Efficacy of a Psychologically-Informed Physiotherapy Intervention in Patients with Chronic Low Back Pain at High Risk of Poor Prognosis: A Pilot and Feasibility Randomized Controlled Trial.

Purpose: To determine the feasibility of a randomized controlled trial (RCT) testing the efficacy of psychologically-informed physiotherapy (PIPT), which includes usual physiotherapy (UP) interventions, compared with UP, and to explore the preliminary effectiveness of the interventions. Method: People with chronic low back pain at high risk of poor prognosis (using the STarT Back screening tool) were recruited and allocated to PIPT or UP. Effectiveness of recruitment strategies, adherence to intervention, risk of contamination, and specific challenges were assessed. Functional capacity, pain, quality of life, kinesiophobia, catastrophization, central sensitization, and self-efficacy were measured at baseline, 6-, 12- and 24-week follow-ups. Results: Forty participants were recruited mainly by diffusing through Laval University's email list, and 10 physiotherapists treated the participants recruited. The retention rate of participants at 24 weeks was 72.5%. Adherence to treatment by participants and physiotherapists was very good. The risk of contamination was low, and the specific challenges identified were modifiable. Significant improvement over time in all clinical variables of interest, except self-efficacy, was observed with no difference between groups. Conclusions: As most success criteria were met, conducting an RCT evaluating PIPT and PU is feasible with modifications. PIPT and UP appear to be similarly effective.

Objectif: déterminer la faisabilité d'une étude randomisée et contrôlée (ÉRC) évaluant l'efficacité de la physiothérapie fondée sur la psychologie (PTFP), qui inclut les interventions de physiothérapie conventionelle (PC), par rapport à la PC, et explorer l'efficacité préliminaire des interventions. Méthodologie: les chercheurs ont recruté des personnes qui souffrent de douleurs lombaires chroniques, ayant une probabilité élevée de mauvais pronostic (au moyen de l'outil de dépistage STarT Back) et les ont réparties entre la PTFP et la PC. Ils ont évalué l'efficacité des stratégies de recrutement, l'adhésion à l'intervention, le risque de contamination et les difficultés particulières. Ils ont également mesuré la capacité fonctionnelle, la douleur, la qualité de vie, la kinésiophobie, la catastrophisation, la sensibilisation centrale et l'autoefficacité en début d'étude ainsi que lors des suivis à six, 12 et 24 semaines. Résultats: les chercheurs ont recruté 40 participants, principalement en diffusant le projet par courriel à la communauté de l'Université Laval, et dix physiothérapeutes les ont traités. Le taux de rétention des participants était de 72,5 % à 24 semaines. Les participants et les physiothérapeutes ont démontré une très bonne adhésion au traitement. Le risque de contamination était faible, et les difficultés particulières constatées pouvaient être modifiées. Les chercheurs ont observé une amélioration considérable au fil du temps pour toutes les variables cliniques d'intérêt, sauf l'autoefficacité, sans différence entre les groupes. Conclusions: puisque la plupart des critères de succès étaient respectés, il est faisable de réaliser une ÉRC pour évaluer la PTFP et la PU, sous réserve de modifications. La PTFP et la PC semblent avoir une efficacité similaire.

Incidence and risk factors of chronic postoperative pain in same-day surgery: A prospective cohort study.

BACKGROUND: The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting. METHODS: We assessed pain 90 days after ambulatory surgery in an international, multicentre prospective cohort study of patients ≥45 years old with comorbidities or ≥65 years old. Pain was assessed using the Brief Pain Inventory. Chronic postsurgical pain was defined as a change ≥1 in self-rated average pain at the surgical site between baseline and 90 days, and moderate to severe chronic postsurgical pain as a score ≥4 in self-rated average pain at the surgical site at 90 days. Risk factors for chronic postsurgical pain were identified using multivariable logistic regression. RESULTS: Between November 2021 and January 2023, a total of 2054 participants were included, and chronic postsurgical pain occurred in 12% of participants, of whom 93.1% had new chronic pain at the surgical site (i.e., participants without pain prior to surgery). Moderate to severe chronic postsurgical pain occurred in 9% of overall participants. Factors associated with chronic postsurgical pain were: active smoking (OR 1.82; 95% CI 1.20 to 2.76), orthopaedic surgery (OR 4.7; 95% CI 2.24 to 9.7), plastic surgery (OR 4.3; 95% CI 1.97 to 9.2), breast surgery (OR 2.74; 95% CI 1.29 to 5.8), vascular surgery (OR 2.71; 95% CI 1.09 to 6.7), and ethnicity (i.e., Hispanic/Latino ethnicity OR 3.41; 95% CI 1.68 to 6.9 and First Nations/Native persons OR 4.0; 95% CI 1.05 to 15.4). CONCLUSIONS: Persistent postsurgical pain after same-day surgery is common, usually moderate to severe in nature, and occurs mostly in patients without chronic pain prior to surgery.

The Early Microbial Colonizers of a Short-Lived Volcanic Island in the Kingdom of Tonga.

The island of Hunga Tonga Hunga Ha'apai (HTHH) in the Kingdom of Tonga was formed by Surtseyan eruptions and persisted for 7 years before being obliterated by a massive volcanic eruption on 15 January 2022. Before it was destroyed, HTHH was an unparalleled natural laboratory to study primary succession on a newly formed landmass. We characterized the microbial communities found on the surface sediments of HTHH using a combination of quantitative PCR, marker gene sequencing, and shotgun metagenomic analyses. Contrary to expectations, photosynthetic cyanobacteria were not detected in these sediments, even though they are typically dominant in the earliest stages of primary succession in other terrestrial environments. Instead, our results suggest that the early sediment communities were composed of a diverse array of bacterial taxa, including trace gas oxidizers, anoxygenic photosynthesizers, and chemolithotrophs capable of metabolizing inorganic sulfur, with these bacteria likely sourced from nearby active geothermal environments. While the destruction of HTHH makes it impossible to revisit the site to conduct in situ metabolic measurements or observe how the microbial communities might have continued to change over time, our results do suggest that the early microbial colonizers have unique origins and metabolic capabilities. IMPORTANCE The volcanic island of Hunga Tonga Hunga Ha'apai in the Kingdom of Tonga represents a very rare example of new island formation and thus a unique opportunity to study how organisms colonize a new landmass. We found that the island was colonized by diverse microbial communities shortly after its formation in 2015, with these microbes likely originating from nearby geothermal environments. Primary succession in this system was distinct from that typically observed in other terrestrial environments, with the early microbial colonizers relying on unique metabolic strategies to survive on the surface of this newly formed island, including the capacity to generate energy via sulfur and trace gas metabolism.

Strategies to prevent long-term opioid use following trauma: a Canadian practice survey.

PURPOSE: To evaluate how Canadian clinicians involved in trauma patient care and prescribing opioids perceive the use and effectiveness of strategies to prevent long-term opioid therapy following trauma. Barriers and facilitators to the implementation of these strategies were also assessed. METHODS: We conducted a web-based cross-sectional survey. Potential participants were identified by trauma program managers and directors of the targeted departments in three Canadian provinces. We designed our questionnaire using standard health survey research methods. The questionnaire was administered between April 2021 and November 2021. RESULTS: Our response rate was 47% (350/744), and 52% (181/350) of participants completed the entire survey. Most respondents (71%, 129/181) worked in teaching hospitals. Multimodal analgesia (93%, 240/257), nonsteroidal anti-inflammatory agents (77%, 198/257), and physical stimulation (75%, 193/257) were the strategies perceived to be the most frequently used. Several preventive strategies were perceived to be very effective by over 80% of respondents. Of these, some that were reported as not being frequently used were perceived to be among the most effective ones, including guidelines or protocols, assessing risk factors for opioid misuse, physical health follow-up by a professional, training for clinicians, patient education, and prescription monitoring systems. Staff shortages, time constraints, and organizational practices were identified as the main barriers to the implementation of the highest ranked preventive strategies. CONCLUSIONS: Several strategies to prevent long-term opioid therapy following trauma are perceived as being effective by those prescribing opioids in this population. Some of these strategies appear to be commonly used in everyday practice and others less so. Future research should focus on which preventive strategies should be given higher priority for implementation before assessing their effectiveness.

RéSUMé: OBJECTIF: Évaluer comment les cliniciens canadiens impliqués dans les soins aux patients traumatisés et prescrivant des opioïdes perçoivent l'utilisation et l'efficacité des stratégies visant à prévenir le traitement prolongé par opioïde après un traumatisme. Les obstacles et facilitateurs de la mise en œuvre de ces stratégies ont aussi été analysés. MéTHODES: Nous avons réalisé une enquête transversale via le Web. Les participants potentiels ont été identifiés par les gestionnaires et directeurs de programmes de traumatologie des départements ciblés dans trois provinces canadiennes. Nous avons conçu notre questionnaire en utilisant la méthodologie de recherche usuelle des enquêtes de santé. Le questionnaire a été administré entre avril 2021 et novembre 2021. RéSULTATS: Notre taux de réponse a été de 47 % (350/744) et 52 % (181/350) des participants ont complété l'enquête dans sa totalité. La majorité des personnes interrogées (71 %, 129/181) travaillait dans des hôpitaux universitaires. L'analgésie multimodale (93 %, 240/257), les anti-inflammatoires non stéroïdiens (77 %, 198/257) et la stimulation physique (75 %, 193/257) étaient les stratégies perçues comme étant le plus fréquemment utilisées. Plusieurs stratégies préventives étaient perçues comme étant très efficaces par plus de 80 % des répondants. Parmi celles-ci, certaines étaient signalées comme n'étant pas utilisées très souvent, mais perçues comme étant les plus efficaces, notamment les lignes directrices et protocoles évaluant les facteurs de risque d'utilisation abusive des opioïdes, le suivi de la santé physique par un professionnel, la formation des cliniciens, l'éducation des patients et les systèmes de suivi des prescriptions. La pénurie de personnels, les contraintes de temps et les pratiques de l'établissement ont été identifiées comme étant les principaux obstacles à la mise en place des stratégies préventives classées parmi les premières. CONCLUSIONS: Plusieurs stratégies de prévention du traitement par opioïdes à long terme après un traumatisme sont perçues comme efficaces par ceux qui les prescrivent à cette population de patients. Certaines de ces stratégies apparaissent comme couramment utilisées dans la pratique quotidienne et d'autres moins souvent. La recherche future devrait se concentrer sur la détermination des stratégies préventives auxquelles il faudrait accorder la plus grande priorité de mise en œuvre avant d'évaluer leur efficacité.

Psychometric properties of the French and English short form of the Protective Behavioural Strategies for Marijuana Scale in Canadian university students.

BACKGROUND: The Protective Behavioural Strategies for Marijuana (PBSM-17) scale serves to identify and measure strategies employed by young adults before, during or after cannabis use. After the adaptation and translation of the PBSM-17 into French, a methodological study was conducted to evaluate the psychometric properties of this French version (FV) and of the original English version (EV) in a sample of bilingual Canadian university students. METHODS: A total of 211 cannabis users (mean age=22.1 years) completed a sociodemographic questionnaire, a question on frequency of cannabis use (four categories: 1-3 times a month, once a week, more than once a week, everyday) and both versions (FV and EV) of the PBSM-17. RESULTS: Both versions had similar internal reliability (α=0.91; α=0.88). The one-factor solution explained 36.46% of the variance for the FV and 42.26% for the EV. As hypothesised, greater use of protective behavioural strategies was related to lower frequency of cannabis use. One-way ANOVA test results revealed a statistically significant difference in use of strategies by frequency of cannabis use for both the FV (F(3, 207)=27.38, p<0.001) and EV (F(3, 207)=29.32, p<0.001). Post hoc comparisons showed that everyday users employed fewer strategies on average than lower-frequency users. CONCLUSION: The FV and EV of the PBSM-17 demonstrated satisfactory psychometric properties. The proposed FV of the PBSM-17 is a reliable instrument that could be used for research and clinical purposes. Protective behavioural strategies can serve as indicator of lower-risk cannabis use and could be targeted in prevention interventions.

[French translation, cultural adaptation and assessment of preliminary psychometric properties of the Protective Behavioral Strategies for Marijuana Scale]. / Traduction française, adaptation culturelle et évaluation des propriétés psychométriques préliminaires de l'échelle des stratégies de protection comportementale liées à la consommation de cannabis.

OBJECTIVE: Young adults (18- to 24-year-olds) constitute the age group with the highest proportion of cannabis users. In the context of legalization, it is important to promote lower-risk cannabis use. The Protective Behavioral Strategies for Marijuana Scale (PBSM-17) identifies strategies used by consumers. However, this scale is not available in French and is not adapted to the Canadian context. This article presents the process that led to the translation, cultural adaptation and evaluation of the preliminary psychometric properties of PBSM-17. METHOD: The methodological study was carried out in six steps. The first four steps led to the translation towards French and adaptation of the scale. A validation among 12 young people contributed to establish the criterion equivalency (step 5). The evaluation of psychometric properties (step 6) was carried out among 211 bilingual university students (61 % women; mean age 22 years old). RESULTS: The French version presents satisfactory preliminary psychometric properties: internal consistency is acceptable (α = 0.88); criterion equivalency was established between the French and the original English version (t (210) = 1.04, p = 0.30; 95% CI [-0.20, 0.63]). The scores obtained on both versions by the same participant were found to be strongly correlated (r = 0.95, p <0.001). CONCLUSION: The results support the use of the French version of PBSM-17. The proposed protective strategies can be used as a measurement tool and represent behaviors that can be targeted in a lower-risk cannabis use context.

OBJECTIF: Les jeunes de 18 à 24 ans constituent la plus grande proportion de consommateurs de cannabis. Dans un contexte de légalisation de cette substance, il importe de promouvoir une consommation à moindre risque. L'échelle Protective Behavioral Strategies for Marijuana Scale (PBSM-17) permet d'identifier les stratégies de protection comportementale utilisées chez les consommateurs. Toutefois, cette échelle n'est pas disponible en français et n'est pas adaptée au contexte canadien. Cet article présente la démarche ayant mené à la traduction, l'adaptation culturelle et l'évaluation des propriétés psychométriques préliminaires du PBSM-17. MÉTHODE: L'étude méthodologique s'est déroulée en six étapes. Les quatre premières étapes ont mené à la traduction et l'adaptation de l'échelle. La validation auprès de 12 jeunes a permis d'établir l'équivalence conceptuelle. L'évaluation des propriétés psychométriques a été réalisée auprès de 211 étudiants universitaires bilingues (61 % femme; âge moyen 22 ans). RÉSULTATS: La version traduite et adaptée présente des propriétés psychométriques préliminaires satisfaisantes : la cohérence interne est acceptable (α = 0,88); l'équivalence de critères (validité de construit) est établie entre la version française et la version anglaise (t (210) = 1,04, p = 0,30 ; IC 95 % [-0,20, 0,63]). Les scores obtenus aux deux versions par le même participant s'avèrent fortement corrélées (r = 0,95, p < 0,001). CONCLUSION: Les résultats soutiennent l'utilisation de la version française du PBSM-17. Les stratégies de protection proposées peuvent être utilisées comme outil de mesure et représentent des comportements à adopter dans un contexte d'usage du cannabis à moindre risque.

Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).

INTRODUCTION: The number of elderly patients undergoing major surgery is rapidly increasing. They are particularly at risk of developing postoperative neurocognitive disorders (NCD). Earlier studies suggested that processed electroencephalographic (EEG) monitors may reduce the incidence of postoperative NCD. However, none of these studies controlled for intraoperative nociception levels or personalized blood pressure targets. Their results remain unclear if the reduction in the incidence of postoperative NCD relates to avoidance of any electroencephalographic pattern suggesting excessive anesthesia depth. OBJECTIVE: The objective of this trial is to investigate-in patients ≥ 70 years old undergoing major non-cardiac surgery-the effect of EEG-guided anesthesia on postoperative NCD while controlling for intraoperative nociception, personalized blood pressure targets, and using detailed information provided by the EEG monitor (including burst suppression ratio, density spectral array, and raw EEG waveform). MATERIAL AND METHODS: This prospective, randomized, controlled trial will be conducted in a single Canadian university hospital. Patients ≥ 70 years old undergoing elective major non-cardiac surgery will be included in the trial. The administration of sevoflurane will be adjusted to maintain a BIS index value between 40 and 60, to keep a Suppression Ratio (SR) at 0%, to keep a direct EEG display without any suppression time and a spectrogram with most of the EEG wave frequency within the alpha, theta, and delta frequencies in the EEG-guided group. In the control group, sevoflurane will be administered to achieve an age-adjusted minimum alveolar concentration of [0.8-1.2]. In both groups, a nociception monitor will guide intraoperative opioid administration, individual blood pressure targets will be used, and cerebral oximetry used to tailor intraoperative hemodynamic management. The primary endpoint will be the incidence of NCD at postoperative day 1, as evaluated by the Montreal Cognitive Assessment (MoCA). Secondary endpoints will include the incidence of postoperative NCD at different time points and the evaluation of cognitive trajectories up to 90 days after surgery among EEG-guided and control groups. STUDY REGISTRATION: NCT04825847 on ClinicalTrials.gov.

Real-Life Response to Erenumab in a Therapy-Resistant Case Series of Migraine Patients From the Province of Québec, Eastern Canada.

BACKGROUND AND OBJECTIVE: Erenumab is the first migraine-specific preventive therapy approved by Health Canada since the approval of onabotulinumtoxinA 10 years ago. It is one of four calcitonin gene-related peptide antagonist monoclonal antibodies that have been commercialized worldwide for use in the headache pipeline. The objective of our study was to determine real-life efficacy of monthly erenumab for the prevention of migraine in a small case series of difficult-to-treat patients followed at a tertiary headache clinic from the Canadian province of Québec. METHODS: We performed a retrospective chart audit of patients having failed four or more conventional migraine oral preventive therapies and who were treated with monthly self-administered subcutaneous erenumab (70 or 140 mg/mL dose) over a 1-year period. We assessed the patients' baseline characteristics, response to treatment, and tolerability. RESULTS: A total of 18 patients with a diagnosis of high-frequency episodic migraines or chronic migraine met criteria (83.3% female; mean age: 48.7 years; mean duration of migraine condition: 32.9 years). Patients self-administered erenumab using a prefilled disposable autoinjector on a monthly basis; 16 patients received a 140 mg/mL dosage, two patients received a 70 mg/mL dosage. At 1 year follow-up, 50% of patients reported ≥ 50% reduction in migraine frequency and were deemed responders. Patients attempted six doses of erenumab therapy prior to discontinuation for non-response, except for two patients with other concomitant chronic pain conditions, who required ten doses to reach a 50% response. For the overall cohort, there was a decrease of 5.2 monthly migraine days; 9 days for responders and 1.3 days for non-responders (t-test (df = 16) = - 2.77, p = 0.014). There was an additional decrease of 7 monthly non-migraine days amongst patients with unremitting daily headaches; 8 days for responders and 5 days for non-responders (p > 0.05). There was a decrease of 5.4 monthly days using acute analgesics; 8.9 days for responders and 2 days for non-responders (T(16) = - 2.33, p = 0.033). The overall mean reduction in disability using the Headache Impact Test (HIT-6) score was 5.6 points; only responders showed a reduction in HIT-6 severity category (p > 0.05). The most commonly reported adverse event was constipation (16.7%), which did not lead to treatment discontinuation and was successfully managed in all patients with early counselling and intervention. CONCLUSION: This study supports the efficacy of erenumab in a case series of therapy-resistant migraine patients from the region of Québec. A high rate of previously failed preventive oral agents and medication overuse did not predict response in our patient cohort. In the presence of real-world complexity factors, such as psychological distress, regular opioid consumption and concomitant chronic pain conditions, a longer therapy trial may be warranted in obtaining optimal response.

ZnO nanowire embedded TiO2 film as an electrode for perovskite CsPbI2Br solar cells.

A comparative study was conducted to look into the impact of various electron transporting films on the performance of perovskite CsPbI2Br solar cells. The solar cells with ZnO nanowires embedded TiO2 as an electrode outperformed those with pure TiO2 or pure ZnO. The enhanced performance is ascribed to the synergetic effect of both TiO2/ZnO constituent properties. In particular, an appropriate amount of ZnO nanowires embedded in TiO2 films could optimize the properties of the electron transporting layer by improving electron transport, light harvesting, and overall photovoltaic performance, leading to the power conversion efficiency as high as 10.53%.

Strategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping review protocol.

INTRODUCTION: Globally every year, millions of patients sustain traumatic injuries and require acute care surgeries. A high incidence of chronic opioid use (up to 58%) has been documented in these populations with significant negative individual and societal impacts. Despite the importance of this public health issue, optimal strategies to limit the chronic use of opioids after trauma and acute care surgery are not clear. We aim to identify existing strategies to prevent chronic opioid use in these populations. METHODS AND ANALYSIS: We will perform a scoping review of peer-reviewed and non-peer-reviewed literature to identify studies, reviews, recommendations and guidelines on strategies aimed at preventing chronic opioid use in patients after trauma and acute care surgery. We will search MEDLINE, EMBASE, PsycINFO, CINHAL, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest and websites of trauma and acute care surgery, pain, government and professional organisations. Databases will be searched for papers published from 1 January 2005 to a maximum of 6 months before submission of the final manuscript. Two reviewers will independently evaluate studies for eligibility and extract data from included studies using a standardised data abstraction form. Preventive strategies will be classified according to their types and targeted trauma populations and acute care surgery procedures. ETHICS AND DISSEMINATION: Research ethics approval is not required as this study is based on the secondary use of published data. This work will inform research and clinical stakeholders on the required next steps towards the uptake of effective strategies aimed at preventing chronic opioid use in trauma and acute care surgery patients.

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.

Toward a phenomic analysis of chronic postsurgical pain following cardiac surgery.

Background: Despite the same surgical approach, up to 40% of patients develop chronic postsurgical pain (CPSP) following cardiac surgery, whereas the rest are chronic pain free. This variability suggests that CPSP is controlled partially through genetics, but the genes for CPSP are largely unknown. Aims: The aim of this study was to identify potential CPSP phenotypes by comparing patients who developed CPSP following cardiac surgery vs. those who did not. Methods: A research ethics board-approved, cross-sectional study of post-cardiac surgery pain was conducted at Toronto General Hospital from 2011 to 2015. Patients were recruited to complete a short survey of chronic pain scores and the Short-Form McGill Pain Questionnaire-2. A subset of patients completed a longer survey of eight validated pain phenotyping questionnaires and/or four psychophysical assessments. All surveys and psychophysical testing were conducted after surgery. Patients were stratified by presence of chronic pain and groups were compared using descriptive statistics. Results: Six hundred forty-three patients completed the short form survey. The mean postsurgery assessment time was 41.5 (SD = ±25.1) months. Over a quarter (27.8%) reported CPSP at the chest as a consequence of their surgery. Of patients reporting CPSP, 46.6% reported mild pain (0-3), 35.8% reported moderate pain (4-7), and 17.6% reported severe pain (7-10) in accordance with the numerical rating scale. Patients with moderate and/or severe CPSP were younger, had a greater body mass index, and had higher anxiety sensitivity, pain catastrophizing, and somatization scores. Conclusions: Chronic pain levels after cardiac surgery are associated with anxiety, catastrophizing, and sensory abnormalities in body parts outside the field innervated by injured nerves, indicating the presence of widespread central sensitization to incoming sensory inputs from intact nerves.

Contexte: Malgré qu'ils aient été soumis à la même approche chirurgicale, jusqu'à 40 % des patients souffrent de douleur chronique postopératoire après une chirurgie cardiaque, tandis que le reste des patients n'en souffrent pas. Cette variabilité porte à croire que la douleur chronique postopératoire est en partie maitrisée génétiquement, mais les gènes en cause dans la douleur chronique postopératoire sont très peu connus.But: Identifier les phénotypes de douleur chronique postopératoire possibles en comparant des patients souffrant de douleur chronique postopératoire à des patients n'en souffrant pas après une chirurgie cardiaque.Méthodes: Une étude transversale de la douleur après une chirurgie cardiaque approuvée par la commission d'éthique de la recherche a été menée à l'Hôpital général de Toronto de 2011 à 2015. Les patients ont été recrutés pour répondre à un court questionnaire portant sur les scores de douleur chronique et à une version abrégée du McGill Pain Questionnaire-2. Un sous-ensemble de patients a répondu à une enquête plus longue comprenant huit questionnaires validés portant sur le phénotypage de la douleur et/ou sur quatre mesures psychophysiques. Tous les questionnaires et les tests psychophysiques ont été menés après la chirurgie. Les patients ont été stratrifiés en fonction de la présence de douleur chronique et les groupes ont été comparés à l'aide de statistiques descriptives.Résultats: 634 patients ont répondu à la version courte de l'enquête. Le temps moyen de l'évaluation post-chirurgie était de 41,4 mois (écart-type ± 25,1). Plus d'un quart (27,8%) des participants ont rapporté de la douleur chronique postopératoire au thorax en tant que conséquence de la chirurgie. Parmi les patients rapportant de la douleur chronique post-opératoire, 46,6 % ont rapporée une douleur faible (0-3), 35,8 % ont rapporté de la douleur modérée (4-7) et 17,6 % ont rapporté de la douleur sévère (7-10), selon l'échelle d'évaluation numérique. Les patients souffrant de douleur chronique postopératoire de modérée à sévère étaient plus jeunes, avaient un indice de masse corporelle plus élevé et obtenaient des scores plus élevés en ce qui concerne la sensibilité à l'anxiété, la catastrophisation de la douleur et la somatisation.Conclusion: Les niveaux de douleur chronique après une chirurgie cardiaque sont associés à l'anxiété, à la catastrophisation et à des anomalies sensorielles dans des parties du corps à l'extérieur de la zone innervée par les nerfs par les nerfs endommagés, ce qui indique la présence d'une sensibilisation centrale généralisée aux signaux sensoriels provenant des nerfs intacts.

The Canadian minimum dataset for chronic low back pain research: a cross-cultural adaptation of the National Institutes of Health Task Force Research Standards.

BACKGROUND: To better standardize clinical and epidemiological studies about the prevalence, risk factors, prognosis, impact and treatment of chronic low back pain, a minimum data set was developed by the National Institutes of Health (NIH) Task Force on Research Standards for Chronic Low Back Pain. The aim of the present study was to develop a culturally adapted questionnaire that could be used for chronic low back pain research among French-speaking populations in Canada. METHODS: The adaptation of the French Canadian version of the minimum data set was achieved according to guidelines for the cross-cultural adaptation of self-reported measures (double forward-backward translation, expert committee, pretest among 35 patients with pain in the low back region). Minor cultural adaptations were also incorporated into the English version by the expert committee (e.g., items about race/ethnicity, education level). RESULTS: This cross-cultural adaptation provides an equivalent French-Canadian version of the minimal data set questionnaire and a culturally adapted English-Canadian version. Modifications made to the original NIH minimum data set were minimized to facilitate comparison between the Canadian and American versions. INTERPRETATION: The present study is a first step toward the use of a culturally adapted instrument for phenotyping French- and English-speaking low back pain patients in Canada. Clinicians and researchers will recognize the importance of this standardized tool and are encouraged to incorporate it into future research studies on chronic low back pain.

Persistent pain in a community-based sample of children and adolescents.

BACKGROUND: Very few studies have investigated the psychological factors associated with the pain experiences of children and adolescents in community samples. OBJECTIVES: To examine the lifetime prevalence of, and psychological variables associated with, persistent pain in a community sample of children and adolescents, and to explore differences according to sex, age and pain history. METHODS: Participants completed the Childhood Anxiety Sensitivity Index (CASI), the Child Pain Anxiety Symptoms Scale (CPASS), the Multidimensional Anxiety Scale for Children-10 (MASC-10), the Pain Catastrophizing Scale for Children (PCS-C) and a pain history questionnaire that assessed chronicity and pain frequency. After research ethics board approval, informed consent/assent was obtained from 1022 individuals recruited to participate in a study conducted at the Ontario Science Centre (Toronto, Ontario). RESULTS: Of the 1006 participants (54% female, mean [± SD] age 11.6±2.7 years) who provided complete data, 27% reported having experienced pain that lasted for three months or longer. A 2×2×2 (pain history, age and sex) multivariate ANOVA was conducted, with the total scores on the CASI, the CPASS, the MASC-10 and the PCS-C as dependent variables. Girls with a history of persistent pain expressed higher levels of anxiety sensitivity (P<0.001) and pain catastrophizing (P<0.001) than both girls without a pain history and boys regardless of pain history. This same pattern of results was found for anxiety and pain anxiety in the older, but not the younger, age group. CONCLUSIONS: Boys and girls appear to differ in terms of how age and pain history relate to the expression of pain-related psychological variables. Given the prevalence of persistent pain found in the study, more research is needed regarding the developmental implications of persistent pain in childhood and adolescence.

Reliability and validity of the Child Pain Anxiety Symptoms Scale (CPASS) in a clinical sample of children and adolescents with acute postsurgical pain.

Pain anxiety refers to the cognitive, emotional, physiological, and behavioural reactions to the experience or anticipation of pain. The Child Pain Anxiety Symptoms Scale (CPASS) has recently been developed and validated in a pediatric community sample. The goal of the present study was to examine the psychometric properties of the CPASS in a sample of children and adolescents with acute postsurgical pain. Eightythree children aged 8­18 years (mean 13.8 years, SD 2.4) completed measures of pain anxiety, anxiety sensitivity, pain catastrophizing, anxiety, depression, and pain intensity and unpleasantness 48­72 hours after major surgery; and pain intensity and unpleasantness, pain anxiety, and functional disability approximately 2 weeks after discharge from the hospital. The CPASS showed excellent internal consistency (a = 0.915). Stronger partial correlations of pain anxiety with anxiety sensitivity (r = 0.70) and pain catastrophizing (r = 0.73) compared to pain anxiety with anxiety (r = 0.53) and depression (r = 0.59) suggest excellent construct validity. Pain anxiety was significantly associated with pain intensity (r = 0.44) and unpleasantness (r = 0.32) 48­72 hours after surgery (concurrent validity) and with pain unpleasantness (r = 0.29) and functional disability (r = 0.50; but not pain intensity, r = 0.20) 2 weeks later (predictive validity). The CPASS showed adequate sensitivity to change over time (mean change = 9.52; effect size = 0.49) and good sensitivity and specificity. The results of the present study provide initial validity and reliability of the CPASS in a clinical sample of children and adolescents after major surgery.

Brief research report: uncertainty-inducing and reassuring facts about HPV: a descriptive study of French Canadian women.

We sought to describe information that makes women feel (1) uncertain and (2) reassured about their human papillomavirus (HPV) status and the potential health implications of an HPV DNA test result and (3) to examine information seeking after receiving their result. Thirty women (previously tested HPV negative) read factual information on HPV and cervical cancer and were asked which facts were uncertainty inducing and which were reassuring. Twenty-four facts reassured women of their HPV negative status, 11 facts made women feel uncertain, and 10 facts made them feel both. The most common reason for seeking information in the future was receiving a positive test result. The authors outline what specific facts about HPV health providers can emphasize to alleviate anxiety and encourage women to feel reassured of their low cancer risk following a negative test result.

Structure of posttraumatic stress disorder symptoms in pain and pain-free patients scheduled for major surgery.

UNLABELLED: Factor-analytic studies of the structure of posttraumatic stress disorder (PTSD) symptoms have yielded inconsistent results. One of the reasons for the inconsistency may be that PTSD is highly comorbid with other disorders; the observed factor structure might depend on the particular comorbid disorder. One such disorder is chronic pain. The goal of the present study was to investigate whether PTSD symptom structure differs between pain and pain-free patients scheduled to undergo major surgery. Four hundred and forty-seven patients who were approached 7 to 10 days prior to scheduled surgery completed the PTSD Checklist-Civilian (PCL-C) Version and the Current Pain and Pain History Questionnaire; the latter was used to divide patients into pain (N = 175) and pain-free (N = 272) groups. Results showed that in pain-free patients, PTSD symptoms were best expressed as 2 symptom clusters (re-experiencing/avoidance; emotional numbing/hyperarousal) accounting for 52.4% of the variance. In pain patients, PTSD symptoms were best expressed as a single symptom cluster accounting for 51.1% of the variance. These results suggest different interrelationships among PTSD symptoms in these 2 populations. Results reflect the need for (1) controlling for pain in studies looking at PTSD-symptom expression and (2) further research on PTSD-symptom expression in pain populations. PERSPECTIVE: These results may have important implications for research on the comorbidity between PTSD and chronic pain, as well as for treatment of PTSD symptoms in patients presenting with pain problems.

Maternal family history of hypertension attenuates neonatal pain response.

Reduced sensitivity to naturally occurring and laboratory pain stimuli has been observed in individuals with hypertension, high-normal blood pressure, and a family history of hypertension. The present study sought to extend these findings by examining the relationship between familial history of hypertension and pain responsivity in neonates. Eighty infants had intramuscular (IM) injections of vitamin K performed in the delivery room within 1h of birth as per institutional practice. Video recordings of the injection procedure were used by trained observers to code infant pain responses using facial grimacing and cry duration. Prior to the birth of the child, the infants' parents each completed a family blood pressure history survey and these responses were used to identify infants with and without a maternal and paternal family history of hypertension. As compared to infants without a maternal family history of hypertension, infants with a maternal family history of hypertension had significantly shorter crying times, F(1,74)=6.96, p=.01, eta(2)=.086, and marginally lower facial grimacing scores, F(1,74)=2.68, p=.10, eta(2)=.035, during vitamin K injection. The presence of attenuated responses to the IM injection in neonates with a maternal family history of hypertension provides important and novel evidence that reduced pain responding in individuals at risk for hypertension is not a learned response style, but rather may arise from prenatal or genetic influences.