"Working Together": Perspectives of Healthcare Professionals in Providing Virtual Care to Youth with Chronic Pain during the COVID-19 Pandemic.

BACKGROUND: The onset of the coronavirus disease in 2019 necessitated a rapid transition to virtual care for chronic pain treatment. METHODS: A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Interviews were conducted in February 2021 with a sample of healthcare professionals (HCPs; n = 6) who had provided multidisciplinary treatment (MDT) through an outpatient hospital pediatric chronic pain program. Satisfaction surveys were distributed to all MDT professionals employed by the clinic in April 2021 (n = 13 of 20 eligible; 65% response rate). Participants represented medicine, rehabilitation, and mental health professionals. RESULTS: Analysis of interviews generated five themes: (1) adaptation to virtual care, (2) benefits of virtual care, (3) limitations of virtual care, (4) shifting stance on virtual care over time, and (5) considerations for implementing virtual care. The satisfaction survey data revealed that respondents were able to effectively provide appropriate diagnoses, recommendations, and/or care plans for pediatric chronic pain via virtual care (n = 12, 92.3%). Detailed survey responses are presented by discipline. CONCLUSIONS: This study provides a rich exploration of HCPs' experiences in providing MDT for pediatric chronic pain within a virtual care model. The current results may contribute to the future development of guidelines for virtual care delivery with pediatric chronic pain populations.

Virtual multidisciplinary pain treatment: Experiences and feedback from children with chronic pain and their caregivers.

BACKGROUND: The onset of the coronavirus disease 2019 (COVID-19) necessitated a rapid transition to virtual care for chronic pain treatment. OBJECTIVE: This study examined experiences of patients and caregivers who received virtual multidisciplinary pain treatment (MDT) for pediatric chronic pain between March 2020 and August 2021. METHODS: A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Satisfaction surveys were administered to a convenience sample of patients (aged 8 to 18; N = 20) and their caregivers (N = 20) who received MDT through an outpatient hospital pediatric chronic pain program. Interviews were conducted with a subset of these patients and their caregivers (n = 6). RESULTS: Analysis of interviews revealed four themes: 1) benefits of virtual care; 2) challenges of virtual care; 3) recommendations and evaluation of virtual care; and 4) patient preferences. Analysis of the satisfaction survey data revealed that while patients and caregivers were satisfied with many aspects of virtual care, 65% (n = 13) of patients reported a preference for in-person appointments, with caregivers showing equal preference for in-person and virtual appointments, though this was a non-significant difference (p = .37). Overall, both patients and caregivers stated a stronger preference for in-person physiotherapy sessions but were willing to have psychology sessions provided virtually. Finally, the most reported preference was for a hybrid model of care incorporating at least some in-person contact with providers. CONCLUSION: This study provides a rich exploration of virtual care for multidisciplinary pediatric chronic pain treatment. The current results may inform the future development of guidelines for virtual care delivery with pediatric chronic pain populations.

Synthetic cannabinoid for the treatment of severe chronic noncancer pain in children and adolescents.

Background: The prevalence of chronic pain in children and adolescents is high. In some patients, it can be severe and refractory to conventional treatment options. There is increasing interest in the use of cannabinoids for therapeutic purposes in children and adolescents. Nabilone, a synthetic cannabinoid, is approved in Canada for the treatment of nausea and vomiting associated with chemotherapy. It can also be used off label for treatment of chronic pain. Aims: This study aims to characterize the use of nabilone for severe chronic pain in a pediatric population. Methods: This is a retrospective cohort study of patients 18 years or younger who were prescribed nabilone for chronic pain in a tertiary multidisciplinary pediatric chronic pain clinic between July 1, 2013, and June 30, 2017. Results: During the 4-year study period, we screened the charts of 507 patients and identified a total of 28 patients (5.5%) who were treated with nabilone as part of their chronic pain treatment. Common indications for nabilone treatment include mixed neuropathic/nociceptive pain, abdominal pain, neuropathic pain, and spasticity. In all patients, nabilone was prescribed as an adjunctive treatment. Seven patients (25%) reported a slight improvement in pain symptoms. Side effects were reported by 21.4% of patients. The most common reported side effects were sedation and cognitive slowing. Conclusions: Adjunctive treatment with nabilone may improve pain symptoms in a subset of pediatric chronic pain patients. Further research investigating the long-term safety and efficacy of nabilone in the treatment of chronic pain in children is needed.

Contexte: La prévalence de la douleur chronique chez les enfants et les adolescents est élevée. Chez certains patients, elle peut être sévère et réfractaire aux options de traitement conventionnelles. On s'intéresse de plus en plus à l'utilisation de cannabinoïdes à des fins thérapeutiques chez les enfants et les adolescents. Nabilone, un cannabinoïde synthétique, est approuvé au Canada pour le traitement des nausées et des vomissements associés à la chimiothérapie. Il peut également être utilisé hors étiquette pour le traitement de la douleur chronique.Buts : Cette étude vise à caractériser l'utilisation du Nabilone pour les douleurs chroniques sévères chez une population pédiatrique.Méthodes : Il s'agit d'une étude de cohorte rétrospective de patients âgés de 18 ans ou moins à qui du Nabilone a été prescrit pour la douleur chronique dans une clinique pédiatrique multidisciplinaire tertiaire de la douleur chronique entre le 1er juillet 2013 et le 30 juin 2017.Résultats : Au cours de la période d'étude de quatre ans, nous avons examiné les dossiers de 507 patients et répertorié un total de 28 patients (5,5%) traités par Nabilone dans le cadre de leur traitement de la douleur chronique. Les indications courantes pour le traitement par Nabilone comprennent les douleurs neuropathiques/nociceptives mixtes, les douleurs abdominales, les douleurs neuropathiques et la spasticité. Chez tous les patients, Nabilone a été prescrit comme adjuvant. Sept patients (25 %) ont rapporté une légère amélioration des symptômes de la douleur. Des effets secondaires ont été rapportés par 21,4 % des patients. Les effets indésirables les plus fréquemment rapportés étaient la sédation et le ralentissement cognitif.Conclusions : Le traitement adjuvant par Nabilone peut améliorer les symptômes de la douleur chez un sous-ensemble de patients pédiatriques souffrant de douleur chronique. D'autres études sur l'innocuité et l'efficacité à long terme du Nabilone dans le traitement de la douleur chronique chez les enfants sont nécessaires.

Variability in discharge opioid prescribing practices for children: a historical cohort study.

PURPOSE: Legitimate opioid prescriptions can increase the risk of misuse, addiction, and overdose of opioids in children and adolescents. This study aimed to describe the prescribing patterns of discharge opioid analgesics following inpatient visits and to determine patient and prescriber characteristics that are associated with prolonged opioid prescription. METHODS: In a historical cohort study, we identified patients discharged from hospital with an opioid analgesic prescription in a tertiary pediatric hospital from 1 January 2016 to 30 June 2017. The primary outcome was the duration of opioid prescription in number of days. We assessed the association between patient and prescriber characteristics and an opioid prescription duration > five days using a generalized estimating equation to account for clustering due to repeated admissions of the same patient. RESULTS: During the 18-month study period, 15.4% of all admitted patients (3,787/24,571) were given a total of 3,870 opioid prescriptions at discharge. The median [interquartile range] prescribed duration of outpatient opioid therapy was 3.75 [3.00-5.00] days. Seventy-seven percent of the opioid prescriptions were for five days or less. Generalized estimating equation analysis revealed that hospital stay > four days, oxycodone prescription, and prescription by clinical fellows and the orthopedics service were all independently associated with a discharge opioid prescription of > five days. CONCLUSIONS: Most discharge opioids for children were prescribed for less than five days, consistent with current guidelines for adults. Nevertheless, the dosage and duration of opioids prescribed at discharge varied widely.

RéSUMé: OBJECTIF: Les ordonnances légales d'opioïdes peuvent augmenter le risque d'abus, de dépendance et de surdose d'opioïdes chez les enfants et les adolescents. Cette étude avait pour objectif de décrire les schémas de prescription d'analgésiques opioïdes au congé des séjours hospitaliers et à déterminer les caractéristiques des patients et des prescripteurs qui sont associées à la prescription prolongée d'opioïdes. MéTHODE: Dans une étude de cohorte historique, nous avons identifié les patients ayant reçu leur congé de l'hôpital avec une ordonnance d'analgésiques opioïdes dans un hôpital pédiatrique de soins tertiaires entre le 1er janvier 2016 et le 30 juin 2017. Le critère d'évaluation principal était la durée de la prescription d'opioïdes en nombre de jours. Nous avons évalué l'association entre les caractéristiques des patients et des prescripteurs et la durée d'une ordonnance d'opioïdes > cinq jours à l'aide d'une équation d'estimation généralisée pour tenir compte du regroupement dû aux admissions répétées d'un même patient. RéSULTATS: Au cours de la période d'étude de 18 mois, 15,4 % de tous les patients admis (3787/24 571) ont reçu un total de 3870 ordonnances d'opioïdes à leur congé. La durée de prescription médiane [écart interquartile] du traitement d'opioïdes hors hôpital était de 3,75 [3,00-5,00] jours. Soixante-dix-sept pour cent des ordonnances d'opioïdes étaient de cinq jours ou moins. L'analyse de l'équation d'estimation généralisée a révélé qu'un séjour à l'hôpital > quatre jours, une prescription d'oxycodone et la prescription par des fellows cliniques et le service d'orthopédie ont tous été indépendamment associés à une ordonnance d'opioïdes au congé > cinq jours. CONCLUSION: La plupart des opioïdes prescrits au congé pour les enfants ont été prescrits pour moins de cinq jours, conformément aux lignes directrices actuelles pour les adultes. Néanmoins, la posologie et la durée des opioïdes prescrits au congé variaient considérablement.

Development of a Screening Tool for Pediatric Neuropathic Pain and Complex Regional Pain Syndrome: Pediatric PainSCAN.

OBJECTIVE: Neuropathic pain (NP) and complex regional pain syndrome (CRPS) in children can result in significant disability and emotional distress. Early assessment and treatment could potentially improve pain, function, quality of life, and reduce costs to the health care system. Currently, there are no screening tools for pediatric NP and CRPS. This research aimed to develop and establish the content validity of a screening tool for pediatric NP and CRPS using a phased approach. MATERIALS AND METHODS: Phase I surveyed clinical experts using a modified Delphi procedure to elicit disease concepts for inclusion. In phase II, a consensus conference including clinicians, researchers, and people with lived experience, informed the initial item pool. Consensus for item inclusion was achieved using a nominal group technique for voting. Phase III used iterative rounds of cognitive interviews with children aged 8 to 18 years with CRPS or NP to evaluate the tool's comprehensiveness and individual item relevance and comprehensibility. Descriptive statistics were used to describe participant characteristics. Content analysis was used to analyze patient interviews. RESULTS: Phase I (n=50) generated an initial item pool (22 items). Phase II generated a comprehensive item pool (50 items), after which an initial version of the screening tool was drafted. Following phase III (n=26) after item revision and elimination, 37 items remained. DISCUSSION: The Pediatric PainSCAN is a novel screening tool that has undergone rigorous development and content validity testing. Further research is needed to conduct item reduction, determine scoring, and test additional measurement properties.