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 Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a chronic pelvic pain syndrome characterized by cycling pain localized to the bladder and urologic symptoms of urgency, frequency, and dysuria (Nickel et al., 2009). There is an established relationship between catastrophizing and pain among IC/BPS patients (Tripp, Nickel, et al., 2006; Tripp et al., 2012). The present study aimed to identify the mechanisms through which catastrophizing predicts pain using a moderated mediation model. 341 women diagnosed with IC/BPS were recruited from tertiary care urology clinics and completed questionnaires (McGill Pain Questionnaire, Pain Catastrophizing Scale, Brief Chronic Pain Coping Inventory, Centre for Epidemiologic Studies Depression Scale). A moderated mediation model was examined to test if illness-focused behavioural coping strategies mediated the relationship between catastrophizing and affective pain, and if depression moderated this effect. Catastrophizing had a direct effect on affective pain, β=0.40, SE=0.054, p<0.001. Illness-focused behavioural coping was a significant mediator of the catastrophizing-affective pain relationship, β=0.061, SE=0.019. The mediating effect of illness-focused coping was significantly stronger for participants with greater depressive symptomology (β=0.09, SE=0.031) in comparison to participants with less depressive symptoms (β=0.04, SE=0.016); index of moderated mediation was 0.049 (95% confidence interval: 0.0004 to 0.11). The relationship between catastrophizing and affective pain is partially mediated by illness-focused behavioural coping strategies. Importantly, this mediating effect is significantly stronger for individuals with greater depressive symptomology (i.e., moderated model). These findings have the potential to improve programs for the management of IC/BPS pain through targeting specific psychosocial factors associated with pain. Interventional procedures for treatment of chronic non-cancer pain are often used both independently and within the context of multimodal therapy. Apart from procedures involving implantable therapies (neuro-stimulation and intrathecal pumps), techniques for relieving chronic pain can be classified as neuraxial and peripheral. Neuraxial procedures include injections of local anesthetics with or without steroids in the epidural space for degenerative spine disease and in arthritic facet and sacroiliac (SI) joints, diagnostic and therapeutic selective nerve root blocks for herniated intervertebral discs compressing spinal nerve roots, diagnostic and definitive (radiofrequency ablation) procedures involving nerve supply to facet and SI joints. Peripheral procedures include injections of local anesthetics with or without steroids around injured peripheral nerves and into major and minor arthritic limb joints. Current evidence on efficacy and effectiveness of these procedures will be presented at the symposium and recommendations based on this evidence will be discussed. Limitations of available evidence and controversies regarding recommendations on use of these procedures will be also presented. Research and medical information has traditionally been delivered exclusively from healthcare professionals or through traditional media channels (i.e., television). New social media platforms such as Facebook and Twitter are seeking to change this as complex medical information in the form of articles, website links, videos, as well as online conversations are now taking place and are shared across vast online networks of followers. Creating a social media account is easy but maintaining an active and engaged network can be challenging. This presentation will discuss five “Dos” and five “Don’ts” for researchers, healthcare professionals and organizations with, or looking to create, social media platforms. These tips will help with: creation of strong content, effective distribution of content, and consistent end-user engagement. Using the case example a new health-focused social media platform, @CardiacPainRC, we will discuss these tried and tested methods and lend advice about how to strengthen online knowledge platforms and how to drive end-user traffic and engagement, effectively.
POSTER AIM:
Total knee arthroplasty (TKA) is a painful surgery but it requires early mobilization for successful joint function. Therefore, effective pain management is essential for rehabilitation. Multimodal analgesia including: spinal anesthetic, nerve blocks, periarticular infiltration, opioids, and co-analgesics have been shown to effectively manage post-operative pain. One of the criticisms of nerve block is the potential to impair quadriceps muscle strength which limits mobility. Both adductor canal (AC) and peri-articular infiltration (PI) have been shown to manage pain without impairing motor function. However, it is unclear which technique is most effective. The purpose of this 3 arm trial was to examine the effect of both AC+PI vs AC vs PI. The primary outcome was pain on walking at post-operative day (POD)1.
METHODS:
Following Ethics Board approval, patients undergoing unilateral TKA were approached to participate in this trial. Inclusion criteria included: 18 years or older, ASA I–III, able to speak and read English. Patients were excluded if they had a contraindication to regional anesthesia/local anesthetics, chronic pain not related to their knee, were using opioids for 3 months or longer, or had a peripheral neuropathy. The sample size was calculated based on the primary outcome, and with a α0.5 and 15% attrition rate, a sample of 159 participants was required. Eligible and consenting participants were randomized into 1 of the 3 groups. On the day of surgery, the participant was admitted to the ‘block room’ where they received either AC block with 30 mL of 0.5% Ropivicaine or sham block. PI was performed intra-operatively with a 110 mL solution of Ropivacaine 300 mg, morphine 10 mg, ketorolac 30 mg, in normal saline. Those patients randomized to AC only received normal saline.
RESULTS:
A total of 159 participants consented and 144 completed the trial. The mean age was 67 years, and 63% were female. On POD1 participants who received AC+PI reported statistically lower pain on walking (3.3) as compared to those who received AC (6.2) or PI (4.9). Participants who received AC reported statistically higher pain scores at rest and knee flexion as compared to those who received AC+PI or PI. On POD2 participants who received AC+PI reported statistically less pain on walking (3.3), as compared to those who received AC (6.2) or PI (4.9). On POD2 there was no difference between the groups for pain at rest, or flexion. Participants who received AC used more IV PCA on POD 0. There was no difference between the groups regarding distance walked.
CONCLUSIONS:
Participants who received both AC + PI reported statistically less pain on walking on POD1 and 2. There was no difference between the groups on distance walked, however, this was only reported 1 time per day and did not capture distance walked over a 24 hour period if the participant walked multiple times.
POSTER AIM:
Chronic non-cancer pain is a significant health problem in Canada. Little organized information exists on services currently available for the treatment of chronic non-cancer pain (CNCP) across Ontario. The aim of the study is to document teaching hospital-based pain clinic structures and services offered for management of CNCP in Toronto.
METHODS:
Semi-structured, personal interviews with 4 key informants (clinic directors or one of his/her close collaborators), in charge of CNCP service delivery in 4 teaching hospitals were conducted. Each interview asked broad questions concerning infrastructure, research and professional development education. Strengths and barriers associated with each program were identified. Key informant interviews were audio taped, transcribed, and imported into spread-sheets for thematic analysis.
RESULTS:
Preliminary analysis revealed that all clinics provided some form of multidisciplinary services by having a core team comprised of a pain physician, a nurse, and a psychologist/or physical therapist at minimum. The time between an accepted referral and consultation was approximately 2–6 months. If offered treatments are unsuccessful patients are discharged into community care, with no further follow-up. Common barriers for CNCP management include lack of resources (i.e. staff, space and funding), and need for systematic training, collaboration and research.
CONCLUSIONS:
The present study, first to our knowledge, demonstrated that multiple factors compromise the ability to provide comprehensive pain services even in academic pain clinics in Toronto. The study findings are important for administrators and policy makers interested in addressing the serious problem of chronic pain in Toronto and Ontario in general.
POSTER AIM:
The aim of this study was to update the results of 2006 literature review that evaluated self-reported pain intensity measures for children and adolescents.
METHODS:
Two separate searches were conducted in six databases for: (1) self-reported measures of single-item ratings of pain intensity and (2) Numerical Rating Scale measures, for children aged 3–18 years. Measures were excluded if they were disease specific and previously included in the 2006 review. Results of the search were divided among eight reviewers to screen for relevance. Two reviewers then assessed the potentially relevant studies for inclusion independently. Disagreements that arose were resolved by discussion including a third reviewer.
RESULTS:
The overall database search resulted in 13,346 articles found (after duplicate removal). Screening for eligibility resulted in four new single-item measures to be included in the updated review: (1) Numerical Rating Scale, (2) Verbal Numerical Rating Scale, (3) Computer Face Scale and (4) Colour Analogue Scale. The four scales were determined to be psychometrically sound in terms of reliability, feasibility and responsiveness, but had differences in interpretability and feasibility. Similar to the previous review, no single scale was found to be optimal for use with all types of pain and across age groups.
CONCLUSIONS:
This update in self-report pain intensity measures can be used to: (1) make recommendations on pain intensity measures to be used in the assessment of pediatric acute, recurrent, and chronic pain treatment strengthen and (2) guide future research in the use of pain scales for the pediatric population.
POSTER AIM:
The purpose of this study is to describe the frequency, incidence and severity of acute, abdominal postoperative pain as well as the incidence and prevalence of chronic pain in the TWH Bariatric surgery population. Studies have shown that surgical weight loss intervention is an effective tool in treating obesity and improving obesity-related medical comorbidities. The University of Toronto Collaborative Bariatric surgery program performs two types of laparoscopic bariatric surgeries: Roux-en-Y gastric bypass and vertical sleeve gastrectomy. There are several inherent challenges with providing effective postoperative pain management in this patient population. Due to a paucity of literature in this area, further research is warranted in order to inform appropriate postoperative pain management strategies.
METHODS:
This is a longitudinal, descriptive correlational study. Fifty consecutive Toronto Western Hospital (TWH) patients who have undergone bariatric surgery have been asked to complete the Brief Pain Inventory (BPI) preoperatively and at 6 months postoperatively. Verbal Numerical Pain Rating Scores, patient satisfaction with pain management, and analgesic use was obtained on postoperative day 0, 1, at discharge and 48–72 hrs and 6 months postoperatively. Data will analysed for demographic and dependent variable frequencies and correlations.
RESULTS:
Preliminary results show a high degree of patient satisfaction with postoperative pain management, with a trend towards decreased rest and movement-related pain over time. A trend towards decreased average chronic pain severity and pain interference scores at 6 months postoperatively was noted.
CONCLUSIONS:
It is anticipated that results will help to inform the assessment and management of acute and chronic pain in Bariatric Surgery patients.
