVID-19 pandemic. DESIGN We used data from the Impacts of COVID-19 on Canadians Living With Long-Term Conditions and Disabilities, a national cross-sectional survey with 13,487 respondents. Unmet needs were defined as needing rehabilitation (ie, physiotherapy/massage/chiropractic, speech therapy, occupational therapy, counseling services, or support groups) but not receiving due to the pandemic. We used multivariable modified Poisson regression to examine the association between demographic, socioeconomic, and health-related characteristics and unmet rehabilitation needs. RESULTS More than half of the sample were 50 years and older (52.3%), female (53.8%), and 49.3% reported unmet rehabilitation needs. Those more likely to report unmet needs were females, those with lower socioeconomic status (receiving disability benefits or social assistance, job loss, increased work hours, decreased household income or earnings), and those with lower perceived general health or mental health status. CONCLUSIONS Among Canadians with disabilities or chronic health conditions, marginalized groups are more likely to report unmet rehabilitation needs. Understanding the systemic and upstream determinants is necessary to develop strategies to minimize unmet rehabilitation needs and facilitate the delivery of equitable rehabilitation services.
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Affiliation(s)
- Astrid DeSouza
- From the Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada (AD, DW, JJW, SH-J, PC); Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada (AS, DW, JJW, SH-J, SM, PC); Department of Medicine, University of Toronto, Toronto, Canada (ADF); Toronto Rehabilitation Institute, University Health Network, Toronto, Canada (ADF); Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada (SH-J, SM); Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (SH-J); and School of Rehabilitation Science, McMaster University, Hamilton, Canada (LM)
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Liddy C, Cooper L, Bellingham G, Deyell T, Ingelmo P, Moroz I, Poulin P, Singer A, Logan GS, Visca R, Zahrai A, Buckley N. Patient-Reported Wait Times and the Impact of Living with Chronic Pain on their Quality of Life: A Waiting Room Survey in Chronic Pain Clinics in Ontario, Manitoba, and Quebec. Can J Pain 2024; 8:2345612. [PMID: 38894731 PMCID: PMC11185187 DOI: 10.1080/24740527.2024.2345612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/17/2024] [Indexed: 06/21/2024]
Abstract
Background Wait times at Canadian multidisciplinary pain clinics have been reported as excessive for nearly 2 decades. Aims The aim of this study was to gain insight into the patient experience of waiting for chronic pain specialty care. Methods A cross-sectional survey of new patients waiting for an appointment was conducted in six multidisciplinary pain clinics, including one pediatric clinic, in Ontario, Quebec, and Manitoba between February 2020 and October 2022. Participants were asked about the length of time they waited for their appointment since being referred, their quality of life, health care professionals seen while waiting, and an open-ended question, "Is there anything else you'd like to tell us?" Results Among the 493 adult and 100 pediatric respondents, 53% of adults and 82% of children reported wait times under 6 months, whereas 22% of adults and 4% of children waited longer than a year. Between 52% and 63% of adults and 29% to 48% of children reported being affected by chronic pain "quite a bit" or "extremely" on measures of quality of life. The most visited health care professionals while waiting for a pain clinic appointment were family doctors/nurse practitioners for adults and physiotherapists for children. Qualitative analysis of open-ended question responses revealed eight themes: system navigation issues, administrative issues, decreased quality of life, distress, self-advocacy, coping strategies, communication, and distrust. Conclusions Our findings provide real-time regional snapshots into the impact of long wait times experienced by Canadians living with chronic pain. There is an urgent need to better support patients during the waiting period. Expanding technologies such as electronic consultation hold great promise.
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Affiliation(s)
- Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lynn Cooper
- Canadian Injured Workers Alliance, Thunder Bay, Ontario, Canada
| | - Geoff Bellingham
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
| | - Tracy Deyell
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Division of Pediatric Anesthesia, Montreal Children’s Hospital, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Isabella Moroz
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Patricia Poulin
- Department of Anesthesiology, The Ottawa Hospital Pain Clinic, Ottawa, Ontario, Canada
- Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabrielle S. Logan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Regina Visca
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
- RUISSS McGill Centre of Expertise in Chronic Pain, Montréal, Quebec, Canada
| | - Amin Zahrai
- Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
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Vowles KE, Knaggs RD, Palomares AC. Pandemic impact and adaptation to telehealth in chronic pain treatment providers across two COVID-19 pandemic years. Pain Pract 2024; 24:303-307. [PMID: 37877647 DOI: 10.1111/papr.13309] [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] [Indexed: 10/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has had substantial impacts for both people using pain services and healthcare professionals delivering them. While the effects on service users have been studied, less is known about the effects for service providers. This study aimed to assess the impact of the pandemic on providers and the evolving role of telemedicine in treatment. DESIGN & METHODS An electronic survey was distributed to the professional membership of the European Pain Federation (EFIC). The survey evaluated impact and adjustment to the COVID-19 pandemic separately across two pandemic years (March 2020-February 2021 and March 2021 to February 2022) and assessed worry about COVID-19, disruption and adjustment of pain services, and use of telehealth services. The change between the first and second pandemic years and the degree to which telehealth services were adopted was evaluated. RESULTS From 149 respondents, 131 (88%) participants provided sufficient data to be included in the analysis. Both providers worry about the pandemic and service disruption decreased significantly from the first to the second year of the pandemic. Prior to the pandemic, only 30% of providers offered telehealth appointments but this increased to 64% and 83%, respectively, in the first and second years of the pandemic. CONCLUSIONS Although provider worry and disruption to delivery of pain services decreased during the second year of COVID-19 pandemic, waiting times for appointments continued to lengthen. The pandemic has hastened the adoption of telemedicine in pain services and plans to continue telehealth services seem common.
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Affiliation(s)
- Kevin E Vowles
- School of Psychology, Queen's University Belfast & Belfast Centre for Pain Rehabilitation, Belfast Health and Social Care NHS Trust, Belfast, UK
| | - Roger D Knaggs
- School of Pharmacy, University of Nottingham, and Primary Integrated Community Services, Nottingham, UK
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Zgierska AE, Burzinski CA, Garland EL, Barrett B, Lennon RP, Brown RL, Schiefelbein AR, Nakamura Y, Stahlman B, Jamison RN, Edwards RR. Experiences of adults with opioid-treated chronic low back pain during the COVID-19 pandemic: A cross-sectional survey study. Medicine (Baltimore) 2023; 102:e34885. [PMID: 37832078 PMCID: PMC10578753 DOI: 10.1097/md.0000000000034885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/02/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to evaluate the impact of the COVID-19 pandemic on adults with opioid-treated chronic low back pain (CLBP), an understudied area. Participants in a "parent" clinical trial of non-pharmacologic treatments for CLBP were invited to complete a one-time survey on the perceived pandemic impact across several CLBP- and opioid therapy-related domains. Participant clinical and other characteristics were derived from the parent study's data. Descriptive statistics and latent class analysis analyzed quantitative data; qualitative thematic analysis was applied to qualitative data. The survey was completed by 480 respondents from June 2020 to August 2021. The majority reported a negative pandemic impact on their life (84.8%), with worsened enjoyment of life (74.6%), mental health (74.4%), pain (53.8%), pain-coping skills (49.7%), and finances (45.3%). One-fifth (19.4%) of respondents noted increased use of prescribed opioids; at the same time, decreased access to medication and overall healthcare was reported by 11.3% and 61.6% of respondents, respectively. Latent class analysis of the COVID-19 survey responses revealed 2 patterns of pandemic-related impact; those with worse pandemic-associated harms (n = 106) had an overall worse health profile compared to those with a lesser pandemic impact. The pandemic substantially affected all domains of relevant health-related outcomes as well as healthcare access, general wellbeing, and financial stability among adults with opioid-treated CLBP. A more nuanced evaluation revealed a heterogeneity of experiences, underscoring the need for both increased overall support for this population and for an individualized approach to mitigate harms induced by pandemic or similar crises.
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Affiliation(s)
- Aleksandra E. Zgierska
- Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Cindy A. Burzinski
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI
| | - Eric L. Garland
- University of Utah, College of Social Work, Salt Lake City, UT
| | - Bruce Barrett
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI
| | - Robert P. Lennon
- Department of Family and Community Medicine, and Law School, Pennsylvania State University College of Medicine, Hershey, PA
| | - Roger L. Brown
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | | | - Yoshio Nakamura
- Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, University of Utah School of Medicine, Salt Lake City, UT
| | - Barbara Stahlman
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Robert N. Jamison
- Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA
| | - Robert R. Edwards
- Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA
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Ziadni MS, Jaros S, Anderson SR, You DS, Darnall BD, Mackey SC. A Longitudinal Investigation of the Impact of COVID-19 on Patients With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:1830-1842. [PMID: 37225065 PMCID: PMC10201913 DOI: 10.1016/j.jpain.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
The COVID-19 pandemic prompted unexpected changes in the healthcare system. This current longitudinal study had 2 aims: 1) describe the trajectory of pandemic-associated stressors and patient-reported health outcomes among patients receiving treatment at a tertiary pain clinic over 2 years (May 2020 to June 2022); and 2) identify vulnerable subgroups. We assessed changes in pandemic-associated stressors and patient-reported health outcome measures. The study sample included 1270 adult patients who were predominantly female (74.6%), White (66.2%), non-Hispanic (80.6%), married (66.1%), not on disability (71.2%), college-educated (59.45%), and not currently working (57.9%). We conducted linear mixed effect modeling to examine the main effect of time with controlling for a random intercept. Findings revealed a significant main effect of time for all pandemic-associated stressors except financial impact. Over time, patients reported increased proximity to COVID-19, but decreased pandemic-associated stressors. A significant improvement was also observed in pain intensity, pain catastrophizing, and PROMIS-pain interference, sleep, anxiety, anger, and depression scores. Demographic-based subgroup analyses for pandemic-associated stressors revealed that younger adults, Hispanics, Asians, and patients receiving disability compensation were vulnerable groups either during the initial visit or follow-up visits. We observed additional differential pandemic effects between groups based on participant sex, education level, and working status. In conclusion, despite unanticipated changes in pain care services during the pandemic, patients receiving pain treatments adjusted to pandemic-related stressors and improved their health status over time. As the current study observed differential pandemic impacts on patient subgroups, future studies should investigate and address the unmet needs of vulnerable subgroups. PERSPECTIVE: Over a 2-year timeframe, the pandemic did not adversely influence physical and mental health among treatment-seeking patients with chronic pain. Patients reported small but significant improvements across indices of physical and psychosocial health. Differential impacts emerged among groups based on ethnicity, age, disability status, gender, education level, and working status.
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Affiliation(s)
- Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Sam Jaros
- Department of Epidemiology, Stanford University School of Medicine, Palo Alto, California
| | - Steven R Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
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De Clifford-Faugère G, Nguena Nguefack HL, Choinière M, Pagé MG, Blais L, Guénette L, Dorais M, Lacasse A. Trends in Prescription Chronic Pain Medication Use before and during the First Wave of the COVID-19 Pandemic in Québec, Canada: An Interrupted Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6493. [PMID: 37569033 PMCID: PMC10419123 DOI: 10.3390/ijerph20156493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND In Canada, a state of health emergency was declared in May 2020 as a result of the COVID-19 pandemic. This study aimed to assess trends in the use of prescription medication for pain management by people living with chronic pain before and during the first wave of the pandemic. METHODS Participants (n = 177) were adults reporting chronic pain who had completed a web-based questionnaire in 2019 and for whom complete longitudinal private and public insurance prescription claims were available. The monthly prevalence of medication use for nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and prescribed cannabinoids was assessed. An interrupted time series analysis was then performed to evaluate if the COVID-19 pandemic had had an impact on trends in pain medication use. RESULTS The beginning of the first wave of the pandemic was associated with the onset of a downward trend in opioid use (p < 0.05); no such association was found regarding NSAIDs. However, point prevalence of opioid use at the beginning (Nov. 2019) and at the end (Mai 2020) of the study period remained somewhat stable (17.0% vs. 16.4%). Regarding prescribed cannabinoids, a gradual increase in use was observed over the entire study period independently from the impact of the first wave of the pandemic (15.3% vs. 22.6%, p < 0.05). CONCLUSION While the occurrence of the first wave did have an impact on opioid use among people living with chronic pain, access to and use of opioids appear to have returned to normal before the end of the first wave of COVID-19.
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Affiliation(s)
- Gwenaëlle De Clifford-Faugère
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC J9X 5E4, Canada; (G.D.C.-F.); (H.L.N.N.)
| | - Hermine Lore Nguena Nguefack
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC J9X 5E4, Canada; (G.D.C.-F.); (H.L.N.N.)
| | - Manon Choinière
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (M.C.); (M.G.P.)
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - M. Gabrielle Pagé
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (M.C.); (M.G.P.)
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Québec, QC G1V 0A6, Canada;
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec—Université Laval, Québec, QC G1V 4G2, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l’Île-Perrot, QC J7V 0S2, Canada;
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC J9X 5E4, Canada; (G.D.C.-F.); (H.L.N.N.)
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Hirth MJ, Hahn J, Jamwal RJ. Exploring the patient experience of telehealth hand therapy services during the COVID-19 pandemic. J Hand Ther 2023; 36:606-615. [PMID: 36127236 PMCID: PMC9259471 DOI: 10.1016/j.jht.2022.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 06/14/2022] [Accepted: 07/01/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Electronic Survey. INTRODUCTION Internationally the COVID-19 pandemic has resulted in an unprecedented shift from face-to-face therapy to telehealth services. PURPOSE OF THE STUDY This paper explores the patient experience and satisfaction with telehealth hand therapy in a metropolitan setting during a period (March 1 to May 31, 2021) of 'moderate' COVID-19 risk when there was minimal community transmission of COVID-19. METHODS Patients attending telehealth services were invited to participate in an English language online survey at the conclusion of their therapy session via a pop-up invitation. RESULTS During the recruitment period there were 123 survey responses (29% response rate; 98% completion rate). Half of the respondents (n = 78, 53%) reported saving between 10 and 29 minutes of travel time (each way) by attending a telehealth appointment, while 36% (n = 44) saved more than 30 minutes (each way). Almost all respondents (n = 117, 95%) noted telehealth should be used in the future. The main benefit for telehealth was more easily fitting appointments around other commitments, followed by reducing stress and costs surrounding hospital attendance. Most participants (n = 97, 79%) reported no challenges using telehealth. The most cited challenges included the therapist not being able to provide hands on treatment (n = 14, 11%) and for seven respondents getting the technology to work (6%). DISCUSSION The elevated level of participant satisfaction of attending telehealth sessions informs us that this mode of therapy delivery could benefit patients in a post-pandemic environment. CONCLUSIONS Metropolitan funding models prior to the pandemic did not allow for this mode of therapy and hence consideration for an ongoing hybrid funding model of both face-to-face and telehealth should be considered by policy makers, insurance and government funding bodies.
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Affiliation(s)
- Melissa J Hirth
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia; Malvern Hand Therapy, Malvern, Victoria, Australia.
| | - Jodie Hahn
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca J Jamwal
- Occupational Therapy Department, Austin Health, Heidelberg, Victoria, Australia
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Naye F, Légaré F, Paquette JS, Tousignant-Laflamme Y, LeBlanc A, Gaboury I, Poitras ME, Toupin-April K, Li LC, Hoens A, Poirier MD, Décary S. Decisional needs assessment for patient-centred pain care in Canada: the DECIDE-PAIN study protocol. BMJ Open 2023; 13:e066189. [PMID: 37156591 PMCID: PMC10173373 DOI: 10.1136/bmjopen-2022-066189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION The 2021 Action Plan for Pain from the Canadian Pain Task Force advocates for patient-centred pain care at all levels of healthcare across provinces. Shared decision-making is the crux of patient-centred care. Implementing the action plan will require innovative shared decision-making interventions, specifically following the disruption of chronic pain care during the COVID-19 pandemic. The first step in this endeavour is to assess current decisional needs (ie, decisions most important to them) of Canadians with chronic pain across their care pathways. METHODS AND ANALYSIS DesignGrounded in patient-oriented research approaches, we will perform an online population-based survey across the ten Canadian provinces. We will report methods and data following the CROSS reporting guidelines.SamplingThe Léger Marketing company will administer the online population-based survey to its representative panel of 500 000 Canadians to recruit 1646 adults (age ≥18 years old) with chronic pain according to the definition by the International Association for the Study of Pain (eg, pain ≥12 weeks). ContentBased on the Ottawa Decision Support Framework, the self-administered survey has been codesigned with patients and contain six core domains: (1) healthcare services, consultation and postpandemic needs, (2) difficult decisions experienced, (3) decisional conflict, (4) decisional regret, (5) decisional needs and (6) sociodemographic characteristics. We will use several strategies such as random sampling to improve survey quality. AnalysisWe will perform descriptive statistical analysis. We will identify factors associated with clinically significant decisional conflict and decision regret using multivariate analyses. ETHICS AND DISSEMINATION Ethics was approved by the Research Ethics Board at the Research Centre of the Centre Hospitalier Universitaire de Sherbrooke (project #2022-4645). We will codesign knowledge mobilisation products with research patient partners (eg, graphical summaries and videos). Results will be disseminated via peer-reviewed journals and national and international conferences to inform the development of innovative shared decision-making interventions for Canadians with chronic pain.
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Affiliation(s)
- Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - France Légaré
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, Québec, Canada
| | - Jean-Sébastien Paquette
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
| | - Isabelle Gaboury
- Faculty of Medicine and Health Sciences, Department of Family Medecine and Emergency Medicine, Research Centre of the CIUSSS de l'Estrie-CHUS, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Longueuil, Quebec, Canada
| | - Marie-Eve Poitras
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Research Centre of the CIUSS du Saguenay-Lac-Saint-Jean, Université de Sherbrooke, Chicoutimi, Quebec, Canada
- Centre de santé et de services sociaux de Chicoutimi, Quebec, Quebec, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Alison Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Dominique Poirier
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Quebec, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
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11
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Borg Debono V, Neumark S, Buckley N, Zacharias R, Hapidou E, Anthonypillai J, Faria S, Meyer CL, Carter T, Parker N, Lau B, Abreu E, Duggan S, Bisson E, Pierre J, Visca R, Poulin P. Transition to Virtual Care Services during COVID-19 at Canadian Pain Clinics: Survey and Future Recommendations. Pain Res Manag 2023; 2023:6603625. [PMID: 37051562 PMCID: PMC10085656 DOI: 10.1155/2023/6603625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/01/2023] [Accepted: 03/08/2023] [Indexed: 04/05/2023]
Abstract
Introduction. Due to the COVID-19 pandemic, healthcare centers quickly adapted services into virtual formats. Pain clinics in Canada play a vital role in helping people living with pain, and these clinics remained essential services for patients throughout the pandemic. This study aimed to (1) describe and compare the transition from in-person to virtual pain care services at Canadian pain clinics during the onset of the COVID-19 pandemic and (2) provide postpandemic recommendations for pain care services to optimize the quality of patient care. Materials and Methods. We used a qualitative participatory action study design that included a cross-sectional survey for data collection and descriptive analysis to summarize the findings. Survey responses were collected between January and March of 2021. The survey was administered to the leadership teams of 11 adult pain clinics affiliated with the Chronic Pain Centre of Excellence for Canadian Veterans. Responses were analyzed qualitatively to describe the transition to the virtual pain services at pain clinics. Results. We achieved a 100% response rate from participating clinics. The results focus on describing the transition to the virtual care, current treatment and services, the quality of care, program sustainability, barriers to maintaining virtual services, and future considerations. Conclusions. Participating clinics were capable of transitioning pain care services to the virtual formats and have in-person care when needed with proper safety precautions. The pandemic demonstrated that it is feasible and sustainable for pain clinics to have a hybrid of virtual and in-person care to treat those living with pain. It is recommended that moving forward, there should be a hybrid of both virtual and in-person care for pain clinics. Ministries of Health should continue to develop policies and funding mechanisms that support innovations aimed at holistic healthcare, interdisciplinary teams, and the expansion of clinics’ geographical reach for patient access.
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Affiliation(s)
- Victoria Borg Debono
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Samuel Neumark
- Translational Research Program, Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, 263 McCaul Street, Toronto, Ontario M5T 1W7, Canada
| | - Norman Buckley
- Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Ramesh Zacharias
- Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Eleni Hapidou
- Michael G. DeGroote Pain Clinic, Hamilton Health Science, 1200 Main Street W, Hamilton, Ontario L8N 3Z5, Canada
| | - Jennifer Anthonypillai
- Michael G. DeGroote Pain Clinic, Hamilton Health Science, 1200 Main Street W, Hamilton, Ontario L8N 3Z5, Canada
| | - Susy Faria
- Michael G. DeGroote Pain Clinic, Hamilton Health Science, 1200 Main Street W, Hamilton, Ontario L8N 3Z5, Canada
| | - Carrie-Lynn Meyer
- Michael G. DeGroote Pain Clinic, Hamilton Health Science, 1200 Main Street W, Hamilton, Ontario L8N 3Z5, Canada
| | - Thomas Carter
- CBI Health Clinics, 272 Richmond Street E Suite 100, Toronto, Ontario M5A 1P4, Canada
| | - Nadia Parker
- CBI Health Clinics, 272 Richmond Street E Suite 100, Toronto, Ontario M5A 1P4, Canada
| | - Brenda Lau
- CHANGEpain Clinic, 5655 Cambie Street Lower Level, Vancouver, British Columbia V5Z 3A4, Canada
| | - Emmanuel Abreu
- CHANGEpain Clinic, 5655 Cambie Street Lower Level, Vancouver, British Columbia V5Z 3A4, Canada
| | - Scott Duggan
- Kingston Health Sciences Centre-Hotel Dieu Hospital Site, 166 Brock Street, Kingston, Ontario K7L 5G2, Canada
| | - Etienne Bisson
- Kingston Health Sciences Centre-Hotel Dieu Hospital Site, 166 Brock Street, Kingston, Ontario K7L 5G2, Canada
| | - Josie Pierre
- Operational Stress Injury (OSI) Clinic and Pain Management, Ste-Anne’s Hospital, 305 Boul des Anciens-Combattants Sainte-Anne-de-Bellevue, Montreal, Quebec H9X 1Y9, Canada
| | - Regina Visca
- McGill University Health Centre, Alan Edwards Pain Management Unit Montreal General Hospital, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | - Patricia Poulin
- Department of Anesthesia and Pain Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario K1N 6N5, Canada
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12
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A formal evaluation of The Ottawa Hospital Pain Clinic orientation session: A quality improvement project. Can J Pain 2023; 7:2111993. [PMID: 36643864 PMCID: PMC9839373 DOI: 10.1080/24740527.2022.2111993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Chronic pain affects approximately one in every five Canadians and has a substantial impact on psychological well-being, relationships, ability to attend work or school, and overall functioning.The Ottawa Hospital Pain Clinic introduced orientation sessions, with the aim of providing new patients with pain education to help prepare patients for engagement with multimodal pain management strategies. This report summarizes the results of a formative evaluation of the orientation session at The Ottawa Hospital Pain Clinic to determine whether patients perceived the orientation session as beneficial. Methods Interviews were conducted, transcribed, and then thematically analyzed to understand patients' perspectives on the orientation session. Coding was done by two team members using the constant comparison analyses method with key ideas, concepts, and patterns identified and compared to identify similarities. Results Between September 6 and October 18, 2019, 18 patients attended an orientation session and 12 consented to participation and completed telephone interviews. The six themes identified included (1) feeling of community, (2) participants feeling heard by providers, (3) appreciation of the holistic approach, (4) availability of community resources, (5) barriers to access, and (6) discordant feelings of preparedness for the physician appointment. Conclusion Results from this evaluation indicate that the orientation session offered at The Ottawa Hospital Pain Clinic improves chronic pain literacy, reduces feeling of isolation, and instills hope. As such, it appears to be a valuable component of pain clinic programs.
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13
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Hayes CJ, Gannon MA, Woodward EN, Long CR, George M, Ray-Griffith S, Tobey LR, Goree J. Implementation and Preliminary Effectiveness of a Multidisciplinary Telemedicine Pilot Initiative for Patients with Chronic Non-Cancer Pain in Rural and Underserved Areas at a Major Academic Medical Center. J Pain Res 2023; 16:55-69. [PMID: 36636266 PMCID: PMC9831086 DOI: 10.2147/jpr.s383212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
Background Arkansas lacks adequate access to high-quality pain care, as evidenced, in part, by it having the second highest opioid prescribing rate in the United States. To improve access to high-quality treatment of chronic pain, we developed the Arkansas Improving Multidisciplinary Pain Care and Treatment (AR-IMPACT) Telemedicine Clinic, a multidisciplinary and interprofessional team of specialists who provide evidence-based pain management for patients with chronic pain. Methods We conducted a single-arm pilot trial of the AR-IMPACT Telemedicine Clinic with rural, university-affiliated primary care clinics. We assessed the AR-IMPACT Telemedicine Clinic using an implementation framework and preliminary effectiveness measures. Specifically, we assessed 5 of the 8 implementation outcomes of the framework (ie, penetration, adoption, acceptability, appropriateness, and feasibility) using a mixed methods approach. To evaluate implementation outcomes, we used surveys, interviews, and administrative data. We used electronic health record data to measure preliminary effectiveness (ie, changes in average morphine milligram equivalents per day and pain and depression scores). Results The AR-IMPACT team saw 23 patients that were referred by 13 primary care physicians from three rural, university-affiliated primary care clinics over one year. Of the 19 patients willing to participate in the pilot study, 12 identified as women, 31.6% identified as Black, and over 50% had less than a bachelor's level education. Patients rated the clinic positively with high overall satisfaction. Referring physicians indicated high levels of appropriateness, acceptability, and feasibility of the program. AR-IMPACT team members identified several barriers and facilitators to the feasibility of implementing the program. No changes in preliminary effectiveness measures were statistically significant. Conclusion Overall, the AR-IMPACT Telemedicine Clinic obtained moderate penetration and adoption, was highly acceptable to patients, was highly acceptable and appropriate to providers, and was moderately feasible to providers and AR-IMPACT team members.
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Affiliation(s)
- Corey J Hayes
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA,Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA,Correspondence: Corey J Hayes, Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 782, Little Rock, AR, 72205, USA, Tel +501 526-8113, Email
| | - Matthew A Gannon
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, 72701, USA
| | - Eva N Woodward
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA,Center for Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Christopher R Long
- Office of Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, 72701, USA
| | - Masil George
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Shona Ray-Griffith
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA,Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Leah R Tobey
- Center for Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Johnathan Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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14
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Muñoz KA, Duncan J, Clark K, Shull S, Manfredi JM. The impact of COVID-19 on access to canine integrative medical care in Michigan, USA, and Ontario and British Columbia, Canada. Vet Anaesth Analg 2022; 49:580-588. [DOI: 10.1016/j.vaa.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
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15
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Shanthanna H, Nelson AM, Kissoon N, Narouze S. The COVID-19 pandemic and its consequences for chronic pain: a narrative review. Anaesthesia 2022; 77:1039-1050. [PMID: 35848380 PMCID: PMC9350079 DOI: 10.1111/anae.15801] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic transformed everyday life, but the implications were most impactful for vulnerable populations, including patients with chronic pain. Moreover, persistent pain is increasingly recognised as a key manifestation of long COVID. This narrative review explores the consequences of the COVID-19 pandemic for chronic pain. Publications were identified related to the COVID-19 pandemic influence on the burden of chronic pain, development of new-onset pain because of long COVID with proposed mechanisms and COVID-19 vaccines and pain interventions. Broadly, mechanisms underlying pain due to SARS-CoV-2 infection could be caused by 'systemic inflammatory-immune mechanisms', 'direct neuropathic mechanisms' or 'secondary mechanisms due to the viral infection or treatment'. Existing chronic pain populations were variably impacted and social determinants of health appeared to influence the degree of effect. SARS-CoV-2 infection increased the absolute numbers of patients with pain and headache. In the acute phase, headache as a presenting symptom predicted a milder course. New-onset chronic pain was reportedly common and likely involves multiple mechanisms; however, its prevalence decreases over time and symptoms appear to fluctuate. Patients requiring intensive support were particularly susceptible to long COVID symptoms. Some evidence suggests steroid exposure (often used for pain interventions) may affect vaccine efficacy, but there is no evidence of clinical repercussions to date. Although existing chronic pain management could help with symptomatic relief, there is a need to advance research focusing on mechanism-based treatments within the domain of multidisciplinary care.
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Affiliation(s)
- H Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - A M Nelson
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, CA, USA
| | - N Kissoon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - S Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
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16
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Mun CJ, Campbell CM, McGill LS, Wegener ST, Aaron RV. Trajectories and Individual Differences in Pain, Emotional Distress, and Prescription Opioid Misuse During the COVID-19 Pandemic: A One-Year Longitudinal Study. THE JOURNAL OF PAIN 2022; 23:1234-1244. [PMID: 35272053 PMCID: PMC8898783 DOI: 10.1016/j.jpain.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/02/2022]
Abstract
Recent studies suggest that the COVID-19 pandemic can serve as a unique psychosocial stressor that can negatively impact individuals with chronic pain. Using a large online sample in the U.S., the present study sought to investigate the impact of the pandemic on the trajectories of pain severity and interference, emotional distress (ie, anxiety and depressive symptoms), and opioid misuse behaviors across one year. Potential moderating effects of socio-demographic factors and individual differences in pain catastrophizing, pain acceptance, and sleep disturbance on outcome trajectories were also examined. Adults with chronic pain were surveyed three times across 1 year (April/May 2020 [N = 1,453]; June/July 2020 [N = 878], and May 2021 [N = 813]) via Amazon's Mechanical Turk online crowdsourcing platform. Mixed-effects growth models revealed that pain severity and interference, emotional distress, and opioid misuse behaviors did not significantly deteriorate across one year during the pandemic. None of the socio-demographic factors, pain catastrophizing, or sleep disturbance moderated outcome trajectories. However, individuals with higher pain acceptance reported greater improvement in pain severity (P< .008, 95% CI: -.0002, -.00004) and depressive symptoms (P< .001, 95% CI: -.001, -.0004) over time. Our findings suggest that the negative impact of the pandemic on pain, emotional distress, and opioid misuse behaviors is quite small overall. The outcome trajectories were also stable across different socio-demographic factors, as well as individual differences in pain catastrophizing and sleep disturbance. Nevertheless, interventions that target improvement of pain acceptance may help individuals with chronic pain be resilient during the pandemic. PERSPECTIVE: Individuals with chronic pain overall did not experience significant exacerbation of pain, emotional distress, and opioid misuse across one year during the COVID-19 pandemic. Individuals with higher pain acceptance showed greater improvement in pain severity and depressive symptoms over time during the pandemic.
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Affiliation(s)
- Chung Jung Mun
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
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17
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Gevers-Montoro C, Deldar Z, Furlan A, Lazar EA, Ghalibaf E, Ortega-De Mues A, Khatibi A. From hands-on to remote: Moderators of response to a novel self-management telehealth programme during the COVID-19 pandemic. Eur J Pain 2022; 26:1368-1379. [PMID: 35610958 PMCID: PMC9320893 DOI: 10.1002/ejp.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/17/2022] [Accepted: 05/04/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND In March 2020, state-wide lockdowns were declared in many countries, including Spain. Citizens were confined to their homes and remotely supported activities were prioritized as an alternative to in-person interactions. Previous data suggest that remote and self-management interventions may be successful at reducing pain and related psychological variables. However, individual factors influencing the effectiveness of these interventions remain to be identified. We aimed to investigate the psychological and motivational factors moderating changes in pain observed in chiropractic patients undertaking a novel telehealth self-management programme. METHODS A cohort of 208 patients from a chiropractic teaching clinic was recruited to participate in the study. Patients received telehealth consultations and individualized self-management strategies tailored for their current complaint. They were encouraged to make use of these strategies daily for 2-4 weeks, whilst rating their pain intensity, motivation and adherence. Validated questionnaires were completed online to assess catastrophizing, kinesiophobia and anxiety. RESULTS A total of 168 patients completed the first 2 weeks of the programme, experiencing significant reductions in all variables. Kinesiophobia emerged as a key factor influencing pain reduction and moderating the association between motivation and pain relief. In turn, adherence to the programme was associated with lower pain intensity, although moderated by the degree of motivation. CONCLUSIONS In the context of COVID-19, when introducing remote and self-management strategies, pain cognitions and motivational factors should be taken into consideration to foster adherence and yield better pain outcomes.
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Affiliation(s)
- Carlos Gevers-Montoro
- Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Zoha Deldar
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Andrea Furlan
- KITE, Toronto Rehabilitation Institute, University of Toronto, University Health Network, Institute for Work & Health, Toronto, Ontario, Canada
| | - Eric A Lazar
- Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain
| | - Erfan Ghalibaf
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | | | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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18
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Melchior M, Dziadzko M, Conradi S, Poisbeau P, Aubrun F. Impact of coronavirus disease 2019 on chronic pain structures: data from French national survey. J Comp Eff Res 2022; 11:649-658. [PMID: 35510519 PMCID: PMC9149779 DOI: 10.2217/cer-2022-0003] [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] [Indexed: 11/21/2022] Open
Abstract
Aims: The authors evaluated the impact of the first coronavirus disease 2019 pandemic wave on French chronic pain structures (CPSs). Methods: An online survey assessed CPS resource allocation, workflow and perceived impact on patient care. Results: All CPS workflow was severely impacted by the reallocation of 42% of specialists. In-person appointments were cancelled by 72% of participants. Follow-up was maintained in 91% of participants (telemedicine). Skills in end-of-life decision-making/counseling were rarely solicited. The perceived impact of the crisis on the experience of patients was high (eight out of ten), with a significant increase in access-to-care delay. Conclusion: CPSs maintained patient follow-up. Special features of CPS specialists were rarely solicited by coronavirus disease 2019 teams experiencing a high workload. Recommendations on optimal CPS resource reallocations have to be standardized in crisis conditions.
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Affiliation(s)
- Meggane Melchior
- Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique et Université de Strasbourg, Strasbourg, 67000, France
| | - Mikhail Dziadzko
- Département d'Anesthésie-Réanimation-Douleur, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, 69004, France.,Research on Healthcare Performance, Institut National de la Santé et de la Recherche Médicale U1290, Université Claude Bernard Lyon 1, Lyon, 69373, France
| | - Séverine Conradi
- Centre Hospitalier Régional Universitaire de Tours de Nancy - Hôpital Central, Nancy, 54000, France.,Laboratoire APEMAC-EPSAM Université de Lorraine, Metz, 57000, France
| | - Pierrick Poisbeau
- Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique et Université de Strasbourg, Strasbourg, 67000, France
| | - Frédéric Aubrun
- Département d'Anesthésie-Réanimation-Douleur, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, 69004, France.,Research on Healthcare Performance, Institut National de la Santé et de la Recherche Médicale U1290, Université Claude Bernard Lyon 1, Lyon, 69373, France
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19
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Ziadni MS, You DS, Cramer EM, Anderson SR, Hettie G, Darnall BD, Mackey SC. The impact of COVID-19 on patients with chronic pain seeking care at a tertiary pain clinic. Sci Rep 2022; 12:6435. [PMID: 35440688 PMCID: PMC9017421 DOI: 10.1038/s41598-022-10431-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/06/2022] [Indexed: 02/07/2023] Open
Abstract
Empirical data on the health impacts of the COVID-19 pandemic remain scarce, especially among patients with chronic pain. We conducted a cross-sectional study matched by season to examine patient-reported health symptoms among patients with chronic pain pre- and post-COVID-19 pandemic onset. Survey responses were analyzed from 7535 patients during their initial visit at a tertiary pain clinic between April 2017-October 2020. Surveys included measures of pain and pain-related physical, emotional, and social function. The post-COVID-19 onset cohort included 1798 initial evaluations, and the control pre-COVID-19 cohort included 5737 initial evaluations. Patients were majority female, White/Caucasian, and middle-aged. The results indicated that pain ratings remained unchanged among patients after the pandemic onset. However, pain catastrophizing scores were elevated when COVID-19 cases peaked in July 2020. Pain interference, physical function, sleep impairment, and emotional support were improved in the post-COVID-19 cohort. Depression, anxiety, anger, and social isolation remained unchanged. Our findings provide evidence of encouraging resilience among patients seeking treatment for pain conditions in the face of the COVID-19 pandemic. However, our findings that pain catastrophizing increased when COVID-19 cases peaked in July 2020 suggests that future monitoring and consideration of the impacts of the pandemic on patients' pain is warranted.
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Affiliation(s)
- Maisa S Ziadni
- Systems Neuroscience and Pain Lab, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA.
| | - Dokyoung S You
- Systems Neuroscience and Pain Lab, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
| | - Eric M Cramer
- Systems Neuroscience and Pain Lab, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
| | - Steven R Anderson
- Systems Neuroscience and Pain Lab, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
| | - Gabrielle Hettie
- Systems Neuroscience and Pain Lab, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
| | - Beth D Darnall
- Systems Neuroscience and Pain Lab, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
| | - Sean C Mackey
- Systems Neuroscience and Pain Lab, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
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20
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Leitch J, Webb A, Pudwell J, Chamberlain S, Henry R, Nitsch R. Magnesium-based trigger point infiltrations versus local anesthetic infiltrations in chronic pelvic myofascial pain: A randomized, double-blind control study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:877-885. [PMID: 35339694 DOI: 10.1016/j.jogc.2022.02.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if a novel, magnesium-based trigger point infiltration formulation is more effective in treating chronic myofascial pelvic pain than lidocaine-only infiltration. METHODS This was a single-centre, double-blind, randomized controlled trial of women diagnosed with chronic pelvic myofascial pain associated with trigger points. We compared a novel magnesium-based infiltration formulation with lidocaine infiltration of trigger points and with a control group of participants who were waitlisted for a chronic pain clinic. Treatment groups completed a 12-week program that included 8 trigger point injection treatments and nine visits during which pain scores were recorded and questionnaires administered. The primary outcome measure was change in mean pain score between baseline and the final visit. Secondary outcomes included pain with function scores, scores on the World Health Organization Quality of Life questionnaire, procedural pain, concomitant medication use, and complications. RESULTS We assigned 44 women diagnosed with chronic myofascial pelvic pain associated with trigger points to either the magnesium-based infiltrate (n = 15), lidocaine infiltrate (n = 17), or waitlist (n = 12) group. In the intent-to-treat analysis, a clinically relevant decrease in mean pain score out of 10 was observed in the magnesium-based (-2.6 ± 3.2) and lidocaine (-2.9 ± 3.1) infiltration groups, but not in the waitlist group (-0.5 ± 2.3). The per protocol analysis post-hoc tests, adjusted for multiple comparisons, found a significant difference in the average change in pain score between the magnesium-based infiltrate and the waitlist groups (P = 0.045), while differences between the lidocaine infiltrate and waitlist groups approached statistical significance (P = 0.052). Both treatment groups saw improvements in pain with function and quality of life scores. CONCLUSION While this study is underpowered, it does not support the use of a magnesium-based trigger point infiltrate in the treatment of chronic myofascial pelvic pain over lidocaine-only infiltration. Nonetheless, these results are consistent with current management recommendations and suggest improvements in pain, pain with function, and quality of life scores with either magnesium-based or lidocaine-only infiltration. We outline an approach to assessment and treatment that can be adopted by general gynaecologists.
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Affiliation(s)
- Jordan Leitch
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - Amanda Webb
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Susan Chamberlain
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Richard Henry
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - Romy Nitsch
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON.
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21
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Killackey T, Baerg K, Dick B, Lamontagne C, Poolacherla R, Finley GA, Noel M, Birnie KA, Choinière M, Pagé MG, Dassieu L, Lacasse A, Lalloo C, Poulin P, Ali S, Battaglia M, Campbell F, Harris L, Mohabir V, Nishat F, Benayon M, Jordan I, Stinson J. Experiences of Pediatric Pain Professionals Providing Care during the COVID-19 Pandemic: A Qualitative Study. CHILDREN 2022; 9:children9020230. [PMID: 35204950 PMCID: PMC8870259 DOI: 10.3390/children9020230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
Chronic pain affects 1 in 5 youth, many of whom manage their pain using a biopsychosocial approach. The COVID-19 pandemic has impacted the way that healthcare is delivered. As part of a larger program of research, this study aimed to understand the impact of the pandemic on pediatric chronic pain care delivery including impact on patients’ outcomes, from the perspective of pediatric healthcare providers. A qualitative descriptive study design was used and 21 healthcare providers from various professional roles, clinical settings, and geographic locations across Canada were interviewed. Using a reflexive thematic analysis approach 3 themes were developed: (1) duality of pandemic impact on youth with chronic pain (i.e., how the pandemic influenced self-management while also exacerbating existing socioeconomic inequalities); (2) changes to the healthcare system and clinical practices (i.e., triaging and access to care); (3) shift to virtual care (i.e., role of institutions and hybrid models of care). These findings outline provider perspectives on the positive and negative impacts of the pandemic on youth with chronic pain and highlight the role of socioeconomic status and access to care in relation to chronic pain management during the pandemic in a high-income country with a publicly funded healthcare system.
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Affiliation(s)
- Tieghan Killackey
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (T.K.); (C.L.); (L.H.); (V.M.); (F.N.)
| | - Krista Baerg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada;
| | - Bruce Dick
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Christine Lamontagne
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, ON K1N 6N5, Canada;
| | - Raju Poolacherla
- Department of Anesthesia and Perioperative Medicine, Western University, London, ON N6A 3K7, Canada;
| | - G. Allen Finley
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.N.); (K.A.B.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kathryn A. Birnie
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.N.); (K.A.B.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Research Center of the Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC H2X 0A9, Canada; (M.C.); (M.G.P.)
| | - M. Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Research Center of the Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC H2X 0A9, Canada; (M.C.); (M.G.P.)
| | - Lise Dassieu
- Department of Biomedical Sciences, Research Center of the Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC H3C 3J7, Canada;
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC J9X 5E4, Canada;
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (T.K.); (C.L.); (L.H.); (V.M.); (F.N.)
| | - Patricia Poulin
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Otttawa, ON K1N 6N5, Canada;
- Department of Psychology, The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Samina Ali
- Departments of Pediatrics & Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, ON M6G 1H4, Canada;
- Division of Child and Youth Psychiatry, CAMH, Toronto, ON M6J 1H4, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON M5G 1E2, Canada;
| | - Lauren Harris
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (T.K.); (C.L.); (L.H.); (V.M.); (F.N.)
| | - Vina Mohabir
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (T.K.); (C.L.); (L.H.); (V.M.); (F.N.)
| | - Fareha Nishat
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (T.K.); (C.L.); (L.H.); (V.M.); (F.N.)
| | - Myles Benayon
- Department of Medicine, McMaster University, Hamilton, ON L8S 3L8, Canada;
| | | | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (T.K.); (C.L.); (L.H.); (V.M.); (F.N.)
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- Correspondence:
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22
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Shiner CT, Gardner T, Haskelberg H, Li I, Faux SG, Millard M, Mahoney AEJ. OUP accepted manuscript. PAIN MEDICINE 2022; 23:1621-1630. [PMID: 35312759 PMCID: PMC8996725 DOI: 10.1093/pm/pnac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Objectives Societal and health system pressures associated with the coronavirus disease 2019 (COVID-19) pandemic exacerbated the burden of chronic pain and limited access to pain management services for many. Online multidisciplinary pain programs offer an effective and scalable treatment option, but have not been evaluated within the context of COVID-19. This study aimed to investigate the uptake and effectiveness of the Reboot Online chronic pain program before and during the first year of the COVID-19 pandemic. Methods Retrospective cohort analyses were conducted on routine service users of the Reboot Online program, comparing those who commenced the program during the COVID-19 pandemic (March 2020–March 2021), to those prior to the pandemic (April 2017–March 2020). Outcomes included the number of course registrations; commencements; completion rates; and measures of pain severity, interference, self-efficacy, pain-related disability, and distress. Results Data from 2,585 course users were included (n = 1138 pre-COVID-19 and n = 1,447 during-COVID-19). There was a 287% increase in monthly course registrations during COVID-19, relative to previously. Users were younger, and more likely to reside in a metropolitan area during COVID-19, but initial symptom severity was comparable. Course adherence and effectiveness were similar before and during COVID-19, with moderate effect size improvements in clinical outcomes post-treatment (g = 0.23–0.55). Discussion Uptake of an online chronic pain management program substantially increased during the COVID-19 pandemic. Program adherence and effectiveness were similar pre- and during-COVID. These findings support the effectiveness and scalability of online chronic pain management programs to meet increasing demand.
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Affiliation(s)
- Christine T Shiner
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
- Department of Pain Medicine, St Vincent’s Hospital, Sydney, Australia
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Correspondence to: Christine Shiner, Department of Rehabilitation and Pain Medicine, St Vincent’s Hospital Sydney, 170 Darlinghurst Rd, Darlinghurst NSW 2010, Australia. Tel: + 61 2 8382 9542; Fax: +61 2 8382 9518; E-mail:
| | - Tania Gardner
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
- Department of Pain Medicine, St Vincent’s Hospital, Sydney, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
| | - Steven G Faux
- Department of Pain Medicine, St Vincent’s Hospital, Sydney, Australia
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9111474. [PMID: 34828520 PMCID: PMC8624418 DOI: 10.3390/healthcare9111474] [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: 08/13/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care for both COVID-19 and non-COVID-19 patients. The purpose of this study is to systematically identify the facilitators and barriers experienced by outpatient health care organizations in an effort to maintain effective and efficient patient throughput during the pandemic. MATERIALS AND METHODS This study systematically reviewed articles focused on initiatives taken by ambulatory care organizations to maintain optimal outpatient throughput levels while balancing pandemic precautions, published during 2020. RESULTS Among the 30 articles that met the inclusion criteria, three initiatives healthcare organizations have taken to maintain throughput were identified: the use (and enhanced use) of telehealth, protocol development, and health care provider training. The research team also identified three barriers to patient throughput: lack of telehealth, lack of resources, and overall lack of knowledge. CONCLUSIONS To maintain patient throughput during the COVID-19 pandemic, healthcare organizations need to develop strategies such as the use of virtual consultation and follow-up, new guidelines to move patients along the care delivery value-chain, and ongoing training of providers. Additionally, the availability of required technology for telehealth, availability of resources, and adequate knowledge are vital for continuous patient throughput to ensure continuity of care during a pandemic.
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24
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Killackey T, Noel M, Birnie KA, Choinière M, Pagé MG, Dassieu L, Lacasse A, Lalloo C, Brennenstuhl S, Poulin P, Ingelmo P, Ali S, Battaglia M, Campbell F, Smith A, Harris L, Mohabir V, Benayon M, Jordan I, Marianayagam J, Stinson J. COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:139-150. [PMID: 34263096 PMCID: PMC8253119 DOI: 10.1080/24740527.2021.1931069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The COVID-19 pandemic presents one of the greatest threats to pediatric pain care seen in generations. Due to public health restrictions, many pediatric pain clinics halted in-person appointments, delaying and disrupting access to care. There is no existing research on the impacts of COVID-19 on pediatric chronic pain care in Canada or the challenges experienced by health care professionals and pain clinics. Aims: The aim of this study was to evaluate the impact of COVID-19 on Canadian pediatric chronic pain care by documenting how health care professionals provided care during the first six months of the pandemic. Methods: Two Canadian online cross-sectional surveys were conducted: one among Canadian pediatric pain clinic directors (Study 1) and another among multidisciplinary pediatric pain health care professionals (Study 2). Results: Responses from 13/13 Canadian pediatric pain clinics/rehabilitation programs indicated that all clinics provided virtual care during the pandemic. No significant changes were reported on the frequency of appointment requests. Most clinics reported no perceived change in patient pain levels (n = 9/13, 69%) or occurrence of pain flares (n = 10/13, 77%). Results from 151 individual health care professionals indicated that the majority (90%) of non–emergency department respondents were providing virtual care. The main challenges of virtual care included technological barriers, financial concerns, infrastructure and logistics, privacy, and clinical challenges. Conclusions: This study documented the impact of the COVID-19 pandemic on pediatric chronic pain care in Canada and highlighted the rapid shift to using virtual solutions. Simultaneously, respondents outlined current challenges and potential solutions to consider in the development of virtual care guidelines and policy in Canada.
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Affiliation(s)
- Tieghan Killackey
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada
| | - Melanie Noel
- Alberta Children's Hospital, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - M Gabrielle Pagé
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Lise Dassieu
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Chitra Lalloo
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Poulin
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pablo Ingelmo
- Chronic Pain Service, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Samina Ali
- Departments of Pediatrics & Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Division of Child Youth & Emerging Adulthood Psychiatry, CAMH, Toronto, Ontario, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Smith
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Interprofessional Pain and Addiction Recovery Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lauren Harris
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada
| | - Vina Mohabir
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada
| | - Myles Benayon
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Jennifer Stinson
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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25
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Dassieu L, Pagé MG, Lacasse A, Laflamme M, Perron V, Janelle-Montcalm A, Hudspith M, Moor G, Sutton K, Thompson JM, Choinière M. Chronic pain experience and health inequities during the COVID-19 pandemic in Canada: qualitative findings from the chronic pain & COVID-19 pan-Canadian study. Int J Equity Health 2021; 20:147. [PMID: 34162393 PMCID: PMC8220113 DOI: 10.1186/s12939-021-01496-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic pain affects about 20 % of the Canadian population and can lead to physical, psychological and social vulnerabilities. However, this condition remains poorly recognized and undertreated. During 2020, as the COVID-19 pandemic disrupted daily living and health care systems, the situation of people with chronic pain has drawn little public attention. METHODS This qualitative study was part of a pan-Canadian mixed-methods project and aimed to understand the experiences and challenges of people living with chronic pain during the COVID-19 pandemic in Canada. Between May and August 2020, we conducted in-depth semi-structured interviews with 22 individuals living with chronic pain across the country. We used reflexive thematic analysis to interpret data. RESULTS Our findings underscored four dimensions of the chronic pain experience during the pandemic: (1) Reinforced vulnerability due to uncertainties regarding pain and its management; (2) Social network as a determinant of pain and psychological condition; (3) Increasing systemic inequities intermingling with the chronic pain experience; (4) More viable living conditions due to confinement measures. Though several participants reported improvements in their quality of life and reduced social pressure in the context of stay-at-home orders, participants from socio-economically deprived groups and minorities reported more challenges in accessing pain relief, health care services, and psychosocial support. CONCLUSIONS The COVID-19 pandemic has revealed and intensified pre-existing disparities and challenges among people living with chronic pain in terms of material resources, psychosocial condition, social support, and access to care. In post-pandemic times, it will be essential to address flaws in health and welfare policies to foster equity and social inclusiveness of people with chronic pain.
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Affiliation(s)
- Lise Dassieu
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Saint- Antoine Building, 850 Saint Denis St, H2X 0A9, Montreal, Quebec, Canada.
| | - M Gabrielle Pagé
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Saint- Antoine Building, 850 Saint Denis St, H2X 0A9, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Anesthesiology and Pain Medicine, Université de Montréal, Pavillon Roger-Gaudry, succursale Centre-ville, C.P. 6128, H3C 3J7, Montreal, Québec, Canada
- Faculty of Arts and Science, Department of Psychology, Pavillon Marie- Victorin, Université de Montréal, 90 avenue Vincent d'Indy, H2V 2S9, Montreal, Québec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Quebec, Canada
| | - Maude Laflamme
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Saint- Antoine Building, 850 Saint Denis St, H2X 0A9, Montreal, Quebec, Canada
- Faculty of Arts and Sciences, Department of Sociology, Université de Montréal, H3C 3J7, Montreal, Québec, Canada
| | - Vickie Perron
- Pain BC Society, Vancouver, British Columbia, Canada
| | - Audrée Janelle-Montcalm
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Saint- Antoine Building, 850 Saint Denis St, H2X 0A9, Montreal, Quebec, Canada
| | | | - Gregg Moor
- Pain BC Society, Vancouver, British Columbia, Canada
| | | | - James M Thompson
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Manon Choinière
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Saint- Antoine Building, 850 Saint Denis St, H2X 0A9, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Anesthesiology and Pain Medicine, Université de Montréal, Pavillon Roger-Gaudry, succursale Centre-ville, C.P. 6128, H3C 3J7, Montreal, Québec, Canada
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26
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Murphy L, Ng K, Isaac P, Swidrovich J, Zhang M, Sproule BA. The Role of the Pharmacist in the Care of Patients with Chronic Pain. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2021; 10:33-41. [PMID: 33959490 PMCID: PMC8096635 DOI: 10.2147/iprp.s248699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Pharmacists across the healthcare continuum are well positioned to collaborate with patients to effectively manage their chronic pain. Evidence supports positive outcomes when pharmacists undertake these roles; however, there are barriers preventing uptake across the profession. This paper aims to expand awareness of the breadth of these roles, including pharmaceutical care provision, interprofessional collaboration, pain and medication education, support for patients in self-management and acceptance of responsibility to be culturally responsive and decrease stigma. Pharmacists are accessible healthcare professionals and can improve the care of patients with chronic pain.
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Affiliation(s)
- Laura Murphy
- Department of Pharmacy, University Health Network, Toronto, ON, Canada
| | - Karen Ng
- Toronto Academic Pain Medicine Institute, Toronto, ON, Canada
| | - Pearl Isaac
- Pharmacy Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jaris Swidrovich
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Maria Zhang
- Pharmacy Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Beth A Sproule
- Pharmacy Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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27
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Lacasse A, Pagé MG, Dassieu L, Sourial N, Janelle-Montcalm A, Dorais M, Nguena Nguefack HL, Godbout-Parent M, Hudspith M, Moor G, Sutton K, Thompson JM, Choinière M. Impact of the COVID-19 pandemic on the pharmacological, physical, and psychological treatments of pain: findings from the Chronic Pain & COVID-19 Pan-Canadian Study. Pain Rep 2021; 6:e891. [PMID: 33598594 PMCID: PMC7880148 DOI: 10.1097/pr9.0000000000000891] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Multimodal treatment is recognized as the optimal paradigm for the management of chronic pain (CP). Careful balance between pharmacological and physical/psychological approaches is thus desirable but can be easily disrupted. OBJECTIVES This study aimed at exploring the impact of the COVID-19 pandemic on pharmacological and physical/psychological treatments of CP. METHODS A Pan-Canadian cross-sectional web-based study was conducted between April 16th and May 31st 2020 among adults living with CP when the country was in the ascending slope of the first COVID-19 pandemic wave. RESULTS A total of 2864 participants shared their treatment experience (mean age: 49.7 years and women: 83.5%). Among medication users (n = 2533), 38.3% reported changes in their pharmacological pain treatment. The main reasons were as follows: (1) changes in pain symptoms, (2) lack of access to prescribers/cancellation of medical appointments, and (3) increased medication intake in compensation for stopping physical/psychological treatments because of the pandemic. Among participants who used physical/psychological pain management approaches before the pandemic (n = 2467), 68.3% had to modify their treatments or self-management strategies. Common reasons were lack of access to clinics/exercise facilities and the need to compensate for having to stop another type of physical/psychological treatment because of the pandemic-related public health safety measures. CONCLUSIONS Our study underlines the negative impact of the COVID-19 pandemic on access to pain relief, which is considered a fundamental human right. Results will help to justify resource allocation and inform the development of interventions to be better prepared for waves to come and future health crises.
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Affiliation(s)
- Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département d'anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Lise Dassieu
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Nadia Sourial
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Audrée Janelle-Montcalm
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l'Île-Perrot, QC, Canada
| | - Hermine Lore Nguena Nguefack
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Marimée Godbout-Parent
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | | | | | | | - James M. Thompson
- Department of Public Health Sciences, Queens University, Kingston, ON, Canada
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département d'anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
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28
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Choinière M, Peng P, Gilron I, Buckley N, Williamson O, Janelle-Montcalm A, Baerg K, Boulanger A, Di Renna T, Finley GA, Intrater H, Lau B, Pereira J. Accessing care in multidisciplinary pain treatment facilities continues to be a challenge in Canada. Reg Anesth Pain Med 2020; 45:943-948. [PMID: 33024007 DOI: 10.1136/rapm-2020-101935] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multidisciplinary pain treatment facilities (MPTFs) are considered the optimal settings for the management of chronic pain (CP). This study aimed (1) to determine the distribution of MPTFs across Canada, (2) to document time to access and types of services, and (3) to compare the results to those obtained in 2005-2006. METHODS This cross-sectional study used the same MPTF definition as in 2005-2006-that is, a clinic staffed with professionals from a minimum of three different disciplines (including at least one medical specialty) and whose services were integrated within the facility. A comprehensive search strategy was used to identify existing MPTFs across Canada. Administrative leads at each MPTF were invited to complete an online questionnaire regarding their facilities. RESULTS Questionnaires were completed by 104 MPTFs (response rate 79.4%). Few changes were observed in the distribution of MPTFs across Canada compared with 12 years ago. Most (91.3%) are concentrated in large urban cities. Prince Edward Island and the Territories still lack MPTFs. The number of pediatric-only MPTFs has nearly doubled but remains small (n=9). The median wait time for a first appointment in publicly funded MPTFs is about the same as 12 years ago (5.5 vs 6 months). Small but positive changes were also observed. CONCLUSION Accessibility to public MPTFs continues to be limited in Canada, resulting in lengthy wait times for a first appointment. Community-based MPTFs and virtual care initiatives to distribute pain services into regional and remote communities are needed to provide patients with CP with optimal care.
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Affiliation(s)
- Manon Choinière
- Department of Anesthesiology and Pain Medicine, Université de Montréal Faculté de Médecine, Montreal, Quebec, Canada .,Research Center, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Philip Peng
- Anesthesiology and Pain Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Anesthesiology, University Health Network-Western Hospital, Toronto, Ontario, Canada
| | - Ian Gilron
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.,Anesthesiology, Kingston General Hospital, Kingston, Ontario, Canada
| | - Norman Buckley
- Anestheiology, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Michael F. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Owen Williamson
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,JPOCSC Pain Management Clinic, Fraser Health Authority, Surrey, British Columbia, Canada
| | | | - Krista Baerg
- Pediatrics, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada.,Pediatrics, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Aline Boulanger
- Department of Anesthesiology and Pain Medicine, Université de Montréal Faculté de Médecine, Montreal, Quebec, Canada.,Pain Clinic, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Tania Di Renna
- Department of Anesthesiology and Pain Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.,Anesthesiology, Women's College Hospital, Toronto, Ontario, Canada
| | - Gordon Allen Finley
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.,Center for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Howard Intrater
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada.,Pain Clinic, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Brenda Lau
- Pain Medicine, Department of Anesthesia, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.,CHANGEpain Clinic, Vancouver, Quebec, Canada
| | - John Pereira
- Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Calgary Chronic Pain Center, Alberta Health Services, Edmonton, Alberta, Canada
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