A Review of the Application of Myofascial Release Therapy in the Treatment of Diseases.

Myofascial release (MFR) therapy is widely used in clinical practice to treat various musculoskeletal and pain-related conditions. However, there is a lack of comprehensive reviews that systematically evaluate its effectiveness across different medical conditions, leading to inconsistent applications and understanding of its therapeutic potential. This review aims to synthesize the current applications of myofascial release therapy in the treatment of various diseases, highlighting its efficacy and identifying areas where further research is needed. The review covers the application of myofascial release therapy in conditions such as chronic pain, fibromyalgia, post-surgical recovery, and neurological disorders. It evaluates the outcomes of existing studies, identifies gaps in the literature, and discusses the mechanisms through which myofascial release exerts its effects. Additionally, the review provides insights into the limitations of current research and suggests directions for future studies to enhance the clinical application of myofascial release therapy.

An in-Depth Exploration of Consumer and Consumer Representative Views on Chronic Pain Management in Australia: A Key Informant Interview Study.

Chronic pain affects millions of Australians. Despite guidelines recommending non-pharmacological approaches as the first line treatment, opioid medications remain among the most common treatments. This study interviewed consumers and consumer representatives (i.e., representatives of peak pain advocacy organizations in Australia) to gain first-hand perspectives on chronic pain treatment in Australia. Individual semi-structured Key Informant Interviews (KIIs) with three consumers and three representatives were undertaken. Interviews were transcribed, and thematic analysis applied. Results showed that consumers and consumer representatives identified critical treatment access barriers. Another shared theme related to overarching principles of care, with sub-themes pertaining to the need for an interdisciplinary approach and pain education. A further shared theme focused on typical medical interventions, with one shared subtheme regarding the benefits and drawbacks of pain medications. Both groups highlighted the importance of a biopsychosocial approach with consideration of mental health, particularly related to perceived stigma and comorbidities. These findings highlight that chronic pain remains both undertreated and inadequately treated in Australia. There is a critical need to use novel approaches to overcome access barriers and stigma, and to advance precision medicine to match patients to the treatment most likely to be of benefit as early as possible in their journey.

Older and Better: A Narrative Review of Successful Aging and Adaptation to Pain in Late Life.

"Invariably, the self-assessed QoL was far better than I, as a physician, would have anticipated from the diseases and disabilities that you reported." -Ben Eiseman, MD, based on a survey of his octogenarian Yale University classmates. BACKGROUND: Chronic pain control is a high priority for the elderly; it is one of the most frequently encountered medical problems in this group. Chronic pain affects 60%-75% of people aged 65 years and older. Chronic pain's prevalence is even higher in those living in assisted living or nursing homes. Based on epidemiological data, the prevalence of chronic pain is directly proportional to age and is especially so in women. At least one in 3 patients over age 65 report significant ongoing pain that is often inadequately treated. Despite this high prevalence of chronic pain in older persons, aging research sheds light on how this suffering may be reduced. Healthy aging is not an oxymoron. Successful aging and adaptation to chronic pain involve similar medical, temperamental, behavioral, and cultural factors. Older patients with chronic pain face well-documented cultural bias, fear, and clinical pessimism; but adaptive coping is a realistic expectation. OBJECTIVES: This narrative review aims to summarize the available literature on strategies used by older persons to optimize adaptation to late-life pain. STUDY DESIGN: This is a narrative review of a PubMed literature search 1947 to March 4, 2024. METHODS: A PubMed literature search covering years 1947 to March 4, 2024 was performed using permutations of the search terms pain, chronic pain, persistent pain, aging, elderly, and coping. Relevant articles were also obtained from careful review of the references in articles identified in the search. RESULTS: I summarized the available literature on strategies used by older persons to optimize adaptation to late-life pain. There are distinct differences between older persons and younger persons in the strategies they use to cope with chronic pain. Furthermore, I identified significant overlap between strategies and actions used by older persons to cope with pain and those strategies and actions used to successfully adapt to the aging process; these commonalities demonstrate a linkage of these adjustment processes and have clinical utility. Also presented are 2 cases that demonstrate the relevance of these factors for treating elderly patients with chronic pain. LIMITATIONS: The literature search was limited to PubMed, which excluded psychology databases. CONCLUSIONS: Chronic pain is common in the elderly and is not adequately treated. Data indicate that older persons can benefit from guidance toward distinct attitudes and actions they can employ to cope with persistent pain. Epidemiologic and aging literature describe attitudes and behaviors that facilitate health and wellbeing during aging. Data from gerontology and from research on chronic pain in elderly patients converge upon factors that are common to better adaptation to both aging and late-life pain. I describe these common factors, which I categorize as treatment-factors, traits, attitudes, and actions. Two cases are presented to demonstrate these concepts.

Yoga as an Adjunctive Treatment for Chronic Low Back Pain: A Narrative Review.

BACKGROUND: Yoga has been recognized for its many mental and physical health benefits. A growing body of literature supports yoga's indication in chronic low back pain (CLBP) management. CLBP is a major public health concern, given its high rates of associated disabilities and large healthcare costs. A biopsychosocial approach has been deemed the most effective and appropriate management strategy for this condition. When alternative and comprehensive approaches for managing the complexity of CLBP are considered, yoga poses a safe, accessible adjunctive treatment option. OBJECTIVES: The goal of this review is to demonstrate, by highlighting yoga's benefits on mental and physical health and the pathophysiology associated with CLBP, that yoga is an effective form of CLBP management. Our other goal is to establish that yoga encompasses a biopsychosocial approach to managing CLBP. STUDY DESIGN AND METHODS: After thorough examination of the available published literature, this narrative review evaluated 24 articles examining yoga's benefits to CLBP patients. RESULTS: CLBP is associated with high rates of anxiety, depression, chronic stress, and pain catastrophizing. Numerous studies support yoga as an effective intervention for depression, anxiety, chronic stress, and pain catastrophizing, given yoga's effects on the sympathetic nervous system, endocrine system, and various neurotransmitters and brain regions, and improvements in these areas may ameliorate the clinical symptoms experienced by CLBP patients. Physically, symptoms experienced by those with CLBP include pain, impaired function and mobility, disability, fatigue, and medication dependence, all of which, according to the literature, yoga has been shown to improve. Additionally, the chronicity and persistence of low back pain are related to central and peripheral sensitization, and yoga may intervene in these pathways to minimize symptom propagation. LIMITATIONS: This review is not without limitations. The current literature lacks standardization regarding which yoga poses are safe, appropriate, and effective for CLBP patients, which limits the generalizability of yoga therapy. Additionally, few existing prospective trials study yoga in the management of CLBP. Though numerous randomized controlled trials (RCTs) are included in this review, most of the current literature details other reviews or analyses of RCTs, includes smaller sample sizes, and lacks long-term follow-up data. Furthermore, many of these studies include patients who have volunteered or self-selected to trial yoga therapy for their back pain, indicating inherent selection bias. CONCLUSION: Overall, the current management strategies for CLBP do not encompass an effective biopsychosocial approach, and an intervention such as yoga is a promising adjunctive treatment for the condition.

Single Institutional Cross-Sectional Phone Survey Study: Evaluation of Causes for Loss to Follow-up After Spinal Cord Stimulator Implantation.

BACKGROUND: Spinal cord stimulation (SCS) is often an option of last resort for patients with post-laminectomy syndrome or an alternative option for patients with complex regional pain syndrome, chronic nonsurgical low back pain, or painful diabetic peripheral neuropathy when conservative management has failed. Although SCS is a helpful option, it is not without complications that can frequently lead to explantation of the SCS device and dissatisfaction with the treatment. Furthermore, as with any technology, SCS has potential issues that may lead to patient frustration and ultimately result in patient noncompliance and lack of follow-up visits. OBJECTIVES: The goals of this study are to explore the magnitude of and reasons for patient loss to follow-up after SCS device implantation. STUDY DESIGN: A cross-sectional phone survey. SETTING: A tertiary-care academic hospital. METHODS: A cross-sectional phone survey was performed on 49 patients who were deemed lost to follow-up when they did not return to the clinic one month after being implanted with permanent SCS devices at Beth Israel Deaconess Medical Center. Patients were administered an institutional review board-approved questionnaire exploring their reasons for not returning to the clinic. RESULTS: Over a 5-year period, 257 patients underwent full implantation of an SCS device. Of the 49 patients lost to follow-up, 24 were able to be contacted, and they completed the questionnaire. Twenty of the patients continued to use the SCS device but were lost to follow-up for the following reasons: 58% (14/24) due to improvement of pain, 13% (3/24) due to minimal improvement in pain control, 4% (1/24) due to other urgent health conditions, and 8% (2/24) due to patient noncompliance and missing follow-up appointments (4/24). Four patients discontinued using the SCS device after an average of 1.5 years +/- one year, 12% (3/24) due to inadequate pain control and 4% (1/24) due to inability to recharge the device (1/24). Of these patients, 2 of the 4 contacted their SCS representatives for help with troubleshooting prior to discontinuation. None of the patients was explanted. LIMITATIONS: The main limitation of this study was the incompletion rate, which was 51.0% (25 out of 49 patients). CONCLUSIONS: This paper, the first cross-sectional study of loss to follow-up among patients who are implanted with SCS devices, identifies that up to 19% of patients are quickly lost to follow-up after implantation. Only half of the patients in this study could be reached, with most successfully using their device for meaningful pain control, but a substantial number of patients likely required additional device optimization for pain relief.

Peripheral Nerve Stimulation Using High-frequency Electromagnetic Coupling (HF-EMC) Technology to Power an Implanted Neurostimulator With a Separate Receiver for Treating Peripheral Neuropathy.

BACKGROUND: Peripheral neuropathy is estimated to be prevalent in up to 12% of the population, increasing to 30% in older demographics. This makes peripheral neuropathy one of the most common neurological diseases in the United States. OBJECTIVES: This retrospective study aims to report on the efficacy and safety of peripheral nerve stimulation (PNS) on the treatment of peripheral neuropathy in a commercial setting. STUDY DESIGN: This was a retrospective study. A chart review was conducted for all eligible study patients. SETTING: This study was conducted at the Advanced Spine and Pain Center in San Antonio, a center focused on physical medicine and rehabilitation, pain management and advanced interventional procedures that effectively ease pain. METHODS: From September 2018 through July 2022, a total of 63 consecutive patients with peripheral neuropathy who presented with chronic pain symptoms originating from the shoulder, hip, knee, ankle, and groin were trialed in this study. All patients were required to be at least 18 years old. These patients underwent PNS therapy via implantation of the Freedom® PNS System (Curonix LLC) in order to treat their chronic pain related to or due to peripheral neuropathy from various peripheral nerve origins. RESULTS: The mean Numeric Rating Scale (NRS-11) score of 63 patients at baseline was 7.24 (SD, 1.80). At 2-3 weeks postimplantation, the mean NRS-11 score decreased to 3.43 (SD, 2.38). A total of 53 out of the 63 patients reported a reduction in their NRS-11 score at the 2-3 week follow-up. A total of 24 patients completed a long-term follow-up. The mean follow-up time was 763.13 days (SD, 428.42); all patients had their PNS system permanently implanted for at least 8 months (range, 255-1,592 days). LIMITATIONS: This was a retrospective study investigating the efficacy and safety of the Freedom® PNS System in patients with peripheral neuropathy. We were limited to the data available in the patient charts. CONCLUSION: PNS effectively treats chronic pain due to peripheral neuropathy for patients who have failed other conservative treatments.

Open Surgical Implantation of Lumbosacral Dorsal Root Ganglion Stimulators for Chronic Pain: Analysis of Patient Outcomes and Operative Technique.

OBJECTIVE: Dorsal root ganglion (DRG) stimulator leads were designed to be placed percutaneously, yet open surgical placement via laminectomy is an option. We present the largest series to date of surgically-placed DRG stimulators and the first series where open surgical implantation was the chosen technique and not a salvage procedure. METHODS: A retrospective review of a prospective database of DRG implants identified 17 patients who had open lumbosacral DRG lead placement performed by a single surgeon (NDT) between October 2021 and April 2023. Descriptive statistics, fluoroscopy exposure times, and complications were reported. The window of data collection was 1 month pre-operatively to 12 months post-operatively. Phone interviews were conducted to collect information on pain outcomes and patient satisfaction. RESULTS: We identified 17 patients (12 women, 5 men) who had lumbosacral DRG placement. Phone interviews were conducted for 10/17 patients, with mean follow-up of 11.9 months. 53% reduction in mean pain score was achieved (n=10, p<0.001). There were no infections, hematomas, or symptomatic lead migrations. 1/17 experienced a superficial dehiscence and 2/17 had an intra-operative repairable durotomy with no post-operative sequelae. Mean fluoroscopy time per lead was 15.4±9.9s (n=10). CONCLUSION: Open DRG lead placement via laminotomy/laminectomy is reported as a salvage procedure but may have comparable safety and efficacy profile to percutaneous implantation when utilized as the primary implantation method. Before establishing open DRG as an alternative permanent implantation method, more studies are needed to determine whether such benefits as less migration outweigh the risks of a more invasive implantation procedure.

The Combined Relationship of Prescription Drug Monitoring Program Enactment and Medical Cannabis Laws with Chronic Pain-Related Healthcare Visits.

BACKGROUND: U.S. state electronic prescription drug monitoring programs (PDMPs) are associated with reduced opioid dispensing among people with chronic pain and may impact use of other chronic pain treatments. In states with medical cannabis laws (MCLs), patients can use cannabis for chronic pain management, reducing their need for chronic-pain related treatment visits and moderating effects of PDMP laws. OBJECTIVE: Given high rates of chronic pain among Medicaid enrollees, we examined associations between PDMP enactment in the presence or absence of MCL on chronic pain-related outpatient and emergency department (ED) visits. DESIGN: We created annual cohorts of Medicaid enrollees with chronic pain diagnoses using national Medicaid claims data from 2002-2013 and 2016. Negative binomial hurdle models produced adjusted odds ratios (aOR) for the likelihood of any chronic pain-related outpatient or ED visit and incident rate ratios (IRR) for the rate of visits among patients with ≥ 1 visit. PARTICIPANTS: Medicaid enrollees aged 18-64 years with chronic pain (N = 4,878,462). MAIN MEASURES: A 3-level state-year variable with the following categories: 1) no PDMP, 2) PDMP enactment in the absence of MCL, or 3) PDMP enactment in the presence of MCL. Healthcare codes for chronic pain-related outpatient and ED visits each year. KEY RESULTS: The sample was primarily female (67.2%), non-Hispanic White (51.2%), and ages 40-55 years (37.2%). Compared to no-PDMP states, PDMP enactment in the absence of MCL was not associated with chronic pain-related outpatient visits but PDMP enactment in the presence of MCL was associated with lower odds of chronic pain-related outpatient visits (aOR = 0.81, 95% CI:0.71-0.92). PDMP enactment was not associated with ED visits, irrespective of MCL. CONCLUSIONS: During a period of PDMP and MCL expansion, our findings suggest treatment shifts for persons with chronic pain away from outpatient settings, potentially related to increased use of cannabis for chronic pain management.

Interdisciplinary pain program participants with high catastrophizing scores improve function utilizing enriched therapeutic encounters and integrative health techniques: a retrospective study.

Introduction: Pain catastrophizing describes helplessness, rumination, and magnification of a pain experience. High pain catastrophizing is an independent risk factor for disability, pain severity, inadequate treatment response, chronicity, and opioid misuse. Interdisciplinary pain programs (IPPs) are beneficial and cost-effective for individuals with chronic pain, but their functional impact on individuals with high pain catastrophizing is not well established. The emerging field of placebo studies suggests that patient-provider relationships, positive treatment expectations, and sociobiologically informed care trigger physiological responses that may enhance therapeutic interventions. Methods: In this retrospective observational cohort study, we compared admission and discharge data for 428 adults with high-impact chronic pain (mean 8.5 years) who completed the Spaulding-Medford Functional Restoration Program (FRP). The interdisciplinary FRP team of physiatrists, behavioral health clinicians, physical therapists, and occupational therapists specializes in evidenced-based conventional rehabilitation, integrative health, and pain psychoeducation via enriched therapeutic encounters, fostering collaboration, validation, trust, self-efficacy, and positive expectations. Clinical outcome measures included the Canadian Occupational Performance Measure (COPM) assessing functional performance (COPM-PS) and satisfaction with function (COPM-SS), the Pain Numeric Rating Scale (NRS), the Pain Catastrophizing Scale (PCS), and the Patient Health Questionnaire-9 (PHQ-9). Results: FRP participants with clinically elevated catastrophizing at baseline (PCS ≥30, mean PCS 39) achieved statistically significant improvements in function (mean delta -2.09, CHI2 = 15.56, p < 0.001), satisfaction with function (COPM-SS mean delta -2.50, CHI2 = 7.42, p = 0.007), pain (NRS mean delta 2.7), mood (PHQ-9 mean delta 1.87, p = 0.002), and catastrophizing (PCS mean delta 4.16, p < 0.001). Subgroup analysis revealed racial disparities in pain scores, and exploratory analysis showed a trend toward reducing opiate consumption. Discussion: Despite the known association of adverse outcomes with high catastrophizing, FRP participation was associated with increased productive engagement, reduced pain, reduced maladaptive thought processes, and improved mood. Although causation and efficacy cannot be established from a retrospective design, this is the first study to identify functional improvement in patients with high-impact chronic pain and clinically relevant high pain catastrophizing who participate in an IPP combining conventional and complementary rehabilitation with psychoeducation. These enriched therapeutic encounters may enhance the treatment process by promoting trust, empathy, collaboration, and beneficial reframing of patients' experiences, expectations, and goals.

Anatomical landmarks and procedure technique of Levator Scapulae Plane Block (LeSP block): Case report: Ultrasound-guided block of the superficial, deep and distal planes of the levator scapulae muscle for treatment of shoulder girdle myofascial pain.

Neck pain is a prevalent issue associated with musculoskeletal disorders. This study describes the interfascial Levator Scapulae Plane Block (LeSP Block) technique, using ultrasound guidance for local anesthetic administration to treat chronic neck pain. Two patients, 1 77-year-old female and 1 50-year-old female, underwent the LeSP Block. Immediate postprocedure pain relief was achieved in both, with 1 patient experiencing complete pain remission (VAS = 0) and the other showing significant improvement (VAS = 2) after 30 days. The LeSP Block demonstrated effectiveness and ease of use, suggesting its inclusion in pain management strategies for shoulder girdle and scapular pain. Further anatomical studies aimed at improving the anatomical description of the accessory spinal nerve are recommended to refine the technique.

Edible cannabis for chronic low back pain: associations with pain, mood, and intoxication.

Introduction: Cannabis, commonly known for both therapeutic and intoxicating effects, is gaining accessibility on legal markets and traction as a potential alternative therapy for pain mediation, particularly in those suffering from chronic low back pain. However, the effectiveness in this population of legal market forms of cannabis, particularly commonly used edibles, is unknown. Methods: Therefore, this study utilized a naturalistic prospective design where participants with chronic low back pain with intentions to initiate cannabis use for treatment were recruited and self-selected edible cannabis products containing varying amounts of delta- 9 tetrahydrocannabinol (THC) and cannabidiol (CBD). Products were categorized as CBD-dominant, THC-dominant, or combined THC and CBD (THC + CBD). Results: 249 participants [140 female (56.62%), mean (SD) age of 46.30 (16.02), 90% White] were tracked over 2 weeks of ad libitum use and assessed during a naturalistic acute cannabis administration session on changes in pain, mood, and subjective drug effects. During acute administration, a significant correlation between THC dose and short-term pain relief was found, suggesting that higher THC doses were associated with greater pain reduction (p < .05). In addition, THC was associated with higher levels of subjective cannabis drug effects (p < .001), regardless of whether CBD was also in the edible product. Acute CBD dose was primarily associated with short-term tension relief (p < .05); however, there were no associations between CBD dose and acute pain. Over the 2-week ad libitum administration period results suggested pain reductions across participants using all forms of cannabis. However, trends suggested that more frequent use of CBD-dominant edible cannabis may be associated with greater reductions in perceived pain over the 2-week observation period (p = .07). Discussion: These findings support the short-term analgesic effects of THC and anxiolytic effects of CBD and further suggest that orally-administered THC and CBD should continue to be evaluated for the potential to provide both acute and extended relief from chronic low back pain. Clinical Trial Registration: https://clinicaltrials.gov/study/NCT03522324?locStr=Boulder,%20CO&country=United%20States&state=Colorado&city=Boulder&cond=chronic%20low%20back%20pain&intr=Cannabis&rank=1, identifier NCT03522324.

The Pain Descriptors Used by Individuals with Musculoskeletal Pain from Northern India.

Background: Chronic pain is a common health problem worldwide that results in significant costs to society and has negative impacts on the individuals with chronic pain. In order to study and treat pain, valid and reliable pain assessment is necessary, including assessment of pain quality. However, all of the most commonly used measures of pain quality were developed in Western countries. Evidence has shown that some of these measures are not content valid for use in non-Western countries. Moreover, it remains unclear which pain descriptors are universal across people from different countries who speak different languages, and which are specific to individuals from a particular country or even from a particular region within one country. Aim: The current study sought to: (1) identify the number and frequency of words used by native speakers of Hindi in northern India to describe their pain; (2) compare the rates of descriptor use in these individuals with samples of individuals from Nepal and the USA; and (3) investigate the content validity of the most commonly used pain quality measures for measuring pain in this Hindi-speaking population. Methods: Two hundred and forty individuals with chronic musculoskeletal pain who speak and understand Hindi were asked to describe their pain. Results: The results showed overlap as well as differences in the words used to describe pain with samples of individuals with pain from other countries. Moreover, none of the pain quality measures examined were found to be content valid in the Hindi-speaking sample, suggesting that these measures need to be adapted to assess pain quality in this population. Conclusion: The study findings confirm the conclusion that pain quality measures developed in one country or in one pain population are not necessarily valid for assessing pain quality in a population from another country. The findings also suggest the possibility that a measure could be developed which would allow for more valid assessment of pain quality in individuals with pain from different countries.

Spinal Cord Stimulator Implantation for Complex Regional Pain Syndrome in Patient With Extensive Vertebral Surgical History: A Case Report.

Spinal cord stimulation (SCS) has emerged as a novel therapeutic option for refractory complex regional pain syndrome (CRPS). However, SCS placement is often complicated by a prior history of surgical manipulation and hardware implantation along the spinal column. Through this case exploration, we aim to expand the technical approach to SCS implantation in CRPS and encourage further research into innovative approaches for this treatment modality. Our patient is a 61-year-old female with a past medical history of bilateral C7 cervical pedicle fracture status and extensive surgical manipulation, including cervical laminectomy and hardware placement along the cervical spine. The development of CRPS refractory to conventional therapies complicated her course. We obtained non-contrast computed tomography (CT) to confirm intact lamina in vertebral levels below C3 and proceeded with the SCS trial with successful lead placement up to C5. Despite prior surgical manipulation of the vertebral spine hindering our ability to access the ideal C2 level, we were able to achieve significant coverage up to the C5 level. Obtaining non-contrast CT preoperatively and carefully assessing the epidural space patency were integral to our ability to assess the feasibility of lead placement in a patient with extensive hardware. Through this approach, we are able to offer SCS to patients who would otherwise be precluded from this modality.

Chronic pain experiences of immigrant Indian women in Canada: A photovoice exploration.

Background: Over the past two decades, the prevalence of chronic pain has significantly increased globally, with approximately 20% of the world's population living with pain. Although quantitative measures are useful in identifying pain prevalence and severity, qualitative methods, and especially arts-based ones, are now receiving attention as a valuable means to understand lived experiences of pain. Photovoice is one such method that utilizes individuals' own photography to document their lived experiences. Aims: The current study utilized an arts-based method to explore immigrant Indian women's chronic pain experiences in Canada and aimed to enhance the understanding of those experiences by creating a visual opportunity for them to share their stories. Methods: Twelve immigrant Indian women captured photographs and participated in one-on-one interviews exploring daily experiences of chronic pain. Results: Women's photographs, and description of these photographs, provided a visual entry into their lives and pain experiences. Three themes emerged from our analysis: (1) bodies in pain, (2) traversing spaces including immigration, and (3) pain management methods. Findings revealed that women's representations of pain were shaped by a clash between culturally shaped gender role expectations and changing gender norms due to immigration processes. The use of photovoice visually contextualized and represented pain experiences, proving to be a valuable tool for self-reflection. Conclusions: This research uncovers the multifaceted nature of chronic pain and identifies the influence of immigration, gender, and social relations on the exacerbation of pain in immigrant Indian women.

Contexte : Au cours des deux dernières décennies, la prévalence de la douleur chronique a considérablement augmenté au niveau mondial, alors qu'environ 20 % de la population mondiale vit désormais avec la douleur. Bien que les mesures quantitatives soient utiles pour déterminer la prévalence et la sévérité de la douleur, les méthodes qualitatives, en particulier celles basées sur les arts, sont désormais considérées comme un moyen précieux de comprendre les expériences vécues de la douleur. La méthode Photovoice, qui utilise les photographies prises par les individus pour documenter leurs expériences vécues, est l'une de ces méthodes.Objectifs : Cette étude a utilisé une méthode basée sur les arts pour explorer les expériences de douleur chronique vécues par des femmes immigrantes d'origine indienne au Canada. Elle visait à améliorer la compréhension de ces expériences en leur donnant l'occasion de partager leurs histoires.Méthodes : Douze femmes immigrantes d'origine indienne ont pris des photos et ont participé à des entrevues individuelles portant sur leur expérience quotidienne de la douleur chronique.Résultats : Les photographies des femmes, ainsi que la description de ces photographies, ont permis d'entrer visuellement dans leur vie et leur expérience de la douleur. Trois thémes ont émergé de notre analyse : (1) les corps en souffrance, (2) la traversée des espaces, y compris l'immigration, et (3) les méthodes de prise en charge de la douleur. Les résultats ont révélé que les représentations de la douleur chez les femmes étaient façonnées par un conflit entre les attentes culturelles en matiére de rôle de genre et l'évolution des normes de genre due aux processus d'immigration. L'utilisation de la méthode Photovoice a permis de contextualiser et de représenter visuellement les expériences de la douleur, ce qui s'est avéré un outil précieux pour l'autoréflexion.Conclusions : Cette recherche met en lumiére la nature multifacette de la douleur chronique et révéle l'influence de l'immigration, du genre et des relations sociales sur l'exacerbation de la douleur chez les femmes immigrantes d'origine indienne.

Acceptability of the power over pain portal among patients awaiting tertiary care consultation: A qualitative study of patients' perceptions.

Objective: Chronic pain affects approximately 7.6 million Canadians and access to care remains an issue. The Power Over Pain (POP) Portal offers immediate access to evidence-based resources ranging from low- (e.g. education, self-management), to high- (e.g. individual counseling) intensity. We explored the POP Portal's acceptability, usability, and perceived usefulness among patients newly referred to a tertiary care pain clinic. Methods: We used a descriptive, qualitative approach with a prospective cohort of 60 adult patients recently referred to The Ottawa Hospital Pain Clinic. Patients were offered an orientation session and asked to participate in a seven-week follow-up interview. Data were thematically analyzed in an iterative process, whereby responses were reviewed and coded by two members of the research team. Results: Of the 60 patients referred to the POP Portal by clinic clerks, 45 participated in the orientation session, and 40 completed a four-week follow-up. All 40 patients had used the POP Portal and recommended that we continue to offer the POP Portal to patients awaiting care. We identified overarching themes of acceptability (five subthemes), usability (ten subthemes), accessibility (three subthemes), and patient value of the POP Portal (three subthemes). This includes (1) the POP Portal provides easy access to chronic pain resources; (2) the POP Portal is helpful in developing an understanding of chronic pain; and (3) improvements to the POP Portal are needed to increase usability and foster a user-friendly experience. Conclusions: The POP Portal offers accessible and diverse resources for people living with pain awaiting a tertiary care consultation; however, patients would like to see resources specific to diagnosis. Improvements are suggested to allow greater increase the POP Portal usability.

Persistent pain, long-term opioids, and restoring trust in the patient-clinician relationship.

The erosion of trust in the patient-clinician relationship is an underappreciated, and vital, component of the prescription opioid crisis. Drawing from lived experience of patients and clinicians, and a narrative evidence review, this report discusses how opioid use for persistent pain can impact the patient-clinician relationship from the vantage points of the patient and the family physician. For patients, the stress of dealing with persistent pain, misalignment with clinicians regarding goals of care, experiences of disrespect and stigma, fear of abrupt tapers, and frustration with a fragmented health system, all combine to breed a lack of trust. Clinicians, for their part, experience challenges due to inadequate resources for pain management and opioid safety, pressure to deprescribe opioids rapidly, inconsistent prescribing practices of colleagues, 'policing' opioid prescriptions when concern arises for opioid use disorder and adversarial relationships with frustrated patients wary of clinician intentions. As a result, many clinicians struggle to maintain a therapeutic relationship with patients in great need of empathy and healing. To support implementation of evidence-based guidelines and achieve public health goals of safer prescribing and reducing harm from prescription opioids, we recommend steps health systems and clinicians can take to rebuild trust in the patient-clinician relationship, enable patient-centered pain care, and embed patient perspectives into opioid safety processes. PERSPECTIVE: Erosion of patient-clinician trust is a barrier to implementing evidence-based guidelines that aim to improve opioid safety. This paper explores lived patient and clinician experiences and recommends steps for health systems and clinicians to rebuild this trust as a strategy to actualize the benefits of adherence to these guidelines.

Evaluation of the effect of CYP2D6 and OCT1 polymorphisms on the pharmacokinetics of tramadol: Implications for clinical safety and dose rationale in paediatric chronic pain.

AIMS: Our investigation aimed to assess the dose rationale of tramadol in paediatric patients considering the effect of CYP2D6/OCT1 polymorphisms on systemic exposure. Recommendations were made for the oral dose of tramadol to be used in a prospective study in children (3 months to < 18 years old) with chronic pain. METHODS: Intravenous pharmacokinetic and genotype data from neonatal patients (n = 46) were available for this analysis. The time course of tramadol and O-desmethyltramadol (M1) concentrations was characterized using a nonlinear mixed effects approach in conjunction with extrapolation principles. Clinical trial simulations were then implemented to explore the effects of polymorphism, maturation and developmental growth on the disposition of tramadol and M1. Reported efficacious exposure range in adult subjects were used as reference. RESULTS: The pharmacokinetics of tramadol and M1 was characterized by a two-compartment model. The total clearance of tramadol (CLPP) comprised CYP2D6-mediated metabolism (CLPM) and other pathways (CLPO). Age-related changes in CLPM, CLPO and M1 clearance (CLMO) were described by a sigmoid function, with CYP2D6 as a covariate on CLPP and CLPM,  and OCT1 on CLMO. Simulation scenarios including different CYP2D6/OCT1 combinations revealed that steady-state concentrations are above the putative ranges for analgesia in >15% and >70% of subjects after doses of 3 and 8 mg/kg, respectively. CONCLUSIONS: In the absence of genotyping, reference exposure ranges can be used to define the dose rationale for tramadol in paediatric chronic pain. However, a starting dose of 0.5 mg/kg/day should be considered, followed by stepwise titration to the desired analgesic response.

Effective Use of Intravenous Lignocaine for Radiotherapy-Induced Brachial Plexopathy.

Radiotherapy-induced brachial plexopathy (RIBP) is a rare but debilitating complication of breast cancer treatment. There is limited information available on the effective treatments for this condition. We present the case of a 68-year-old female with well-controlled schizophrenia and a history of breast cancer who was referred to our pain management clinic for dysesthesia in the left upper limb secondary to RIBP. The patient exhibited a remarkable response to intravenous (IV) lidocaine infusion, with near-complete resolution of her symptoms. This case highlights the potential of IV lidocaine infusion as a valuable component of a multimodal strategy for managing RIBP.

Evaluation of chiropractic students' knowledge and attitudes following pain interventions: A randomized educational trial at 2 institutions.

OBJECTIVE: To examine chiropractic students' attitudes regarding knowledge of pain neuroscience, chronic pain, and patient-centered care before and after educational interventions. Secondarily, this study aimed to compare measures of these skills between cohorts at different timepoints throughout training programs. METHODS: Using stratified randomization, 281 Year 3 chiropractic students at 2 institutions were allocated into 1 of 3 educational interventions and served as active-control comparison groups: pain neuroscience education, chronic pain education, or patient-centered care. Participants completed validated surveys regarding their experience with the education interventions immediately pre- and post-lecture and 12 weeks after completion. For further comparison, surveys were also completed by 160 Year 1 students and 118 Year 2 students at 1 of the institutions. Independent sample t tests and 1-way analysis of variance were used for data analysis. RESULTS: All Year 3 lecture groups showed immediate improvements (pain neuroscience education: 3.99 + 3.09/100, p = .18 [95% CI: 10.10 to -1.77]; chronic pain education: 0.42 + 0.74/7, p = .02 [95% CI: 0.72 to 0.07]; patient-centered care: 0.25 + 0.12/6, p = .05 [95% CI: 0.12-0.51]), but these were not sustained at the 12-week follow-up (pain neuroscience education: -6.25 + 4.36/100, p = .15 [95% CI: 14.93 to -2.42]; chronic pain education: 0.33 + 0.16/7, p = .19 [95% CI, 0.66 to 0.01]; patient-centered care: 0.13 + 0.13/6, p = .30 [95% CI: 0.41 to -0.13]). Compared to active controls, only the patient-centered care group showed an immediate statistically significant difference. CONCLUSIONS: While this study found that immediate improvement in targeted competencies is possible with focused interventions, they were not sustained long term.