Trajectories of opioid consumption as predictors of patient-reported outcomes among individuals attending multidisciplinary pain treatment clinics.

PURPOSE: This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment. METHODS: This study used data from the Quebec Pain Registry (2008-2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life). RESULTS: We identified three trajectories of opioid consumption: "no or very low and stable" opioid consumption (n = 2067, 96.3%), "increasing" opioid consumption (n = 40, 1.9%), and "decreasing" opioid consumption (n = 39, 1.8%). Patients in the "no or very low and stable" trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the "increasing" opioid consumption group had significantly greater depression scores at 6-month compared to patients in the "no or very low and stable" trajectory group. CONCLUSION: Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.

The Contribution of Insomnia and Obstructive Sleep Apnea on the Transition from Acute to Chronic Painful Temporomandibular Disorders and their Persistence: A Prospective 3-Month Cohort Study.

Background: Insomnia, and Excessive Daytime Sleepiness (EDS), a surrogate marker of Obstructive Sleep Apnea (OSA), are common sleep-related conditions among painful temporomandibular disorders (TMD) patients. OSA was found to increase the risk of chronic painful TMD. Aims: This prospective cohort study aims to determine the contribution of insomnia and EDS on acute to chronic painful TMD transition as well as its persistence when chronic pain is defined by: (i) duration (> 3 months), and (ii) dysfunction (Graded Chronic Pain Scale [GCPS II-IV]). Methods: From 456 patients recruited between 2015 to 2021, through four locations in Canada, 378 completed the follow-up. A diagnosis was obtained using the Research Diagnostic Criteria or the Diagnostic Criteria for TMD. Insomnia was assessed with the Insomnia Severity Scale (ISS), and OSA was assessed using the Epworth Sleepiness Scale (ESS) which measures EDS, both at baseline. Patients completed the GCPS form at baseline and 3-month follow-up. Results: Borderline associations were found between EDS and the transition or persistence of chronic painful TMD when chronic pain was defined by pain duration (RR adjusted_duration = 1.11, P = 0.07) and dysfunction (RRadjusted_dysfunction =1.40, P = 0.051). Furthermore, EDS was specifically associated with persistent painful TMD when chronic pain was defined by pain duration (RR = 1.13, 95%CI: 1.00-1.26, P = 0.04). Insomnia was not related to the study outcomes (RRadjusted_duration = 0.94, P = 0.27, RRadjusted_dysfunction =1.00, P = 0.99). Conclusion: Results indicate that EDS contrary to insomnia predicted the persistence of chronic painful TMD at a 3-month follow-up.

Contexte: L'insomnie et la somnolence excessive en journée, un marqueur substitut de l'apnée du sommeil obstructive, sont des affections courantes liées au sommeil chez les patients souffrant de troubles temporo-mandibulaires douloureux. On a découvert que l'apnée obstructive du sommeil augmentait le risque de troubles temporo-mandibulaires douloureux chroniques.Objectifs: Cette étude de cohorte prospective vise à déterminer la contribution de l'insomnie et de la somnolence excessive en journée à la transition des troubles temporo-mandibulaires douloureux aigus à chroniques, ainsi qu'à leur persistance lorsque la douleur chronique est définie par : (i) la durée (> 3 mois), et (ii) la dysfonction (Échelle de douleur chronique graduée [GCPS II-IV]).Méthodes: Sur 456 patients recrutés entre 2015 et 2021 dans quatre endroits au Canada, 378 ont terminé le suivi. Un diagnostic a été établi en utilisant les Critères de diagnostic pour la recherche ou les Critères de diagnostic pour les troubles temporo-mandibulaires douloureux. L'insomnie a été évaluée à l'aide de l'Indice de sévérité de l'insomnie (ISI) et l'apnée obstructive du sommeil a été évaluée à l'aide de l'Échelle de somnolence d'Epworth (ESS), qui mesure la somnolence excessive en journée, tous deux au début de l'étude. Les patients ont rempli le formulaire GCPS au début de l'étude et lors du suivi à trois mois.Résultats: Des associations marginales ont été trouvées entre la somnolence excessive en journée et la transition ou la persistance des troubles temporo-mandibulaires douloureux chroniques lorsque la douleur chronique était définie par la durée de la douleur (RR ajusté pour la durée = 1,11, P = 0,07) et la dysfonction (RR ajusté pour la dysfonction = 1,40, P = 0,051). De plus, la somnolence excessive en journée était spécifiquement associée à la persistance des troubles temporo-mandibulaires douloureux lorsque la douleur chronique était définie par la durée de la douleur (RR = 1,13, IC à 95 % : 1,00-1,26, P = 0,04). L'insomnie n'était pas liée aux résultats de l'étude (RR ajusté pour la durée = 0,94, P = 0,27, RR ajusté pour la dysfonction = 1,00, P = 0,99).Conclusion: Les résultats indiquent que la somnolence excessive en journée, contrairement à l'insomnie, prédisait la persistance des troubles temporo-mandibulaires douloureux chroniques lors du suivi de trois mois.

"He told me my pain was in my head": mitigating testimonial injustice through peer support.

Introduction: Women with disabilities are exposed to sexism and ableism, earn less income, and work in exceptionally challenging conditions compared to women without disabilities and men with or without disabilities. Adolescent girls living with scoliosis may begin experiencing this compounding bias during their encounters with healthcare from the moment they start noticing differences in their bodies. Being significantly more likely than boys to progress to a curve angle where painful treatment such as bracing or spinal fusion surgery is required, adolescent girls living with scoliosis are therefore more likely to experience chronic pain. The long-term impact of pain and pain-related stigma includes lower educational attainments, decreased vocational functionality, and social impairments in adults after having experienced chronic pain in adolescence. Approach: In this article, the authors will explore the effects and mechanisms of gender-specific peer support in disrupting this trajectory to adverse outcomes. Through individual interviews consisting of open-ended questions, the researchers gathered narrative data from Curvy Girls members, a community-based peer support group for girls and young women living with scoliosis. The data was analyzed using an applied philosophical hermeneutics approach, with intersectionality and testimonial injustice as their framework. Findings: They found that the study participants had their pain narratives reinterpreted by the adults in their lives, including their parents and healthcare practitioners, leading them to question and doubt their own experiences. Discussion: These negative outcomes were mitigated through the peer support they received and offered from Curvy Girls. Participants reported having gained confidence and a sense of belonging after they joined this group, allowing them to better cope with their condition more effectively in different facets of their lives.

The Daily Grind of Living With Chronic Pain: An Applied Hermeneutic Exploration.

The purpose of this research is to explore the philosophy regarding understanding the complex experience of living with chronic pain. As well, this article addresses a person's suffering as an evolving process of learning to not only manage pain but to learn how to live well through exploring their suffering narrative. A hermeneutical interpretive approach was used to engage participants in this research and to offer a philosophical reinterpretation of living with chronic pain from a humanistic and tacit perspective. This work is offered to invite and extend our discussions about the complexity of living with chronic pain. It can also be understood as a process of rewriting oneself from a lived chaotic state of pain into a new affective historical consciousness. This transition from acute to chronic pain explored through a philosophical context can provide insight into the ways in which patients learn to live well with their condition.

Lives Penciled in, the Reality of Chronic Health Conditions and Trauma: Reflexivity, Health, and Shadowed Identities.

When living with chronic health conditions or experiences of trauma our lives can become perpetually penciled in. The use of the penciled-in metaphor means to arrange our time tentatively: a date, an appointment, a meeting, seeing a movie, or attending a class. In our technologically-driven world of electronic calendars where everything is entered electronically, the utility of the pencil and hand-written agendas have all but vanished. However, for the purpose of this article, the pencil provides a metaphoric common ground to learn about the totality of the disruption experienced by living with chronic health conditions and their residual trauma. The pencil is touchable, tangible and as a researcher and a person who lives with challenging health concerns, metaphors help me to create an understanding of the chaos of living a life in pain with cancer. This article is a person-centered account of the process of reflexive coping and self-processing of pain by a pain researcher and educator. This article focuses on the metaphor of penciled-in lives to provide a qualitative account of experiences of pain from chronic health issues and the trauma both physical and emotional it causes. This act of reflexivity becomes a personal examination of life. It reveals to me my beliefs, decisions, and practices before and during my hermeneutic journey and how these may have prejudiced my thinking and behaviors.

Reflecting back to move forward: Lessons learned about COVID-19 safety protocols from pediatric anesthesiologists.

BACKGROUND: The COVID-19 pandemic brought about the immediate need for enhanced safety protocols in health care centers. These protocols had to evolve as knowledge and understanding of the disease quickly broadened. AIMS: Through this study, the researchers aimed to understand the experiences of pediatric anesthesiologists at the Montreal Children's Hospital and the Shriners' Hospital Canada as they navigated the first wave of COVID-19 at their institutions. METHODS: Nine participants from the Montreal Children's Hospital and the Shriners' Hospital were interviewed. Interviews were recorded, transcribed verbatim, and then analyzed using an applied philosophical hermeneutics approach. FINDINGS: Participants expressed their wish for simple and easy-to-apply protocols while recognizing the challenge of keeping up with evolving knowledge on the disease and its transmission. They pointed to some limitations and unintended consequences of the safety protocols and the system-wide flaws that the COVID-19 pandemic helped bring to light. They described their frustrations with some aspects of the safety protocols, which they at times felt could be more efficient or better suited for their daily practice. CONCLUSIONS: The findings of this study highlighted the importance of listening to and empowering anesthesiology staff working in the field during crises, the implications of shifting from patient-centered care to community-centered care, and the fine line between sharing as much emerging information as possible and overwhelming staff with information.

Advice for Dentists from Temporomandibular Disorder Patients: A Phenomenological Study.

BACKGROUND: Despite increased efforts to improve the health of those with temporomandibular disorder (TMD), the focus remains on medical knowledge rather than patients' opinions and needs regarding quality of treatment and pain management. OBJECTIVES: We aimed to identify what TMD patients want their dentists to know and do. METHODS: Open-ended questions were used to understand the perspectives of 6 TMD patients. Two researchers examined the transcripts using interpretive phenomenological analysis. FINDINGS: TMD participants consistently stressed the need for their dentists to listen and provide them with more advice and information to cope with TMD conditions. They also noted the need for dentists to be skilled in communications, particularly maintaining respectful doctor-patient relations and interpersonal communication. CONCLUSIONS: Health care providers must acquire practical communication skills and expand their knowledge of TMDs to better support their patients. Improving relations between doctors and their TMD patients could result in positive health outcomes. The implications of this study will be to decrease medical crises and expensive interventions, provide better assistance to patients and refer them to other necessary health care professionals, an approach that will lead to lower care costs, more satisfaction and higher quality of life.

Experience and Management of the Adverse Effects of Analgesics After Surgery: A Pediatric Patient Perspective.

After surgery, the adverse effects (AEs) of analgesics are common and critical factors influencing the postoperative experience of pediatric patients. Inadequate management of AEs has been found to prolong hospital stay, increase readmission rates and decrease satisfaction with care. The aim of this qualitative descriptive study was to better understand the AEs of analgesics from the perspective of adolescent patients with idiopathic scoliosis after spinal surgery. A total of 7 patients participated in the study. Semistructured interviews were conducted at discharge and 1 week after discharge. Transcribed data were analyzed using qualitative content analysis and themes were identified. Overall, participants most frequently reported gastrointestinal and cognitive AEs, with constipation being the most persistent and bothersome. The pediatric participants used a combination of 3 strategies to mitigate analgesic AEs, namely pharmacologic, nonpharmacologic, and reduction of analgesic intake. Participants demonstrated a lack of understanding of AEs and involvement in their own care. Future studies should be conducted to evaluate the efficacy of nonpharmacological strategies in managing analgesic AEs for pediatric patients after surgery.

Enriching Clinical Encounters Through Qualitative Research.

Although many medical and dental journals publish qualitative research this does not mean they are being read by those who could directly benefit from their scholarly contributions. From clinician to the patient. This perspective on qualitative research for medical and dental education was written with the intention of introducing qualitative research to those who may be unaware of its possibilities and utility for clinical education. Its task is to inform others about life conditions they may not have experienced themselves other than in a biomedical context. As researchers, clinicians, and especially for students who read academic, medical, and clinical research papers which are appropriately discipline-and methodology-specific. We may find ourselves encultured to privileging one type of research methodology over others. For example, exclusively considering quantitative research methodologies as being more rigorous and trustworthy. This brief commentary may offer the opportunity for interested healthcare providers and researchers to expand their understanding of the purpose of qualitative research, its role and application in enhancing patient engagement, clinical practices, and person-centered research.

The Experiences of People Living With Chronic Pain During a Pandemic: "Crumbling Dreams With Uncertain Futures".

People living with chronic pain experience multiple challenges in their daily activities. Chronic pain is complex and often provokes life circumstances that create increased social isolation. Living with chronic pain during the pandemic may add additional layers of complexity to their daily lives. The researchers endeavored to explore the experiences of people living with chronic pain during the COVID-19 pandemic. Researchers conducted semi-structured, open-ended interviews about how the pandemic influenced participants' lives. The interviews were recorded and analyzed using an applied philosophical hermeneutics approach. The findings were feeling socially isolated, losing their sense of livinghood, and experiencing augmented stress levels which, in most cases, aggravated their chronic pain. In addition to gaining an in-depth understanding of the needs of people living with chronic pain, these findings may guide policy decisions with the intention of improving health care access and the overall experiences of people living with chronic conditions during a pandemic.

Play the Pain: A Digital Strategy for Play-Oriented Research and Action.

The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale qualitative health research, using play (as a state of being, a communication mode or context, and a set of imaginative, expressive, and game-like activities) as a research method for recursive learning and action planning. Our proposal builds on Gregory Bateson's cybernetic approach to knowledge production. Using chronic pain as an example, we show how pragmatic, structural and cultural constraints that define the relationship of patients to the healthcare system can give rise to conflicted messaging that impedes inclusive health research. We then review existing literature to illustrate how different types of play including games, chatbots, virtual worlds, and creative art making can contribute to research in chronic pain. Inspired by Frederick Steier's application of Bateson's theory to designing a science museum, we propose DiSPORA (Digital Strategy for Play-Oriented Research and Action), a virtual citizen science laboratory which provides a framework for delivering health information, tools for play-based experimentation, and data collection capacity, but is flexible in allowing participants to choose the mode and the extent of their interaction. Combined with other data management platforms used in epidemiological studies of neuropsychiatric illness, DiSPORA offers a tool for large-scale qualitative research, digital phenotyping, and advancing personalized medicine.

Living With a Trifecta of Pain and Cancer With Personal Reflections of COVID-19.

The purpose of preparing this Feature Article was to explore and share my lived experience of living with multiple layers of chronic pain, with a diagnosis of advanced, aggressive and metastasized prostate cancer, and COVID-19. My exploration begins with the manifestations of chronic pain from a bicycling accident, psoriatic arthritis, with cancer treatments and the pain it creates during a panademic has added to the challenges of social distancing, isolation, and medical treatments. As with many patient experiences, we the person as patient outside of health care sometimes struggle to find the right words, the proper sentence structure and as Tamas writes about the expectation of others to provide, "Clean and reasonable scholarship about messy, unreasonable experiences is an exercise in alienation." I write this while living with extreme chronic pain, continue cancer treatments while the threat and additional anxiety of COVID-19 looms over me. This is my story.

A Phenomenological Exploration of the Personal Implications of Female Adolescents Living With Chronic Pain.

INTRODUCTION: Chronic pain (CP) negatively impacts everyday previously taken-for-granted activities resulting in considerable psychosocial stress for the individual. Qualitative research in pediatric CP is limited despite the considerable influence CP has on the process of establishing one's personal identity during these formative years and invites the opportunity to understand how CP affects these young individuals from their perspective. The objective of the study was to inquire into the experiences of female adolescents living with CP in order to enhance our understanding of how CP affects their personal lives. METHOD: We used an interpretive phenomenological approach; two researchers interviewed eight female patients of the Montreal Children's Hospital Chronic Pain Management Clinic (aged 14-17 years) for one session each. RESULTS: Self-reported factors that improved these female adolescents' personal life included having engaging hobbies, accepting the incurability of CP, and envisioning a fulfilling future. DISCUSSION: The findings from this study suggest a need to orient CP-related services around goals and interests that female adolescents living with CP set for themselves in order to improve their perceived quality of life.

The Quebec Low Back Pain Study: a protocol for an innovative 2-tier provincial cohort.

INTRODUCTION: The neurobiological mechanisms underlying recovery from or persistence of low back pain (LBP) remain misunderstood, limiting progress toward effective management. We have developed an innovative two-tier design to study the transition from acute to chronic LBP. The objective of the first tier is to create a provincial web-based infrastructure to recruit and monitor the trajectory of individuals with acute LBP. The objective of the second tier is to fuel hypothesis-driven satellite data collection centers with specialized expertise to study the role of biomechanical, epigenetic, genetic, neuroanatomical, ontological, physiological, psychological, and socioeconomic factors in LBP chronicity. METHODS: This article describes the first tier of the protocol: establishment of the Core Dataset and Cohort. Adults with acute LBP will be recruited through networks, media, and health care settings. A web-based interface will be used to collect self-reported variables at baseline and at 3, 6, 12, and 24 months. Acute LBP will be defined according to the Dionne 2008 consensus. Measurements will include the Canadian minimum data set for chronic LBP research, DN4 for neuropathic pain, comorbidities, EQ-5D-5L for quality of life, and linkage with provincial medico-administrative databases. The primary outcome will be the transition to chronic LBP, as defined by Deyo 2014. Secondary outcomes include health care resource utilization, disability, sick leave, mood, and quality of life. PERSPECTIVE: This study brings together diverse research expertise to investigate the transition from acute to chronic LBP, characterize the progression to recovery or chronicity, and identify patterns associated with that progression.

A Reconceptualization of the Negative Self-Stereotyping of the Patient-Partner to the Introduction of the Patient Perspective Consultant.

The label of "patient-partner" is widely used when referring to a person living with a specific health condition that participates in research teams or consults on clinical practice guidelines. However, being a patient-partner says nothing about one's potential role outside a biomedical context. Labeling a person as such can be detrimental to their perception of themselves. The intention of this paper is to provide a philosophical conceptual framework to understand the complexities and consequences of labeling people as patients outside of direct healthcare. A philosophical hermeneutic approach was used to explore how labeling and self-stereotyping can affect the patient-partner, leading to the possible erosion of their personhood. The authors suggest that research teams instead employ the more accurate and dignified term, "patient perspective consultant." Accurate titles allow team members to relate to each other, leaving room for everyone to contribute meaningfully. The shift from patient-partner to patient perspective consultant does not change the nature of the role. It clarifies the context through increased accuracy, and adds dignity and purpose.

Philosophical Hermeneutics and Teaching Through Behandlung: The Treatment and Handling of Patients With Care.

The purpose of this Feature article is to share a teaching approach for academic researchers and clinicians about the treatment of patients beyond their biomedical needs. To achieve this objective, we will delve into the writings of H-G Gadamer which offer a relational approach to the healing process through the exploration of how the German word Behandlung applies to medical and dental education. Through conversational philosophical hermeneutics, Gadamer endeavors to unite the consciousness of one subject with that of the others and refers to the process as appropriation whereby the researcher/clinician is working toward understanding the experience of the individual within the context of a community of patient experiences.