Patient Presentations in a Community Pain Clinic after COVID-19 Infection or Vaccination: A Case-Series Approach.

OBJECTIVES: Early case report studies and anecdotes from patients, medical colleagues, and social media suggest that patients may present to chronic pain clinics with a number of complaints post COVID-19 infection or vaccination. The aim of this study is to systematically report on a consecutive series of chronic pain patients seen in a community-based pain clinic, who acquired symptoms after COVID-19 infection or vaccination. METHODS: This retrospective cross-sectional descriptive study identified all patients seen at the clinic over a 4-month period (January-April 2022) with persistent symptoms after COVID-19 infection, vaccination, or both. Information was collected on sex, gender, age, details of vaccination, new pains, or exacerbation of old pain plus the development of novel symptoms. RESULTS: The study identified 21 community dwellers (17 females and 4 males; F/M 4.25/1; age range 22-79 years; mean age 46.3 years), with symptoms attributed to COVID-19 infection or vaccination. Several patients suffered exacerbation of previous pains or developed novel pains, as well as high levels of anxiety and mood disorders. A review of the existing literature provides support for the spectrum of symptoms displayed by the study group. CONCLUSIONS: Information collected in this study will add to the body of COVID-19-related literature and assist particularly community practitioners in recognizing and managing these conditions.

Diagnosis and conservative management of sural neuropathy: a case report.

Nerve entrapments in the lower extremity are rare and can be difficult to diagnose. Here we describe a Canadian Armed Forces veteran with left posterior-lateral calf pain. The patient's condition was previously misdiagnosed as a left-sided mid-substance Achilles tendinosis, which subsequently led to mismanagement, persistent pain and severe functional limitations. After performing a thorough evaluation, we diagnosed the patient with chronic left-sided sural neuropathy secondary to entrapment within the gastrocnemius fascia. The patient's physical symptoms abated completely with chiropractic care, while overall disability improved substantially after taking part in an interdisciplinary pain program. The objectives of this case report are to describe a challenging differential diagnosis of sural neuropathy, and present conservative whole-person management options according to the patient's needs and goals.

La compression des nerfs dans les membres inférieurs est rare et peut être difficile à diagnostiquer. Nous décrivons ici le cas d'un vétéran des Forces armées canadiennes souffrant d'une douleur postéro-latérale gauche au mollet. L'état du patient avait été diagnostiqué à tort comme une tendinite achilléenne moyenne du côté gauche, ce qui a entraîné une mauvaise prise en charge, une douleur persistante et de graves limitations fonctionnelles. Après une évaluation approfondie, nous avons diagnostiqué chez le patient une neuropathie surale chronique du côté gauche, secondaire à une compression du fascia gastrocnémien. Les symptômes physiques du patient ont complètement disparu grâce aux soins chiropratiques, tandis que l'incapacité globale s'est considérablement améliorée après avoir participé à un programme interdisciplinaire de lutte contre la douleur. Les objectifs de ce rapport de cas sont de décrire un diagnostic différentiel difficile de neuropathie surale et de présenter des options de gestion conservatrice de la personne entière en fonction des besoins et des objectifs du patient.

Comparison of Older and Younger Patients Referred to a Non-interventional Community Pain Clinic in the Greater Toronto Area (GTA).

AIM: To compare demographic and pain characteristics of older (≥ 65) vs younger (< 65) chronic non-cancer pain patients referred to a community pain clinic in the Greater Toronto Area (GTA), Ontario, Canada. METHODS: This is a retrospective study of 644 consecutive new patients with pain seen during 2016-2017 (older group n = 126; younger group n = 518). Demographic characteristics, Brief Pain Inventory pain ratings, and diagnosis were obtained using retrospective chart review. Patients were classified into group I (pure biomedical pathology), group II (mixed biomedical causes and psychological factors) and group III (no detectable physical pathology but psychological factors were considered important). RESULTS: Older patients comprised 19.6% of the overall population (higher than the average GTA older population). Regarding older vs younger group, male/female ratio was 1:1.3 vs 1:1.7 respectively, while 71% of the older patients were foreign born vs 37% of the younger group (p < 0.001). Low back was the most prevalent pain site for both groups; 70% of the older patients were classified as group I vs 35% of the younger patients (p < 0.0001), and only 6% as group III (vs 18% of the younger population, p < 0.05). CONCLUSION: The study points to considerable differences between younger and older patients with pain with the latter presenting with significant biomedical pathology but lesser psychopathology. The results are comparable to those obtained from a university pain clinic as well as a rural Northern Ontario clinic. Implications of the study for planning of pain care are discussed.

Demographics, Pain Characteristics and Diagnostic Classification Profile of Chronic Non-Cancer Pain Patients Attending a Canadian University-Affiliated Community Pain Clinic.

INTRODUCTION: Little information exists regarding the characteristics of patients with chronic non-cancer pain (CNCP) attending Canadian pain clinics. The study describes the demographics, pain characteristics and the diagnostic classification profile of such patients attending a university-affiliated community-based pain clinic in the Greater Toronto Area. METHODS: Retrospective descriptive study based on 644 unique consecutive CNCP patients assessed between January 2016 and December 2017. RESULTS: The female/male ratio was 1.6:1; 80% were younger than 65 years; 43% held some form of employment (full-time, part-time or self employment); median pain duration was 3 years; car accidents and medical conditions accounted for 28 and 27% of pain onset, respectively; 34% had four or more distinct areas of pain; and low back pain (LBP) was the most prevalent site (66%), but was the sole site of pain in less than a third of these patients. Age was positively associated with LBP prevalence. Self-reported health service utilization (visits to the emergency room, pain physician or psychologist) increased with patient psychopathology. Cannabis was used by 15% of the cohort and opioids by 34.5%, with only one in six opioid users exceeding 90 mg of morphine equivalent dose per day. Comparison of our data to three previously published studies from other Canadian pain clinics demonstrated both similarities and substantial differences between the populations. CONCLUSION: Our study highlights regional differences between CNCP population phenotypes. Recognition of biomedical, psychological and socio-environmental factors affecting pain should be considered for patient stratification and rational approaches to treatment, as "one size treatment does not fit all".

Optimizing pain relief during pregnancy using manual therapy.

QUESTION: Many of my pregnant patients have muscle and joint aches, and are reluctant to use analgesics. What is known about chiropractic care during pregnancy? ANSWER: As pregnant women move into their second and third trimesters, their centres of mass shift anteriorly, causing an increase in lumbar lordosis, which causes low back and pelvic girdle pain. Increasing recent evidence attests to the effectiveness and safety of treating this pain using manual therapy. Massage therapy and chiropractic care, including spinal manipulation, are highly safe and effective evidence-based options for pregnant women suffering from mechanical low back and pelvic pain.