Understanding Pain: From Cells to Brain to Individual Perceptions

Noosha Yousefpour a , Shannon Tansley b , Samantha Locke a , Valerie Cabana a , Chengyang Wang c , Arkady Khoutorsky d , Yves De Koninck e , Alfredo Ribeiro-da-Silva a a Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada; b Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada; c Psychology and Anesthesia, McGill University, Montreal, Quebec, Canada; d Anesthesia, McGill University, Montreal, Quebec, Canada; e Psychiatry and Neuroscience, Laval University, Quebec City, Quebec, Canada CONTACT Sabrina Noosha Yousefpour [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/ ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: Inhibitory synapse loss in the dorsal horn of the spinal cord strongly correlates with pain hypersensitivity in animal models of neuropathic pain. This selective synapse loss potentially contributes to disinhibition of spinal cord nociceptive circuits and maintenance of neuropathic pain. The present study aims to elucidate the key mechanism underlying this inhibitory synapse loss. Specifically, we investigate the role of microglia and the complement system, a well characterized synaptic pruning pathway, in neuropathic pain. Methods: In a mouse model of neuropathic pain, using immunohistochemistry in combination with high resolution light and electron microscopy, we analyzed the integrity of inhibitory and excitatory synapses and their colocalization with complement factors. To investigate microglial involvement in phagocytosing inhibitory presynaptic inputs we performed an engulfment assay. Lastly, we depleted spinal microglia and complement factors in neuropathic and control mice then assessed the effect of these manipulations on dorsal horn synapse loss and pain-related behaviour. Results: In neuropathic mice, we found a reduction in the number of intact inhibitory synaptic structures. A significant proportion of the remaining synapses colocalized with complement factors C1q and C3. The engulfment assay showed that microglia phagocytosed inhibitory presynaptic compartments. Furthermore, microglia and complement depletion prevented inhibitory synapse loss and pain hypersensitivity. Discussion/Conclusions: Together, these findings suggest that microglia contribute to disinhibition of spinal nociceptive circuits in neuropathic pain through engulfment of inhibitory synapses in the spinal dorsal horn. The selectivity of microglia-mediated synapse pruning in neuropathic pain is likely dependent on complement factors.

Sabrina Bouferguene a , Naïcha-Éveline Germélus b , Pierre Rainville c , and Caroline Arbour d a Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; b Hôpital du Sacré-Cœur de Montréal Research Center, Montréal, Québec, Canada; c Department of Stomatology, Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada; d Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada CONTACT Sabrina Bouferguene [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Chronic pain after moderate-to-severe traumatic brain injury (TBI) could be affected by age. Still, pain presentation in adult TBI has never been investigated across a large age range. We examined whether age contributes to chronic pain presentation after moderate-to-severe TBI. Methods : N = 54 adults between 18–85 years (36 males, 46 ± 19 years) were recruited 23 ± 14 months after moderate-to-severe TBI. Chronic pain was assessed with the Brief Pain Inventory. Thermal and mechanical detection/pain thresholds were gathered using Quantitative Sensory Testing (QST). Data were transformed into z-scores to account for variation in gender and pain sites. Results : Participants were categorized into three groups: n = 18 young (<35 years), n = 17 middle-aged (36–55 years), n = 19 older adults (≥55 years). Chronic pain was reported by n = 30 (56%) participants with an average intensity of 5 ± 2/10. Overall, young and middle-aged participants (≤55 years) with pain presented higher cold detection z-scores when compared to same age participants without pain ( t = 2.28, p = 0.03). In contrast, older participants (≥55 years) suffering from chronic pain exhibited a lower heat pain z-score when compared to pain participants of the other age groups ( F = 8.82, p = 0.001), but not when compared to same age participants without pain ( t = 0.28, p = 0.79). Correcting for gender and time elapsed since TBI, age was not significantly related to chronic pain status ( X 2   = 0.347, OR  = 1.01, p = 0.57). Discussion/Conclusions : Our results support previous ones showing thermal hypoesthesia in young TBI with chronic pain. For the first time however, we show that being over 55 years could predispose to thermal hyperalgesia after TBI, suggesting possible age-related differences in neuroplasticity following adults.

Erika Gentile a , Florian Bobeuf 0000-0002-4798-1091 b , Anna Bendas 0000-0002-2903-4015 a , Kelly Cool 0000-0001-5078-6599 a , Maxime Lussier b , Louis Bherer c , Mathieu Roy 0000-0002-3335-445X a a Psychology, McGill University, Montreal, Quebec, Canada; b Centre de recherche de l’Institut universitaire de gériatrie de Montreal, Montreal, Quebec, Canada; c Centre de recherche de l’Institut universitaire de gériatrie de Montréal & l’Institut de Cardiologie de Montréal, Montreal, Quebec, Canada CONTACT Erika Gentile [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Chronic low back pain (CLBP) is the most prevalent and problematic of all chronic pain syndromes. In addition to enduring persistent pain, they also experience a reduction in cognitive abilities. This is because CLBP patients have more difficulty summoning the cognitive resources necessary to meet professional and personal responsibilities, often providing them with a major obstacle in every day functioning. While almost all cognitive domains appear to be compromised, executive functioning seem to be one of the most affected abilities. Despite this, such cognitive deficits are rarely the focus of therapeutic interventions since they are widely viewed as secondary to chronic pain. Thus, an effective treatment for them is still unknown. Fortunately, physical exercise has been shown to be beneficial throughout the lifespan by optimizing overall physical and cognitive health and is one of few interventions that reliably improves pain management in CLBP. The present study aimed to test the impact of a physical exercise intervention on executive functioning in patients with CLBP. Twenty-three patients with non-specific CLBP completed a 14-week aerobic and muscular exercise program. Before and after the program, they performed a dual task that assessed their ability to identify different stimuli while simultaneously using their left and right hand. Our findings showed that after the exercise program, the patients’ ability to perceive multiple stimuli and coordinate the execution of two motor responses was improved. These results suggest that higher-order cognitive behavior, such as executive functioning, can be ameliorated with the help of exercise in these patients. Introduction/Aim : Besides having to live in constant pain and limited mobility, patients with chronic low back pain (CLBP) have a constellation of symptoms that further contribute to their disability, such as cognitive impairment. While almost all cognitive domains appear to be compromised, executive functions seem to be one of the most affected abilities. Currently, physical exercise is one of the few interventions that reliably improves the management of pain in CLBP. However, since the cognitive deficits seen in CLBP patients are widely viewed as a secondary to pain, the impact of exercise therapy on such deficits have yet to be investigated. The present study sought to examine the effects of exercise training on dual task performance – a measure of executive functioning – in CLBP patients. Methods : Twenty-three patients (15 female, 8 male, age range 22–65) with non-specific CLBP participated in a 14-week aerobic and muscular exercise program. Before and after the program, patients completed a dual task that required them to perform an identification task while simultaneously using their left and right hand. Reaction times were recorded. Results : Preliminary results revealed a significant three-way interaction between time, task, and side (left and right hand), F(1,22) = 4.126, p = .054. After exercise training, patients showed a near-significant reduction in reaction time difference between the two hands suggesting that patients’ ability to perceive multiple stimuli and coordinate the execution of two motor responses improved, F(1,22) = 3.775, p = .065. Discussion/Conclusions : Our findings indicate that patients’ task coordination ability required to execute multiple tasks is improved with exercise. Further, it provided insight into a feasible intervention that has the potential to enhance the cognitive health and subsequently, the functionality and quality of life of chronic pain sufferers.

Samah Hassan a b c , Qingping Zheng a , Erica Rizzolo a , Evrim Tezcanli a , Sukriti Bhardwaj a , Kieran Cooley a d e a Canadian College of Naturopathic Medicine, ON, Canada; b Institute of Medical Science, University of Toronto, ON, Canada; c Toronto Rehabilitation Institute, University Health Network, ON, Canada; d Australian Research Centre in Complementary and Integrative Medicine – University Technology Sydney, Ultimo, Australia; e Pacific College of Oriental Medicine, San Diego, CA, USA CONTACT Samah Hassan [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Chronic pain (CP) is a major public-health problem. Many patients with CP are increasingly prescribed opioids, which have led to an opioid crisis. Integrative Medicine (IM) which combines pharmacological and complementary and alternative medicine (CAM) has been proposed as opioid alternative for CP treatment. Nevertheless, many CAM therapies have been viewed with prejudice and skepticism based on claims of limited or low-quality evidence. To explore the true effectiveness of the IM approach or any of the CAM therapies to reduce or cease opioid use in CP patients An online search of MEDLINE and Embase, CINAHL, PubMed supp. and Allied and Complementary Medicine Database (AMED) for studies published in English from inception until February 15th, 2018 was conducted. The Mixed Methods Appraisal Tool (MMAT) was used to critically appraise selected studies. \The electronic search yielded 5200 citations. Twenty-three studies met all eligibility criteria and underwent data extraction. The majority of studies showed that opioid use was reduced significantly after using IM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use followed by multidisciplinary approaches, cognitive-behavioural model and acupuncture. The majority of the studies had limitations with sample size, duration and study designs. There is a small, but defined body of literature demonstrating positive preliminary evidence that IM approach including CAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it’s vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/CAM therapies for CP. Introduction/Aim: Chronic pain (CP) is a major public-health problem. Many patients with CP are increasingly prescribed opioids, which have led to an opioid crisis. Integrative Medicine (IM) which combines pharmacological and complementary and alternative medicine (CAM) has been proposed as opioid alternative for CP treatment. Nevertheless, many CAM therapies have been viewed with prejudice and skepticism based on claims of limited or low-quality evidence. To explore the true effectiveness of the IM approach or any of the CAM therapies to reduce or cease opioid use in CP patients Methods: An online search of MEDLINE and Embase, CINAHL, PubMed supp. and Allied and Complementary Medicine Database (AMED) for studies published in English from inception until February 15th, 2018 was conducted. The Mixed Methods Appraisal Tool (MMAT) was used to critically appraise selected studies. Results: The electronic search yielded 5200 citations. Twenty-three studies met all eligibility criteria and underwent data extraction. The majority of studies showed that opioid use was reduced significantly after using IM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use followed by multidisciplinary approaches, cognitive-behavioural model and acupuncture. The majority of the studies had limitations with sample size, duration and study designs. Discussion/Conclusions: There is a small, but defined body of literature demonstrating positive preliminary evidence that IM approach including CAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it’s vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/CAM therapies for CP.

Céline Gélinas a , Melissa Richard-Lalonde a , Francis Bernard b , Mélanie Bérubé c , Emmanuel Charbonney d , Jean-Nicolas Dubé e , Julie Houle f , Suzanne Morin g , Marc Perreault h , Nathalie Thiffault i , Yannick Tousignant-Laflamme j , Darina M. Tsoller k , Virginie Williams l , David Williamson m , Manon Choinière 0000-0001-9593-8883 n a Ingram School of Nursing, and Jewish General Hospital - CIUSSS Centre-Ouest-Ile-Montreal, Centre for Nursing Research and Lady Davis Institute, McGill University, Montréal, Québec, Canada; b CIUSSS du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Département des soins intensifs, Université de Montréal, Montréal, Québec, Canada; c CIUSSS du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; d CIUSSS de la Mauricie-et-Centre-du-Québec, CIUSSS du Nord-de-l’Île-de-Montréal, Université de Montréal, Montréal, Québec, Canada; e Centre hospitalier affilié universitaire régional - CIUSSS de la Mauricie-et-Centre-du-Québec, Université de Montréal, Trois-Rivières, Québec, Canada; f Département des sciences infirmières, CIUSSS de la Mauricie-et-Centre-du-Québec, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; g Department of Medicine, McGill University, Montréal, Québec, Canada; h Faculty of Pharmacy, McGill University Health Center, and Université de Montréal, Montréal, Québec, Canada; i Centre hospitalier affilié universitaire régional - CIUSSS de la Mauricie-et-Centre-du-Québec, Trois-Rivières, Québec, Canada; j School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada; k Jewish General Hospital - CIUSSS Centre-Ouest-Ile-Montreal, Centre for Nursing Research and Lady Davis Institute, Montréal, Québec, Canada; l Département des soins intensifs, CIUSSS du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; m Faculty of Pharmacy, CIUSSS Nord-de-l’Ile-de-Montréal, Research Centre and Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada; n Department of Anesthesiology and Pain Medicine, Research Centre of the Centre hospitalier de l’Université de Montréal and Université de Montréal, Montréal, Québec, Canada CONTACT Céline Gélinas [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Practice guidelines recommend that pain be assessed on a regular basis (q 2-3 h) in the intensive care unit (ICU) We aimed to describe pain assessment documentation in adult ICUs. 1 Methods : A retrospective cohort design was used in this multi-site study of four ICU settings in the province of Quebec. Pain assessment tools (i.e., 0–10 Numeric Rating Scale and Critical-Care Pain Observation Tool) were available in all ICUs. Medical charts of patients admitted to the ICU for a minimum of 48 hours in 2017 and 2018 were reviewed and we extracted data from the second 24-hour period following ICU admission. Information related to socio-demographic (age, sex), clinical (diagnosis, ICU length of stay, mechanical ventilation duration), pain assessments, and opioid administration was collected. Results : A total of 297 patient charts (31% male, mean age = 60 y, SD = 18.1) were reviewed. Admitting ICU diagnosis was medical (38%), surgical (26%) and trauma (36%). Median ICU length of stay was 6.6 days and median duration of mechanical ventilation (80% of patients were mechanically ventilated) was 74.7 hours. Pain assessments were documented in only 51% of reviewed charts, and when present the median number was 4 assessments/24 hours. Pain reassessments following opioid administration were documented in only 22% of patients who received opioids. Discussion/Conclusions : Documentation of pain assessments in the ICU is suboptimal and opioid administration is not monitored with regular pain reassessments. Improvement strategies must be deployed to improve optimal documentation and to ensure pain management practices for relieving pain in the ICU. Disclosure statement No potential conflict of interest was reported by the authors.

Marie-Eve Martel a , Chrystelle El-Khoury b , and M Gabrielle Pagé c a Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; b Centre de recherche, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada; c Centre de recherche, Centre hospitalier de l’Université de Montréal, & Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada CONTACT Marie-Eve Martel [email protected] 1 John Smith, University of Toronto, Psychology, Toronto, Ontario, Canada, @johnsmithuoft, @johnsmithuoft 2 Jane Doe, Queen’s University, Nursing, Kingston, Ontario, Canada, [email protected], @jdoequeens 1 John Smith, University of Toronto, Psychology, Toronto, Ontario, Canada, @johnsmithuoft, @johnsmithuoft 2 Jane Doe, Queen’s University, Nursing, Kingston, Ontario, Canada, [email protected], @jdoequeens © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Many chronic pain patients suffer from other chronic health conditions, which can lead to increased burden of symptom self-management. This increased perceived burden can negatively impact on patients’ beliefs, behaviors and treatment adherence. This study aims to identify predictors of perceived medical burden among chronic pain patients suffering from ≥1 additional medical condition. Methods : A transversal observational study design was used. A total of 137 individuals with chronic pain (≥3 months) and ≥1 other medical condition were recruited from patient associations and social and conventional media and completed online questionnaires. A linear regression model using backward selection process was used to identify pain characteristics (duration, interference, average and worst pain intensities), patient (age, sex, gender, self-efficacy, patient engagement in healthcare), and medical (number and severity of comorbidities) characteristics associated with perceived medical burden. Results : The final regression model included 3 variables: patient engagement in healthcare ( b = −.25, p < .05) and pain interference ( b = .48, p < .05), but not severity of comorbidities ( p = 0.069) were significantly associated with perceived medical burden. Results showed the less individuals are engaged in their healthcare, the greater the burden perceived. In addition, the more pain interferes with daily activities, the more their medical conditions is perceived as burdensome. Discussion/Conclusions : Results revealed that objective measures of severity of conditions, as evaluated by the Self-Administered Comorbidity Questionnaire and comorbidity count, are not associated with perceived medical burden. Targeting patient and pain characteristics might prove beneficial to reduce perceived medical burden and facilitate symptom self-management.

Léa Proulx-Bégin a , Alberto Herrero Babiloni b , Sabrina Bouferguene c , Gilles Lavigne a , Louis De Beaumont d , and Caroline Arbour e a Psychology, Research Center, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada; b Research Center, Hôpital du Sacré-Coeur de Montréal Université de Montréal, Montréal, Québec, Canada; c Faculty of Medecine, Research Center, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Biomedical Sciences, Montréal, Québec, Canada; d Surgery, Faculty of Medecine, Research Center, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada; e Faculty of Nursing, Research Center, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada CONTACT Léa Proulx-Bégin [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: Repetitive transcranial magnetic stimulation (rTMS) can modulate heat pain thresholds (HPT) in health and disease. One obstacle of rTMS however is the number of sessions required to induce a significant effect on pain. We aimed to examine whether conditioning – a physiological response elicited through unconscious association of stimuli – can be used to optimize the effect of rTMS on HPT. Methods: Twenty healthy subjects were randomly assigned to: 1) conditioning (n = 10;6F;23y±2) or 2) non-conditioning (n = 10;4F;23y±3) groups and took part in two laboratory visits (one with active rTMS the other with sham). For the active visit, two rTMS sessions of 20 min with a 20 min resting period in between were conducted over the left motor cortex (10Hz at 80% RMT). For sham visit, same parameters were used with a sham coil. HPT were evaluated over the right wrist area at baseline and after each rTMS/sham session. For the conditioning procedure, heat temperature eliciting moderate pain was determined at baseline. Then, in the conditioning group, the thermode temperature was decreased by 3°C during the resting period. Results: Descriptive analyses showed a tendency towards an increase in HPT from baseline ( M =  42.95; SD =  2.93) to 1 st ( M =  43.88; SD =  2.04) and 2 nd ( M =  44.68; SD =  2.44) rTMS sessions in the conditioning group, but not in the non-conditioning ( M =  43.23; SD =  3.18; M =  43.87; SD =  3.51; M =  43.35; SD =  4.13) with active rTMS, which was less pronounced in HDT. Sham rTMS did not lead to HPT changes regardless of conditioning. Discussion/Conclusions: Preliminary results suggest the value of conditioning to optimize the effects of rTMS on HPT, potentially opening new avenues in TMS research.

Celia Cassiani a , Abla Oussama b , Kathryn Birnie 0000-0002-8223-8834 a , Lindsay Jibb 0000-0001-6995-2825 c , Karyn Positano b , Sarah Lloyd a , Jennifer Stinson a a Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; b Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; c Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada CONTACT Celia Cassiani [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Children with cancer have reported pain and distress during needle insertion into a subcutaneous port (SCP) despite numbing with a topical anesthetic.1–4 Virtual reality (VR) has shown to reduce acute pain in adults and children.5,6 Research is limited surrounding the use and safety of VR for procedural pain management for children with cancer. 7 This study aims to determine the feasibility (i.e., accrual rate, reasons for non-participation, safety, acceptability) of implementing a randomized controlled trial (RCT) of VR for SCP needle insertion in children with cancer and provide estimates of the impact on pain and distress. Methods : A pilot RCT comparing an intervention (VR headset) to an active control group (iPad) during SCP needle insertion in children 8–18 with cancer. Feasibility data will be analyzed through descriptive statistics. Results : Recruitment and data analysis are ongoing. Currently, 119 patients were screened for eligibility, 48 were eligible, 36 were approached, and 22 enrolled. Participants cited “not interested”, or “comfortable without distraction” as reasons for non-participation. Average age of participants is 12.8 years (SD = 3.2). Nine (75%) participants enjoyed using the VR, 7 (58%) found the VR headset a helpful distraction, and 11(91.7%) nurses were satisfied with the overall experience of using VR during port access. No safety issues were reported. Conclusion : Preliminary results suggest that VR during port insertion for children with cancer is feasible, safe, and acceptable for children with cancer and their nurses. Next steps include analyzing feasibility and effectiveness outcomes before completing a definitive trial.

Sheila O’Keefe-McCarthy 0000-0003-2909-8286 a , Karyn Taplay a , Lisa Keeping-Burke b , Allison Flynn-Bowman a , Maria Vasilaki a , Jennifer Tsang c , Chris Glover d , Colleen Norris e , and Jennifer Price f a Department of Nursing, Brock University, St. Catharines, Ontario, Canada; b Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada; c Niagara Health, Internal Medicine, St. Catharines, Ontario, Canada; d Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada; e Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; f Women’s College Hospital, Cardiology/Rehab, Toronto, Ontario, Canada CONTACT Sheila O’Keefe-McCarthy [email protected] Department of Nursing, Brock University, St. Catharines, ON, Canada © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: Proactive immediate treatment of acute pain is critical in the first hours of acute coronary syndrome (ACS) onset to prevent transition to persistent cardiac pain. Aim: The purpose of this research was to design the Acute-Heart PAiN-APP. There are no known digital health technologies (DHTs) (APPs) developed or evaluated to treat acute cardiac pain during an emergency hospital admission for ACS that are designed by patients and health care providers (HCPs). Methods: In Phase I we conducted qualitative interviews with individuals with ACS and HCPs to determine the preferred content and format for the APP. Results: 18 patients and 4 HCPs suggested that the APP consist of four interactive parts: 1) Coaching through the acute heart pain, 2) Symptom tracking of pain and anxiety, 3) SMART goals to manage the acute symptoms: a) choice of diversion: relaxation-paced breathing, b) guided imagery c) music and d) forms of gaming, and 4) immediate visual representation of pre-and-post APP effect on pain and anxiety levels. Discussion/Conclusions: The Acute-Heart PAiN-APP is an interactive DHT adjuvant treatment for ACS. The APP will permit a therapeutic level of patient control, symptom monitoring and self-management of ACS-pain. More importantly, this intervention may preserve threatened ischemic myocardial muscle, which may circumvent the transition to persistent forms of cardiac pain and related disability.

Shokoufeh Modanloo a , Juliana Choueiry a , Sandra Dunn b , Dawn Stacey c , Denise Harrison 0000-0001-7549-7742 a a Children’s Hospital of Eastern Ontario (CHEO) Research Institute, University of Ottawa, Ottawa, Ontario, Canada; b Better Outcomes Registry & Network (BORN), Ottawa, Ontario, Canada; c Ottawa Hospital Research Institute, Ottawa, Ontario, Canada CONTACT Shokoufeh Modanloo [email protected] Children’s Hospital of Eastern Ontario (CHEO) Research Institute, University of Ottawa, Ottawa, Ontario, Canada © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Early childhood vaccination is painful and distressing for infants and parents. Clinical practice guidelines recommend effective evidence-based pain management strategies during vaccination (breastfeeding, upright holding, sucrose). This study aims to identify and quality appraise publicly accessible online information regarding parent-targeted resources for pain management during vaccinations of infants. Methods : An environmental scan for electronic resources containing parent-targeted information on infant vaccination were included, using internet sources in English i) Google search and ii) Social Media networks. Characteristics of the resources were collected. The quality of resources was evaluated by Center for Disease Control (CDC) Clear Communication Index (CCI) (score range 0–100%, higher than 90% are acceptable). Descriptive statistics were used to analyze the data. Results : 65 eligible resources were identified. The mean resources’ CCI score was 60% (± 0.19) with most resources scoring as low to moderate quality (score 33% to 87%). Only 5% of resources were considered to be acceptable quality, almost all requiring revisions. Pain management information was presented in 30 (46%) resources; 24 (37%) included breastfeeding, 27 (42%) holding, and 22 (34%) sweet solutions. No statement regarding pain management strategies were found in over half (54%) of the resources. In resources describing pain management, distraction and holding were the most frequently suggested strategies. Discussion/Conclusions : Most online parent-targeted vaccination resources are of low quality and do not include evidence-based pain management strategies. Thus, there is a need for researchers, policy makers, and educational institutes to develop improved, publicly accessible information about infant vaccination and pain management strategies.

Perri R. Tutelman a , Lindsay A. Jibb 0000-0001-6995-2825 b , Christine T. Chambers 0000-0002-7138-916X c , Jennifer N. Stinson 0000-0002-9969-8052 d , Jennifer A. Parker 0000-0001-9900-4703 e , Melanie Barwick 0000-0002-2478-604X f , Fiona Campbell g , Emily K. Drake h , Conrad V. Fernandez i , Karen Irwin j , Paul C. Nathan k , Holly O. Witteman l , #KidsCancerPain Parent/Patient Partners m a Department of Psychology and Neuroscience, Dalhousie University & Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada; b School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; c Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University & Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada; d , Faculty of Nursing, University of Toronto & Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada; e Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada; f Child Health Evaluative Sciences, Hospital for Sick Children & Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; g Department of Anesthesia, University of Toronto & Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; h Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada; i Department of Pediatrics, Dalhousie University & Division of Haematology/Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada; j Cancer Knowledge Network, Toronto, Ontario, Canada; k Faculty of Medicine, University of Toronto & Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada; l Department of Family and Emergency Medicine, Université Laval & Population Health and Optimal Health Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Québec City, Québec, Canada; m Parent/Patient Partners, USA CONTACT Perri R. Tutelman [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : #KidsCancerPain is a social media campaign that partnered with the Cancer Knowledge Network to disseminate evidence-based information on pediatric cancer pain directly to parents. Parent perspectives on the use of social media as a tool to translate research remain unclear. The purpose of this study was to explore parent-perceived benefits and limitations of the #KidsCancerPain campaign. Methods : At the conclusion of the #KidsCancerPain campaign parents of children with cancer who viewed the campaign content were recruited to complete an online survey. Parents were asked to provide open-ended responses describing their perspectives on the benefits and limitations of the campaign. Data were analyzed using content analysis. Results : A total of 120 parents (94% mothers) provided responses. Parent-perceived benefits of the #KidsCancerPain campaign clustered into three categories: (1) provision of practical pain management strategies (e.g., new techniques to manage their child’s pain), (2) reinforcement of pain management practices they were already using, and (3) provision of confidence and support to manage their child’s pain, fear and distress. Parent-perceived limitations of the campaign were its applicability (e.g., child not experiencing pain or completed treatment) and visibility (e.g., some parents only recently became aware of the campaign, and some reported limited social media use). Discussion/Conclusions : Parents described both benefits and limitations of the #KidsCancerPain campaign related to managing their child’s pain. Strategies to optimize the reach of social media content should be made in consultation with parents prior to future campaigns. These data will help guide broader parent-directed dissemination efforts using social media.

Scott Holmes a , Nadia Barakat a , Natalia I. Lopez a , Laura Simons b , Alyssa Lebel c , David Borsook a a Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Boston, MA, USA; b Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA; c Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA CONTACT Scott Holmes [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : The neuro-functional basis of pain chronification is not yet understood. Altered brain activity associated with pain symptoms has been identified in neuropathic pain patients. The extent to which brain networks may be altered in persons with acute neuropathic pain remains unclear. Methods : Participants included patients with ankle sprain (n = 24, Age = 16.1years, SD = 4.1) with clinically confirmed neuropathic pain and a group of age-matched healthy controls (n = 12, Age = 16.1, SD = 2.95). Participants completed questionnaires about pain symptoms and underwent a resting-state fMRI (rs-fMRI) scan. Graph theory was applied on rs-fMRI data using the CONN toolbox implemented in Matlab. Individual brain regions were evaluated based on global and local efficiency, betweenness centrality, cost, average path length, clustering coefficient and nodal degree. Results : Patients reported higher scores than healthy controls on the Pediatric Pain Screening Tool (p < 0.001) and Functional Disability Inventory (p < 0.001) suggesting a significant impact of pain on physical and psychological functioning. No group differences were observed for global and local efficiency, cost, average path length, clustering coefficient or nodal degree (p-FDR>0.05). The ankle sprain cohort exhibited higher betweenness centrality in the posterior aspect of the left parahippocampal gyrus compared to healthy controls (t(30) = 4.20,p-FDR = 0.029). Discussion/Conclusions : Findings suggest that functional brain network properties may be affected in persons with acute neuropathic pain. The increased betweenness centrality in the parahippocampal cortex in persons with neuropathic pain may pertain to changes in memory encoding due to the presence of pain. Perturbed network configuration from acute neuropathic pain relating to memory formation may underlie a component of pain chronification.

Mizanur Rahman a , Noorzahan Begum b , Taskina Ali b , Mahadi Abdur Rouf c , and Shahriar Masood d a Department of Physiology, Enam Medical College, Savar, Bangladesh; b Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; c Department of Physiology, Northern International Medical College, Dhaka, Bangladesh; d Department of Physiology, Jahurul Islam Medical College, Bajitpur, Kishoregonj, Bangladesh CONTACT Mizanur Rahman [email protected] Department of Physiology, Enam Medical College, Bangladesh © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction : Effects of vitamin B 12 on pain have been demonstrated in different animal and human studies. But comparison of these effects with similar effects of ketorolac tromethamine (KT) and their combination have not been established. To assess the effects of vitamin B 12 on pain and also to compare them with those of the combinations of vitamin B 12 with KT in rat models. Methods : This experimental study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from March 2015 to February 2016. For this, 20 (twenty) Long Evans rats (215 ± 35 gm) of both sexes (Ref: Banode SV, Borkar AS, Badwaik RT. Effect of ketorolac on opioid induced antinociception in rats. IJMPS. 2012;3:7–13) were divided into control (A, with 5 ml/kg normal saline Ref: Moallem SA, Hosseinzadeh H, Farahi S. A study of acute and chronic anti-nociceptive and antiinflammatory effects of thiamine in mice. Iran Biomed J. 2008; 12 (3):173-178.) and experimental (B1, with 15 mg/kg B 12 ; B2, with 10 mg/kg KT; B3, with B 12 + KT) (Ref: Banode SV, Borkar AS, Badwaik RT. Effect of ketorolac on opioid induced antinociception in rats.IJMPS. 2012; 3(3):7-13; Imtiaz M. Effect of vitamin B12 and folic acid and their combination on pain and inflammation in rats.[Thesis] [Dhaka (Bangladesh)]: BSMMU. 2011.) groups with 5 rats in each group. All the drugs and vitamin were administered intraperitoneally (Ref: Kim MJ, Hong BH, Zhang EJ, Ko YK, Lee WH. Antinociceptive effects of intraperitoneal and intrathecal vitamin E in rat formalin test. Korean Journal of Pain. 2012; 25(4):238-244.) in a single dose just one hour before formalin test. Statistical analysis was done by ANOVA, followed by Bonferroni post hoc test. In the interpretation of results, p ≤ 0.05 was considered as significant. Results : B 12 lowered only the jerking frequency and KT lowered both jerking frequency and flexing-licking duration significantly (p ≤ 0.001) in the late phase of formalin test. On the other hand, combination of B 12 and KT significantly (p ≤ 0.001) lowered both the study variables in all 3 phases of formalin test. Conclusion : From this study it may be concluded that, vitamin B 12 possess analgesic effects and combination of B 12 with KT is more effective than those of their individual administration. Disclosure statement No potential conflict of interest was reported by the authors. Figure 1. Frequency of jerking (A) and duration of flexing and licking (B) in early phase of formalin test in different groups of rats. Each bar symbolizes for mean ± SE for 5 rats. *** = p ≤ 0.001, compared to those of control. KT = Ketorolac tromethamine. Figure 2. Frequency of jerking (A) and Duration of flexing and licking (B) in the interphase of formalin test in different groups of rats. Each bar symbolizes for mean ± SE for 5 rats. *** = p ≤ 0.001 and * = p ≤ 0.05 compared to those of control. KT = Ketorolac tromethamine. Figure 3. Frequency of jerking (A) and duration of flexing and licking (B) in late phase of formalin test in different groups of rats. Each bar symbolizes for mean ± SE for 5 rats. *** = p ≤ 0.001, compared to control and ### = p ≤ 0.001, comparison between only KT vs KT + Vit.B 12. KT = Ketorolac tromethamin. Frequency of jerking (A) and duration of flexing and licking (B) in early phase of formalin test in different groups of rats. Each bar symbolizes for mean ± SE for 5 rats. *** = p ≤ 0.001, compared to those of control. KT = Ketorolac tromethamine. Frequency of jerking (A) and Duration of flexing and licking (B) in the interphase of formalin test in different groups of rats. Each bar symbolizes for mean ± SE for 5 rats. *** = p ≤ 0.001 and * = p ≤ 0.05 compared to those of control. KT = Ketorolac tromethamine. Frequency of jerking (A) and duration of flexing and licking (B) in late phase of formalin test in different groups of rats. Each bar symbolizes for mean ± SE for 5 rats. *** = p ≤ 0.001, compared to control and ### = p ≤ 0.001, comparison between only KT vs KT + Vit.B 12. KT = Ketorolac tromethamin.

Claire Arbitre a , Nathalie Gaucher a , Evelyne D. Trottier a , Claude Julie Bourque b , Jessica Darilus c , Priscille-Nice Sanon d , Lionel N. Dabirabe d , Nancy Robitaille e , and Yves Pastore e a Pediatric Emergency Department, Université de Montréal, Montreal, Quebec, Canada; b Unité de Recherche en partenariat Famille, Centre de Recherche, Université de Montréal, Montréal, Québec, Canada; c Parent Partner, Montréal, Québec, Canada; d Patient Partner, Montréal, Québec, Canada; e Pediatric Hematology Department, Université de Montréal, Montreal, Quebec, Canada CONTACT Claire Arbitre [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : The quality of life of children with sickle cell disease (SCD) depends on the severity and number of vaso-occlusive crises (VOC). The objective of this study was to explore the experiences of pediatric patients and their families during VOC. Methods : This qualitative study used semi-structured interviews, designed in partnership with two patients and one parent. Two groups of participants were interviewed independently: adolescent patients and parents of pediatric patients hospitalised within the last 2 years for VOC. Data was transcribed in full and analysed using NVivo12. Descriptive thematic content analysis was performed by coding themes emerging from participants’ discourses and systematically compared. Results : Between June and August 2018, eight interviews were conducted. Ten parents and five adolescents participated. Teenagers’ and parents’ answers mirrored each other’s. Prompt pain relief was crucial, although the side effects of pain medications used were an added source of suffering. Recent quality improvement initiatives such as standardized order sheets were noteworthy improvements. Given the unpredictability and severity of VOC, their impact on both patients’ and families’ lives were substantial, as was the long term emotional burden. Parents felt guilty given the hereditary nature of the disease, they encouraged neonatal and prenatal testing, and they sought definitive treatments for both VOC and SCD. Tensions within parent-teenager relationships were described centered on developing autonomy and protecting the child to improve adherence to treatments. Discussion/Conclusions : Participants emphasized the need to provide timely adequate analgesia. Understanding the impact of VOC on patients’ lives and their socio-familial context is important to tailor clinical interventions. Joshua A. Rash 0000-0003-0927-0712 a , Norman Buckley 0000-0002-1031-6813 b , Jason W. Busse 0000-0002-0178-8712 b , Tavis S. Campbell c , Bill Casley d , Kimberly Corace e , Lynn Cooper f , David Flusk g , Alfonso Iorio 0000-0002-3331-8766 h , Kim L. Lavoie i , Patricia A. Poulin 0000-0002-3934-9870 j , and Becky Skidmore k a Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada; b Anesthesia, McMaster University, Hamilton, Ontario, Canada; c Psychology, University of Calgary, Calgary, Alberta, Canada; d Opioid Response Task Force, Health Canada, Ottawa, Ontario, Canada; e Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada; f Canadian Injured Workers Alliance, Thunder Bay, ON, Canada; g Anesthesia, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada; h Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; i Psychology, University of Quebec at Montreal, Montreal, Québec, Canada; j Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; k Independent Information Specialist, Ottawa, Ontario, Canada CONTACT Josh Rash [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : The objective of this review was to synthesize the published evidence about knowledge, attitudes, beliefs, and practices that healthcare providers hold regarding the prescription of opioids for chronic non-cancer pain. Methods : Ovid MEDLINE, Embase, PsycINFO, Cochrane Library and CINAHL bibliographic databases were searched from inception until April 2018. Qualitative and quantitative study designs that report on healthcare provider knowledge, attitudes, beliefs or practices in North America were eligible for inclusion. Studies reporting on interventions were also eligible for inclusion. Research assistants screened articles for inclusion and performed data extraction and risk of bias using validated tools.Confidence in evidence was evaluated using the GRADE approach. Results : 96 studies were included that reported on nearly 18,500 healthcare providers. Healthcare providers are reluctant to prescribe opioids for chronic non-cancer pain. Perceived inadequate training, low self-efficacy, apprehension about diversion, suspicion of drug seeking behavior, fear of regulatory scrutiny, and concern about patient addiction and side effects contribute to this reluctance. There was significant variability in estimates of healthcare provider adherence to recommendations made by clinical practice guidelines. There is reasonable confidence that adherence to risk reduction strategies is under 50%. 26 studies were included that evaluated an intervention. Discussion/Conclusions : Conclusions were difficult to draw due to variability in interventions, high risk of bias, methodological concerns, and limited number of studies reporting on interventions. Multifaceted interventions targeting several provider-related barriers were promising, but may be challenging to reproduce. Todd A. Vogel a , A. Ross Otto a , and Mathieu Roy 0000-0002-3335-445X a Department of Psychology, McGill University, Montreal, Quebec, Canada CONTACT Todd A. Vogel [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pain is aversive and entails a motivational drive to escape further harm (Eccleson & Crombez, 1999). The expenditure of cognitive effort can also be aversive and the decision to engage in effortful cognitive processing involves evaluating the costs and benefits of the action (Kurzban et al. 2013). As cognitively demanding tasks are commonly used in investigating pain modulation, we contrasted the aversiveness of pain with the aversiveness of expending cognitive effort using a novel trade-off paradigm. Thirty-nine participants were offered a series of choices between different levels of a painful thermal stimulus and a cognitively demanding task. We observed a trade-off between expending cognitive effort and experiencing physical pain, wherein participants were more likely to accept pain with increasing cognitive demands. Our findings highlight the aversiveness nature of cognitive effort and its shared characteristics with other primary aversive stimuli. Introduction/Aim : The expenditure of cognitive effort can be aversive and the decision to engage in effortful cognitive processing involves evaluating the costs and benefits of the action (Kurzban et al. 2013). Pain is also aversive and entails a motivational drive to escape further harm (Eccleson & Crombez, 1999). While avoidance of cognitive effort has been examined using a secondary incentive, such as monetary reward (Westbrook et al., 2013), it remains unclear how the cost/benefit analysis of expending effort is affected when paired with a primary incentive, such as pain avoidance. As difficult cognitive tasks are often used to investigate modulation of pain (see Torta et al., 2017), the characteristics of performing a cognitively demanding task itself should be taken into consideration. Here we contrasted the aversiveness of cognitive effort expenditure with physical pain using a novel trade-off paradigm. Methods : Thirty-nine participants were offered a series of choices between different levels of a painful thermal stimulus and a cognitively demanding task. Five different levels of the N -back working memory task ( N = 0 to N = 4) were used as the cognitively demanding task. The level of cognitive effort required to perform the task increased parametrically with the level of cognitive load (Braver et al., 1997). For the painful thermal stimulus, five different temperatures were used to elicit a painful sensation (45°C to 49°C). Temperatures and N -back task speeds were individually calibrated to equate the sensation and difficulty, respectively, across participants. At the start of each trial, the participant was shown a given level of each task (e.g., 2-back or a temperature corresponding to 28/100 on a pain scale) and was asked to make a decision between the two. After a decision was made, the corresponding task was administered (e.g., several trials of the N -back task, or a painful thermal stimulus). Results : Our findings indicated a trade-off between the level of cognitive effort required and the level of physical pain. That is as the level of cognitive demand increased, participants were more likely to accept physical pain than choose to expend cognitive effort, F (4,152) = 61.69, p < .001. Conversely, as the level of offered pain increased participants were less likely to accept physical pain and instead preferred to expend cognitive effort, F (4,152) = 51.18, p < .001. Response times to making a decision mirrored this observed trade-off. That is, as physical pain and cognitive effort reached their equivalence point (i.e., the levels at which acceptance for either option is 50%), participants took longer to make a decision, b = 2.04, t (43.10) = 9.60, p < .001. Discussion/Conclusions : Our findings highlight the aversive nature of cognitive effort. When paired with a primary aversive stimulus, such as pain, people will sometimes forego expending cognitive effort in exchange for the aversive stimulus. These results suggest that cognitive effort shares characteristics with other primary aversive stimuli and that avoiding expenditure of effort is motivationally driven. Yalinie Kulandaivelu a b , Chitra Lalloo a b , Joanna Sale c d , Emily Seto e , and Jennifer Stinson d f a Management and Evaluation, Institute for Health Policy, Toronto, Ontario, Canada; b Hospital for Sick Children, Child Health and Evaluative Sciences, Toronto, Ontario, Canada; c Li Ka Shing Knowledge Institute, Musculoskeletal Health and Outcomes Research, St. Michael’s Hospital, Toronto, Ontario, Canada; d Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; e Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; f Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Child Health and Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada CONTACT Yalinie Kulandaivelu [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Project ECHO® is an innovative, interactive model for healthcare provider (HCP) education that expands access and capacity to provide evidence-informed care. It uses videoconference technology to create a community of practice (CoP) among interprofessional specialist teams at an academic “Hub” and community HCPs called “Spokes” across the province of Ontario. This study examines the development of a CoP in Project ECHO for paediatric acute and chronic pain, and barriers and facilitators to its development. Methods : A qualitative description design was undertaken with semi-structured, audio- taped interviews. The interview guide focused on structural components of a CoP (domain, practice, community) and barriers and facilitators to its development through the perspectives of HCPs. Interviews were transcribed verbatim and analyzed using qualitative content analysis. Results : 21 HCPs who had participated in Project ECHO were interviewed (10 of 14 Ontario Local Health Integration Networks represented; 19% physicians, 19% nursing professions, and 62% allied health). Participants’ responses indicated evidence for each component of a CoP. The main barrier to CoP development reported was differences in participants’ perceptions of the program aims; main facilitator was the ECHO program format. Discussion/Conclusions : This is one of the first studies to examine the CoP elements of the ECHO model. Further development of the CoP concept for healthcare settings is needed to enhance program delivery. Findings will be used to aid revisions of future program iterations. Matilda E. Nowakowski a , Graham Nishikawa b , Cathy Page b , Harsha Shanthanna c , Philip Chan c , Heather Radman b , and Julie Holmes b a Department of Psychiatry and Behavioural Neurosciences/Chronic Pain Clinic, McMaster University/St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada; b Chronic Pain Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada; c Department of Anesthesia/Chronic Pain Clinic, McMaster University/St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada CONTACT Matilda E. Nowakowski [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : There is growing research evidence highlighting the importance of patient pain neuroscience education in the management of chronic pain (Louw et al., 2016). The current study investigated the effects of a 2-session pain neuroscience education group on pain catastrophizing, kinesiophobia, and readiness for adopting a self-management approach to chronic pain. Methods : Patients attended a 2-session pain neuroscience education group prior to partaking in an 8-week self-management for chronic pain group consisting of exercise therapy and cognitive-behaviour therapy. Patients completed the Pain Catastrophizing Scale (PCS; Sullivan et al., 1995), Tampa Scale for Kinesiophobia (TSK, Miller et al., 1991), and Pain Stages of Change Questionnaire (PSOCQ; Kerns et al., 1997) before and after completing the pain neuroscience education group. Results : Twenty-three patients participated in the study ( M age = 58.65 years, SD = 2.38, 74% female). The most common chronic pain complaint was lower back pain (65.2%) followed by neck pain (17.4%). There were significant decreases in PCS scores (Pre: M = 22.71, SD = 8.76, Post: M = 18.90, SD = 10.76, t (20) = 3.36, p < .01) and precontemplation scores on the PSOCQ (Pre: M = 3.1, SD = .70, Post: M = 2.86, SD = .63, t (19) = 2.36, p = .03) from pre to post pain neuroscience education group. There were no changes on TSK scores. Discussion/Conclusions : The current study provides preliminary evidence for the potential usefulness of a brief 2-session pain neuroscience education group as part of a self-management for chronic pain intervention. Vahid Ashoorion a , Behnam Sadeghirad a , Li Wang 0000-0003-1585-8846 a , Atefeh Noori b , Luciane C. Lopes c , Yechan Kim d , Yaping Chang e , Meisam Abdar f , Leila Nasiri g , Mehdi Ghasemi h , Nadia Rehman b , Rachel Couban a , Yasir Rehman b , Gordon H. Guyatt 0000-0003-2352-5718 b , and Jason W. Busse a a Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; b Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; c Pharmaceutical Science, University of Sorocaba, Soracaba, Sao Paolo, Brazil; d Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada; e OrthoEvidence Inc., Burlington, Ontario, Canada; f Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran; g Tehran University of Medical Sciences, Tehran, Iran; h Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran CONTACT Vahid Ashoorion [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Each year 67,000 Canadians undergo total knee arthroplasty (TKA) and approximately 20% develop persistent post-surgical pain (PPSP). A complaint associated with functional limitations, reduced quality of life, and increased care-seeking. We systematically reviewed observational studies to explore factors associated with PPSP after TKA. Methods : We searched Medline, EMBASE, Cochrane CENTRAL, AMED, PsycINFO, SCOPUS and SPORTDiscuss from inception to October 31, 2018. When possible, we pooled estimates of association for all independent variables reported by more than one study. Random effects models were used for all meta-analysis. We assessed certainty in evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Results : Twenty-five studies, involving 44,069 participants, were eligible for review. Mean age of enrolled patients was 68.56 ± 8.77 years and 76% were female. Eligible studies reported the association of 56 predictors with PPSP after TKA, which clustered into 6 groups: (1) patient characteristics, (2) clinical findings, (3) genetic factors, (4) surgical approach, (5) radiographic findings, and (6) peri-operative management. Low and very-low quality evidence showed that higher preoperative pain (OR = 3.82, 95%CI 1.27 to 11.47) and female sex (OR = 1.23, 95%CI 1.08 to 1.4) were significantly associate with PPSP after TKA. Neither older age (OR = 0.97, 95%CI 0.88 to 1.07), higher BMI (OR = 1.07, 95%CI 1.00 to 1.13), or mood disorders (OR = 1.14, 95%CI 1.0 to 1.3) were predictors of PPSP following TKA. Discussion/Conclusions : Addressing high peri-operative pain may be important in reducing PPSP after TKA. Tiffany Got a , Muhamad Bonse b , Ryan Lewis c , Bruce Haycock c , Jennifer Campos c , Behrang Keshavarz c , Susan Gorski c , and Andrea Furlan d a Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;; b Faculty of Engineering, Ryerson University, Toronto, Ontario, Canada;; c Toronto Rehabilitation Institute, University Health Network, iDAPT, Toronto, Ontario, Canada;; d Department of Medicine, University of Toronto, Toronto, Ontario, Canada CONTACT Tiffany Got [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Opioids have a broad impact on the central nervous system; side effects may impact the psychomotor and cognitive skills required for driving. This study aims to evaluate the impact of chronic short-acting opioid therapy on driving performance measures in a high-fidelity driving simulator. Methods : Adult chronic pain patients using short acting opioids (SAO) or not using any opioids (NO) were recruited from Toronto Rehab Hospital’s comprehensive integrated pain program. Participants completed a baseline off-road test battery assessing cognitive and visual function. After an acclimatization trial in the driving simulator, subjects completed three 10-minute-long scenarios under varying road conditions in the high-fidelity simulator (iDAPT DriverLab). Results : This ongoing study has evaluated 14 patients (SAO = 6, NO = 8) to date. The final sample size will increase to N = 40 to ensure test power. From the preliminary analysis, the SAO and NO groups were comparable on demographic variables, pain characteristics and performance on the cognitive and visual test battery. Vehicular control differed between groups; the standard deviation of lane position was 225.3 ± 55.4 and 256.1 ± 39.7 mm in the NO and SAO groups respectively. The brake reaction times were similar, 1111 ± 234 ms (NO) and 1107 ± 92 ms (SAO). Discussion/Conclusions : This study will complement the existing body of literature on driving and opioids, which is mainly composed of observational and epidemiological evidence, since it lacks high quality experimental studies and studies conducted in high fidelity driving simulators. Michelle Biehl a , Lisa Wild b , Kyle Waldman c , Sherida Chambers b , Farzana Haq d , Ronald A. Easteal a , and Monakshi Sawhney e a Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada; b Department of Surgery, Humber River Hospital, Toronto, Ontario, Canada; c Department of Anesthesiology, Humber River Hospital, Toronto, Ontario, Canada; d Emerging Issues, Canadian Institute for Health Information (CIHI), Toronto, Ontario, Canada; e School of Nursing, Queen’s University, Kingston, Ontario, Canada CONTACT Michelle Biehl [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Total knee arthroplasty (TKA) is a painful procedure that requires effective pain management to facilitate early rehabilitation. Peripheral nerve blocks including the adductor canal block (ACB) and femoral nerve block (FNB) are effective in managing anterior knee pain but not posterior knee pain. The iPACK (Interspace between the Popliteal Artery and posterior Capsule of the Knee) targets posterior knee pain. However, there is limited data regarding the effectiveness of the iPACK block when added to other blocks. The aim of this study was to determine the efficacy of the iPACK block for pain management in patients undergoing TKA. Methods : A retrospective chart review was conducted to identify the time to first opioid dose, pain, and ambulation distance postoperatively in patients (n = 607) who underwent TKA under spinal anesthesia and received either FNB, ACB, FNB plus iPACK, or ACB plus iPACK block between June 2017 and July 2018. Results : Mean pain scores on movement were lower on the day of surgery for patients who received an iPACK block in addition to FNB (0/10) or ACB (1/10) compared to patients who received ACB (2/10), and FNB (1.5/10) alone (p = 0.25). There was no difference between the groups regarding time to first opioid dose, pain or ambulation distance to POD 2. Discussion/Conclusions : iPACK block was associated with decreased pain on POD 0 when combined with FNB and ACB, however this was not clinically significant. The lack of significant findings regarding other outcomes may be related to the reliance on chart data. A prospective study may report different findings. Brittany N. Rosenbloom a , Lisa Isaac b , Fiona Campbell b , Gabrielle Pagé c , Jennifer Stinson d , and Joel Katz 0000-0002-8686-447X a a Psychology, York University, Toronto, Ontario, Canada; b Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada; c Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Québec, Canada; d Nursing, The Hospital for Sick Children, Toronto, Ontario, Canada CONTACT Brittany Rosenbloom [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : The Functional Disability Inventory (FDI) and the Patient Reported Outcomes Measurement Information System (PROMIS) Pediatric Pain Interference Scale (PPIS) are commonly used measures of disability but the former is general whereas the latter is pain-specific. We compared the FDI and PPIS in children after major surgery and identified differential predictors for each scale. Methods : We studied 79 children (58.23% female, mean age = 14.56 years, SD = 2.31) and their parents/guardians prior to surgery (T0), during hospitalization (T1), and at 6- (T2) and 12-months (T3) post-surgery. Data was collected by questionnaire and chart review. Results : At T3, FDI (M = 12.51, SD = 11.01, Range: 0–42) and PPIS scores (M = 11.65, SD = 8.30, Range: 0–31) were highly correlated (r = .807, p < .001). Multivariate linear regression revealed the final model for T3 FDI included the following T0 variables: child pain anxiety, FDI, child chronic pain acceptance, and parent anxiety sensitivity [R 2  = .363, F(4,53) = 4.401, p = .004]. T0 child FDI (B = .363, p = .010) and T0 parent anxiety sensitivity (B = .438, p = .027) were the only significant predictors of child T3 FDI. Multivariate regression analysis revealed the final model predicting T3 PPIS included T0 child pain anxiety, child symptoms of posttraumatic stress, child general anxiety, child anxiety sensitivity, child pain self-efficacy, child FDI, child PPIS, and parent anxiety sensitivity [R 2  = .361, F(8,43) = 3.033, p = .009]. Only T0 parent pain anxiety was a significant predictor of T3 PPIS (B = .340, p = .039). Discussion/Conclusions : While the FDI and PPIS are highly correlated for children after major surgery, they represent different constructs and the one-year outcomes for each measure are predicted by different risk factors. Catherine Paré a , Michael J. L. Sullivan 0000-0002-4228-1678 a , and Lara Kojok a Department of Psychology, McGill University, Montreal, Quebec, Canada CONTACT Catherine Paré [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Research suggests that post-traumatic stress symptoms are prevalent in individuals who have sustained whiplash injuries following motor vehicle accidents. “Mutual maintenance” models have been used to explain high rates of comorbidity between pain and Post-Traumatic Stress Disorder (PTSD). Although several studies have provided support for mutual maintenance models of PTSD and pain, the processes by which post-traumatic stress symptoms and pain are mutually maintained has not been systematically investigated. The purpose of the present study was to examine the role of expectancies as a mediator of the relationship between PTSD symptoms and pain. Methods : A sample of 127 individuals with whiplash injuries completed measures of pain, PTSD, and recovery expectancies at the beginning and end of their participation in a 7-week multidisciplinary pain rehabilitation program. Results : Correlational analyses revealed that recovery expectancies were significantly associated with pre-treatment PTSD symptoms and post-treatment pain severity. Cross-sectional linear regressions revealed that pre-treatment symptoms of PTSD, but not recovery expectancies, emerged as a significant predictor of pre-treatment pain severity. However, pre-treatment PTSD symptoms and recovery expectancies both contributed unique variance to the prediction of pain severity at treatment termination. Discussion/Conclusions : The results of this study showed that recovery expectancies have a prospective, but not concurrent, relation to pain severity. Recovery expectancies predicted end-of-treatment pain severity but did not mediate the relation between PTSD symptoms and pain severity. The results suggest that intervention techniques designed to modify recovery expectancies could enhance treatment outcomes for individuals with whiplash injuries who are also experiencing symptoms of PTSD. Kate Wahl a , Michelle Lisonek b , Kelly Smith c , Paul Yong b *, and Susan Cox a * a School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; b Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; c Obstetrics and Gynecology, Vancouver General Hospital, Vancouver, British Columbia, Canada CONTACT Kate Wahl [email protected] * These authors contributed equally to this work These authors contributed equally to this work © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Endometriosis is a gynecological condition that affects 10% of reproductive-age women. At least half of this population experience deep dyspareunia – pain with deep penetration during sexual activity. The neglect of dyspareunia by endometriosis patients and providers is well documented and has been attributed to taboos about sexual intercourse or normalization of sexual pain. Methods : Semi-structured interviews about the nature of sexual pain with participants in a clinical data registry who consented to be contacted for future research, had suspected or diagnosed endometriosis, were at least 18 years old, and had current or previous sexual pain alone or with a partner. Thematic analysis of the interview transcripts was conducted. Results : Six participants were interviewed. In addition to predetermined themes about the nature of dyspareunia, four emergent themes were related to the neglect of endometriosis-associated sexual pain in the patient-provider relationship. These were normalization, self-management, acceptance, and limited definition. Discussion/Conclusions : As suggested in previous research, participants considered pain a normal part of sexual intercourse. Participants also described self-management techniques (changing positions, non-penetrative sexual activities) that reduce the impact of dyspareunia. Furthermore, participants accepted sexual pain because of its brief duration. Finally, conventional definitions of endometriosis-associated dyspareunia that focus on pelvic pain with vaginal penetration excluded the experiences of people whose pain occurred elsewhere (in the hips, back, thighs) or who primarily engaged in non-penetrative sexual activity. Each of these factors may contribute to the neglect of endometriosis-associated sexual pain in clinical and research encounters. Sandra J. Poulson a , Melissa M. Holmes a , and Loren J. Martin a Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada CONTACT Sandra J. Poulson [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/ ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Neuropathic pain caused by injury or disease of the somatosensory system occurs less frequently in children. Young children show better sensory recovery and are less likely to develop long-term chronic neuropathic pain than adults following nerve injury. These differences also appear to strongly correlate with developmental stage. To investigate the influence of development on neuropathic pain, we applied a nerve injury model to naked mole-rat subordinate adults, the majority of which do not experience puberty. Using adult mice for comparison, we measured responses to three stimuli: mild and strong mechanical and mild cold. We found similar mechanical responses, but there was a lack of response to mild cold in the naked mole-rat. We followed with assays using stimuli that target nociceptive pathway receptors implicated in cold perception: mustard oil, icilin, menthol, and a cold sensitivity dry ice assay. Our results show species differences in stimuli responses, likely reflecting the unusual evolutionary pressures experienced by the naked mole-rat. Introduction/Aim : The nociceptive system of the African naked mole-rat contains unique adaptations that make the species insensitive to skin pain from some chemical stimuli. Sensitivity to thermal and mechanical stimuli are hallmark symptoms of adult chronic pain following nerve injury, yet young children are less likely to develop chronic neuropathic pain. The majority of adult naked mole-rats never undergo puberty due to the eusocial nature of each colony and are socially subordinate to a single queen naked mole-rat and 1 to 3 breeding males. Thus, to distinguish differences in evoked stimuli sensitivity development typically observed in an adult (post-pubertal) rodent neuropathic pain model, we compared nociceptive behavior of adult subordinate (pre-pubertal) naked mole-rats and mice. Methods : We developed the Decosterd and Woolf spared nerve injury (SNI) model of neuropathic pain for the naked mole-rat and applied SNI and sham surgery to male and female subordinate naked mole-rats, and also applied SNI and sham surgery to CD1 adult mice. We then measured behavior across 4 weeks using a mild mechanical assay (Chaplan up and down method, von Frey), a strong mechanical assay (Tal and Bennett 1994, pin prick test), and a mild cold assay (Yoon et al. 1994, acetone droplet test) to the hind paw ipsilateral to surgery. Results : Sensitivity to a mild mechanical stimulus and a strong mechanical stimulus were comparable between naked mole-rats and mice, despite the higher baseline threshold in naked mole-rats (a difference also observed between rats and mice). However, naked mole-rats showed no sensitivity to mild cold application before or after nerve injury whereas mice showed a marked increase in sensitivity to mild cold stimulus after nerve injury. Discussion/Conclusions : All naked mole-rat subordinate (pre-pubertal) adults develop mechanical but not mild cold sensitivity after nerve injury. The mechanical sensitivity after nerve injury may be due to a developed adult peripheral nervous system separate from a lack of pubertal maturity. This study provides a unique glimpse into separating adult status from pubertal status with respect to evoked stimulus sensitivity after nerve injury. The lack of sensitivity development to mild cold stimulus observed in naked mole-rats may be due to a modification or expression difference in receptors of nociceptive fibers, considering other rare sensory adaptations observed in this species. We followed the observation of lack of mild cold sensitivity with assays using mustard oil, icilin, menthol, and a cold sensitivity dry ice assay to determine differences in behavior compared to mice. Our results show differences between responses among subordinate naked mole-rats and mice, likely reflecting the unusual evolutionary pressures experienced by the eusocial, subterranean colony-dwelling naked mole-rat. Rebecca E. Lewinson a , and Joel Katz 0000-0002-8686-447X a Department of Psychology, York University, Toronto, Ontario, Canada CONTACT Rebecca Lewinson [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background : How others rate another person’s pain is an important field of study, as it can determine how and when patients receive treatment for their pain. Anchoring effects occur when exposure to a numeric quantity biases a person’s subsequent judgment involving other quantities. Anchoring effects have been demonstrated in clinical and non-clinical settings, but rarely have been studied in the context of pain. This study aims to determine whether exposure to a random numeric anchor influences subsequent pain intensity ratings. Methods : 385 participants read a vignette describing a patient with chronic pain before being randomly assigned to one of four groups. Groups 1 and 2 spun an 11-wedge number wheel (0–10) that was programmed to stop on a high number (“8”) or a low number (“2”), respectively. Group 3 spun a similar letter wheel (A-K) that stopped on “C” or “I” (Control 1). Group 4 did not spin a wheel (Control 2). Participants were then asked to rate the patient’s pain intensity using a 0–10 numeric rating scale. Results : The high-number group rated the patient’s pain ( Median±IQR  = 8  ±  2) significantly higher than the letter wheel control ( Median±IQR = 7 ± 2 , p = .023) and the low-number group ( Median±IQR  = 6  ±  2, p < .001). The low-number group rated the pain significantly lower than Control 1 and 2 ( Median±IQR = 7 ± 2 ) (both p < .05). Conclusions : Pain ratings were influenced by prior exposure to a random number with no relevant information about the patient’s pain. Anchoring effects may operate in clinical settings among health care providers, or patients themselves, when asked for a numeric pain rating. Helene Bertrand Department of family practice, University of British Columbia, Vancouver, British Columbia, Canada CONTACT Helene Bertrand [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : topical mannitol was shown to down regulate the capsaicin pain receptor. How effective would it be for pain control in clinical practice? Methods : a chart review of 235 patients who received a 30% mannitol, cream for pain. Each patient used the cream on whatever part of their body was painful. Their chart contained a data sheet with: date, time, numeric pain score 0 = no pain to 10 = worst imaginable pain before and 30 minutes after application, minutes until relief, duration of relief. Results : Of the 235 participants, there were 366 different areas of the body that were treated. The average pain relief was 50.8% (SD 29.8), median 52.94%. Areas of the body experiencing over 60% relief were the thumb and fingers, wrists, thigh, leg and knee (where the affected nerves are closest to the skin surface). The following areas had pain relief scores between 50% and 59%: foot, neck, arm, hip and back. 7 people developed a transient rash in the area where the cream was being applied, which resolved when cream use was stopped. Discussion/Conclusions : The average pain relief for mannitol cream was 50.8% whereas for narcotics it is 36%, for oral or topical NSAIDS it is 23% and acetaminophen it is 13%. This is, however, only a retrospective observational study, not a randomized placebo-controlled study so it is, subject to the placebo effect. Topical mannitol may prove useful in providing pain relief. It needs to be tested in a randomized, placebo-controlled study which is currently underway. Monica C. O’Neill a , Rebecca R. Pillai Riddell a , Hartley Garfield b , and Saul Greenberg b a Psychology, York University, Toronto, Ontario, Canada; b Paediatrics, University of Toronto, Toronto, Ontario, Canada CONTACT Monica C. O’Neill [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Investigating the relationship between child-caregiver behaviours during preschoolers’ vaccinations and preschool attachment could inform the use of the vaccination paradigm for early screening and intervention by health care providers. The present study examined if caregiver sensitivity during the vaccination appointment moderated the relationship between preschooler pain behaviour and attachment. Methods : Child-caregiver dyads ( n = 40) with preschool (4–5 years) immunization and attachment data were selected from the OUCH Cohort. Video footage from preschoolers’ vaccinations were used to code caregiver sensitivity (MBQS-SF; Tarabulsy et al., 2009) and pain reactivity (0–29 seconds post-needle) and regulation (30–59 seconds post-needle [FLACC; Merkel et al., 1997]). In a separate lab-based assessment, the separation-reunion procedure was coded using the PARS (Moss et al., 2015) to examine preschoolers’ scaled scores on the six attachment categories (secure, avoidant, ambivalent, disorganized, controlling-caregiving, controlling-punitive). Results : Moderation analyses examined the unique contribution of caregiver sensitivity, preschoolers’ pain (reactivity and regulation separately), and their interaction on the six attachment scales. There was a significant interaction between preschooler pain regulation and caregiver sensitivity on controlling-punitive behaviours (R 2  = .289, B = −.261, p = .002). Specifically, there was a significant positive relationship between preschooler pain-related distress during the regulatory period and controlling-punitive attachment behaviours, when caregiver sensitivity was low ( B =  .159, p =  .001) or average ( B =  .060, p =  .034). Discussion/Conclusions : When caregiver sensitivity was low or average, higher preschooler pain during the regulatory period predicted higher controlling punitive attachment behaviours. Findings identify how preschooler pain regulation and caregiver responding may inform the child-caregiver relationship outside of the vaccination context. Anni Fan a , Xiang Qun Shi b , and Ji Zhang c d a Department of Microbiology and Immunology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; b The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada; c The Alan Edwards Centre for Research on Pain, Department of Neurology, McGill University, Montreal, Quebec, Canada; d Neurosurgery, Department of Microbiology and Immunology, Faculty of Medicine, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada CONTACT Ji Zhang [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Though several studies have shown that high salt diet (HSD) is related to the development of chronic diseases, the effect of long-term high-salt intake on the immune system and pain behavior remains elusive. Here, we aimed to investigate whether and how HSD affected mouse pain thresholds and innate immunity, especially myeloid cells. Methods : Healthy C57BL/6 male and female mice were fed with HSD (containing 4% NaCl in chow and 1% NaCl in water) right from weaning period (3-week after birth) for 1–3 months. Results : Behavioral analysis demonstrated that HSD-fed mice were hypersensitive to mechanical stimuli. Moreover, HSD induced an expansion of circulating monocytes, especially the proinflammatory monocyte (Ly6C high , CCR2 + ) subsets. HSD also increased the density of Iba-1+ microglia and the number of FcγII/III receptor (CD16/32) expressing cells in the lumbar spinal cord. Prolonged HSD feeding, meanwhile, resulted in increased infiltration of monocyte to the peripheral nerves, contributing to the monocyte-derived macrophage (CD11b + , F4/80 + ) population. Finally, shifting the HSD back to the regular laboratory chow (with 0.3% NaCl) cannot reverse the HSD-induced mechanical hypersensitivity myeloid cell expansion and polarization towards the inflammatory subsets in the periphery. However, treating HSD mice with CCR2 antagonist effectively normalized the pain threshold and myeloid cell profile in the peripheral blood and nerves. Discussion/Conclusions : Long term HSD feeding decreased mouse mechanical thresholds, in parallel with an expansion and polarization of myeloid cells towards inflammatory status. Such changes were not reversible when HSD-fed mice back to normal diet. However, blocking CCR2 signaling successfully attenuated HSD-induced hypersensitivity. Eid Aldossary a , Monakshi Sawhney a , Joan Tranmer a , and Laurie Gedcke-Kerr a Faculty of Health Sciences, School of Nursing, Queen’s University, Kingston, Ontario, Canada CONTACT Eid Aldossary [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Poor pain management can result from nurses’ lack of knowledge, or personal beliefs or attitudes Recent studies report that nursing students have inadequate knowledge regarding effective pain management, and often perform poorly on pain knowledge and attitudes surveys Improving pain knowledge is an important step for nursing students to optimize ineffective pain management practices during their education and when in clinical practice. Therefor the purpose of this study was to examine nursing students’ knowledge, attitudes, and self-efficacy in assessing and managing pain before and after participating in a pain educational intervention. Methods : This study included a sample of 26 undergraduate nursing students who are in the second year of the 4-year Baccalaureate program. All consenting participants completed a pre-test prior to the intervention. The intervention consisted of didactic and on-line education. The post-test was completed following the intervention. Results : The results showed that the students had significantly higher KASRP scores after the educational program (67.7%) versus before (56.8%) (p < .001). Prior to the pain education, 39.4% of students indicated they were confident at assessing and managing pain; there was a statistically significant increase to 69.1% after the program (p < .001). Pharmacological knowledge was a topic in need of improvement amongst participants as we found that knowledge in this area did not increase after the intervention. Discussion/Conclusions : This intervention increased students’ knowledge, attitudes and self-efficacy regarding pain management. Further research is needed to test this intervention in other programs in Ontario and Canada. Additionally, this information may be useful for educators when planning clinical opportunities for students to acquire appropriate pain knowledge and attitudes, with the goals of improving nursing practice, and enhancing patient care. Marie-Eve Martel a , Chrystelle El-Khoury b , and M Gabrielle Pagé c a Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; b Centre de recherche, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada; c Centre de recherche, Centre hospitalier de l’Université de Montréal, & Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada CONTACT Marie-Eve Martel [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : More than half of chronic pain patients suffer from other chronic health conditions. This study aims to 1) examine the degree to which pain management is a priority among individuals with multiple medical conditions and 2) identify predictors of pain prioritization. Methods : The sample is comprised of 99 patients suffering from chronic pain (≥ 3 months) and ≥ 1 other medical condition recruited through patient associations and social/conventional media. Self-report questionnaires (pain characteristics, patient characteristics, type and severity of comorbidities) were completed at baseline and a pain prioritization diary was completed twice weekly for 6 weeks. Univariate regression models were used to identify pain, patient and comorbidity variables ( p > 0.20) that would be included in a final multivariate model to examine pain management priority (model 1) and stability of prioritization (model 2). Results : Pain management prioritization scores ranged from 1.67 to 4.92 out of 5 (SD = 0.76) and 16.2% of participants reported ≥ 20% increase or decrease in the priority given to pain management over a six-week period. Model 1: Perceived illness burden was the only predictor retained in the univariate analysis ( p = 0.074) to predict levels of pain management prioritization. Model 2: None of the characteristics examined were significantly associated with stability of prioritization of pain management symptoms. Discussion/Conclusions : Prioritization of pain management is a dynamic process that does not seem to be influenced by severity of pain, individual characteristics or severity of comorbidities. The next step is to examine time-varying predictors of pain management prioritization. Nancy Carnide a , Morgane Le Pouésard a , Emma Irvin a , Dwayne Van Eerd a , Heather Johnston a , Quenby Mahood a , Margaret Tiong a , Zoe Sinkins b , Sara Macdonald a , Maria-Laura Santos, and Andrea D. Furlan a c d a Institute for Work & Health; b McMaster University, Hamilton, Ontario, Canada; c Department of Medicine, University of Toronto, Toronto, Ontario, Canada; d Toronto Rehab-University Health Network, Toronto, Ontario, Canada CONTACT Nancy Carnide [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Canada is in the middle of a public health crisis related to opioids. Prior attempts to overcome the crisis in Canada have been insufficient as the number of people dying continues to increase. Methods : This review was funded by the Canadian Institutes of Health Research (CIHR) to identify emerging strategies for subgroups at highest risk of opioid-related harms and likely to benefit most from the implementation of these strategies. Systematic methods were used to search, select, critically appraise and synthesize published and unpublished studies conducted in the past five years Results : The research team found 46 studies of high and medium quality that reported on a variety of emerging strategies to tackle the opioid crisis. A sufficient number of recent high- and moderate-quality studies on novel approaches to address Canada’s opioid crisis suggest a number of evidence-based prevention strategies are available. They include various clinical practice, educational and regulatory/policy strategies to improve opioid prescribing practices, and various clinical practice strategies to reduce opioid-related emergency department visits. Too few recent studies of sufficient quality and consistency in their findings are available to suggest promising new treatment, harm reduction and enforcement strategies. Discussion/Conclusions : Evidence-based prevention strategies that have not yet been widely used in Canada should be considered to help tackle the opioid crisis. Peter Shih-Ping Hung a , Alborz Noorani a , Jia Y. Zhang b , and Mojgan Hodaie c a Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; b Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; c Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada CONTACT Peter Shih-Ping Hung [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Classic trigeminal neuralgia (TN) is a severe chronic neuropathic facial pain disorder that, despite frequently being linked to microstructural changes within trigeminal nerve root entry zone, has well-documented cortical thickness alterations. These alterations occur in brain regions important for sensory and affective processing of pain and can be reversed by successful surgical interventions. As existing studies are limited to pre-treatment and early post-treatment time-points, longitudinal effects of non-invasive surgical interventions like Gamma Knife radiosurgery (GKRS) on the cortical thickness in TN patients remains unclear and are thus the focus of our current structural magnetic resonance imaging study. Methods : 18 patients treated with GKRS as their first surgery for TN underwent pre-treatment, 6 months post-treatment, and 12 months post-treatment 3-Tesla imaging. FreeSurfer 6.0 facilitated extraction of cortical thickness from 68 Desikan-Killiany brain regions. 7 false discovery rate-corrected paired Student’s t-tests were then conducted per region to contrast cortical thicknesses between hemispheres and across time-points. Results : GKRS resulted in longitudinal, bilateral increases in cortical thickness within fusiform gyrus, precentral gyrus, paracentral lobule, and inferior temporal gyrus. GKRS also resulted in transient increases in cortical thickness in contralateral banks of superior temporal sulcus, ipsilateral superior frontal gyrus, and contralateral caudal middle frontal gyrus. Discussion/Conclusions : For the first time, we demonstrated that radiosurgery for TN leads to longitudinal and transient cortical thickness changes within default mode, executive control, limbic, somatomotor, and visual brain networks. Further studies are needed to ascertain the functional role these structural changes may play in GKRS’ therapeutic effect. Li Wang 0000-0003-1585-8846 a , Niveditha Devasenapathy b , Brian Y. Hong c , Jared Cohen d , Sasha Kheyson d , Yvgeniy Oparin d , Sean Alexander Kennedy 0000-0002-4970-8152 e , Beatriz Romerosa f , Nikita Arora d , Henry Kwon g , Daniel Lu d , Kate Jackson d , Allen Li d , Giuliana Guarna d , Rachel Couban h , and Jason W. Busse 0000-0002-0178-8712 h a Anesthesia, McMaster University, Hamilton, Ontario, Canada; b Public health Foundation of India, Indian Institute of Public Health -Delhi, Gurgaon, India; c Plastic Surgery, University of Toronto, Toronto, Ontario, Canada; d McMaster University, Hamilton, Ontario, Canada;; e Department of Medical Imaging, University of Toronto; f Department of Anesthesia and Critical Care, University Hospital of Toledo, Toledo, Spain; g Wayne State University School of Medicine, Detroit, MI, USA; h Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada CONTACT Li Wang [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Persistent post-surgical pain (PPSP) is a common complication after breast cancer surgery; but reported prevalence rates range from 10% to 69%. We conducted a systematic review to address this uncertainty. Methods : We searched MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2018, to identify observational studies that reported the prevalence and intensity of PPSP after breast cancer surgery. We performed random effects meta-analysis with Freeman-Tukey transformation for overall, moderate and severe PPSP prevalence, and pooled pain intensity after converting all pain scales to the 10cm VAS. Results : We included 184 observational studies with 298,549 patients. The overall prevalence of any PPSP was 33.6% (95%CI 30.3% to 36.9%). The pooled prevalence of moderate and severe pain was 16.1% (95%CI 12.6% to 19.8%) and 3.7% (95%CI 2.6% to 5.0%) respectively. PPSP prevalence was 36.2% (95%CI 29.5% to 43.2%) at 3 months to 1 year after surgery, 33.7% (95%CI 15.3% to 55.1%) at 1 to 2 years, 26.6% (95%CI 11.3% to 45.5%) at 2 to 4 years and 36.6% (95%CI 21.1% to 53.7%) at 4 years or later. The prevalence of neuropathic pain was 33.7% (95%CI 22% to 46.5%). The average pain intensity on a 10cm VAS was 2.7 (95%CI 2.2 to 3.1). We found significant subgroup effects between any pain (40.9%, 95%CI 37.4% to 44.6%) vs specific pain (28.8%, 95%CI 24.8% to 33.0%; interaction p<0.001) and low threshold pain (mild to severe pain, 35.3%, 95%CI 31.4 to 39.2%) vs high threshold of pain (moderate to severe pain 24.9%, 95%CI 18.9% to 31.4%; interaction p=0.005). Meta-regression did not show significant association between PPSP and length of follow-up, proportion of loss to follow-up, proportion of breast conserving surgery, radiotherapy and chemotherapy. Discussion/Conclusions : PPSP after breast surgery is common and affects approximately 1 in 3 women undergoing this procedure. Of those who develop persistent pain, 48% will report at least moderate pain and 11% will experience severe pain although the average pain is mild. Michael McGillion a , Carley Ouellette a , Sheila O’Keefe-Mccarthy 0000-0003-2909-8286 b , Kathleen Dallessio c , Shaunattonie Henry d , and Judy Watt Watson e a School of Nursing, McMaster University, Hamilton, Ontario, Canada; b Brock University, St. Catherines, Ontario, Canada; c Elesvier, Milton, Ontario, Canada; d Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada; e Faculty of Nursing, University of Toronto, Toronto CONTACT Michael McGillion [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Persistent forms of cardiac pain, such as refractory angina, are difficult to treat and debilitating. We aimed to disseminate a web-based, multi-media resource centre for persistent forms of cardiac pain, CardiacPain.Net, as a vehicle for global-scale knowledge dissemination. Conceptualization of CardiacPain.Net was based on the Canadian Institutes of Health Research (CIHR) knowledge to action cycle as well as the CIHR framework for citizen engagement. Content curated on the site for dissemination was categorized according to specific aspects of knowledge inquiry, synthesis, as well as knowledge product tools (e.g. clinical practice guidelines, diagnostic phenotype criteria). Dissemination strategies included opt-in email blasts to Elsevier’s global readership subscribers, as well as online banner journal advertising. Dissemination metrics included total site visits and components visited and downloaded. Customized metrics included unique and return visitor rates, bounce rate, stream views, unique end-user tracking, as well as geo-targeting. Metrics were analyzed in aggregate and distributions were examined for monthly trends. The total dissemination period was for 4 years (2014 to 2018). We aimed to engage 1,000 new end users per month. Evaluation of our dissemination metrics found that CardiacPain.Net reached a total of 48,519 unique end users. Users engaged in a total of 53,927 sessions on the site, with a total of 72,794 page views. An average of 1.39 pages were viewed per user session. Geo-targeting analyses found that end-user engagement spanned 164 countries across 5 continents. Our results suggest that a globally linked multimedia resource centre is an effective vehicle for widespread pain knowledge dissemination. Shahrzad Ghazisaeidi a , Arun Ramani b , Parisa Shooshtari b , Amy Tu c , Katherine Halievski c , David Finn d , Sofia Assi a , Milind Muley c , Vivian Wang c , Ameet Sengar c , Rosanna Weksberg e , Michael Brudno 0000-0001-7947-2243 b , and Michael W Salter c a Physiology, University of Toronto, Toronto, Ontario, Canada; b Centre for Computational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; c Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada; d Pharmacology & Therapeutics, National University of Ireland, Galway, Ireland; e Genetics & Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada CONTACT Shahrzad Ghazisaeidi [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Chronic pain affects 1 in 5 Canadians and costs over $43B annually, yet effective and safe treatment options remain elusive. Recent discoveries have brought to the forefront sex differences in mechanisms of pain as a potential explanation why novel pre-clinical therapeutics have not translated into successfully in clinical trials. Methods : To begin understanding how males and females differ in pain processing, we analyzed gene expression, using RNA sequencing, and DNA methylation, using reduced representation bisulfite sequencing (RRBS), in rodent models of neuropathic pain. Results : Across both sexes, our data reveals peripheral nerve injury (PNI) caused upregulation of 61 genes involved in innate immune responses in spinal cord. In females specifically, we observed PNI-induced downregulation of 5 genes involved in neuronal function and upregulation of two classes of Cathepsins. (C and E). On the other hand, in males, we observed upregulation of 14 genes including those involved in metabolism of purines and glutathione. Additionally we found that PNI leads to methylome remodeling in a sexually dimorphic manner: 125 promoters in rat spinal cord that were differentially methylated in injured males versus females. Discussion/Conclusions : Our data shows robust sex specific DNA methylation and transcriptome signature after PNI. Additionally, our findings leads to the hypothesis that remapping of DNA methylation, with subsequent alterations in the transcriptome, are critically involved in the development of neuropathic pain. We anticipate that future research directed at understanding these differences may lead to effective drug development to combat chronic pain. Brigitte L. Kieffer CONTACT Brigitte L. Kieffer [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Opiates have been used since thousand years for their remarkable pain-relieving and rewarding properties. Opiates produce their potent effects by activating opioid receptors in the brain, highjacking an endogenous opioid system, which is central to hedonic and mood homeostasis. Recently, revolutions in G protein-coupled receptor research, fascinating developments in basic neuroscience and the rising opioid crisis have propelled opioid receptors back on stage. This presentation will discuss rapidly evolving areas in opioid receptor research for addiction, including the key question of whether we can we kill pain without addiction using mu opiates, and how opioid receptors operate within the neurocircuitry of addiction. Recent work linking mu opioid receptor gene and drug activities to whole-brain functional networks, using by fMRI in mice, will also be presented.

Norm Buckley a , Kim Begley b , Megan Groves b a Department of Anesthesia, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; b Department of Anesthesia, Chronic Pain Network, Hamilton, Ontario, Canada CONTACT Norman Buckley [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: The CIHR Strategy for Patient Oriented Research engages patients in research from priority setting to knowledge translation. Chronic Pain Network’s (CPN) mission is to change the way pain is managed in Canada. The Network supports, coordinates and synchronizes leading, innovative and high impact patient-oriented research and creates opportunities for collaboration across the country. Methods: Projects are aligned with patient derived priorities (Poulin et al., 2018) and are reviewed twice yearly by the Patient Oriented Research committee for milestone achievement, patient engagement, training and mentoring and knowledge translation. Patient partners are joining project teams and serve on governance committees. The 12 Clinical Research Network sites have 10 full time research coordinators in place. Results: The Network currently has twenty-seven projects that align with identified patient priorities in the areas of: Clinical trials testing new ways to prevent, detect or manage diseases (9) Basic science encompassing the fundamental work to advance knowledge (8) Population Studies addressing groups who share a common characteristic such as sex or health conditions (6) Behavioural Science in multiple contexts (4) Clinical trials testing new ways to prevent, detect or manage diseases (9) Basic science encompassing the fundamental work to advance knowledge (8) Population Studies addressing groups who share a common characteristic such as sex or health conditions (6) Behavioural Science in multiple contexts (4) Discussion/Conclusions: Some projects have modified due to budget restrictions; all are on track logistically; new initiatives have arisen including providing a strategy for pain management in hemophilia (underway), and a national discussion on biomarkers (Feb 2019). CPN patient groups have been recognized as a national resource for Health Canada in its Opioid Response, and support for furthering the Canadian Pain Strategy has arisen from CPN activities.

Nancy Carnide a , Morgane Le Pouésard a , Emma Irvin a , Dwayne Van Eerd a , Heather Johnston a , Quenby Mahood a , Margaret Tiong a , Zoe Sinkins b , Christa Orchard c , Sudaba Popal, Nimish Mittal d , Siobhan Cardoso a , Andrea D. Furlan a e d a Institute for Work & Health, Toronto, Ontario, Canada; b McMaster University, Hamilton, Ontario, Canada; c Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; d Toronto Rehab-University Health Network, Toronto, Ontario, Canada; e Department of Medicine, University of Toronto CONTACT Nancy Carnide [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Canada is in the middle of a public health crisis related to opioids that shows no signs of abating. The social and legislative landscape around cannabis in Canada is evolving. A synthesis of the data on the potential intersection between cannabis use and opioid outcomes is urgently needed at this pivotal time. The aim of this study was to conduct a scoping review to develop a broad understanding of the relationship between cannabis and opioid use and related outcomes Methods : We used scoping review methods to search, select, and summarize published studies conducted in the past 20 years. Results : We included 81 studies that reported on the relationship between a variety of cannabis measures and a range of opioid-related outcomes. Within the Prevention Pillar, a total of 30 studies showed no association for prescription synthetic cannabinoids, as well as mixed results for medical cannabis, cannabis legislation, and non-medical cannabis use. Within the Treatment Pillar, a total of 17 studies showed mixed results for prescription synthetic cannabinoids, medical cannabis use, and non-medical cannabis use. Within the Prevention/Harm Reduction Pillar, a total of 34 studies showed no studies for synthetic cannabinoids or cannabis legislation, and mixed results for medical cannabis and non-medical cannabis use. Discusson/Conclusions : As this is a scoping review, we cannot make policy or practice recommendations; however, the findings of this review can point to gaps in research that should be addressed in order to make future recommendations based on high-quality evidence.

Maham Zain a , Robert P. Bonin a Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada CONTACT Maham Zain [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Wide dynamic range (WDR) neurons of the spinal dorsal horn respond to a wide range of innocuous and noxious mechanical stimulation and encode the intensity of mechanical stimuli as changes in firing rate. However, there are inconsistent findings regarding whether WDR neuron activity is altered in pathological pain states. Additionally, there is still ambiguity regarding which stimulus parameters drive WDR firing. The aim of the current investigation was to review the available literature in order to ascertain whether WDR neuronal firing in rats is better predicted by pressure or force of a mechanical stimulus (von Frey filaments) and to assess possible mediating factors. Methods : A systematic search was performed on PubMed. All papers were screened on the basis of a certain inclusion criteria and selected publications had a number of variables extracted from text, tables and figures. Forces of the von Frey filaments were converted to pressure by constructing a conversion equation based on manufacturer reported force and diameters. Statistical analyses were performed on the pooled data. Results : We observed that WDR firing rate was better predicted by the calculated pressure of von Frey stimulation rather than applied filament force, as reported in all studies. The pressure-evoked firing rate of WDR neurons was not altered by any experimental pain model except for arthritis and inflammation models, where mechanical stimuli evoked a higher firing rate than controls. Conversely, there was a consistent increase the spontaneous firing rate of WDR neurons in neuropathic pain, arthritis and inflammation, and chemoneuropathy pain models. Discussion/Conclusions : Evidence suggests that pressure of a mechanical stimulus, compared to force, is a better predictor of WDR neuronal firing. Additionally, these data indicate that changes in WDR encoding of applied pressure are unlikely to significantly contribute to pathological sensory processing but indicate a possible role for these neurons in spontaneous pain.

Geraldine Martorella a , Madalina Boitor b , Mélanie Bérubé b , Suzanne Fredericks c , Sylvie Le May d , and Céline Gélinas b a College of Nursing, Florida State University, Tallahassee, Florida, USA; b Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; c Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada; d Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada CONTACT Geraldine Martorella [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Alternative intervention formats have been implemented for people with pain. Several systematic reviews on Web-based interventions for pain have been conducted but the contribution of tailored Web-based interventions has not been evaluated. The aim was to examine the effects of tailored Web-based interventions for adults compared to usual care, face to face and standardized Web-based interventions on pain intensity? The effects on physical and psychological functions were also assessed. Methods : A systematic review was conducted (January 2000-December 2015). The DerSimonian-Laird random effects models were used to calculate effect estimates. Five outcomes were evaluated: pain intensity, pain-related disability, anxiety, depression and pain catastrophizing. Three time intervals were selected: short [<1 month], medium [1–6 months], and long-term [6–12 months] effects. Results : After full-text review, 17 studies were eligible. Only one study concerning acute pain was removed from the meta-analysis. When compared to usual care, benefits were observed immediately after with small effect sizes (<0.40) for pain intensity (N = 1310, P = 0.003) and pain-related disability (N = 953, P < 0.001). No improvements were observed at follow-up. When compared to the active control group, no improvements were found, except for a small effect size on pain catastrophizing (N = 333, P < 0.001) immediately after the intervention. Discussion/Conclusions : Tailored Web-based interventions did not prove to be more efficient than standardized Web-based interventions. Some efficacy was shown on pain catastrophizing when compared to active control interventions. Considering the diversity of tailored Web-based interventions for chronic pain, their efficacy is yet to be explored. Moreover, their contribution to acute pain management is embryonic.

L. Shafran Topaz a , A. Frid a , Y. Granovsky a b , S. Shapira a , L. Meir -Yalon a , C. Buxbaum b , N. Bosak b , E. Domany b , R. Hadad b , M. Khamaisi a b , D. Yarnitsky a b 1 The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; 2 Neurology Department, Rambam Health Care Campus, Haifa, Israel CONTACT L. Shafran Topaz [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/ ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background : The reason some diabetic polyneuropathy (DPN) patients develop neuropathic pain while others present with painless symptoms is unknown. Altered central pain processing has been associated with neuropathic pain. Previous EEG studies found unique cortical patterns in patients with neuropathic pain however these studies were limited to univariate analysis of locally activated areas of cortex. It has been proposed that pain is encoded by complex activity and connectivity patterns which can be explored by application of Machine Learning techniques on the EEG signal. We aimed to investigate whether EEG based functional connectivity can be a potential biomarker for distinction between painful and non-painful DPN. Methods : We recorded contact-heat pain evoked potentials (CHEPs) of 120 painful DPN patients (33F, 63.2 ± 9.9 yrs) and 38 non-painful DPN patients (7F, 64.3 ± 9.5 yrs). Connectivity analysis was conducted based on a measure of synchrony (Phase Locking Value) between the recording sites. We then applied a data-driven analysis scheme to identify the most differentiating functional connections in each frequency band. These connections were validated and used to predict neuropathic pain. Results : We found overall higher cortical functional connectivity between areas of the pain matrix among painful DPN patients. In alpha and theta bands, the connectivity values were significantly different, and differentiated between the two groups with fair-to-excellent specificity (0.797) and sensitivity (0.9). Conclusion : Patients with DPN can be successfully classified into painful and non-painful based solely on EEG functional connectivity data. Increased connectivity between areas of the pain matrix in alpha and tetha band might be a biomarker for neuropathic pain. European Union’s Horizon 2020 research and innovation programme No. 633491.

Anna Bendas 0000-0002-2903-4015 a b c , Kelly Cool 0000-0001-5078-6599 a b c , Scott J. Thompson 0000-0003-3306-4513 a b c , Florian Bobeuf 0000-0002-4798-1091 a b c , Pierre Rainville a b c , Louis Bherer a b c , Julien Cohen-Adad 0000-0003-3662-9532 a b c , Mathieu Roy 0000-0002-3335-445X a b c a Department of Psychology, McGill University, Montreal, QC, Canada; b Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada; c Centre de recherche de l’Institut universitaire de gériatrie de Montréal & Institut de Cardiologie de Montréal, Montreal, QC, Canada CONTACT Anna Bendas [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : The Global Burden of Disease study (2015) reported that chronic low back pain (CLBP) is the most prevalent and disabling condition amongst numerous chronic illnesses. According to the guidelines provided by Airaksinen and colleagues (2006), a supervised physical exercise intervention is an important first-step treatment of nonspecific chronic low back pain. Here, we investigated the impact of a 14-week long personalized physical exercise training program on pain intensity, perceived disability and several psychological factors in people suffering from CLBP. Methods : Twenty-three participants (female – 16, male – 7, age range 22–72 years old) suffering from chronic low back pain were recruited to complete 14 weeks of cardiovascular and muscle strengthening program. At the beginning and at the end of this intervention, we assessed their pain intensity following the NIH (2017) guidelines, and asked participants to complete several psychosocial questionnaires (Beck Depression Inventory, Pain Catastrophizing Scale, and Oswestry Disability Index). Results : Following a long-term physical exercise intervention, perceived pain intensity decreased significantly (p = 0.001). Pain catastrophizing score (p = 0.004), Oswestry disability index (p = 0.005) and Beck depression index (p = 0.022) showed a significant decrease. Discussion/Conclusions : Our findings suggest that a long-term physical exercise training regimen substantially contributes to the reduction of pain intensity levels and improves psychological factors in patients with chronic low back pain. In order to further support our hypothesis, we are looking forward to including the results from a wait-list control group in our future analysis.

Katherine Halievski a , Michael W. Salter a b a The Hospital for Sick Children, Neurosciences and Mental Health, Toronto, Ontario, Canada; b Physiology, University of Toronto, Toronto, Ontario, Canada CONTACT Katherine Halievski [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: Treatment options for chronic pain are limited owing in large part to individual allelic, sex, and microbiota differences. Indeed it is likely that multiple factors together determine individual differences. Methods: To explore whether a sex difference exists in the role of microbiota in different painful conditions, we subjected male and female mice to broad-spectrum oral antibiotics for three weeks prior to either a hindpaw incision or a spared nerve injury (SNI). We then assessed pain using a battery of nociceptive behavioural tests: mechanical hypersensitivity, dynamic weight bearing, and thermal hypersensitivity. Results: While all mice responded to the antibiotics as each developed a grossly enlarged caecum, antibiotic treatment alone did not alter mechanical or thermal sensitivity. However, after hindpaw incision we found that mechanical withdrawal thresholds of male mice showed slower recovery to baseline than those of vehicle-treated males. Antibiotic-treated males also showed an increased rear-load in dynamic weight bearing testing compared to vehicle-treated males. Thermal hypersensitivity did not differ between vehicle- and antibiotic-treated males. After SNI, vehicle- and antibiotic-treated male mice showed no behavioural differences using this battery of tests. Antibiotic-treated female mice were not different than vehicle-treated females in any assay after either hindpaw incision or SNI. Discussion/Conclusions: Thus, long-term antibiotic treatment affects behavioural responses in an acute pain model in a sex-specific manner.

Dyana Castillo a , Constance Heidt b , Lachlan McWilliams a a Psychology, University of Saskatchewan, Saskatoon, SK, Canada; b Department of Clinical Health Psychology, Saskatchewan Health Authority, Saskatoon, SK, Canada CONTACT Dyana Castillo [email protected] © 2019 Crown copyright. Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction : Attachment insecurity (i.e., anxiety and avoidance in relationships) is associated with a wide range of negative outcomes, including the experience of pain and pain-related disability. To date, research on this topic has utilized samples of individuals and has examined “actor effects” (i.e., relationships between individuals’ own attachment characteristics and their own pain variables). The current study investigates attachment and pain within dyads of romantic partners in order to investigate “partner effects” (i.e., relationships between individuals’ attachment characteristics and the functioning of their partners). Method : An online survey was administered to both members of 173 heterosexual romantic couples. They provided self-reports of attachment and pain experienced over the past four weeks. The Actor-Partner Interdependence Model, a statistical method that accounts for interdependence within dyads, was used. Results : Males’ attachment anxiety was associated with higher levels of self- and partner-reported pain (i.e., both actor and partner effects). Females’ attachment anxiety was associated with higher levels of self-reported pain, but there was not a significant partner effect. Attachment avoidance was generally unrelated to pain reports. However, there was a significant partner effect for females’ avoidance (i.e., attachment avoidance reported by women was positively associated with the pain reports of their male partners. Conclusion : Results highlight the importance of considering dyadic relationships when investigating the potential impact of attachment insecurity on the experience of pain.

S. Fatima Lakha 0000-0002-3325-7553 a b , Alex Orlovic a , Demetry Assimakopoulos c , and Angela Mailis d e f a Research Department, Pain and Wellness Center, Vaughan, Ontario, Canada; b Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; c Comprehensive Integrated Pain Program – Rehabilitation Pain Service, University Health Network, Toronto, Ontaria, Canada; d Pain and Wellness Centre, Vaughan, Ontario, Canada; e Department of Medicine, Division of Physical Medicine, University of Toronto, Toronto, Ontario Canada; f Toronto Rehab Institute/University Health Network, Toronto, Ontario, Canada CONTACT S.Fatima Lakha [email protected] Research Department, Pain and Wellness Center, Vaughan, Ontario, Canada © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: To compare demographic and pain characteristics of elderly (>65) vs younger (<65) chronic non-cancer pain (CNCP) patients referred to a university-affiliated community pain clinic in GTA, Ontario. Methods: This is a retrospective study of 644 consecutive new CNCP patients (elderly n = 126 and younger n = 518) seen during 2016–2017. Demographic characteristics, Brief Pain Inventory (BPI) pain ratings, and diagnosis were obtained using retrospective chart review. Patients were classified in 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: Male/female ratio was 1:1.3 vs 1:1.7 and mean age 74 ± 6 vs 45 ± 12 respectively for the elderly vs younger patients. About three-quarters of the elderly were foreign-born (71%) vs the younger population (37%, p < 0.001). Low back/buttocks/hips were the most prevalent site of pain; average BPI pain score (7/10) was similar between the two groups. The majority of the elderly (73%) was classified as group I vs 40% of the younger patients (p < 0.0001). Only 3% of the elderly were classified in Group III vs 16% of the younger population (p < 0.05). Opioids were consumed by 45% of elderly and 34% of younger patients, while current cannabis use for pain was minimal between the elderly (5%) vs 18% of the younger patients (<0.0001). Discussion/Conclusions: Elderly CNCP patients present with greater physical and less psychosocial impairment as opposed to younger patients (similar to previous findings from an academic Toronto pain clinic). Further differences vs similarities will be discussed.

Jiale Hu 0000-0003-1993-8704 a , Joann Harrold b , Janet Squires c , Shokoufeh Modanloo a , Denise Harrison 0000-0001-7549-7742 a a School of Nursing and Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada; b Children’s Hospital of Eastern Ontario and Ottawa Hospital, Faculty of Medicine & Neonatology, University of Ottawa, Ottawa, Ontario, Canada; c School of Nursing and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada CONTACT Jiale Hu [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Measuring pain in mechanically ventilated infants is challenging. The measurement of skin conductance (SC) is based on the sympathetic nervous system response to stress. The study aimed to evaluate the validity of SC for assessing pain and stress in mechanically ventilated infants. Methods: A prospective cross-sectional observational design to study SC and its relation to: 1) type of procedure (painful or non-painful), 2) phase of procedure (before, during and after procedure), and 3) referent pain measures (the Premature Infant Pain Profile-Revised (PIPP-R) and Neonatal Facial Coding System (NFCS)). Eligibility criteria: Infants up to 12 months, in the intensive care units, who were mechanically ventilated, and required a painful and non-painful procedure. Results: From October 2017 to November 2018, 130 eligible infants were identified and 55 (30 male and 25 female) infants were studied. SC (number of waves per second) was statistically significantly different between during painful (median 0.27; interquartile range 0.20–0.40) and non-painful procedures (0; 0–0.09). These values during procedures were statistically significantly higher than the SC before (0; 0–0.07) and after painful (0; 0–0.07) or before (0; 0–0.02) and after non-painful procedures (0; 0–0.07). SC statistically significantly correlated with PIPP-R (Spearman’s rho = 0.73) and NFCS (0.67) during painful procedures, and with PIPP-R (0.50) and NFCS (0.44) during non-painful procedures. Discussion/Conclusions: The study showed the validity of SC in relation to the type of procedure, the phase of procedure and the referent pain measures. SC is a potential approach to assessing pain and stress in sick infants requiring machinal ventilation.

Craig M. Dale a , Virginia Prendergast b , Céline Gélinas c , and Louise Rose 0000-0003-1700-3972 d a Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; b Barrow Neurological Institute, Phoenix, Arizona, USA; c Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; d Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada CONTACT Craig M. Dale [email protected];@craig_dale1 © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : To test the reliability and validity of the Critical-Care Pain Observation Tool (CPOT) to detect oropharyngeal pain in critically ill mechanical ventilated adults during routine oral care procedures. Methods : We conducted a prospective observational study in two intensive care units (ICU) in a university-affiliated hospital in Toronto, Canada. Two trained research coordinators independently observed patient behaviors during 2 non-painful (rest and gentle touch) and 3 potentially painful (oral suctioning, tooth brushing, and swabbing with a sponge toothette) oral procedures using the CPOT. Patients were stratified by level of consciousness. We used standard procedures to evaluate criterion validation, discriminative validation, and inter-rater reliability. Results : We recruited 98 patients, primarily intubated (92. 9%), and male (63. 3%). The proportion of patients with CPOT scores >2 indicating pain presence during oral procedures were: oral suction (42.9%); oral swabbing (38.7%); and tooth brushing (29.7%). Level of consciousness did not influence CPOT scores (F = 2.75; P = .07). Criterion validity of the CPOT to detect pain presence was supported during tooth brushing (AUC 0. 80, p = 0. 05) and oral suction (AUC 0. 72, p = 0. 03) but not oral swabbing (AUC 0. 68, p = 0. 16). Mean CPOT scores were significantly higher in the 3 painful exposures compared to the rest conditions demonstrating discriminative validation. Inter-rater reliability was excellent for total CPOT scores (ICC = .78-.91). Discussion/Conclusions : The CPOT is valid and reliable for the detection of oropharyngeal pain during tooth brushing and oral suctioning procedures in adults experiencing invasive mechanical ventilation.

Ngai Chow 0000-0002-1800-0362 a , Mahmood AminiLari a , Rachel Couban b , Li Wang 0000-0003-1585-8846 b , Jason W. Busse 0000-0002-0178-8712 b a Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; b Department of Anesthesia, McMaster University, Hamilton, ON, Canada CONTACT Ngai Chow [email protected] In the present study we just report the results of 4 eligible studies published in English. In the updated study, we have also included 52 articles published in Chinese with the assistance of our Chines colleagues. We will report the results of our new analyses in the near future. In the present study we just report the results of 4 eligible studies published in English. In the updated study, we have also included 52 articles published in Chinese with the assistance of our Chines colleagues. We will report the results of our new analyses in the near future. © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Peripheral neuropathy is a common cause of chronic pain among patients with diabetes, and acupuncture has been suggested as a therapeutic option. To determine the effectiveness of acupuncture for chronic diabetic peripheral neuropathy (DPN). Methods : We searched MEDLINE, EMBASE, CENTRAL, AMED, CINAHL, PsychINFO, trial registries, and reference lists of relevant articles up to February 2017. Pairs of reviewers, independently and in duplicate, screened articles for inclusion, assessed risk of bias and extracted data. We conducted meta-analyses when possible and used the GRADE approach to assess the quality of evidence. Results : Among 4443 potentially eligible studies 4 with 244 patients proved eligible to be included for review. Overall all four studies were at high risk of bias. Compared to sham acupuncture, we found very low quality evidence that acupuncture reduces pain (weighted mean difference [WMD] −1.95cm on a 10cm visual analogue scale, 95% CI −3.27 to −0.64; minimally important difference [MID] 1cm; risk difference (RD) for achieving the MID 52%; 95% CI 19% to 63%) and improves physical functioning (WMD 3.68 points on the short form-36 [SF-36] physical component summary score; 95% CI 1.66 to 5.70; MID is 5-points; RD for achieving the MID 8%, 95% CI 3% to 18%), but does not affect emotional functioning (WMD 1.26 points on the SF-36 mental component summary score, 95% CI: −1.13 to 3.66). Conclusions : Very low-quality evidence suggests that acupuncture reduces pain and improves physical functioning in patients with chronic DPN but does not affect emotional functioning.

Kyle Vader a b , Tom Doulas b , Rupa Patel c , and Jordan Miller a a School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada; b Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada; c Kingston Community Health Centre, Kingston, Ontario, Canada CONTACT Kyle Vader [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: The purpose of this research was to explore the experiences of adults with chronic pain when they participate in physical activity and exercise and to understand perceived barriers and facilitators to participation. Methods: We conducted an interpretive descriptive qualitative study. We recruited adults who self-identified as living with chronic pain from primary care teams and a hospital-based chronic pain clinic in Kingston, Ontario. An audit trail, reflexive dialogue, and thick description were used to maintain analytical rigor. Results: 16 participants took part in an interview between October 2017 and January 2018. The majority of participants identified as female (11/16) and had a median age of 53 years. Three themes and subsequent sub-themes emerged: (1) unique features of physical activity and exercise in the context of chronic pain (physical activity through daily tasks, low intensity physical activity is best, flaring up after physical activity), (2) factors influencing participation in physical activity and exercise (access to fitness equipment/facilities, motivation to participate, uncertainty/fluctuating responses, social supports, perceived benefits, competing demands for time, knowledge, fears, physical abilities, environment, pain/fatigue, and confidence, and (3) potential outcomes of participating in physical activity and exercise (improved pain management, mental and emotional changes, social connections, functional gains, and other aspects of health)" should be deleted and replaced with the following sentence "Three major themes (and sub-themes) emerged: (1) the challenge of staying active (decreased activity levels due to pain, discomfort during physical activity, and uncertain and fluctuating abilities); (2) factors influencing participation (pain, fatigue, perceived risks, beliefs about physical activity, competing demands, social support, motivation, other health conditions, and access to supports for physical activity or exercise); and (3) perceived outcomes (pain management, functional improvements, social participation, mental health, and overall wellbeing). Discussion/Conclusions: A combination of factors were perceived as influencing participation in physical activity and exercise in adults with chronic pain. Potential outcomes of physical activity and exercise focused on overall health and well-being among adults with chronic pain.

Kaytlin Constantin a , Rachel Moline a , and C. Meghan McMurtry 0000-0002-3278-1169 a Department of Psychology, University of Guelph, Guelph, ON, Canada CONTACT Kaytlin Constantin [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: Parent traits relate to child pain outcomes; however, less clear is how these factors affect parent responses, such as heart rate variability (HRV), which provides continuous information about parents’ emotional states. We examined how parent traits relate to changes in parent HRV before and after their child’s completion of the cold pressor task (CPT). Methods: Children between 7 and 12 years of age completed the CPT in the presence of a primary caregiver ( n = 43). Parents completed trait measures of State-Trait Anxiety Inventory, Pain Catastrophizing Scale-Parent, and the Emotion Regulation Questionnaire. Parental HRV [assessed by the high-frequency component of HRV (HF-HRV) and the root mean square of the successive differences (RMSSD)] were monitored during 3 × 2 minute time periods: 1) neutral video (resting), 2) prior to the CPT (pre-CPT), and 3) recovery after the CPT (post-CPT). Resting HRV was examined as a trait variable. HRV reactivity was calculated by subtracting resting HRV from HRV pre-CPT. HRV recovery was calculated by subtracting HRV pre-CPT from HRV post-CPT. Results: four hierarchical regression analyses were conducted in which parent traits were entered as predictors of parent HRV reactivity and recovery (HF-HRV, RMSSD). Resting HRV and trait anxiety predicted HRV reactivity; while resting HRV and trait catastrophizing predicted HRV recovery. Discussion/Conclusions: Findings contribute to existing social communication models of pain. This novel study examined how parent traits relate to changes in parent HRV before and after child acute pain. Clarifying the factors contributing to parent responses has implications for pain management interventions.

Allison Verge a , and Karim Mukhida a Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada CONTACT Alison Verge [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : The McGill pain questionnaire serves as a basis for initial consultation assessment tools used by pain clinics throughout Canada. The effectiveness of pain evaluations using multi-page, text-heavy questionnaires has been recognized as less than ideal for patients for a number of reasons (such as reliance on literacy, the format not facilitating patient self-expression or conversation with physicians). Various novel methods of assessing pain have been suggested, including those that use pictograms and photographs and results have shown that this is a valuable area of research to pursue further. However, researchers to date have only trialed newly-designed models on patient populations and have not consulted patients in their design. Patient input on how they could best express their pain to health care professionals is a critical resource in furthering this area of research and innovation. The goal of this study was to gauge patient opinions on current pain assessment modalities and learn their opinions on future areas of improvement. Methods : Thirty patients were interviewed following their initial consultation appointments at the Pain Management Unit in Halifax. Interviews were transcribed verbatim and analyzed using NVivo Software to look for themes among patients. Results : The study yielded a total of twenty-five themes, such as the questionnaires were repetitive but of appropriate length. The use of a body template was valued. Participants provided perspectives on the use of technology and art for pain assessment. Discussion/Conclusions : Recommendations are proposed based on the themes to help guide the creation or modification of pain assessment tools.

Arthur Woznowski-Vu a , Daniel Flegg a , Rebekah Wickens b , Andrea Aternali c , Karen Meyer d , Michael Sullivan 0000-0002-4228-1678 e , Timothy H. Wideman a a School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; b Department of Psychology, Université du Québec à Montréal (UQAM), Montreal, Quebec, Canada; c Department of Psychology, York University, Montreal, Quebec, Canada; d CBI Health Group (Concordia Physio Sport), Montreal, Quebec, Canada; e Department of Psychology, McGill University, Montreal, Quebec, Canada CONTACT Arthur Woznowski-Vu [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: Recently developed measures for sensitivity to physical activity (SPA) use brief physical tasks and monitor evoked pain-related responses. However, these measures have not yet been studied prospectively. The purpose of this study was to estimate the extent to which SPA predicts pain and disability among adults with recent onset low back pain (<6 months), cross-sectionally and prospectively (3-month follow-up). Methods: SPA was assessed using a repeated lifting task with difficulty tailored to personal pain responses. SPA-related measures included evoked pain (single lift, 10 repeated lifts), pre-post pressure pain threshold (hands, lower back), and task-specific questions (catastrophizing, fear, pain self-efficacy). Otherwise, participants answered questionnaires (Demographic, Pain Catastrophizing Scale, 11-item Tampa Scale of Kinesophobia, Brief Pain Inventory, Pain Disability Index). 3-month follow-up was completed by telephone (pain and disability questionnaires). Results: Hierarchical regression analysis on 72 participants (preliminary analysis). Pain evoked with 10 lifts uniquely predicted pain at initial visit (β = .383, t = 3.587,p = .001) and 3-month follow-up (β = .268, t = 2.049,p = .044), beyond pain evoked with single lift. Pain evoked with 10 lifts uniquely predicted disability at initial visit (β = .283, t = 2.570,p = .012) beyond pain evoked with single lift, but not at 3-month. Task-specific catastrophizing uniquely predicted disability at 3-month (β = .298, t = 2.701,p = .009) beyond general pain catastrophizing, but not cross-sectionally. The pre-post change in pressure pain threshold (lower back) uniquely predicted disability at 3-month follow-up (β = −.271, t = −2.357,p = .021), but not cross-sectionally. Discussion/Conclusions: This is the first study which prospectively analyzed the predictive value of SPA. Also, this is among the first studies to consider task-specific evoked psychological responses as part of a physical task-based SPA measure.

Jaimie Beveridge a , Richelle Mychasiuk a , and Melanie Noel a Psychology, University of Calgary, Calgary, Alberta, Canada CONTACT Jaimie Beveridge [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: Pediatric chronic pain is prevalent, affecting 25% of Canadian youth, and can have devastating effects on functioning and well-being. In order to improve psychological treatments for youth with chronic pain, which are often ineffective, a better understanding of factors that contribute to pediatric chronic pain, and which may be effective targets for treatment, is needed. Parent chronic pain and trauma have been found individually to contribute to chronic pain in offspring. However, chronic pain and trauma often co-occur. As such, this study aimed to examine the cumulative risk of parent chronic pain and trauma symptoms on pediatric chronic pain outcomes. Methods: To date, 172 youth (68% girls) aged 8–18 ( M = 13.26, SD  = 2.59) referred for tertiary-level treatment of chronic pain and one of their parents (92% mothers) completed self-report measures of parent chronic pain status and trauma symptoms and child pain interference and health-related quality of life (HRQoL). Hierarchical multiple regressions were conducted. Results: Parent chronic pain status (step 1) and trauma symptoms (step 2) predicted child pain interference (total model: R 2  = .08, step 1: ∆ R 2  = .03, step 2: ∆ R 2  = .06, all p s<.05) and HRQoL (total model: R 2   = .11, step 1: ∆R 2  = .05, step 2: ∆R 2  = .06, all p s<.05). Discussion/Conclusions: Parents’ own chronic pain and trauma symptoms predicted greater pain interference and lower HRQoL in youth with chronic pain. These findings suggest that parents’ mental and physical health may be important targets for the treatment of pediatric chronic pain. Future research should examine modifiable mechanisms (e.g., parenting behaviours) that may underlie these relationships.

Shaylea Badovinac a , Hannah Gennis a , Rebecca Pillai Riddell a , Hartley Garfield b a Clinical-Developmental Psychology, York University, Toronto, Ontario, Canada; b Pediatrics, University of Toronto, Toronto, Ontario, Canada CONTACT Shaylea Badovinac [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim: Previous studies have shown that infant temperament (Stevens et al., 2013) and parental psychopathology (Moscardino, Axia, & Altoe, 2006) are independently associated with infants’ pain-related distress. The present study aimed to examine whether infant temperament moderates the association between parental psychopathology and infant pain-related distress reactivity and regulation during routine vaccinations. Methods: The study included parent-infant dyads ( n = 58) from the 12-month wave of an ongoing longitudinal study in which dyads were videotaped during infants’ routine vaccinations. Infant pain-related distress was coded from 15-second epochs of video footage collected immediately post-needle (reactivity) and at one minute (regulation 1) and two minutes (regulation 2) post-needle using the Face, Legs, Activity, Cry, Consolability Scale (FLACC; Merkel, Voepel-Lewis, Shayevitz, & Malviya, 1997). Infant negative affectivity and parental psychopathology were assessed using the Early Childhood Behavior Questionnaire (ECBQ; Putnam, Jacobs, Gartstein, & Rothbart, 2010) and the Brief Symptom Inventory 18 (Derogatis, 2001), respectively. Moderated regression models examined the contribution of infant negative affectivity, parental psychopathology, and their interaction, to the prediction of infant pain-related distress. Results: The regression model did not account for a significant proportion of variance in infant pain-related distress behaviour during the reactivity or regulation phases. No main effects or moderation effects were found. Discussion/Conclusions: Parent reports of psychopathology and infant temperament did not predict infants’ pain-related distress behaviours. This may be due to limitations associated with using a normative sample. It is critical to replicate this study in a higher risk or clinical sample.

Jaqueline Raymondi Silva a , Courtney A. Bannerman a , Julia P. Segal b , Francisco Gomes c , Thiago Mattar Cunha c , Ian Gilron a , Nader Ghasemlou a a Department of Biomedical & Molecular Sciences, Queen’s University, Kingston, Ontario, Canada; b Department of Anesthesiology and Biomedical & Molecular Sciences, Queen’s University, Kingston, Ontario, Canada; c Department of Pharmacology, University of Sao Paulo, Sao Paulo, Brazil CONTACT Jaqueline Silva [email protected] Department of Biomedical & Molecular Sciences, Queen’s University, Kingston, ON, Canada © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Inflammatory pain is a result of complex and dynamic interactions between the immune and the nervous systems, and includes the orchestrated recruitment and activation of tissue-resident and circulating immune cells. Our previous studies have identified a central role for Ly6C-lo myeloid cells in the pathogenesis of inflammatory pain. We now show that CCL17 and CCL22, chemokines expressed preferentially by these cells, and their cognate receptor CCR4 are key mediators of this response. CCL17 and CCL22 are both upregulated significantly early after tissue injury and elicit a robust acute pain response when administered subcutaneously. Pharmacological blockade of CCR4 using a specific antagonist abrogates this effect. Acute post-surgical pain is also significantly reduced in both transgenic mice lacking CCR4 and wildtype animals treated with a CCR4 receptor antagonist. Together, these results suggest an essential role for the CCL17/CCL22:CCR4 axis in the genesis of inflammatory pain and opens new therapeutic avenues for its control.

Géraldine Martorella a , Lucinda Graven a , Glenna Schluck a , Mélanie Bérubé b , and Céline Gélinas b a College of Nursing, Florida State University, Tallahassee, Florida, USA; b Ingram School of Nursing, McGill University, Montreal, Quebec, Canada CONTACT Geraldine Martorella [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Cardiac surgeries rank among the most frequent surgical procedures and present a risk of chronic post-surgical pain (CPSP). As a first step in preventing CPSP, a tailored Web-based intervention was developed and successfully tested to tackle pain management during hospitalization. Before proceeding to further development, preliminary acceptability of the intervention must be evaluated. The purpose of this study was to examine clinicians’ perception of a Web-based tailored intervention for pain management in the early recovery phase. Methods : A parallel mixed methods approach was used to assess clinicians’ acceptability of the intervention in the early recovery phase (first month after surgery). Results : 249 participants completed an online survey and 10 participants were individually interviewed. Overall, the intervention was rated as acceptable for the early recovery phase. No difference was found in acceptability ratings by demographics. The intervention was rated as appropriate by 79% of participants. Although clinicians seemingly would recommend it to their patients, they did not perceive that their patients would be as highly willing to use it. Interviews highlighted several strengths of the intervention, such as postoperative pain awareness, customization of content, and flexible dosage and schedule. However, the main weakness was related to patient adherence. Discussion/Conclusions : Opting for a hybrid format and integrating individual treatment preferences could enhance the coaching experience. Considering that the intervention has demonstrated positive effects on the pain experience in the first week after cardiac surgery, it seems logical to explore its potential impact after discharge on the transition to CPSP.

Somayyeh Mohammadi a b , Christine T. Chambers 0000-0002-7138-916X a b c , Margot Latimer d , Lindsay L. Richter a e , and Lukas Propper f a Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada; b Department of Pediatrics, Dalhousie University, Halifax, Canada; c Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada; d School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada; e Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; f Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada CONTACT Somayyeh Mohammadi [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction : There is a higher risk of behavioral and emotional symptoms (e.g., anxiety) in children of parents with chronic pain compared to their peers. This qualitative study investigated the challenges that children of parents with chronic pain face in their daily life and the coping strategies that they use to overcome these challenges. Method : Fifteen children (9 females; 12–17 years old) who live with parents with chronic pain (pain > 3 months) participated in an individual semi-structured interview over the phone. Children answered questions regarding their understanding of their parent’s pain, its impacts on their daily life and their coping strategies. The interviews were transcribed verbatim and analyzed using the phenomenologic approach. Result : Five categories emerged from the data: 1) child’s incomplete understanding about their parent’s chronic pain, 2) noticing something is different when the parent is in pain, 3) growth of personal and interpersonal skills because of living with a parent with pain, 4) parent’s pain limits child’s social life, and 5) experiencing emotional distress because of parents’ pain. Discussion : The results enhance our knowledge on the impact of parental chronic pain on their children and the variety of coping strategies that children use to overcome these challenges. Moreover, the interviews revealed certain positive impacts of living with parents with chronic pain including the development of good personal and interpersonal skills. These findings can be used to develop interventions to support parents and their children to better understand the pain and its multidimensional consequences on the children.

Michael Smyth a , Sebastian Haupt a , and Marie-Claude Grégoire b a Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; b Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada CONTACT Michael Smyth [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. While indicated for use in adult populations, small studies have shown promising results in reducing pain in children with few, if any, adverse effects. The objective of this study was to evaluate the safety of a Butrans (buprenorphine) Transdermal System patch for analgesia in a palliative paediatric setting. Studies of this drug have been mostly limited to adult populations and information regarding transdermal administration of buprenorphine in a paediatric population is predominantly found in case reports. Given this, our aim was to retrospectively assess the safety of buprenorphine in a palliative paediatric care setting. In our patient population, 27.3% of patients experienced only mild adverse drug reactions in the form of skin irritation (erythema in combination with pruritus), which was resolved with topical steroid treatment. The development of skin irritation led to Butrans treatment cessation in only 9.1% of subjects. Given these promising results, Butrans was found to be appropriate for analgesic use in a palliative paediatric setting and hope to see it’s use expanded in the future. Introduction/Aim : Buprenorphine is an opioid medication used for the treatment of moderate to severe pain. In Canada, buprenorphine is not indicated for use in the pediatric population and literature surrounding its use in pediatrics is limited. Our aim was to evaluate the safety of buprenorphine in a pediatric palliative care setting. Methods : Our study was performed at the IWK Health Centre. Medical records of 11 patients were examined for specific clinical characteristics. The study focused primarily on descriptive results; standard data analyses were not performed. Results : Buprenorphine was found to be well tolerated in our patient population. There were no adverse effects reported in 8 of 11 patients during their treatment with buprenorphine. The remaining 3 patients described mild adverse effects in the form of skin irritation which resolved with topical steroid treatment. Efficacy was reported as anecdotal quotes from patient records. Discussion/Conclusions : Currently in medical literature, there is limited data on the safety of buprenorphine in children suffering from pain in a palliative care setting. In our study, the use of buprenorphine in control of pain in this setting was safe in a small group of patients (3 patients exhibited a contact dermatitis which quickly resolved upon removal of the patch; no other adverse effects noted). Other studies have also demonstrated buprenorphine to be a safe and an effective opioid for the treatment of severe pain at the end of life in a pediatric population. The implementation of buprenorphine in pediatrics may be safe and provide proper analgesia.

Shannon Tansley a , Jordyn Heal b , Arkady Khoutorsky c a Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada; b Arts & Science, McGill University, Montreal, Quebec, Canada; c McGill University, Anesthesia, Montreal, Quebec, Canada CONTACT Shannon Tansley [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Perineuronal Nets (PNNs) are net-like structures that are found around the cell soma and proximal dendrites of neurons. PNNs play a role in regulating neuronal plasticity in the cortex and hippocampus. In the spinal cord, previous studies have characterized PNNs around motor neurons in the ventral horn, however, they have not been described in the dorsal horn. In this study, we aim to characterize PNNs in the spinal cord dorsal horn and investigate developmental changes in PNNs formation. We also aim to establish the subtypes of neurons in the dorsal horn surrounded by PNNs. Methods : C57BL/6 mice of different ages (P2, P42-56 and 2 years) were transcardially perfused, and their spinal cord extracted. Spinal cord sections were stained for WFA (L1516, Sigma), Aggrecan (AB1031, Millipore) and NeuN (ABN90, Millipore). Images were collected using wide-field microscope with Apotome and quantified using ZEN and ImageJ. Results : In the spinal cord dorsal horn, WFA staining (chondroitin sulfate sugar chains) is present exclusively in lamina I. A small subset of neurons are labeled with Aggrecan and WFA in lamina I of the dorsal horn and lateral spinal nucleus. PNNs are not present in the spinal cord of P2 mice but were found in adult animals. Discussion/Conclusions : Our study has shown that PNNs are present in spinal cord lamina 1 and the lateral spinal nucleus. These areas are involved in nociceptive processing. We propose that PNNs in the spinal cord dorsal horn are involved in regulation of spinal nociceptive circuits.

Kevin C. Lister a , Sioui Maldonado Bouchard a , Stephania Donayre Pimentel a , Mariam Majeed a , Amanda Cdec Williams b , Andrea Aternali a , Jeffrey S. Mogil a a Psychology Department, McGill University, Montreal, Quebec, Canada; b Department of Clinical, Educational & Health Psychology, University College London, London, UK CONTACT Kevin Lister [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : We designed an experiment to evaluate the potential adaptive significance of chronic pain in mammals, by measuring vigilance behaviour to predator odour. We hypothesized that mice in pain will become hypervigilant to predation threat. Methods : To test threat avoidance behaviour, we developed an octagonal apparatus in which odour can be infused into a single arm. Mice were trained to seek food reward (a Fruit Loop) via the short route around the maze. Once trained, fox urine was infused such that taking the short route would entail encountering the fox odour. The number of short versus long routes chosen was recorded in five trials, in mice in the following conditions: 1) control, 2) 0.6% acetic acid, and 3) 0.6% acetic acid plus 20 mg/kg carprofen. Results : Mice in all groups showed vigilance (I.e., avoidance of the short route) when fox urine was present compared to when it was not. Pain increased vigilance behaviour, and analgesia reversed this hypervigilance. Discussion/Conclusions : We conclude that pain produces hypervigilance against predation. If chronic pain produces the same effect, as has been demonstrated in squid, this may represent the adaptive significance of chronic pain hypersensitivity.

Melissa Richard-Lalonde a , Raphaël Morisseau-Guillot b , Christine Echegaray-Benites c , Céline Gélinas d a Ingram School of Nursing, McGill University, Montréal, Québec, Canada; b Psychiatry, Université de Montréal, Montreal, Quebec, Canada; c McGill University Health Centre, Emergency Department, Montreal, Quebec, Canada; d Ingram School of Nursing, McGill University, and Centre for Nursing Research, CIUSSS Centre-Ouest-Ile-Montréal – Jewish General Hospital, Montréal, Québec, Canada CONTACT Céline Gélinas © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim :Practice guidelines recommend the use of validated behavioral scales such as the Critical-Care Pain Observation Tool (CPOT) for pain assessment in the nonverbal critically ill. While evidence has shown the sustainable use of the CPOT up to 12 months post-implementation, long-term use of the tool had never been studied. This study aimed to evaluate the sustainability of the CPOT use at three- and five-years post-implementation. Methods : Medical charts documenting a 24-hour period within the first 48 hours of the ICU stay were reviewed. Included patients were 18 years or older with a Glasgow Coma Scale of 4–12, without spinal cord injury or neuromuscular blockade. Data collected included documentation of pain assessments with the CPOT, administration of opioids, and pain reassessments. Results : A total of 60 files were included (30 for each time point). The mean age was 63.35 (20–89) years, with 38.3% being male (no difference between samples). Pain assessments done using CPOT were reported on average 7–8 times per 24 hours, ranging from 0–20 assessments (median of 1.00 to 3.00 per shift). There was an average of 1.0–2.5 bolus of opioids administered over the same period. Following an opioid bolus, pain was reassessed <60% of the time. Based on pain reassessments, 59.1% (three years) and 29.4% (five years) of administered opioids were effective in reducing pain scores by two points on the CPOT. Discussion/Conclusions : These findings support that CPOT is still used on a regular basis three and five years after its implementation. Pain reassessments should be improved.

Lillian Du a , A. Hillary Steinhart b , Shlomit Boguslavsky c , Erin Murphy d , Kenneth Croitoru b , Zane Gallinger e , Vivian Huang b , Mark Silverberg f , Adam V. Weizman b , Geoffrey C. Nguyen f , Amol Deshpande g a Gastroenterology, University of Toronto, Toronto, Ontario, Canada; b Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; c Gastroenterology, Mount Sinai Hospital, Toronto, Ontario, Canada; d Nursing, Trent University, Toronto, Ontario, Canada; e Gastroenterology, University of Toronto, Toronto, Ontario, Canada; f Mount Sinai Inflammatory Bowel Disease Centre, University of Toronto, Toronto, Ontario, Canada; g Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada CONTACT Amol Deshpande [email protected] Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : An estimated 35% of all Inflammatory Bowel Disease (IBD) patients in remission continue to experience chronic abdominal pain. Despite the negative impact on quality of life, minimal research effort has been devoted to addressing this issue. IBD patients often seek alternative therapies to manage persistent pain including the use of cannabis, without evidence to support its use. This study describes the characteristics of pain, mood and cannabis use in IBD patients. Methods : This is a cross-sectional survey evaluating a cohort of ambulatory patients, age ≥16 years with a diagnosis of IBD for over one month. Results : A total of 206 surveys were collected with initial results reported on 123. Constant pain was present in 26.8%% of IBD patients with 34.9% reporting at least moderate levels of pain (NRS>4). Opioid use for more than 30 days was reported by 13% of all patients with 31.3% and 34.7% actively using cannabis in Crohn’s Disease (CD) and Ulcerative Colitis (UC), respectively. Of active cannabis users, 67% used less than 2.5 g/d of dried cannabis. History of recreational use was greater in active cannabis users versus non-users but was only significant in UC. Average scores on the cannabis use disorder-short form were >4 in active cannabis users. The PHQ-9 and GAD-7 documented moderate depression and anxiety in all groups with significant levels of depression (18.0 vs. 14.4, p < .05) between active cannabis users versus non-users in CD. Only 14.9% of active cannabis users endorsed subjective improvement in pain or mood. Discussion/Conclusions : Constant pain of at least moderate intensity and associated depression and anxiety is common in IBD. While cannabis use is prevalent, few report subjective improvement.

Milind M. Muley a , Yu Shan Tu a , Benjamin E. Steinberg a , Michael W. Salter a Program in Neuroscience & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada CONTACT Milind M. Muley [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Low back pain secondary to disc herniation is a major health problem. Proinflammatory cytokines have been implicated in the pathogenesis of disc herniation. Here, we assessed the contribution of interleukin-1β (IL-1β) to the development of pain behaviours in a recently developed model of non-compressive disc herniation. Methods : Nucleus pulposus (NP), collected from littermate tail intravertebral discs, was placed on the sciatic nerve of male C57BL/6 mice. In sham animals, only the sciatic nerve was exposed. von Frey algesiometry was used to assess mechanical allodynia. In separate cohorts, immunohistochemistry and PCR were performed on day 7 to respectively study the infiltration of inflammatory cells and IL-1β gene expression in nerve. The effect of the caspase-1 inhibitor, VX-765 (200 mg/kg i.p; days 0–3), on NP-induced pain hypersensitivity was studied. To gain mechanistic insight, we developed an in vitro assay to test the effect of VX-765 on IL-1β secretion from cultured human macrophages. Results : We found that mechanical allodynia appeared on day 1 and persisted to day 7 following NP exposure to the sciatic nerve. We detected an increase in macrophage (F4/80) infiltration in and around the nerve at 1-week post-surgery in NP animals, compared with sham controls. We identified increased IL-1β gene expression in the sciatic nerves treated with NP compared with sham controls. Treatment of NP animals with VX-765 prevented mechanical allodynia as compared to vehicle-treated animals. It was observed that VX-765 prevented the release of IL-1β from cultured macrophages. Discussion/Conclusions : These results indicate an important role for IL-1β secretion from macrophages during the development of pain associated with non-compressive disc herniation. Blocking IL-1β may be a viable strategy in treating pain associated with disc herniation.

Shannon Tansley a , Jordyn Heal b , Annie Castonguay c , Noosha Yousefpour d , Antoine Godin c , Alfredo Ribeiro-da-Silva e , Yves De Koninck f , Luda Diatchenko g , Jeffrey Mogil h , Arkady Khoutorsky i a Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada; b Arts & Science, McGill University, Montreal, Quebec, Canada; c CERVO Brain Research Centre, Université Laval, Québec, QC, Canada; d Department of Physiology, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; e Department of Physiology, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC; f Université Laval, Department of Psychiatry and Neuroscience, CERVO Brain Research Centre, Québec, QC, Canada; g Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; h Department of Psychology, Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; i Anesthesia, McGill University, Montreal, Quebec, Canada © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : In the nervous system, neurons and glial cells are embedded within an extracellular matrix (ECM), whose components not only provide structural support, but also regulate synapse formation and function, and modulate neuronal excitability. The ECM restricts synaptic and structural plasticity, and enzymatic digestion of ECM affects acquisition of memories, and promotes cognitive flexibility and extinction. In this study, we investigated how remodeling of ECM components, specifically perineuronal nets (PNNs) contributes to the sensitization of spinal nociceptive circuits after injury. Methods : Immunohistochemical analysis was used to assess varying components of PNNs in the spinal cord, as well as microglial engulfment. To label projection neurons, AAV2/9-CMV-CRE-eGFP virus was injected into parabrachial nuclei of TdTomato reporter mice. Behavioural studies were performed after intraspinal delivery of AAV2/9-CMV-chABC on 6–8-week-old C57BL/6 mice. Both sexes were used in all studies. Results : In the dorsal horn of the spinal cord, perineuronal nets are preferentially found around projection neurons in the lamina I, and the lateral spinal nucleus. After spared nerve injury (SNI), microglia mediate removal of components of PNNs via engulfment processes. Viral delivery of an enzyme that degrades PNNs (AAV 2/9-CMV-chABC) promotes hypersensitivity in mice in both SNI and CCI (chronic constriction injury) models. Discussion/Conclusions : Nerve injury causes robust microglia-mediated remodeling of the ECM in the dorsal horn of the spinal cord. Removal of perineuronal nets promotes hypersensitivity in mice, suggesting that PNNs are involved in regulation of spinal nociceptive circuits. Ongoing studies are aiming to assess the role of PNNs in chloride regulation after nerve injury.

Sheila O’Keefe-McCarthy a , Karyn Taplay a , Lisa Keeping-Burke b , Allison Flynn-Bowman a , Maria Vasilaki a , and Jenn Salfi a a Department of Nursing, Brock University, St. Catharines, Ontario, Canada; b Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick CONTACT Sheila O’Keefe-McCarthy [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Recognition of early ischemic cardiac pain symptoms is fraught with uncertainty and fear. Highlighting the experiential qualities of individual patient experiences of ischemic cardiac disease in a creative and artistic encounter, enhances the clinician’s critical awareness of the patient experience of living with heart disease. Methods : We employed an arts-based creative research embodied analysis to translate the experiences of 23 individuals’ journeys through symptom recognition of coronary artery disease. Four focus groups and 12 individual qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim. Qualitative description was used to generate categories and themes. Results : Denial and disbelief, self-recrimination, and encroaching symptoms of heart disease were themes that emerged from the data. Seminal words and phrases were extracted from the interviews and constructed into poetry. Patients’ stories were further conceptualized and informed the artistic creations and painted images that metaphorically represented the participants’ cardiovascular pain and illness experiences. Discussion/Conclusions : Arts-informed research provides an empathetic, compassionate and embodied introspection and reflection from the patient’s perspective. It has the power to engage clinicians at a visceral insightful level that allows meaning to be transferred differently, patient stories to be heard, visualized, and felt. The phenomena of cardiac pain as the background, creates an artful place and space to contemplate the emotional journey living with cardiac disease.

Martha López-Canul a , Alexandra Teggin a , Maria-Luisa Vigano a , Luca Posa a , Danilo De Gregorio a , Shelly Yin a , and Gabriella Gobbi a Department of Psychiatry Montreal, McGill University, Québec, Canada CONTACT Martha López-Canul [email protected] © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction/Aim : Neuropathic pain (NP) is a major health problem characterized by high suffering, low productivity and substantial health care costs. An estimated 50% of patients with NP develop sleep disturbances (Finan et al., 2013) and only a restricted number of effective drugs are clinically available for NP associated to insomnia with several side effects. The delta-9-tetrahydrocannabinol (THC) may offer a novel approach to the chronic pain management and insomnia, but its efficacy in these two condition is not yet fully understood. Methods : We induced NP (sciatic nerve ligation) in Wistar rats, 14 days later were treated with vehicle (VEH; 5%Tween 80, 5% PEG and saline) or THC (1, 1.5, 2, 2.5 and 5 mg.kg, i.p.) to assess mechanical allodynia. Then, rats with NP (sciatic nerve injury) were implanted with six stainless-steel wire electrodes in the skull and EEG/EMG was recorded for a period of 6 h (from 6 AM to 12 PM). Results : THC (2.5 and 5 mg/kg) decreased mechanical allodynia in rats with NP (p < 0.001) vs VEH, 1h. after administration in a dose dependent-manner. This effect lasted about 3.5 hours. EEG/EMG analysis showed that rats with NP had a reduced time in non-rapid eyes movement (NREM) sleep (−35%, p < 0.05) and increased wakefulness (+39.6%, p < 0.05) compared to naive rats. THC (5 mg/kg) was able to restore the normal sleep-wake cycle in NP rats. Discussion/Conclusions : The findings suggest that THC has a moderate analgesic effect and good hypnotic effect in a NP paradigm, similar to clinical outcomes reported in humans.