36th Annual Scientific Meeting of the Canadian Pain Society: Abstracts
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A full-text version of the abstracts to be presented at the 36th Annual Scientific Meeting of the Canadian Pain Society is published online only. To view the full-text abstracts, go to www.pulsus.com Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a prevalent, refractory condition characterized by pain in the pelvic area and urinary frequency, largely unresponsive to medical interventions. The present study aimed to examine how catastrophizing and behavioural coping predict physical and mental Quality of Life (QoL) in this population. 175 patients from tertiary care clinics completed questionnaires. Demographics included age, ethnicity, education and employment status. Pain and symptoms were measured using the McGill Pain Questionnaire (SF-MPQ) and the Chronic Prostatitis Symptom Index (NIH-CPSI). Physical and mental QoL was measured using the Medical Outcomes Short Form 12-Item Health Survey (SF-12); Chronic Pain Coping Inventory (CPCI) measured use of behavioural coping strategies and Pain Catastrophizing Scale (PCS) measured catastrophic thinking. Hierarchical regression modelling was conducted to examine the unique effects of appraisals and coping on patient QoL outcomes. Psychosocial variables accounted for a significant amount of variance over and above demographic and medical variables for both physical (Δ R2 = 0.25, p <0.01) and mental (Δ R2 = 0.15, p <0.01) QoL. Guarding, resting, seeking social support and rumination were significant predictors of physical QoL, while resting and helpless catastrophizing were significant predictors of mental QoL. Catastrophic appraisals (rumination, helplessness) and behavioural coping strategies (guarding, resting and seeking social support) are predictive of poorer mental and physical QoL in men with CP/CPPS. The results indicate that these are variables of interest in patient outcomes, and they may be important targets for interventions aimed to improve patient QoL.
Workshop Objective: This Symposium, chaired by Karen Davis, will examine how neural networks represent individual differences in pain perception, attention, associated mood changes, and pain avoidance. Data from cutting edge imaging and modeling approaches, including dynamic functional connectivity, tractography, and graph theory, will shed light on the dynamic states of these representations, and how these may reflect pain sensitivities, coping, vulnerabilities and transitions to chronic pain states.
Learning Objectives: Understand the new, emerging theories of network organization and dynamics underlying acute and chronic pain. Understand how network dynamics variability represent potential sources of intersubject pain variability and vulnerabilities, and conversely how chronic pain may impact neural networks of pain. Understand concepts of pain motivation and learning models that underlie pain avoidance choices. Project ECHO (Extension for Community Healthcare Outcomes) is an evidence based model that provides high quality medical education for common and complex diseases through telementoring and co-management of patients with primary care clinicians. In a one to many knowledge network the ECHO model helps to bridge the gap between primary care clinicians and specialists by enhancing the knowledge, skills, confidence and practice of primary care clinicians in their local communities. As a result patients in rural and urban underserved areas may receive best practice care without long waits or having to travel long distances. Telementoring occurs through ongoing consultations via case-presentations during the videoconferences. The ECHO model was approved in 2014 by the Ministry of Health in Ontario for Chronic Pain and Opioid Stewardship. ECHO Pain provides pain education for primary care clinicians. The program improves pain assessment skills, opioid prescribing practices, confidence, and attitudes in a community of practice while providing no-cost continuing medical education. A new replication tool was developed by the UNM Project ECHO Pain team in collaboration with the US Army Medical Command to ensure a high fidelity replication of the model. The “Hub Readiness Replication Model” was created to: 1-Ensure fidelity of the Four-Point ECHO Model, 2-Create consistency in the replication process, and 3- Be adaptable for use by all ECHO disease-specific clinical and non-clinical ECHO replication programs. This replication tool has the potential to improve the fidelity of ECHO replication efforts around the world.
POSTER AIM: The purpose of this chart review is to better identify symptoms of Ehlers Danlos Syndrome Hypermobility Type (EDS HT) in order to inform the development of a diagnostic questionnaire for future research and improve treatment options available for this condition.
METHODS: Forty-eight patient charts were reviewed retrospectively. Patients suspected of having EDS HT were diagnosed based on history and clinical signs and symptoms. Demographic information, hallmark characteristics of EDS, and EDS-associated symptoms and diagnoses were extracted from patient charts.
RESULTS: Ninety-four % of patients presenting to the clinic with EDS were female and most have not yet received genetic testing (85.4%). The majority of patients did not have a formal documented Beighton score (64.6%) although hypermobility was common (88.2%) among those who had a score (35.4%). Some of the most frequently reported symptoms included gastrointestinal (77.1%), cardiac (35.4%), musculoskeletal (100%), cutaneous (37.5%), bladder (52.1%), and vulvovaginal (41.7%). Additional prevalent symptoms included psychiatric (70.8%), fatigue (64.6%), persistent headaches (79.2%), and sleep disturbances (85.4%). Postural orthostatic tachycardia syndrome (8.3%) and joint dislocations (29.2%) were less commonly identified.
CONCLUSIONS: Although EDS HT is characterized by the absence of typical cutaneous manifestations, these symptoms were common in our sample. While one of the primary sources of chronic joint pain is thought to be recurrent joint dislocations, these symptoms were not commonly reported. This study highlights the challenge of diagnosing EDS HT and will guide future prospective research initiatives and the development of a diagnostic tool to facilitate early detection and prompt referral to specialists.
POSTER AIM: Although instruction in pacing is typically included in the treatment of chronic pain, studies suggest that individuals encounter difficulty employing pacing. Pacing may require individuals to adopt an approach to activities that is perceived as less satisfactory than previous approaches. Self-compassion, which includes accepting personal shortcomings and difficulties without critical judgment, may be an important quality that enables individuals to better tolerate pacing and use it more frequently. The present study examined the relationships between self-compassion, perceived barriers to pacing, and pacing among individuals with chronic pain.
METHODS: Sixty-eight individuals with chronic pain attending a pain self-management program completed measures of self-compassion (Self-Compassion Scale), perceived obstacles to pacing (Pacing Obstacles Questionnaire), and pacing (Patterns of Activity - Pain Pacing Scale) prior to treatment.
RESULTS: Results indicated that self-compassion was significantly related to both perceived obstacles to pacing and pacing. Individuals who evidenced greater self-compassion identified fewer obstacles to pacing and a greater use of pacing. Regression analyses indicated that self-compassion and perceived obstacles to pacing both contributed independently to the prediction of pacing. Individuals who were less likely to negatively judge themselves for their perceived shortcomings and less likely to perceive shortcomings as unique to them identified fewer barriers to pacing.
CONCLUSIONS: The present results suggest that increased self-compassion may assist individuals to better accept the challenges associated with pacing and more frequently employ it as a pain management strategy. Specifically, a willingness to accept personal limitations without self-criticism and to view these limitations as being shared with others may facilitate the use of pacing.
POSTER AIM: The goal of this initiative is to improve perioperative pain management by developing a process for early identification of the highly opioid tolerant patient.
METHODS: Ethics Committee approval was not required as this project was considered a Quality Assurance initiative. A resource tool was created to assist pre-admission nurses and anesthesiologists in consistently identifying individuals who met the definition of high grade opioid tolerance. Once patients were identified, the Acute Pain Service Case Management Coordinator began a new process of completing a comprehensive pain assessment in the preoperative setting. Assessment findings formed the basis of a holistic pain management plan that included collaboration between nursing and anesthesiologist members of the Acute Pain Service.
RESULTS: A consistent definition of high grade opioid tolerance among the multidisciplinary team. The adoption of the acronym H.O.T., (highly opioid tolerant) was established leading to further consistency with the definition and a familiarity with the initiative now known as the “H.O.T. project”. The preoperative comprehensive pain assessment by APS nurses has allowed the patient to be engaged, set realistic goals and experience reduced anxiety through a clearer understanding of what to expect for pain management in the postoperative setting. Enhanced communication has resulted in an individualized pain management plan of care.
CONCLUSIONS: The collaboration among health care team members has resulted in multidisciplinary approach to opioid tolerant perioperative pain management. The results of this initiative support future research and strategies that provide better care to patients who meet the definition of highly opioid tolerant.
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