Book of Posters

Treatment/management/pain programs Le traitement, la gestion ou les programmes de prise en charge de la douleurThe flavour of pain-relief: Tongue stimulation to reduce pain in poststroke patients Maureen Ahiatsi a , Marie-Hélène Milot b , Eléonor Riesco c , Marie-Claude Girard d and Guillaume Léonard e a Université de Sherbrooke, Faculté de médecine et des sciences de la santé; b Université de Sherbrooke, Centre de recherche sur le vieillissement du CIUSSS de l’Estrie-CHUS; c Université de Sherbrooke, Faculté des sciences de l’activité physique et Centre de recherche sur le vieillissement du CIUSSS de l’Estrie-CHUS; d Centre de recherche sur le vieillissement du CIUSSS de l’Estrie-CHUS; e Université de Sherbrooke, Centre de recherche sur le vieillissement du CIUSSS de l’Estrie-CHUS Introduction/Aim : Stroke survivors often experience pain in the affected upper limb (UL), impacting their function and quality of life. To minimise the impact of these deleterious effects, non-invasive neurostimulation techniques, such as cranial nerve non-invasive neuromodulation (CN-NINM), is increasingly studied and used in rehabilitation. By stimulating the tongue, CN-NINM depolarizes cranial nerves, creating direct neural impulses to the brainstem in areas known to play a key role in pain modulation. The objective of this project was to investigate the feasibility and the effectiveness of CN-NINM on pain in the affected UL in individuals with chronic poststroke (> 6months). Methods : In this feasibility pilot pre/post intervention study, 12 adults in the chronic phase of a stroke are recruited. A tonic experimental thermal pain stimulus is used to measure the impact of CN-NINM on experimental pain (tonic heat pain test applied over the participant’s forearm) before and after a single 20-minute application of CN-NINM. Feasibility measures include recruitment rates, adherence to the intervention and adverse effects. Inferential statistics will be used to explore the immediate effect of the CN-NINM intervention on pain perception. Results : All 10 participants recruited to date completed the intervention. No adverse effects were reported. The recruitment rate was 100%. Although some participants experienced a reduction in pain following the intervention, the hypoalgesic effects of CN-NINM remain somewhat marginal and do not reach the threshold of clinical significance. Discussion/Conclusions : Unfortunately, the initial findings looking into the effect of CN-NINM on pain suggest that the intervention has no direct immediate impact on pain perception. Do all patients benefit from the soothing properties of comfort talk to reduce symptom burden during outpatient chemotherapy? A multimethod secondary analysis Caroline Arbour a , Danny Hjeij b , Alexandra Lapierre a , Karine Bilodeau c , Pierre Rainville d and David Ogez e a Faculty of Nursing, Université de Montréal, Centre de recherche de l’Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Quebec, Canada; b Centre de recherche de l’Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Quebec, Canada; c Faculty of Nursing, Université de Montréal, Centre de Recherche de l’Hôpital de Maisonneuve-Rosemont (CRHMR), CIUSSS de l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada; d Faculty of Dental Medicine, Department of stomatology, Centre de recherche de l’Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l’Île de Montréal, Montreal, Quebec, Canada; e Faculty of Medicine, Department of Anesthesia, Université de Montréal, Centre de Recherche de l’Hôpital de Maisonneuve-Rosemont (CRHMR), CIUSSS de l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada Introduction/Aim : Patients undergoing outpatient chemotherapy often report breakthrough pain resisting standard pharmacotherapy, which may lead to treatment discontinuation. Our work on comfort talk (CT), a brief intervention inspired by the language principles of clinical hypnosis, support its feasibility in helping prevent pain outbreaks during chemotherapy perfusions. Still, the profile of patients most likely to benefit from CT is poorly understood. The study aimed to identify preliminary CT assignment criteria to reduce pain and other disturbing symptoms during chemotherapy perfusions. Methods : A secondary analysis of data from two previous CT studies (one quantitative, one qualitative) was conducted. A total of 24 patients were exposed to a nurse-led and partially scripted CT intervention during a planned outpatient appointment and completed the Edmonton Symptom Assessment Scale before and after chemotherapy perfusion. Qualitative content analysis was used on existing data from six interviews with oncology nurses who participated in CT administration during outpatient chemotherapy. Results : Older patients (> 60 years) with metastatic cancer, shorter treatment duration (< 1 hour), and less social support were more likely to report symptom reduction following CT during chemotherapy perfusion. Conversely, nurses’ interviews suggest that CT could prevent pain outbursts mainly in patients: 1) with higher anxiety or fear of needles, 2) undergoing long chemotherapy treatment (> 1 hour), and 3) experiencing late side effects at home. Discussion/Conclusions : A gap exists between oncology patients’ and nurses’ perceptions of CT utility for preventing pain and other disruptive symptoms during outpatient chemotherapy, with several implications for education and future research. Outcomes of spinal cord stimulation: Real-world data from participants with peripheral neuropathic pain syndromes Sireedhorn Assavanop, Siu Min Lim, Jamal Kara, Pranab Kumar, Suneil Kalia, Mojgan Hodaie, Victoria Bains and Anuj Bhatia Neuromodulation for Pain program, Toronto Western Hospital, University Health Network, University of Toronto Introduction/Aim : Peripheral neuropathic pain (PNP) is challenging to treat. Spinal cord stimulation (SCS) has been used to relieve pain in participants with PNP with variable success rates. We present data from our centre to evaluate the outcomes of SCS in participants with PNP. We aimed to identify potential predictors for successful SCS trial and implant. Methods : Fifty-six participants who had a diagnosis of PNP received SCS trials. 28 participants who had successful SCS trials underwent SCS implants between July 1, 2017 to February 28, 2022. Successful SCS trial defined as 50% or more, and successful SCS implant defined as 30% or more reduction in NRS scores compared to baseline. Results : The Pain NRS score (2.8 vs 6.0, p < 0.001), GAD-7 score (4.1 vs 9.7, p=0.002), PDI score (23.4 vs 41.0, p=0.008), PSQ-3 score (95.0 vs 183.3, p=0.039), NPSI score (23.3 vs 61.3, p < 0.001), and PCS score (9.5 vs 26, p=0.002) were significantly lower in the successful SCS implant compared to unsuccessful group. Participants’ Global Impression of Change scale showed remarkable satisfactory outcomes after SCS implant (same or worse/improved: 1/18 in successful vs. 4/5 in unsuccessful implant cohort, p=0.026). Adverse outcomes included reimplantation following infection (3.6%), explantation due to lack of efficacy (1.8%), and lead migration requiring revision (1.8%). Discussion/Conclusions : Success rate of SCS implant in participants with PNP at our centre was 67.9% with significant improvement in mental and physical health at 6-12 months. Potential factors associated with unsuccessful trial or implant in our study were history of anxiety and depression, smoking, higher PSQ-3 score. Clinician knowledge, attitude, beliefs and behavior with regards to managing the psychosocial aspects of pain and disability in hand therapy practice: A qualitative study Folarin Babatunde a , Joy MacDermid a , Luciana Macedo b , Ruby Grewal a and Mike Szekeres a a Western University; b McMaster University Introduction/Aim : Hand and upper limb injuries are very common in orthopaedic settings with substantial burden to the individual and society. Psychosocial factors account for prolonged recovery and long-term disability in these injuries. Psychologically informed hand therapy practice can enhance treatment outcomes through evidence-based risk identification, clinical decision making, delivery of supplemental interventions and mental health service referral. The objective of this study was to gain an understanding of the knowledge, attitudes, beliefs and practice behavior of physical therapists and occupational therapists in hand therapy with regards to screening, assessing, and managing psychosocial issues in patients with hand injuries. Methods : Qualitative descriptive study using individual audio-taped semi-structured interviews. Purposive sampling of clinicians practicing hand therapy in private and public healthcare settings based in Ontario, Canada. Discussions were guided by an interview guide based on the Theoretical Domains Framework. Transcriptions were thematically analyzed. Results : A total of eighteen physical therapists and occupational therapists attended the interviews. Four major themes with twelve subthemes were identified, namely: (a) Taking responsibility (Awareness, Opportunity, Confidence, Apprehension) (b) Knowledge base (Foundational, Clinical), (c) Skill and Resiliency (Communication, Stigmatization, Experience) and, (d) Leveraging resources (Patient, Health system, Socio-environmental). Discussion/Conclusions : Occupational therapists demonstared more confidence with managing psychosocial issues. However, varied foundational and clinical knowledge, organizational climate and leadership, available support and therapist skill and experience account for ongoing challenges with psychosocial adjustment in hand therapy. Physical therapists and Occupational therapists in hand therapy would benefit from additional training, tools and guidelines to support patients with psychosocial issues. Self-treatment of chronic low back pain based on a rapid and objective sacroiliac asymmetry test: A pilot study Hélène Bertrand a , K. Dean Reeves b , Rajneet Mattu a , Remerlita Garcia c , Mahir Mohammed d , Ellen Wiebe a and An-Lin Cheng e a University of British Columbia; b Independent Researcher; c No affiliation; d No institution; e UMKC Introduction/Aim : Low back pain (LBP) is common, costly, and disabling. This study assesses a novel and simple LBP evaluation method and its merit in guiding the direction of a self-treatment exercise. Methods : Randomized open-label intention to treat study. Consecutive patients with LBP ≥ three months and pain ≥ 5/10 were evaluated in a Vancouver clinic with the sacroiliac forward flexion test (SIFFT) by comparing the height of posterior superior iliac spines using a level. Those with asymmetry ≥ 5 mm were offered participation. The assistant, who generated and encrypted the randomization, assigned participants: group 1 learned a two-minute, SIFFT-derived, sacroiliac-leveling exercise (SIFFT-E) as needed for LBP relief; group 2 used a pelvic stabilization belt as needed to prevent LBP, and group 3 continued the usual care. After one month, all participants used SIFFT-E and belt as needed for one month. Our primary outcome measure was the Oswestry disability index (ODI) (decrease) from baseline to one and two months. Results : Of 72 LBP patients, 62(86%) had ≥5mm asymmetry. From zero to one month, the 21 (one dropout) SIFFT-E participants outperformed the 20 usual care participants for ODI improvement (12.5 ± 14.8 vs. -3.4 ± 14.9 points; mean difference 15.9 [CI 6.7-25.0]; P=0.002. Number needed to treat 3.0 for ODI improvement ≥11). Belt use results were intermediate. After all participants used exercise and belt as needed, ODI improvements were clinically significant (12.0 ± 18.4 points). Five (8%) exercise and 12(19%) belt wearers experienced mild side effects. Discussion/Conclusions : Sacroiliac asymmetry appears to be frequent. SIFFT may be clinically useful as an evaluation tool for prescribing a simple self-directed corrective exercise (SIFFT-E) as seen by clinically significant improvements in function. The experience of moment-to-moment opioid withdrawal symptoms and opioid craving in chronic non-cancer pain patients Alice Bruneau a , Sarah Petkau a , Alexandra Gavrilescu a , Yami-Louise Djoudi a , Juliet Ware b , Amanda Sirois a , Jordi Perez c and Marc O. Martel a a McGill University; b University of British Columbia; c Alan Edwards Pain Management Unit, McGill University Health Centre Introduction/Aim : Chronic non-cancer pain (CNCP) patients who are using opioids may experience symptoms of opioid withdrawal and opioid craving. However, little is known on the factors that contribute to momentary fluctuations of opioid withdrawal symptoms and opioid craving in these patients. The first objective of this study was to examine the association between opioid withdrawal symptoms and opioid craving among CNCP patients on opioid therapy. We also examined the psychological factors that may contribute to opioid withdrawal symptoms and craving. Methods : In this ecological momentary assessment (EMA) study, patients (n=44) provided momentary reports of opioid withdrawal symptoms and opioid craving throughout the day, when randomly prompted, for 10 consecutive days. At the same moments, patients also provided reports of pain intensity, negative affect, and pain catastrophizing. Results : A multilevel regression analysis revealed that higher momentary levels of opioid withdrawal symptoms were associated with higher craving (p < .001). Higher momentary levels of pain, negative affect, and catastrophizing were also associated with heightened opioid withdrawal symptoms and craving (all p’s < .05). Results from a multivariable regression analysis indicated that opioid withdrawal symptoms did not significantly contribute to opioid craving after accounting for patients’ moment-to-moment levels of pain intensity, negative affect, and catastrophizing. Discussion/Conclusions : Results from our study advance our understanding of factors contributing to daily opioid withdrawal symptoms and opioid craving among chronic pain patients prescribed opioid therapy. Predictors of fatal and non-fatal overdose following prescription of opioids for chronic pain: A systematic review and meta-analysis of observational studies Li Wang a , Patrick Jiho Hong b , Wenjun Jiang a , Yasir Rehman a , Brian Younho Hong b , Rachel Couban a , Chunming Wang c , David Juurlink b and Jason Busse a a McMaster University; b University of Toronto; c Guangdong Academy of Sciences Introduction/Aim : Long-term opioid use is associated with serious harms, including nonfatal and fatal overdose; however, the factors associated with opioid overdose when prescribed for chronic pain are unclear. We conducted a systematic review and meta-analysis to explore predictors of opioid overdose after prescription for chronic pain. Methods : We searched MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science from inception to October 2022, for observational studies that explored predictors of opioid overdose following opioid prescription for chronic pain. Paired reviewers independently extracted data, assessed risk of bias, and overall certainty of evidence. We performed random-effects meta-analyses for all factors reported by ≥2 studies. Results : Twenty-seven studies (23,948,324 patients) reported the association of over 100 factors with opioid overdose after prescription for chronic pain. Moderate to high certainty evidence supported large associations with opioid overdose and a history of overdose (OR 4.83 [95% CI 3.34 to 6.99]), higher opioid dose (OR 2.77 [95% CI 2.09 to 3.68] for every 90-mg increment in morphine equivalent dose), transdermal fentanyl (OR 2.80 [95% CI 2.30 to 3.41]), long-acting formulations (OR 1.95 [95% CI 1.51 to 2.51]), current substance use disorder (OR 2.42 [95% CI 1.75 to 3.37]), any mental health diagnosis (OR 2.12 [95% CI 1.83 to 2.45]), depression (OR 2.17 [95% CI 1.50 to 3.12]), or pancreatitis (OR 2.00 [95% CI 1.52 to 2.64]). These factors were associated with absolute risks ranging from 2‰ (2 in 1000) to 5‰ for fatal and 4‰ to 10‰ for non-fatal overdose. Discussion/Conclusions : Minimizing high-dose opioid prescribing, fentanyl, long-acting formulations, and opioid prescribing to chronic pain patients that have previously overdosed or present with a current substance use disorder, depression, other mental illness or pancreatitis may reduce risk of overdose. Inhaled medical cannabis for chronic pain: A systematic review and meta-analysis of randomized clinical trials Li Wang a , Vahid Ashoorion a , Fares Hayek a , Kevin Shao a , Cody Tran a , Wenjun Jiang a , Yiwei Chen b , Henry Kwon c , Rachel Couban a and Jason Busse a a McMaster University; b Cornell University; c Wayne State University Introduction/Aim : Medical cannabis is consumed in inhaled forms (i.e., smoked or vaped) by most patients with chronic pain; however, its benefits and harms are uncertain. We aimed to conduct a systematic review and meta-analysis of randomized clinical trials (RCTs) to assess the effectiveness of inhaled forms of medical cannabis for chronic pain. Methods : We searched MEDLINE, EMBASE, AMED, PsycInfo, CENTRAL, CINAHL PubMed, Web of Science, Cannabis-Med, Epistemonikos, and trial registries up to July 2022 to identify RCTs of inhaled medical cannabis for chronic pain. Paired reviewers independently assessed risk of bias and extracted data from eligible studies. We used random-effect models for all meta-analyses and the grading of recommendations assessment, development and evaluation (GRADE) system to assess the certainty of evidence. Results : A total of 12 eligible trials with 395 adult patients living with chronic non-cancer pain compared inhaled medical cannabis, either as smoked cigarettes (7 RCTs) a smoke device (1 RCT) or vaporized (n=5 RCTs), vs. placebo. The median sample size among included trials was 33 patients (interquartile range [IQR] 26-39) and the median length of follow-up was 1.5 days (IQR 5 hours to 5 days). Compared with placebo, inhaled medical cannabis probably improves short-term pain relief between 2.5 hours to 5 days with larger proportion of patients achieving at least 30% pain reduction: risk difference [RD] 20% (95%CI 11% to 30%) based on a relative risk [RR] 1.60 (95%CI 1.30 to 1.95, high certainty), and a weighted mean difference [WMD] of -0.70 cm on a 10 cm visual analogue scale [VAS] (95%CI -1.04 to -0.36 cm, moderate certainty). Inhaled medical cannabis did not improve physical, emotional, role functioning, or sleep quality (moderate certainty), but the follow-up time was likely too short to detect effects on these outcomes. Moderate certainty evidence shows that inhaled medical cannabis probably results in small increased risk of dizziness (RD 10%, 95%CI 3% to 25%), cough (RD 16%, 95%CI 3% to 44%), and euphoria (RD 12%, 95%CI 4% to 23%). Low certainty evidence shows that the short-term inhaled medical cannabis might not increase the risk of cognitive impairment, anxiety, drowsiness, shortness of breath, headache, paranoia, vomiting, nausea, tachycardia, hypotension, weakness, fatigue, bad taste, or dry mouth. Discussion/Conclusions : Moderate to high certainty evidence shows that short-term use of non-inhaled medical cannabis results in a modest improvement in pain relief among patients who live with chronic noncancer pain, along with several transient adverse side effects, compared to placebo. Acupuncture for diabetic peripheral neuropathy: A systematic review and meta-analysis of randomized clinical trials Lei Lan, Li Wang, Rachel Couban, Behnam Sadeghirad and Jason Busse McMaster University Introduction/Aim : Diabetic peripheral neuropathy (DPN) affects up to half of all patients with diabetes mellitus. Acupuncture is a popular treatment for chronic pain, but its’ effectiveness for DPN is uncertain. We completed a systematic review and meta-analysis of randomized clinical trials (RCTs) to assess the effect of acupuncture for DPN. Methods : We searched CENTRAL, CINAHL, EMBASE, MEDLINE, AMED, CNKI, VIP, and Wang Fang from inception to September 2022 for RCTs of acupuncture for DNP. Paired reviewers independently extracted data and assessed risk of bias. We used random-effect models for all meta-analyses and GRADE approach to assess the certainty of evidence. Results : Eighteen RCTs including 1525 participants (32% female) were included. Moderate certainty evidence suggests that, compared with sham acupuncture or usual care, acupuncture is likely to reduce both pain (weighted mean difference [WMD] −1.85 cm [95%CI −2.96 to −0.74 cm] on a 10-cm scale; modeled risk difference for achieving the MID of 1cm, 49% [95% CI 22 to 62]), and severity of neurologic symptoms (WMD -0.79 [-1.46 to -0.12] on the 19-point Toronto clinical scoring system [TCSS]). Low certainty evidence suggested acupuncture may reduce pain compared with amitriptyline (WMD -1.01 cm [-1.26, -0.76 cm]) or pregabalin (WMD -1.96 cm [-2.68, -1.24cm]), and severity of neurologic symptoms compared with mecobalamin (WMD −1.72 [−2.55, -0.89]), lipoic acid and alprostadil (WMD −7.65 [−8.53, -6.78]), but may make no difference with α-LA and BPS (WMD −0.32 [−1.08, 0.44]). Discussion/Conclusions : Acupuncture is likely to improve pain and neurologic symptoms severity associated with DPN compared with sham acupuncture or usual care; however, the evidnece for the comparative effectiveness of acupuncture vs. pharmacothertapy is only low certainty. Prevalence of return to work following acceptance for disability or sick absence benefits: A systematic review and meta-analysis of observational studies Li Wang a , Vahid Ashoorion a , Yaping Chang a , Ke Guo b , Dan Liu c , Sha Diao c , Henry Kwon d , Sara Ghazizadeh e , Zijun Li b , Alireza Malektojari e , Yanfei Li b , Cody Tran a , Sean Kennedy f , Katie Kennedy f , Mina Ma b , Minyan Yang b , Haitong Zhao b , Rachel Couban a and Jason Busse a a McMaster University; b Lanzhou University; c Sichuan University; d Wayne State University; e Hormozgan University of Medical Sciences; f University of Toronto Introduction/Aim : Work-related injuries and illnesses are important public health problems, which account for 4% of annual worldwide GDP (about $1.25 trillion), and costs are disproportionally incurred by claimants with delayed recovery. The prevalence of return to work (RTW) after receiving disability or other benefits is uncertain. We therefore conducted a systematic review and meta-analysis to establish the overall prevalence of return to work after receipt of disability benefits. Methods : We searched MEDLINE, EMBASE, CINAHL, and PsycINFO from inception to March 2022, for observational studies reporting the rate of RTW or claim closure following receipt of disability or sick absence benefits. We used random-effects meta-analysis with Freeman-Tukey Double Arcsine transformation to estimate the overall prevelance of RTW, and logit transformation as a sensitivity analysis Results : We included 181 cohort studies including 2,894,905 patients awarded disability or sick absence benefits. Among them, 42 studies (23%) were conducted in USA, 28 (17%) in Canada, 81 (45%) in Europe, 19 (10%) in Australia and New Zealand, and 11 (6%) in Asia; no studies enrolled participants from South America or Africa. The prevalence of RTW or claim closure ranged from 19%-98%, median 71% (IQR 57-83 %); and the pooled prevalence was 70% (95%CI 67-73%). The sensitivity analysis using logit transformation showed similar results [72% (95%CI 67-75%)]. Meta-regression showed significant association between rate of RTW and length of follow-up (p < 0.001) with 3% increase in RTW for every year of follow-up (95%CI 1 to 4%). The rates of RTW or claim closure were 63% (95%CI 55-70%) within 6 months, 71% (95%CI 64-77%) between 6 months to 1 year, 69% (95%CI 65-73%) between 1 to 2 years, 71% (95%CI 60-81%) between 2 to 3 years, and 80% (95%CI 73-85%) at more than 3 years. No additional subgroup effects were found. Discussion/Conclusions : According to our findings, for every10 patients receiving disability or sick absence benefits, 7 return to work on average. Individuals that have not resumed employment at 6-months after receiving disability benefits are likely to remain disabled at 2 years. Future studies should explore the predictors that were associated with prolonged recovery after receiving disability or sick absence benefits to identify high-risk population and modifiable factors for interventions. The association between initiating chiropractic care and continued prescription opioid use for chronic non-cancer pain: A sequential explanatory mixed-methods study Peter C. Emary a , Amy L. Brown b , Mark Oremus c , Lawrence Mbuagbaw a , Douglas F. Cameron b , Jenna DiDonato d and Jason Busse a a McMaster University; b Private practice; c University of Waterloo; d D’Youville University Introduction/Aim : We explored the association between receipt of chiropractic care and continued opioid use among adult patients with chronic pain attending an Ontario community health centre. Methods : In this sequential explanatory mixed-methods study, we conducted a retrospective analysis of 210 patient records (January 1, 2014 to December 31, 2020) and completed interviews with 14 patients and nine general practitioners. We used generalized estimating equations, adjusted for patient demographics, co-morbidities, visit frequency, and calendar year to evaluate the association between receipt versus non-receipt of chiropractic services and continued opioid use over 12-month follow-up. Results : There were lower rates of opioid fills (IRR=0.66; 95% CI, 0.52-0.83) and refills (IRR=0.27; 95% CI, 0.17-0.42) among patients who initiated chiropractic care (n=49) versus non-recipients (n=161). Although there were no differences in average daily opioid dose between patients who did and did not receive chiropractic care at inception of our cohort study, those patients who subsequently received chiropractic care were less likely to be prescribed higher-dose opioids (> 50 mg MED) compared to non-recipients at 3-months (OR=0.14; 95% CI, 0.04-0.47), 6-months (OR=0.14; 95% CI, 0.05-0.40), 9-months (OR=0.19; 95% CI, 0.07-0.57), and 12-months (OR=0.22; 95% CI, 0.08-0.62). Interviews suggested that patient self-efficacy, limited effectiveness of opioids for chronic pain, stigma regarding opioid use, and access to chiropractic treatment were influencing factors. Discussion/Conclusions : We found a negative association between continued prescription opioid use and receipt of chiropractic care among patients with chronic pain. Intercostobrachial nerve preservation during breast cancer surgery to prevent chronic postoperative pain: A systematic review and meta-analysis of randomized clinical trials Zhaoxia Li a , Fan Wang b , Jason Busse c , Rachel Couban c and Li Wang c a Second Hospital of Gansu Province; b Northwest Minzu University; c McMaster University Introduction/Aim : Damage to the intercostobrachial nerve (ICBN) during breast cancer surgery is associated with chronic postoperative pain, sensory disturbance, and impaired function. We aimed to assess the effects of the ICBN preservation vs. sacrifice in breast cancer surgery patients. Methods : We searched MEDLINE, EMBASE, CENTRAL,China National Knowledge Infrastructure (CNKI) and Wanfang Datadase up to October 2022 for randomized clinical trials (RCTs) that assessed the effects of ICBN preservation vs. sacrifice in breast cancer surgery patients on chronic postoperative pain and sensory disturbance. We used random-effects meta-analysis to pool effects across trials, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate certainty of evidence. Results : Thirty-six RCTs including 3768 breast cancer surgery patients were included. Moderate certainty evidence shows that, compared to ICBN sacrifice, preservation probably reduces the development of chronic postoperative pain at 90 days (relative risk [RR] 0.34, 95% CI 0.22 to 0.53; absolute risk reduction [ARR]14.8%, 95%CI 10.5 % to 17.4%), at 180 days (RR 0.25, 95% CI 0.18 to 0.34; ARR 29.1%, 95%CI 25.6 % to 31.8%) and at 360 days and greater (RR 0.26, 95% CI 0.17 to 0.38; ARR 13.2%, 95%CI 11.0% to 14.8%). The impact of ICBN preservation vs. sacrifice on sensory disturbance will be analyzed and reported at the 2023 Canadian Pain Society conference. Discussion/Conclusions : Preservation of the ICBN during breast cancer surgery is likely to reduce the risk of developing chronic postoperative pain. Effectiveness of usual medical care plus chiropractic care vs. usual medical care alone for low back pain: A systematic review of randomized clinical trials Andrea Darzi a , Behnam Sadeghirad a , Rana Charide a , Samer G. Karam a , Sophia Mangala a , Dale Alameddine b , Sophia Mangala a , Gordon H. Guyatt a and Jason Busse a a McMaster University; b Yale University Introduction/Aim : Low back pain (LBP) is a prevalent complaint for which many patients seek chiropractic care. We conducted a systematic review to explore the effectiveness of chiropractic care, when added to usual medical care, vs. medical care alone. Methods : We searched Medline, AMED, EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, Index to Chiropractic Literature, and Cochrane Library from inception to February 28, 2022. Studies eligible for review included pragmatic randomized controlled trials of chiropractic care plus usual medical care for low back pain compared to usual medical care alone. We used the GRADE approach to assess the certainty of evidence. Results : We included 6 randomised trials which enrolled 2329 patients with variable durations of low back pain. Moderate certainty evidence showed that receiving chiropractic care vs usual medical care alone probably slightly decreases bothersomeness (weighted mean difference [WMD] −0.40cm [95% CI, −0.55 to −0.25] on a 5-point scale). Low certainty evidence suggests that augmenting usual medical care with chiropractic care, compared with usual care alone, may reduce pain (WMD −0.69cm [95% CI, −1.00 to −0.39] on a 10cm NRS scale for pain), improve physical function (WMD −1.01 cm [95% CI, −1.69 to −0.32] on the 24-point Roland Morris disability score for function), reduce of fear avoidance behaviour related to physical activity (WMD −2.5 cm [95% CI, −4.5 to -0.5] on the 0–24-point fear avoidance belief questionnaire physical activity subscale), and reduce medication use (odds ratio 0.76 [95% CI, 0.58 to 1.00]). Low- certainty evidence suggests little to no difference in fear avoidance behaviour related to work activities in those receiving chiropractic care compared to usual care alone (WMD −1.7 cm [95% CI, −4.5 to 1.1] on the 0–42-point fear avoidance belief questionnaire work subscale). No serious adverse events related to treatment were reported for either intervention. Discussion/Conclusions : Compared with usual medical care, augmentation with chiropractic care probably decreases bothersomeness of low back pain, and may improve pain, physical functioning and fear avoidance behaviour related to physical activities and reduce medication use. Adding chiropractic care to usual medical care may make little to no difference in fear avoidance behaviour related to work activities. Although overall results are promising, establishing the role of chiropractic care in the management of low back pain requires large, rigorously conducted trials, that consider duration of pain (acute vs. chronic) as an effect modifier. Medical cannabis versus opioids for chronic noncancer pain: A systematic review and network meta-analysis of randomized clinical trials Haron M. Jeddi, Jason Busse, Behnam Sadeghirad, Mitch Levine, Micheal J. Zoratti, Li Wang, Atefeh Noori, Rachel Couban and Jean-Eric Tarride McMaster University Introduction/Aim : Increased awareness of harms associated with opioids for chronic noncancer pain has generated interest in medical cannabis as a therapeutic alternative. We explored their comparative effectiveness. Methods : We searched EMBASE, MEDLINE, CINAHL, AMED, PsycINFO, PubMed, Web of Science, Cannabis-Med, Epistemonikos and the Cochrane Library (CENTRAL) to March 2021 for trials that randomized adults with chronic noncancer pain to medical cannabis vs. opioids, or to medical cannabis or opioids vs. placebo, and followed patients for ≥4 weeks. We performed Bayesian random-effects network meta-analyses to summarize the evidence and applied the GRADE approach to evaluate the certainty of evidence. Results : Ninety trials involving 22 028 patients were eligible for review, among which the length of follow-up ranged from 28 to 180 days. Moderate certainty evidence showed that opioids provide small improvements in pain, physical functioning, and sleep quality vs. placebo; low to moderate certainty evidence supported similar effects for medical cannabis vs. placebo. Neither were more effective than placebo for role, social or emotional functioning (all high to moderate certainty evidence). Moderate certainty evidence showed there is probably little to no difference between medical cannabis and opioids for physical functioning (weighted mean difference [WMD] 0·47 on the 100-point SF-36 physical component summary score, 95% CrI -1·97 to 2·99), and cannabis results in fewer discontinuations due to adverse events vs. opioids (odds ratio 0·55, 95% CrI 0·36 to 0·83). Low certainty evidence suggested little to no difference between medical cannabis and opioids for pain relief (WMD 0·23cm on a 10cm visual analogue scale [VAS], 95% CrI -0.06 to 0·53) or sleep quality (WMD 0·49mm on a 100mm VAS, 95% CrI -4·72 to 5·59). Discussion/Conclusions : Medical cannabis may be similarly effective and less harmful than opioids for chronic noncancer pain. Medical cannabis for chronic pain: A systematic assessment of equity considerations Omar Dewidar a , Jordi Pardo Pardo b , Vivian Welch a , Glen S. Hazlewood c , Andrea Darzi d , Cheryl Barnabe c , Kevin Pottie a , Jennifer Petkovic a , Shawn Kuria b , Zhiming Sha b , Sarah Allam b , Jason Busse d , Gordon H Guyatt d , Peter Tugwell b a Bruyère Research Institute; b University of Ottawa; c University of Calgary; d McMaster University Introduction/Aim : Background : Chronic pain is the leading cause of disability worldwide. Medical cannabis may be effective for a minority of patients; however, access and impact may be affected by geographical as well as socioeconomic factors. As part of the process of developing a guideline on the use of medical cannabis for chronic pain, the guideline panel sought evidence to incorporate equity considerations into their recommendations using a novel approach. Objective : To systematically identify and evaluate evidence from eligible primary studies to inform equity judgements; for example, regarding generalizability and subgroup effects. Methods : We reviewed all studies identified in four systematic reviews summarizing the evidence for benefits and harms, opioid-sparing effects, long-term effects and values and preferences regarding cannabis for chronic pain. We extracted data on the following dimensions: place of residence, race, occupation, gender, religion, education, socioeconomic status, social capital, age, breastfeeding, and pregnancy. Results : Of the identified 96 studies, 7% were conducted in low-to-middle income countries, 8% were focused on vulnerable populations, approximately half (47%) excluded patients with comorbidities, and 22% excluded pregnant or lactating women. Thirty-six percent of studies analyzed outcomes across at least one dimension of inequity. Differences in effects may exist across at least one dimension of inequities in 19% studies on benefits and harms, 43% studies on values and preferences and 11% studies on long-term effects. Little to no differences in effects across dimensions of inequities were identified for opioid-sparing effects. Discussion/Conclusions : We developed and applied a new approach to systematically identify and assess equity considerations to inform the development of a guideline for cannabis and chronic pain. We anticipate that consideration of these issues will lead to more equitable guideline recommendations. Comparative effectiveness of corticosteroids for prevention of postoperative sore throat in adults undergoing tracheal intubation: A systematic review and network meta-analysis of randomized trials Vahid Ashoorion a , Alireza Malektojari b , Sara Ghazizadeh b , Fatemeh Mehrabi, Bita Mesgarpour, Leila Janani, Sara Moradi a , Patrick Jiho Hong c , Yvgeniy Oparin a , William Yao a , Rachel Couban a , Harsha Shanthanna a and Jason Busse a a McMaster University; b Hormozgan University of Medical Sciences; c University of Toronto Introduction/Aim : Approximately half of patients that undergo endotracheal intubation experience postoperative sore throat (POST) after extubation. We aimed to determine the comparative effectiveness of competing corticosteroids for the prevention of POST, cough and hoarseness after extubation by performing a systematic review and network meta-analysis. Methods : We searched MEDLINE, EMBASE, Web of Science, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials from inception to February 2022 for trials that compared any formulation of corticosteroids to lubricant gel, placebo, saline, or no-treatment to prevent POST. We performed a random-effects network meta-analysis using a frequentist approach at three-time intervals (0-2h, 6-12h and 12.5-24h), and assessed the certainty of evidence using GRADE methodology. Results : We included 44 trials involving 4,177 patients. Moderate certainty evidence showed that budesonide inhaler was among the most effective treatment to prevent POST: absolute risk reduction (ARR) 46% (95%CI: 31%- 48%) at 0-2h; ARR: 47% (95% CI: 42%-47%) at 6-12h and ARR: 40% (95% CI: 36%-40%) at 12.5-24h after extubation. High to moderate certainty evidence showed betamethasone applied on tube also reduced risk of POST, hoarseness and cough. Moderate certainty evidence showed that filling cuff with dexamethasone, IV dexamethasone, beclomethasone inhaler, gargling dexamethasone and applying dexamethasone on tube probably reduce the risk of POST 24h after surgery. Discussion/Conclusions : Budesonide inhaler and betamethasone applied on tube were the most effective treatments to prevent POST after endotracheal intubation. Betamethasone applied on tube was the most effective approach to prevent hoarseness and cough after endotracheal intubation. Factors associated with initiating cannabis use after legalization in Canada: A cross-sectional study Vahid Ashoorion a , Behnam Sadeghirad a , Harman Sandhu b and Jason Busse a a McMaster University; b University of Toronto Introduction/Aim : Cannabis use has increased since the Government of Canada legalized nonmedical use in October 2018. We investigated demographic factors associated with initiating cannabis use following legalization. Methods : We used data from the 2018 and 2019 National Cannabis Survey and constructed multivariable regression models. Respondents’ data were weighted and bootstrapped. We report relative measures of association as adjusted odds ratios (ORs) and absolute measures of association as adjusted risk increases (RIs). Results : Among the 58,195 households surveyed, 28,566 provided complete data (49%) and our weighted analysis represented 27,904,258 Canadians aged ≥ 15 years. Approximately 1 in 5 Canadians endorsed use of cannabis (19.8%), predominantly for non-medical (9.5%) or combined medical and non-medical (5.8%) reasons. Those who initiated cannabis use in the past 3-months (1.9%) were more likely to be younger (25-34 yr vs. ≥65; adjusted OR 1.7, 95%CI 1.1-2.8; adjusted RI 1.1%, 95%CI 0.1%-2.0%) and endorse poor to fair vs. good to excellent physical health (adjusted OR 2.0, 95%CI 1.3-3.1; adjusted RI 1.7%, 95%CI 0.3%-3.1%). The 1% of Canadians who endorsed initiating use of cannabis due to legalization were more likely to reside outside of Quebec (adjusted OR 1.9, 95%CI 1.1-3.2; adjusted RI 0.5%, 95%CI 0.2%-0.9%). Discussion/Conclusions : Canadians initiating cannabis use after nonmedical legalization were likely to be younger and endorse worse physical health, and half of those using cannabis reported therapeutic use. Stricter policies, lower social acceptance, and less availability of cannabis in Quebec appear to have curtailed initiation of use after legalization. Chronic disease group-based treatment: Applications for chronic pain Kelsey Haczkewicz, Natasha Gallant, Zona Iftikhar and Courtney Cameron University of Regina Introduction/Aim : In Canada, 1 in 3 individuals live with at least one major chronic disease.(i.e., cancer, chronic obstructive pulmonary disease, diabetes, ischemic heart disease, or heart failure). A common symptom of chronic disease individuals experience is pain which can, in turn, cause significant psychological distress. The current study was therefore aimed at understanding the types of psychological strategies and supports that are of interest to individuals living with chronic disease and associated symptoms such as pain. Methods : A sample of 208 adults (26.9% male, 72.6% female, 0.2% non-binary) living with chronic disease completed a set of online self-report measures regarding their preferences for a new group focused on providing strategies and support for managing mental health for individuals living with chronic disease. Results : More than 50 chronic diseases were self-reported and many of these participants suggested that pain management should be a focus of the group. Results also showed that 47.5% preferred the group be in a hybrid format, whereas 32.8% preferred the group be in a virtual format. Bi-weekly meetings of an hour or less in length were most preferred. Discussion/Conclusions : Overall, our results provide insights into the format of group-based strategies and support for this population, and these findings also support the inclusion of a pain management module within the group. Opioid prescription and consumption following major joint replacement surgery Rachel Chin a , Sireedhorn Assavanop b , Sarah Tierney c , Sanjho Srikandharajah d , Yasmine Hoydonckx b , Jamal Kara b , Kawalpreet Singh b , Vincent Chan b and Anuj Bhatia b a Queen’s University; b Toronto Western Hospital and University of Toronto; c University of Ottawa; d North York General Hospital Introduction/Aim : This study examines trends in post-discharge opioid use following hip and knee arthroplasty (THA, TKA) to determine appropriateness of opioid prescription and consumption. Methods : Oral morphine equivalents (OMEQ) consumed in the first 48 hours after surgery and discharge opioid pill counts were recorded for 443 patients undergoing elective THA or TKA at an academic and a community hospital. Surveys were conducted 1-2, 6, and 12 weeks after discharge to collect data on consumption patterns and satisfaction. Data on the preoperative and 12-week psychological profiles of patients from TWH was also collected. Results : Median opioid pill count at discharge was 60 [50,80]. Most patients reported that pain relief provided by their opioid prescriptions was “just right” (73.5%, 75.6%, and 78.2% at 1-2 weeks, 6 weeks, and 12 weeks, respectively). However, a significant proportion of patients had 20 or more pills leftover at each follow-up period (53.5%, 36.7%, and 33.9% of the cohort at 1-2 weeks, 6 weeks, and 12 weeks respectively). Significant associations were found between leftover pill count at 6 weeks and female gender, preoperative opioid intake, and surgery type (TKA vs. THA) (p=0.044, p=0.007, p=0.003 respectively); and between pain relief at 6 weeks and opioid consumption in first 48 hours after surgery, (p=0.025). Discussion/Conclusions : While patients are generally satisfied with their opioid prescriptions, one third of them had over 20 pills remaining at the end of the 12-week period. This suggests that patients may be over-prescribed opioids after major joint surgery. Self-compassion moderates the relationship between pain interference and depression in a chronic pain sample Alanna Coady a , Kimberley Kaseweter a , Nina Gregoire a and Susan Holtzman b a University of British Columbia Okanagan; b University of British Columbia Introduction/Aim : Approximately one in four Canadians live with chronic pain. Of those, an estimated 18-85% will experience comorbid depression, resulting in worse health outcomes compared to chronic pain alone. Longitudinal studies demonstrate that greater pain interference (i.e., the inability to fully engage in activities due to pain) predicts an increased risk of developing depression. Promisingly, recent meta-analyses have demonstrated that self-compassion can be a protective factor against depression for those with chronic conditions. Evidence also suggests self-compassion is associated with lower depressive symptoms among people with chronic pain specifically. In order to determine if self-compassion can buffer the harmful sequelae of pain interference, the current study examined whether self-compassion moderated the relationship between pain interference and depressive symptoms. Methods : Participants (N=303) were recruited from a specialized pain treatment clinic in British Columbia and completed a cross-sectional survey online. Results : Moderation analysis revealed that, when controlling for pain severity, pain interference was significantly directly associated with depressive symptoms (b=2.21 SE=0.24, p < .001, 95% CI=1.63, 2.57), as was self-compassion (b=-8.91 SE=0.58, p < .001, 95% CI=-10.05, -7.78). Further, there was a significant interaction between self-compassion and pain interference, F(1, 298)=13.28, p < .001, such that the link between pain interference and depressive symptoms was attenuated among patients who reported higher self-compassion. Discussion/Conclusions : Findings highlight the protective potential of cultivating self-compassion among those with chronic pain, and particularly those who are experiencing high levels of pain interference. Reconsolidation blockade with propranolol as a novel treatment for chronic pain - a double-blind feasibility study Alexia Coulombe-Leveque a , Sylvie Lafrenaye a , Alain Brunet b , Serge Marchand a and Guillaume Léonard a a Université de Sherbrooke; b McGill University, Douglas Hospital Introduction/Aim : Chronic pain is characterized by increased connectivity in the nervous system, similar to that observed in patients with post-traumatic stress disorder (PTSD). The aim of this study was to investigate whether reconsolidation therapy, a new treatment for PTSD that consists in reactivating the hyperactive synapses encoding the threat response (by remembering/describing the trauma) and blocking their reconsolidation using propranolol, is feasible with a chronic pain population. Methods : We conducted a double-blind, placebo-controlled study with 24 adults suffering from chronic lower-back pain (< 3 months) and no contra-indication to propranolol. All participants received pain education (10 short videos) and attended 6 weekly sessions where they received 40-80 mg of propranolol (n=12) or placebo one hour before a short reactivation procedure (description of painful events/movements). Feasibility outcome measures included recruitment rates and side effects frequency/severity; efficacy was measured 4 weeks post-intervention (Brief Pain Inventory). Results : Feasibility: 67 patients were screened over 6 months; 24 participants were enrolled in the study and 22 participants completed the follow-up. Four participants showed an asymptomatic decrease in heart rate during 1 or 2 sessions, and a fifth experienced headache and nausea following her second session. Efficacy: no clinically meaningful difference was observed between the BPI scores of the two groups. Discussion/Conclusions : Reconsolidation therapy is a feasible intervention for chronic pain. Preliminary results suggest no improvement in function of pain; however, we noted prevalent catastrophic/kinesiophobic discourse during the sessions. We hypothesize that correcting these negative pain beliefs might be a prerequisite (unmet in this study) for the success of the intervention. Motivations, perceptions, and effects of cannabis use in individuals with mood and anxiety disorders Ankita Das a , Stefan Kloiber b a Institute of Medical Science, University of Toronto; b University of Toronto Introduction/Aim : Cannabis use is common in individuals with mood and anxiety disorders, the most prevalent mental health conditions in Canada and worldwide. In the era of cannabis legalization, medical cannabis program and a variety of available cannabis products in Canada, there is controversy and uncertainty about the potential risks and benefits of cannabis in such individuals. Objective : To conduct a systematic review of the current scientific literature on perceptions, motivations, knowledge, and effects of cannabis use in individuals with mood and anxiety disorders and then comparing the results from this systematic review with data from a clinical study using a mixed methods approach to assess perceptions and patterns of cannabis in this patient population. Methods: (1) Semi-structured anonymous survey to comprehensively assess and understand patterns of cannabis use, potential risks and areas of potential benefits, subjective knowledge and perceptions around CU in individuals with mood and anxiety disorders including OCD and PTSD. (2) Focus groups and in-depth interviews as a qualitative approach to specifically assess the motivations for cannabis use, expectations of the effects of cannabis on cognition, mood, anxiety, and behavior. (3) Systematic review and synthesis of the current literature of human studies on patterns, perceptions, motivations, attitudes, knowledge, or effects of CU in individuals with mood, anxiety, trauma-related, or obsessive or compulsive disorders/symptoms. Results : Cannabis use appeared to provide symptom relief for mood disorders but seemed to exaggerate depressive symptoms over time. Most frequent users identified cannabis use for mental health conditions, sleep problems and pain management for somatic pain as the most common reasons. In contrast, those with social anxiety expected greater cognitive and behavioural impairment from cannabis use. Some veterans with PTSD reported reasons related to relief of side effects of psychotherapy medication, to facilitate social competency and for direct confrontation of the source of trauma. Medical users reported failing to meet responsibilities because of use and problems with concentration/memory after use. Participants reported differential experiences and effects of products predominantly containing THC or CBD. Cannabis products with high CBD was reported to be particularly helpful for sleep problems and pain including migraines. On the other hand, reported effects of cannabis with high THC content included enhanced creativity, focus, and libido, helpful to overcome inhibitions and be more extroverted. Discussion/Conclusions : Combined results from interviews, survey and systematic review indicate that about half of individuals reported young age ( 60%) of individuals with specific mental health conditions using cannabis report and perceive their CU for medical reasons. Nearly 50% of cannabis users reported CU for medical and at the same time recreational purposes creating a problematic overlap of using a substance for treatment as well as recreationally. Despite > 60% reporting CU for medical reasons, only 20% reported this being recommended and/or prescribed, and only a small number (14.6%) obtained information about CU from a medical practitioner. Also, the majority (> 50%) reported using inhalation as method for CU which is associated with medical problems related to smoke inhalation. An additional risk identified was that the majority (53.1%) of individuals obtained products from non-regulated sources, e.g. dealer. While mental health symptoms were among the most frequent reasons for starting and continuing CU and while participants reported positive effects on some symptoms, concerns and negative effects were clearly reported as well, most frequently worsening of cognition (memory, concentration) energy, motivation, productivity. Although CCU reported experiencing various symptoms and aspects of CUD very few reported motivation for change and reported higher peer approval including concerning aspects such as passing out or driving after CU or frequent/daily CU. Reported motivations and explanations for CU were side effects associated with pharmacological treatment, or CU being perceived as safer than alcohol use though CCU reported higher alcohol consumption compared to PCU and NCU. In addition, while insomnia was frequently reported a reason for CU, participants reported no clear effect on sleep except for improved sleep onset. The systematic review additionally revealed potential risk constellations such as anxiety sensitivity, social anxiety, depression being more frequently associated with CU as well as increased risk for problems related to CU. Data from this research to inform development of engagement, treatment and prevention strategies addressing concerning aspects of CU in this population as well as additional research on potential beneficial effects and constellations. Update, adaptation to the Canadian clinical practice context and validation of a new version of the medication quantification scale: The MQS-4.0 Gwenaelle De Clifford-Faugère a , Hermine Lore Nguena Nguefack a , Marimée Godbout-Parent a , Mamadou Aliou Diallo a , Line Guénette b , Gabrielle Pagé c , Manon Choinière c , Sylvie Beaudoin d , Aline Boulanger e , Anne Marie Pinard f , David Lussier g , Philippe De Grandpré h , Simon Deslauriers i and Anaïs Lacasse j a Université du Québec en Abitibi-Témiscamingue (UQAT); b Centre de recherche du CHU de Québec - Université Laval; Faculté de pharmacie, Université Laval; c Centre de recherche, Centre hospitalier de l’Université de Montréal (CHUM); Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal; d Laboratoire de recherche en épidémiologie de la douleur chronique, Université du Québec en Abitibi-Témiscamingue (UQAT); e Centre d’expertise en gestion de la douleur chronique, Centre hospitalier de l’Université de Montréal (CHUM); Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal; f Centre d’expertise en gestion de la douleur chronique, CHU de Québec-Université Laval; Département d’anesthésiologie et de soins intensifs, Université Laval; Centre intégré de recherche en réadaptation et intégration sociale, Centre intégré de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; g Institut universitaire de gériatrie de Montréal; Département de médecine, Faculté de médecine, Université de Montréal; h Familiprix Chantale Gaboury & Marie-Ève Gélinas; GMF Clinique familiale des Prairies; i VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; j Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT) Introduction/Aim : Quantifying real-world risks associated with pain medications poses several methodological challenges, especially considering that polypharmacy is very common among persons living with chronic pain (CP). To meet these challenges, an index for quantifying the risk associated with analgesics, called the Medication Quantification Scale (MQS), was developed in the US and last updated in 2003. This study aimed to provide an updated version of the MQS based on the current Canadian clinical practice context. Methods : In Step1, an expert committee (clinicians/researchers: n=10) adapted the MQS to the current Canadian clinical practice context (face and content validity). Step 2 was an update of risk weights given to medication subclasses using a prescriber (physicians/pharmacists/nurse practitioners: n=207) and patient (n=141) perception survey (risk weights were derived from median 0-10 scores given to each medication subclass). Step 3 assessed the construct validity of the MQS-4.0 after applying risk weights to the medication use profile of 9,122 ≥12-year-old persons living with CP covered by the Quebec public prescription drug insurance. Results : The expert committee identified 36 medication subclasses for which people living with CP and prescribers have expressed their perception of risk. When applied to prescription claims, the MQS-4.0 score was positively correlated (p < .05) with the original MQS score and variables known to be associated with polypharmacy (e.g., Charlson Comorbidity Index, number of prescribers, healthcare visits). Discussion/Conclusions : This study provides clinicians and the scientific community with an updated index for the quantification of the risk associated with polypharmacy in persons living with CP. Pharmacological treatment of fibromyalgia in Québec and comparison with clinical guidelines Gwenaelle De Clifford-Faugère a , Hermine Lore Nguena Nguefack a , Marimée Godbout-Parent a , Mamadou Aliou Diallo a , Line Guénette b , Gabrielle Pagé c , Manon Choinière c , Sylvie Beaudoin d , Aline Boulanger e , Anne Marie Pinard f , David Lussier g , Philippe De Grandpré h , Simon Deslauriers i and Anaïs Lacasse j a Université du Québec en Abitibi-Témiscamingue (UQAT); b Centre de recherche du CHU de Québec - Université Laval; Faculté de pharmacie, Université Laval; c Centre de recherche, Centre hospitalier de l’Université de Montréal (CHUM); Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal; d Laboratoire de recherche en épidémiologie de la douleur chronique, Université du Québec en Abitibi-Témiscamingue (UQAT); e Centre d’expertise en gestion de la douleur chronique, Centre hospitalier de l’Université de Montréal (CHUM), Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal; f Centre d’expertise en gestion de la douleur chronique, CHU de Québec-Université Laval, Département d’anesthésiologie et de soins intensifs, Université Laval; Centre intégré de recherche en réadaptation et intégration sociale, Centre intégré de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; g Institut universitaire de gériatrie de Montréal; Département de médecine, Faculté de médecine, Université de Montréal; h Familiprix Chantale Gaboury & Marie-Ève Gélinas; GMF Clinique familiale des Prairies; i VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; j Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT) Introduction/Aim : Fibromyalgia is defined as chronic widespread pain. Lack of evidence on certain medications such as opioids and benzodiazepines limit their use, whereas antidepressants and anticonvulsants are effective and safe according to evidence. This study aimed to describe real-world pharmacological treatments used by persons living with fibromyalgia and compare them to treatment guidelines. Methods : Directive interviews were conducted by telephone with 63 individuals self-reporting a diagnosis of fibromyalgia (Quebec, Canada). The questionnaire addressed specific questions about their pain and pharmacological treatments currently used for pain management (prescribed and over-the-counter). Descriptive analyses were performed. Quebec and Canadian fibromyalgia treatment guidelines were used as well as published evidence reports of Health technology assessment organizations. Results : 56% of participants reported another diagnosis in addition to fibromyalgia. Despite a lack of scientific evidence supporting opioid use or benzodiazepines, they were respectively used by 33.3% and 27.0% of our sample. Non-steroidal anti-inflammatory drugs were used by 54.0% of participants, although this medication is not recommended due to its lack of efficacy. Muscle relaxants and tramadol, which are recommended, were used respectively by 25.4% and 23.8% of participants. Among the medications strongly recommended for their efficacy and safety, anticonvulsants were used by 36.5%, serotonin-norepinephrine reuptake inhibitor antidepressants by 55.6%, and tricyclic antidepressants by 22.2%. Cannabinoids (17.5%) and medical cannabis use (34.9%) was also reported. Discussion/Conclusions : Results reveal obvious discordance between evidence-based recommendations and real-word medication use, which highlights the complexity of the pharmacological treatment of fibromyalgia and the need for further real-world evidence. Getting in the flow: Investigating the relationship between intrinsically pleasant tasks and pain reduction Zoha Deldar a , Jerome Genzling b , Roman Sarrazin-Gendron b , Sophie Desjardins c , Mathieu Roy b , Najmeh Khalili-Mahani d , Lea Fhima b , Zoe Arvanitis b and Stephany Dumas b a McGill University; b McGill University; c McGill University; d Concordia University Introduction/Aim : This study aimed to investigate how flow experience affects pain modulation. While pain is a natural response that captures our attention to protect us from harm, it can be reduced by distraction techniques, which redirect our focus away from the source of pain. As pain and cognitive tasks compete for shared resources, it is essential to understand how to modulate attention to painful stimuli. Demanding cognitive tasks have been shown to reduce pain; however, they are often perceived as unpleasant and sub-optimal due to the aversive effort required. Tasks that are intrinsically pleasant, tied to passion, and create a flow experience (i.e., a state of complete absorption in the task linked to passion and intrinsic rewards) are more likely to produce analgesia. When experiencing flow, the task occupies shared mental resources, leading to increased performance and pain reduction. Methods : The study recruited 66 healthy young volunteers, divided into novice and advanced chess player groups, who completed 5 blocks of easy, flow, and difficult chess puzzles, a 2-back task, and a pain-alone task while receiving thermal pain stimulations. They reported pain intensity and unpleasantness and completed game experience and flow questionnaires after each block. Results : Preliminary analyses showed that solving chess puzzles significantly reduced pain intensity and unpleasantness compared to the 2-back and pain-alone tasks between groups. Additionally, flow experience was significantly different between blocks. Discussion/Conclusions : Flow experience can be crucial in cognitive pain reduction, and future research should consider this effect when examining the efficacy of distraction on pain inhibition. Improving access by using a collaborative stepped triaging approach: a pilot project Eliane Domingue a , Rima Noormohamed b , Evan Ward c , Corinne Bryant d and Magali Robert e a Alberta Health Services; b Alberta Health Services, College of Registered Nurses of Alberta; c Mosaic Primary Care Network; d Calgary Foothills Primary Care Network; e University of Calgary Introduction/Aim : The Canadian Pain Task Force has identified one of its goals as improving timely access to patient-centered care.1 At the Calgary Chronic Pain Centre (CPC), a tertiary pain centre, approximately 1500 referrals are on the wait list resulting in a 14 month wait. Four of seven Primary Care Networks (PCN) in the Calgary area offer a pain program with less than a one month wait. The objective of this study was to improve patient access to pain programs by implementing a stepped care approach. 1. Canadian Pain Task Force Report: March 2021- Canada.ca Methods : Through a collaborative process between the four PCNs and CPC, referrals were redirected from CPC to PCN pain programs for individuals who had not attended the PCN pain program and met the eligibility criteria. This information was relayed to the patient and the referring physician. Results : Collaborative networking was done over six months. Between Jan 2022 to July 2022, 217 referrals from CPC were reviewed to identify eligible patients in the geographic location of the participating PCNs. This allowed 74/217 s (34%) to be redirected. This resulted in those individuals entering a program within a month rather than 14. If 34% of referrals could be redirected then this would result in the CPC wait time decreasing from 14 months to 9.25 months. Discussion/Conclusions : The initial objective of using a stepped care triage approach to improve access to care was successful. This study identified the need for further collaboration with Primary Care Networks to optimize the triage process including defining eligibility criteria to ensure timely access. Outcomes associated with brain stimulation combined with intensive rehabilitation for youth with chronic pain Spencer Epp a , Adam Kirton b , Nivez Rasic a , Catherine Lebel a , Frank MacMaster a , Melanie Noel a , Laura Rayner b , Joanne Vallely b and Jillian Vinall Miller a a University of Calgary; b Alberta Children’s Hospital Introduction/Aim : Intensive Interdisciplinary Pain Treatment (IIPT) programs provide day-treatment therapy to help youth with chronic pain (pain for > 3 months) and functional disability. IIPT is associated with decreases in pain interference, related to decreases in middle frontal gyral (MFG) activity. Repetitive transcranial magnetic stimulation (rTMS) of the MFG has been shown to be a safe and effective treatment for adults with chronic pain. rTMS was added to our IIPT intervention for youth. Methods : Currently, 11 youth (of a proposed 25) have completed IIPT with rTMS. rTMS is applied to the MFG at 10Hz for 40 pulses over 4s with an inter-train interval of 26s. Sessions last 37.5min every weekday for three weeks, alongside IIPT. At baseline and discharge from IIPT participants report on their pain interference. On days 1, 6 and 13, participants report on their symptoms following rTMS. Paired T-testing is used to evaluate changes in pain interference. Descriptive statistics were used to examine reports of adverse symptoms following rTMS. Results : Preliminary analysis revealed a decrease in pain interference from baseline (mean: 64.8) to discharge (58.3, p < 0.05). The most frequently reported adverse event was neck pain (n=7), however, fewer youth report neck pain by week three (n=5), and all but one youth reported experiencing less intense neck pain by week three. Discussion/Conclusions : To date, the addition of rTMS to IIPT has maintained previously reported decreases in pain interference post-IIPT. Despite the majority reporting neck pain in the first week, all youth completed the combined three-week rTMS and IIPT intervention. Case report: The feasibility of rTMS in a patient with intrathecal baclofen pump for the treatment of unresolved neuropathic pain following spinal cord injury Stevie Foglia a , Ravjot Rehsi a , Claudia Turco b , Harsha Shanthanna a and Aimee Nelson a a McMaster University; b University of Alberta Introduction/Aim : The purpose of this study was to assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) to treat neuropathic pain (NP) refractory to pharmacological intervention in a patient with complete spinal cord lesion with ongoing treatment with intrathecal baclofen pump. We also aimed to investigate the feasibility of rTMS with an intrathecal baclofen pump. Methods : This study involved 6-weeks of rTMS performed 5-days per week (treatment), a 6-week follow up period with no stimulation, and an 8-week top-up session period. 10 Hz rTMS was delivered to the left primary motor cortex for 2004 pulses. Pain was classified as pressure pain in left foot, burning pain in buttocks, burning pain in sternum, and electrical attacks in the trunk. Assessments included the numerical rating scale (NRS), neuropathic pain scale (NPS), Hamilton Depression and Anxiety rating scales. Results : A 30, 13, and 29% reduction in sternum, buttocks, and left foot pain respectively was observed following the treatment period. This was associated with a 38% decrease in NPS score, and a 65 and 25% reduction in anxiety and depressions scores respectively. Following the third week of treatment, the number of electrical attacks was zero. The change in pain persisted for 1 week following treatment. Top-up sessions did not reduce pain to the level achieved during the treatment period. rTMS stimulation did not cause any interference with the functioning of the intrathecal baclofen pump. Discussion/Conclusions : rTMS may therefore be beneficial for patients with NP who are refractory to pharmacological intervention with a greater effect on certain pain phenotypes. Community linkages for equity-oriented chronic pain care Nicole George and Sara Ahmed McGill University Introduction/Aim : Chronic pain impacts nearly 1 in 5 Canadian adults, with demonstrated inequities in the prevalence, severity, and barriers to care. Linkages between health systems and community resources can add to the continuum of care by addressing unmet needs, such as the social determinants of health. The aim of this research is to co-design tailored community linkages within a chronic pain self-management program at a multidisciplinary rehabilitation center. Methods : Through integrated knowledge translation, stakeholders (individuals living with pain, clinicians, researchers, and program decision-makers, n=8) engaged in a series of 2-hour online meetings. Audio recordings were transcribed, analyzed iteratively, and mapped to the PRECEDE-PROCEED model. Areas of integration were further operationalized by mapping to the biopsychosocial model of pain and social determinants of health. Results : The defined goal of the community-linked program is for individuals living with pain to stay active physically, mentally, and socially. Factors influencing this goal were categorized as predisposing (e.g., knowledge of resources, level of pain), reinforcing (e.g., the influence of peers, caregivers, health professionals), and enabling (e.g., accessible delivery, cost, language, age). Identified community areas included resources for breaking isolation and engaging in meaningful activities (e.g., cultural events). Final prioritized areas and mapping will be presented. Discussion/Conclusions : Health systems require strategies to better connect individuals with chronic pain to resources in the community to help them stay active physically, mentally, and socially. Leveraging the strengths of the community through tailored linkages can support equity-oriented care that reflects the multidimensional experience of living with chronic pain. Combination Analgesic Development for Enhanced Clinical Efficacy (the CADENCE trial): A double-blind, randomized, controlled crossover trial of an alpha-lipoic acid - pregabalin combination for the treatment of fibromyalgia pain Ian Gilron, Sylvia Robb, Dongsheng Tu, Ronald Holden, Roumen Milev and Tanveer Towheed Queen’s University Introduction/Aim : Drug therapy for fibromyalgia is limited by incomplete efficacy and dose-limiting adverse effects (AEs). Combining agents with complementary analgesic mechanisms – and differing AE profiles – could provide added benefit. Methods : We assessed an alpha-lipoic acid (ALA)-pregabalin combination with a randomized, double-blind, 3-period crossover design. Participants received maximally tolerated doses of ALA, pregabalin, and ALA-pregabalin combination—for 6 weeks. Primary outcome was daily pain (0-10); secondary outcomes included Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events, and other measures. Results : The primary outcome of daily pain (0-10) during ALA (4.9), pregabalin (4.6), and combination (4.5) was not significantly different (p=0.54). There were no significant differences between combination and each monotherapy for any secondary outcomes although combination and pregabalin were both superior to ALA for measures of mood and sleep. ALA and pregabalin maximal tolerated doses were similar during combination and monotherapy and AEs were not more frequent with combination therapy. Discussion/Conclusions : These results do not support any additive benefit of combining ALA with pregabalin for fibromyalgia. The observation of similarly reached maximal tolerated drug doses of these two agents (which have differing side effect profiles) during combination and monotherapy – without increased side effects – provides support for future development of potentially more beneficial combinations with complementary mechanisms and non-overlapping side effects. Cold and vibration for children undergoing needle-related procedures: A non-inferiority randomized clinical trial Arianne Ballard a , Christelle Khadra a , Samara Adler a , Emilie Parent b , Olivier Fortin a , Estelle Guingo c , Evelyne D. Trottier d , Benoit Bailey d , Naveen Poonai e and Sylvie Le May a a Université de Montréal; b Université de Sherbrooke; c Université du Québec en Abitibi-Témiscamingue; d Centre Hospitalier Universitaire de Ste Justine; e Schulich School of Medicine and Dentistry, Western University Introduction/Aim : The aim of this study was to determine if a cold vibrating device was non-inferior to a topical anesthetic cream for pain management in children undergoing needle-related procedures in the Emergency Department (ED). Methods : In this randomized controlled non-inferiority trial, we enrolled children aged between 4-17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to either the cold vibrating device or topical anesthetic groups. The primary outcome was the mean difference in procedural pain intensity on the 0-10 Color Analogue Scale (CAS), using a non-inferiority margin of 0.70. Results : A total of 352 participants were randomized (cold vibration device n=176, topical anesthetic cream n=176). Mean (SD) age of children recruited was 9.8 (3.9) years. Procedural pain scores’ mean difference between groups was 0.56 (95% CI: -0.08–1.20) on the CAS, showing that the cold vibrating device was not non-inferior to topical anesthetic. Discussion/Conclusions : The non-inferiority of the cold vibrating device over a topical anesthetic cream was not demonstrated for pain management in children during a needle-related procedure in the ED. Despite this, and because topical anesthetic creams require an application time, had a cost per unit and are underused in the ED setting, the cold vibrating device remains a promising alternative as it is a rapid, easy-to-use and reusable device. AVATAR - Effects of a customized avatar development within an immersive multi-platform virtual environment on pain and anxiety of hospitalized children in hemato-oncology Estelle Guingo a , David Paquin a , Casey Côtes-Turpin a , Christine Genest b , Léandra Desjardins c , Pascal Bernier c , Michel Duval d , Cathy Vézina e , Marie-France Langlet d , Félix Côtes-Charlebois a and Sylvie Le May b a Université du Québec en Abitibi-Témiscamingue; b Université de Montréal; c Centre Hospitalier Universitaire de Sainte-Justine; d Centre Hospitalier Universitaire de Ste Justine; e Université du Québec en Abitibi-Témicamingue Introduction/Aim : Our objective was to study the feasibility, acceptability and effects of an immersive multi-platform distraction (virtual reality and mobile) based on a customized avatar, on pain and anxiety of hospitalized children in hemato-oncology. Methods : This qualitative research-action design study aimed to recruit five children (6-17Y.), currently hospitalized in hemato-oncology in pediatric hospital. Feasibility and acceptability were measured by surveys. Data was collected during semi-structured interviews with both child and one of his parents. Analyses has been done through thematic content analysisusing NVivo. Qualitative data on parents’ perceptions of the intervention was collected through a logbook. Clinicians’ perception was also collected using open-questions surveys. Our study followed a co-design approach in art-based research where children are involved in the game conception by drawing their virtual friend (avatar). Results : Recruitment process is undergoing. We already recruited and collected data on three child-parents dyads. Preliminary results show the following themes: “Anxiety effect,” “mood effect” and “improvement possibilities.” So far, surveys have shown that children and their parents are satisfied with the intervention and consider that the intervention has a positive effect on both the anxiety and pain of children. Discussion/Conclusions : Preliminary results show potential for the use of customized avatar for anxiety and pain management of this group of children. Moreover, our results underline the effects of virtual reality and avatar on children’s mood, by providing distraction for medical procedures and hospital environment. An evaluation of pain BC’s peer-delivered online support groups: Participant satisfaction and valued outcomes Sage Wiebe a , Melanie McDonald b , Carmelle Jaeggle b and Susan Holtzman a a The University of British Columbia; b Pain BC Introduction/Aim : Social support is a critical determinant of mental and physical health among people living with chronic pain (PLCP). Yet, PLCP frequently report high levels of social isolation and a perceived lack of understanding from social networks. Pain BC is a non-profit organization offering a wide range of psychosocial supports for PLCP, including online, peer-delivered support groups. The objective of this study was to evaluate participant satisfaction with Pain BC’s support groups, and to identify which aspects were perceived as most valuable. Methods : Pain BC’s peer-delivered support groups are held twice-monthly in nine geographic regions across BC. Between April and November 2021, anonymous online surveys were sent out after each group session to obtain participant feedback. Results : 743 responses were obtained. Satisfaction was high, with 97% of responses describing the group session as “excellent,” or “very good.” Responses indicated agreement that participants felt respected (99%), welcome (99%), and that the content was useful and easy to understand (96%). Results were similar between geographic-specific groups (e.g., Vancouver, Kootenays) and the group with participants from across BC. A content analysis of 237 responses to an open-ended question about the most valuable take-away from each session will be presented. Discussion/Conclusions : PLCP face systemic barriers to healthcare and often lack support in their daily lives. Findings highlight the perceived value of peer-delivered, online support groups and key factors that may drive satisfaction. In an era of greater openness to, and necessity of, virtual care, findings also support the potential for expanding peer-delivered online groups across provincial borders. Healthcare utilization of youth with chronic pain before and 12 months after participating in an intensive interdisciplinary pain treatment Karen Hurtubise a , Melanie Noel b , Astrid Brousselle c , Nivez Rasic d and Chantal Camden e a McMaster Universty; b Univeristy of Calgary; c Univeristy of Victoria; d University of Calgary; e Université de Sherbrooke Introduction/Aim : Repeated use of healthcare resources renders chronic pain among the highest-costing health conditions in childhood. Identifying treatments that reduce the use of these resources is imperative. This study aimed to analyze the changes in healthcare utilization in a sample of youth with chronic pain, who participated in intensive interdisciplinary pain treatment (IIPT). Methods : Healthcare utilization from a healthcare system perspective was evaluated. From a database of IIPT participants, 30 youth were randomly selected. Anonymized healthcare utilization data (for the year pre- and 12 months post-treatment) were extracted from the provincial health organization data systems for 28 of these youth for which data was available. Changes in healthcare utilization were calculated using Wilcoxon signed-ranked tests, using a significance of 0.05. Results : Of the 28 participants, a decrease in specialist visits was noted in 10 IIPT participants (63%), and significant changes were noted in appointments with allied health professionals for many participants 12 months post-IIPT. Occupational therapy appointments decreased for 9 participants (56%), physiotherapy sessions diminished for 17 participants (74%), and psychology visits were reduced for 12 participants (55%). No statistical changes were observed in hospitalization or emergency visits. Discussion/Conclusions : Unlike previously published findings, our analysis highlighted a significant reduction in healthcare utilization for many youth with chronic pain 12 months following participation in an IIPT. Future research is required with a larger sample and a control group comparator accessing another treatment, exploring associated costs and cost-savings to establish the cost-effectiveness of these programs in Canada. Have we had it backwards: Does analgesic response in spinal cord stimulation drive pain catastrophizing? Neha Kanojia, Anuj Bhatia, Victoria Bains, Jamal Kara and Kawalpreet Singh Toronto Western Hospital Introduction/Aim : Spinal cord stimulation (SCS) can treat chronic neuropathic pain. Numerical Rating Scale (NRS) scores assess analgesic response. Patient Global Impression of Change (PGIC) scale gives composite report of the experience. The psychological evaluation by Pain Catastrophizing Scale (PCS) and improvements in PCS scores correlate with analgesic benefit. The objective of this study was to explore the changes in PCS scores in response to the changes in pain intensity and PGIC during trials and following implants of SCS. Methods : 135 patients with neuropathic pain conditions were enrolled. The patients underwent a SCS trial and a ≥ 50% reduction in pain NRS was considered as the criterion for success. NRS, PGIC, and PCS scores were collected at the end of the SCS trial. In SCS implant patients, reduction of pain NRS by ≥ 30% at 1 year after the implant was considered as a responder. The responders and non-responders were also classified on the basis of PGIC. PCS scores were compared between responders and non-responders after SCS trial and a year after SCS implant. Results : In SCS trial and implant group, NRS scores were significantly low in responders as compared to non-responders. There was no significant difference between the change in PCS scores in SCS trial group. Similarly, the PCS scores were significantly lower in the SCS implant responders as compared to the non-responders when PGIC was used to categorize patients. Discussion/Conclusions : Patients with successful SCS implants reported a decrease in pain catastrophizing as compared to those experiencing successful SCS trials. Trajectories of psychological distress among individuals with chronic pain during the COVID-19 pandemic Kimberley Kaseweter a , Nina Gregoire a , Mark Nazemi b , John-Paul Etheridge c , W. Francois Louw c , Vishal Varshney c and Susan Holtzman a a University of British Columbia Okanagan; b Thrive Health; c University of British Columbia Introduction/Aim : Chronic pain (CP) care is complicated by its multidimensional nature, which manifests with complex physical and psychological comorbidities. Although there is a well-established link between psychological stress and pain-related functioning, little is known about the trajectory of psychological functioning among people with CP over the course of the COVID-19 pandemic. Methods : Our study aimed to determine whether the degree of psychological comorbidities changed in conjunction with the trajectory of the pandemic in a large sample of people with CP. Intake questionnaires from 4772 patients at CP specialty clinics in British Columbia (completed between March 2020 and June 2022) were examined. Bivariate analyses and line graphs were used to examine and visualize the relationships between pain catastrophizing (PCS), anxiety (GAD-7), and depression (PHQ-9) with date of intake completion. Results : Results revealed small negative correlations between the helplessness (r=-.09, p < .01) and rumination (r=-.08, p < .01) subscales of the PCS and questionnaire date. However, line graphs revealed a peak in catastrophizing scores in August 2020. Meanwhile, GAD-7 and PHQ-9 scores remained fairly stable, with average levels in the minimal-to-mild and mild-to-moderate range, respectively. Discussion/Conclusions : The small spike in catastrophizing in August 2020 maps onto the onset of Canada’s second COVID-19 wave, and is in line with recent data from the United States that similarly found increased pain catastrophizing during a peak in COVID cases in July 2020. Mild to moderate depressive symptoms across the duration of the pandemic also highlight the ever-present need for addressing psychiatric symptoms in pain care. Real-world pain relief trajectories among persons using cannabis as a treatment for chronic pain Anaïs Lacasse a , Hermine Lore Nguena Nguefack a , Reza Sharif b , Mélanie Bérubé c , Claudie Audet a and Nancy Julien a a Université du Québec en Abitibi-Témiscamingue (UQAT); b McGill University; c Université Laval Introduction/Aim : Evidence regarding cannabis as a treatment for chronic pain (CP) is needed. This study aimed to describe pain relief trajectories among persons living with CP using cannabis. Methods : Strainprint® data was used (a mobile app that tracks symptoms for which medical cannabis is used). All ≥18-year-old users reporting pain at first use of the app and who used the app for ≥3 months to track their pain symptoms were selected (n=2,360; age:18-76yr; women:61%). When a person uses cannabis, he/she enters pre- and post-use pain severity measures in the app (0-10 scale). As users can consume cannabis for multiple symptoms at once, they can have multiple entries per session and multiple sessions per day. Pain relief was operationalized in an aggregated measure using weeks as the time unit: % of pain-related entries for which a user achieved a clinically important decrease in pain severity (≥2-point). Group-based trajectory modelling was applied to these weekly repeated measures over a 3-month period to identify subgroups of users with similar patterns over time (pain relief trajectories). Results : Three trajectories were found: (1) Users reporting clinically important pain relief almost all of the time (95-98% of the time) (n=1,120); (2) Pain relief most of the time (≥71% of the time) with a slight 3-month increase in effectiveness (n=847); (3) Pain relief occasionally (29-41% of the time) with a decrease in effectiveness over time (n=393). Discussion/Conclusions : Individual-centered statistical approaches are an interesting angle of analysis to understand who is most likely to respond to cannabis. Certified child life specialist in a pediatric emergency department: Impact of a quality improvement project to improve procedural pain and distress management for needle procedure Céline Thémelin, Jocelyn Gravel, Kaitlen Gattuso, Marie-Joëlle Doré-Bergeron, Patricia Laforce, Julie Paquette, Nathalie Gaucher, Charlotte Grandjean-Blanchet, Marie-France Langlet, Sarah Loemba, Valérie Leclair, Annie Lacroix, Corinne Thériault and Evelyne D. Trottier CHU Sainte-Justine Introduction/Aim : Background : Combining coping strategies can help reduce children’s pain and distress during needle procedures in the emergency department (ED). Objective : To evaluate the use of strategies to reduce procedural pain/distress for children in the pediatric ED, with the implementation of an institutional quality improvement (QI) initiative working with a Certified Child Life Specialist (CCLS). Methods : The QI initiative Tout doux aims to alleviate procedural pain/distress. To evaluate the impact of this project on the use of coping strategies during needle procedures in the ED, CCLS interventions were recorded over a one-year period. The number of strategies used during needle procedures was reported to track progress monthly throughout the integration of the QI initiative Tout doux. Results : Between Sept 2021-Aug 2022, the CCLS was present for 397 needle procedures (Mean age: 6yo [0months-17yo]). Procedures included 56% IV-line insertions, 30% venous blood draws and 14% capillary blood tests. Parents were present at 99% of procedures. Preparation strategies were used in 65%, distraction in 98% and deep breathing in 46%. Topical anesthetic was offered for 37% of procedures. The proportion of children receiving at least 3 strategies alleviating procedural pain/distress increased to more than 90% during the last 7 months (except one very busy month) in comparison to 22%-66% for the first 5 months with the implementation of the QI initiative Tout doux. Discussion/Conclusions : The QI initiative Tout doux increased the use of combined coping strategies with the help of a CCLS. Further studies will need to evaluate impact on patients and the sustainability of their use. Key to success to improve best practices: A nurse champion to increase institutional use of procedural pain and distress management strategies Patricia Laforce, Julie Paquette, Marie-Joëlle Doré-Bergeron, Kaitlen Gattuso, Sarah Loemba, Annie Lacroix, Bénédicte Grou and Evelyne D. Trottier CHU Sainte-Justine Introduction/Aim : Since studies have shown that nurse champions are facilitators in implementing best practices, a procedural pain nurse champion (PPNC) became a key part of the Tout doux Quality Improvement (QI) institutional initiative to improve procedural pain/distress management. Aim : To assist the healthcare providers (HCP) in the reduction of children’s procedural pain/distress by increasing the use of coping strategies with the help of a PPNC. Methods : The PPNC coordinates and adapts local deployments with the nursing/medical heads of each sector, including the creation of a local multidisciplinary Tout doux committee. Audits are conducted to assess the baseline use of coping strategies, including prevention, psychological, physical and pharmacological strategies (4Ps). HCP receive mandatory training to enhance their knowledge on the 4Ps. The PPNC offers field support through procedural coaching to translate knowledge into practice. Post-deployment audits are then completed to evaluate the use of the combined strategies. Results : Between June 2021-October 2022, Tout doux has been deployed in 13 sectors. More than 400 audits were conducted pre-deployment. More than 150 post-deployment audits have been completed in 6 sectors. Results show improvement in the use of two or more strategies from 160/234 (68%) procedures pre-deployment to 132/150 (89%) procedures post. Discussion/Conclusions : Deploying the Tout doux project on procedural pain and distress management improved the combined use of coping strategies with the support of a dedicated PPNC. The next step will be to ensure its dissemination throughout the institution and further assess the long-term outcome on patients. Educational strategies to improve procedural pain and distress management in a tertiary pediatric hospital Julie Paquette, Patricia Laforce, Marie-Joëlle Doré-Bergeron, Annie Lacroix, Kaitlen Gattuso, Yann Poirier, Marie-France Langlet, Sarah Loemba and Evelyne D. Trottier CHU Sainte-Justine Introduction/Aim : In order to improve the use of procedural pain/distress coping strategies and create long-lasting changes in practice, educational strategies for healthcare providers (HCP) need to be diverse, dynamic and interdisciplinary. Aim : To increase and diversify the educational opportunities for HCP, in order to enhance training and the use of procedural pain/distress management strategies in a pediatric hospital. Methods : The QI initiative Tout Doux aims to improve procedural pain/distress management in a tertiary pediatric hospital. With Tout Doux, various educational strategies were developed by HCP and patient-family advisors, including a mandatory training on best practices for pain/distress management. Currently employed HCP were offered the choice between an e-learning or a formal presentation. Educational strategies also included short videos, one-pagers and simulations. Data on the number of HCP trained by sector were collected and, when given the choice, their preferred method of training. Results : Between June 2021-July 2022, a total of 1539 HCP were trained on coping strategies for procedural pain/distress management with the integration of Tout doux. Each newly hired HCP (702/1539, 46%) were trained on best practices as part of their training. Currently employed HCP, who were given the choice, preferred the e-learning module on coping strategies (643/837, 77%). In addition, 238 HCP completed an additional e-learning training on psychological strategies. Discussion/Conclusions : Through diverse educational strategies, a QI project aiming to improve procedural pain/distress management in a pediatric institution trained more than 1500 HCP. When given the choice, more than 75% of current HCP preferred the e-learning training compared to the formal lecture. Evidence of effective knowledge mobilization and transmission among Canadian Francophone healthcare network on procedural and acute pain management in children Sarah Loemba, Marie-Joëlle Doré-Bergeron, Patricia Laforce, Julie Paquette, Kaitlen Gattuso, Annie Lacroix, Evelyne D. Trottier and Emilie Trempe CHU Sainte-Justine Introduction/Aim : Effective knowledge mobilization and transmission (KMT) is crucial within an institution and its network to facilitate meaningful clinical practice changes for procedural pain management. Aim : To illustrate how the availability of KMT of evidence-based strategies on pediatric procedural pain/distress prevention/management has facilitated meaningful collaborations and dialogue throughout a national network of Francophone health institutions. Methods : Since 2021, CHU Sainte-Justine has partnered with the organization Solutions for Kids in Pain(SKIP) and deployed a hospital-wide quality improvement project (QI) called Tout doux, aimed to improve procedural pain/distress management for patients/families locally. Since then, interest emerged from the francophone health institution network and Tout doux provided support and shared locally-developed French resources to health care providers (HCP) requiring specific or general knowledge on procedural pain management in children. Addressing these needs, Tout doux conducted virtual or on-site presentation for this network on evidence-based strategies to improve pain management. Results : Between 2021/06-2022/12, 80 HCP throughout 46 healthcare organizations have contacted Tout doux to receive support on best practices in procedural pain prevention/management. 205 HCP throughout 13 hospitals have attended virtual or on-site training on the subject. Through a recently developed post-evaluation survey, 16/16 (100%) HCP said they have learned concepts/messages that has encouraged practice changes and 16/16 (100%) HCP are very/extremely satisfied with the adequacy of the resources and tools provided for their practice. Discussion/Conclusions : With the growing interest of the network, the KMT between Tout doux and its network permitted transmission of evidence-based knowledge to improve procedural pain management practices for children and their families. Who responds to treatment? Factors associated with pain catastrophizing outcomes in pediatric intensive interdisciplinary pain treatment Rob D. Long a , Andrew Walker a , Jillian Vinall Miller a , Si Chen Pan a , Laura Rayner b , Melanie Noel a , Joanne Vallely b and Nivez Rasic a a University of Calgary; b Alberta Children’s Hospital Introduction/Aim : Intensive Interdisciplinary Pain Treatment (IIPT) is the gold standard for youth with chronic pain and functional impairment. Though studies have examined the relationship between baseline patient factors and post-treatment pain intensity, emerging research shows that pain catastrophizing outcomes may be more important to improving functional disability and wellbeing. This study explores patient factors associated with clinically significant post-treatment pain catastrophizing. Methods : Pain catastrophizing (PCS) scores were acquired in 45 IIPT patients aged 12 to 18 years at intake (baseline), discharge, and 3-month follow-up. Patients were dichotomized at discharge/follow-up based on being above or below clinically defined thresholds of high pain catastrophizing (≥26). Univariate logistic regression was used to assess unadjusted associations between patients who remained above these thresholds and baseline age, PROMIS® depression and anxiety, PedsQLTM quality of life social subscale, PCS, and parent pain catastrophizing. Results : Higher baseline PCS, depression, and anxiety scores were associated with significantly increased odds of high post-treatment PCS scores. Age, social functioning, and parent catastrophizing were not significantly associated with high post-treatment scores. Discussion/Conclusions : Differences in PCS outcomes may be explained by its association with emotional dysregulation. Patients with high PCS scores were unaffected by conventional IIPT treatment. Implementation of interventions that target emotional dysregulation (e.g., Acceptance Commitment Therapy or Dialectical Behavioral Therapy) may be beneficial for individuals who have high baseline PCS. This research provides support for using baseline questionnaires to help inform individualized IIPT programming for patients who may require additional, or modified, interventions. Comparing intensive pain rehabilitation outcomes for youth with headache, neuropathic, or musculoskeletal pain Charles Mabutas, Nivez Rasic, Laura Rayner, Si Chen Pan, Melanie Noel and Jillian Vinall Miller University of Calgary Introduction/Aim : A 3-to-6-week multidisciplinary, day-treatment, Intensive Pain Rehabilitation Program (IPRP) was developed at the Alberta Children’s Hospital (ACH) to help youth with chronic pain (pain > 3 months). Uniquely, the IPRP at ACH provides intervention for all types of chronic pain. It is not known at present which pain subgroups experience the greatest benefit from IPRP. Methods : Between April 2016 to November 2022, 23 youth (age=16.2, 78% female) participated in IPRP and filled out baseline, discharge, and 3-month follow-up questionnaires. Eight youth had headache pain, ten youth had neuropathic pain, and five had musculoskeletal pain. At each time point, youth filled out the PROMIS pain interference questionnaire. T-scores were used for analysis. A higher t-score represented greater pain interference. One-way ANOVAs and linear mixed models were used to compare change in pain interference over time, both between and within groups. Results : At baseline, youth with neuropathic pain (M=69.3) had significantly higher pain interference than youth with either headache (M=62.9) or musculoskeletal pain (M=64.3). Across the three-month period, pain interference of the neuropathic pain group remained significantly higher as compared to youth with headache pain (p=0.02). Across the three groups, only youth with headache showed a significant reduction in pain interference between baseline and three-month follow-up (p=0.02). Discussion/Conclusions : Youth with neuropathic pain had the greatest pain-related disability over time; however, youth with chronic headache appear to benefit the most from IPRP intervention. Further investigation will be required to determine which components of IPRP may be most effective for managing youth with higher pain-related disability. Pain informed movement program for people with knee osteoarthritis: A feasibility trial Shirin Modarresi a , Neil Pearson b , Kim Madden c , Margaret Fahnestock c , Dawn Bowdish c and Lisa C. Carlesso c a Michael DeGroote Institute for Pain Research and Care (IPRC), McMaster University; b University of British Columbia; c McMaster University Introduction/Aim : Pain in knee osteoarthritis (KOA) is complex and not well-managed. We aimed to establish the feasibility of a program which we call ‘Pain Informed Movement’ consisting of neuromuscular exercise, mind-body techniques, and pain neuroscience education (PNE) in people with KOA. This program has the potential to further our understanding of how to harness intrinsic pain modulation to improve pain management for KOA. Methods : Single-arm feasibility trial with a nested qualitative component. Primary outcome: complete follow-up. Inclusion criteria: age ≥40years, KOA diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10. Intervention: 8 weeks of twice weekly in-person group exercise sessions, with a third at-home session, and PNE and mind-body techniques provided as videos and integrated into the exercise sessions. Assessment: clinical questionnaires, physical tests including blood draws at baseline and program completion. Secondary outcomes: program acceptability, burden, rates of recruitment, compliance and adherence, and adverse events. A priori success criteria were used. Participants were invited to an online focus group. Results : 19 participants were enrolled, with a complete follow-up rate of 74% (mean age 63.3 years (SD 10.5), 73% female), indicating modifications were necessary to proceed. All other success criteria were met. The focus groups revealed that demonstrations of the mind-body techniques in the videos would be beneficial. Discussion/Conclusions : The Pain Informed Movement program is feasible, but minor modifications are needed to proceed. A pilot two-arm randomized controlled trial will be conducted to explore potential effects of Pain Informed Movement compared to conventional neuromuscular exercise and standard OA education. The effects of combined motor control and isolated extensor strengthening versus general exercise on paraspinal muscle morphology and function in patients with chronic low back pain: A randomized controlled trial Maryse Fortin a , Meaghan Rye a , Alexa Roussac a , Chanelle Montpetit a , Jessica Burdick a , Neda Naghdi a , Brent Rosenstein a , Cleo Bertrand a , Luciana G. Macedo b , Geoffrey Dover a , James Elliott c , Richard DeMont a , Michael H. Weber d and Véronique Pepin a a Concordia University; b McMaster University; c University of Sydney School of Health Sciences; d McGill University Introduction/Aim : 1) To compare the effects of combined motor control and isolated lumbar strengthening exercise (MC + ILEX) versus a general exercise (GE) program on paraspinal muscle morphology and function, and 2) investigate if changes in paraspinal muscle are associated with improvement in pain, functional status (ODI) and quality of life (SF-12). Methods : A total of 50 participants with chronic LBP were randomly allocated to each group (MC+ILEX, n=25; GE, n=25). Both groups completed a 12-week supervised intervention program (2 sessions/week). IDEAL fat-water magnetic resonance imaging (MRI), ultrasound assessments and self-reported questionnaires were acquired at baseline, 6- and 12-week to assess the effect of each intervention on multifidus (MF) and erector spinae (ES) muscle morphology (e.g., cross-sectional area (CSA); and fatty infiltration) and function (e.g., MF thickness change from a rested to contracted state) at L4-L5 and L5-S1, respectively. Results : A mixed model ANOVA with repeated measures revealed significant time*group interactions for MF and ES CSA at L4-L5 (p < 0.01) and L5-S1 level (p < 0.001). A significant decrease in ES fatty infiltration was also observed in the MC+ILEX group at L5-S1, however the time*group interaction was not significant. There was no change in MF function. While both groups experienced significant improvements in pain, function and quality of life, no correlation between the changes in functional scores and MF or ES morphology was noted. Discussion/Conclusions : Participants with chronic LBP included in the MC+ILEX group achieved significantly greater improvement in MF and ES morphology as compared to the GE group. Transition to virtual care services during COVID-19 at Canadian pain clinics: Survey and future recommendations Victoria Borg Debono a , Samuel Neumark b , Norman Buckley a , Ramesh Zacharias c , Eleni Hapidou d , Jennifer Anthonypillai d , Susy Faria d , Carrie-Lynn Meyer d , Thomas Carter e , Nadia Parker e , Brenda Lau f , Emmanuel Abreu g , Scott Duggan h , Etienne J Bisson h , Josie Pierre i , Regina Visca j and Patricia Poulin k a McMaster University; b University of Toronto; c Chronic Pain Centre of Excellence for Canadian Veterans; d Hamilton Health Sciences; e CBI Health Clinics; f CHANGEpain clinic; g CHANGEpain Clinic; h Kingston Health Sciences Centre; i Ste-Anne’s Hospital; j McGill University Health Centre; k University of Ottawa Introduction/Aim : The COVID-19 pandemic led healthcare centers to shift to virtual formats quickly. This study aimed to describe and compare the transition from in-person to virtual pain care services at Canadian pain clinics during the onset of the COVID-19 pandemic and provide post-pandemic recommendations for pain care services to optimize patient care. Methods : A qualitative participatory action study design was used, including a cross-sectional survey for data collection. The survey was administered to leadership teams of 11 adult pain clinics affiliated with the Chronic Pain Centre of Excellence for Canadian Veterans. The data were qualitatively analyzed and categorized into themes and subthemes. Results were shared independently with participants to verify the accuracy and relevancy of the data prior to knowledge dissemination. Results : We achieved a 100% response rate (n=11). All clinics collectively transitioned 72 services from in-person to virtual formats. The results focus on describing the transition process to virtual care, current treatments and services, quality of patient care, program sustainability, barriers to maintaining virtual services, and future considerations. Most clinics (n=9) reported that the overall quality of patient care was unchanged before and after the transition. Discussion/Conclusions : The pandemic demonstrated the feasibility and sustainability of hybrid virtual and in-person care for treating those with pain. It is recommended there should be a hybrid of both virtual and in-person care for pain clinics moving forward, and Ministries of Health should continue to support innovations aimed at holistic healthcare, interdisciplinary teams, and the expansion of clinics’ geographical reach for patient access. Repetitive peripheral magnetic stimulation for phasic heat pain modulation Evgeny Osokin a , Rossi Tomin a , James Khan b , Ali Mazaheri c , David Seminowicz d and Massieh Moayedi a a University of Toronto; b Mount Sinai Hospital; c University of Birmingham; d Western University Introduction/Aim : Existing pain management tools, such as transcutaneous electrical stimulation (TENS) and pharmacology have limited efficacy and can be associated with significant side effects. Repetitive peripheral magnetic stimulation (rPMS) is a novel, non-pharmacological technique that can induce non-invasive analgesia. To date, there are no high-quality controlled studies that demonstrate its efficacy. Thus, the aim of the study was to determine whether rPMS can reduce experimental phasic heat pain. Methods : 54 healthy participants (27M, 27F), aged 18-40 years, consented to procedures approved by University of Toronto’s Human Research Ethics Board. Participants attended two sessions: a control session and a stimulation session, counterbalanced across subjects. In the stimulation session, participants received one of three stimulations: TENS or rPMS. RPMS parameters were either intermittent theta burst stimulation (iTBS), or continuous TBS (cTBS). Phasic heat pain stimuli were applied before and after stimulation. Outcome measures collected included pain intensity, pain unpleasantness, and the area of secondary hyperalgesia. A repeated-measures ANCOVA was run in each sex to determine the effect of stimulation type on outcome measures. Results : There was a significant effect of the stimulation arm on pain intensity and secondary hyperalgesia in females (F=3.603, p=0.044 and F=6.697, p=0.005, respectively), but not in males (p > 0.05). There was no significant effect of the treatment arm on pain unpleasantness both in females and males (p > 0.1). Discussion/Conclusions : These results show that rPMS can potentially impact central sensitization in women. Sustained changes in wellbeing in patients with chronic pain attending an intensive chronic pain management program during the COVID - 19 pandemic Jiyeon Park a , Jennifer Anthonypillai b and Eleni G. Hapidou b a McMaster University; b McMaster University and Hamilton Health Sciences Introduction/Aim : Chronic pain may result in a decline of one’s wellbeing and is strongly linked to depression, anxiety and catastrophizing. The aims of the study were to examine sustained changes in wellbeing in patients with chronic pain 6 months after attending an intensive interdisciplinary pain management program. Methods : Data were collected from 37 (48%) participants of the intensive interdisciplinary chronic pain management program at the Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, who responded to the follow-up survey 6 months after discharge (40% females, 62% Veterans, 76% Virtual program). Participants completed psychometric instruments including emotional distress, pain interference, stages of change, acceptance of pain, and subjective happiness. Results : ANOVAs demonstrated maintenance of significantly improved outcomes for depression, catastrophizing, kinesiophobia, sensitivity to pain traumatization, recent bothersome symptoms, pain interference, self-management strategies, pain acceptance, and happiness at follow-up (p < 0.001). Results also showed many significant interactions among the factors examined with most pointing towards better outcomes in females and veterans overall. Male civilians fared worse than all others on pain interference, bothersome symptoms, depression, anxiety (trend), catastrophizing, kinesiophobia, sensitivity to pain traumatization, and stages of change (p < 0.05). Discussion/Conclusions : Results highlight the effectiveness of the program in decreasing emotional distress/improving wellbeing in patients with chronic pain long after discharge, during the pandemic. They also point to differences in outcomes between males and females, veterans and civilians. Findings support and strengthen those of previous studies in our program and the literature and point to the need to improve outcomes of male civilians. The lived experience of people with chronic pain undergoing a combined opioid deprescribing and self-management intervention Katherine Poser, Jordan Miler, Kevin Varette, Chad McClintock, Nicole Bobbette, Abey Abebe and Kyle Vader Queen’s University Introduction/Aim : To reduce the burden and suffering of those living with chronic pain, primary care providers have prescribed opioids at increasing rates. Opioid prescription has led to an increase in opioid misuse and opioid-related deaths in epidemic proportions. In response, opioid deprescribing and self-management programs have shown promising results. This study explores the experiences of patients who participated in an intervention that combines opioid deprescribing and self-management. Methods : An interpretive descriptive design was used. Participants were eligible for this study if they 1) had non-cancer related chronic pain 2) were on a daily opioid dose of > / 50mg morphine equivalents and 3) participated in a combined opioid deprescribing and 6-week chronic pain self-management intervention in primary care. 15 participants completed semi-structured interviews after completing the intervention. All interviews were audio recorded and transcribed. Thematic analysis and a constant comparative approach were used as the main analytic strategies. Results : Key themes constructed from the data were empowerment, impact of a therapeutic relationship, application of knowledge, physical comorbidities, inclusion of mental health support, and accessibility. Discussion/Conclusions : While patient participants expressed a reduction in pain, improved function and quality of life, and feeling supported with continued implementation of the intervention, their feedback suggests potential adjustments to the intervention are required. Mandatory detailing to ensure supportive communication among participants, alteration of the delivery schedule to provide a more combined intervention, and the need for both virtual and in-person offerings are key areas for improvements to the intervention. Improvements in parent mental health and responses to pain moderate child brain connectivity and decreases child pain interference following intensive pain rehabilitation Sankait Rattu a , Si Chen Pan b , Nivez Rasic a , Melanie Noel a , Laura Rayner c , Catherine Lebel a and Jillian Miller a a University of Calgary; b Sir Winston Churchill High School; c Alberta Children’s Hospital Introduction/Aim : With Intensive Pediatric Pain Rehabilitation (IPRP), parents are taught how to best support their child with chronic pain. Given the critical role of the parent in their child’s daily care, it is imperative to identify whether IPRP is associated with changes in parents’ mental health and behaviour, and whether these changes contribute to improvements in their child’s pain-related disability. Methods : Data was collected on 22 parents and their respective children, aged 10-18 years. Pre- and post-IPRP, parents and children completed questionnaires regarding their own pain catastrophizing and anxiety symptoms. Additionally, parents completed questionnaires related to their responses to their child’s symptoms. Patients underwent a 3T MRI scan pre- and post-IPRP. Diffusion tensor imaging (DTI) and fractional anisotropy (FA), a quantitative measure of white matter microstructure, were acquired. Paired t-tests were used to compare parent and patient questionnaire data pre- and post-IPRP. Linear mixed models will be used to examine whether parents’ mental health and behaviour moderates FA values to reduce child pain interference pre- to post-IRPP. Results : Parent anxiety, catastrophizing, and distraction/monitoring behaviours significantly decreased pre- to post-IPRP (p < 0.05). Child pain interference also significantly decreased (p < 0.001). The next steps will be to determine whether decreases in parent anxiety, catastrophizing, distraction/monitoring behaviours, and changes in FA are associated with decreased child pain interference pre- to post-IPRP. Discussion/Conclusions : Parental mental health and behaviour improve pre- to post-IPRP. It will be important to examine whether improvements in parental functioning help to facilitate improvements in child outcomes. Adjuvant pharmacotherapy with spinal COR stimulation – A help or a hindrance? A scoping review Amarnath Reddy Basavanapalli a , Sachin Sahni a , Anuj Bhatia a , Pranab Kumar a and Bengt Linderoth b a Toronto Western Hospital; b Karolinska Institutet Introduction/Aim : Spinal cord stimulation (SCS) can ameliorate neuropathic pain. The analgesic benefit from SCS may be altered by the use of adjuvant analgesic medications by patients who recieve SCS implants. We undertook a scoping review to scan and summarize the evidence for modulation of SCS therapy by adjuvant pharmacotherapy. Methods : A literature review of SCS studies on humans and animals was performed by using medical databases including MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL and Google scholar from inception until October 31, 2022. Data extraction and analysis was done on the effect of pharmacotherapy on pain and related domains and adverse effects. Results : 22 studies, 13 on humans and 9 on animals, were identified. In human studies, SCS non-responders with neuropathic pain reported substantial improvement with administration of intrathecal baclofen, clonidine and ketamine. The suppressive effect of SCS on mechanical hypersensitivity was enhanced with antidepressents., However, gabapentenoids did not augment the analgesic benefit from SCS. Patients who eliminated opioid use, or who were opoid naive, had superior clinical outcomes with SCS compared to those who continued opoids. In animal studies, SCS augmentation was seen with intrathecal GABA, baclofen and clonidine. In one study, intrathecal ketamine enhanced pain relieving effect of SCS on tactile hypersensitivity and play a role in converting SCS non-responders to responders. Discussion/Conclusions : This review suggests adjunctive pharmacotherapy may have a role in enhancing analgesic benefits from SCS therapy. Further prospective comparitive studies are required to establish the impact of adjuvant pharmacotherapy on SCS for pain. Nerve blocks in patients with chronic headaches, neck, and low back pain: Preliminary results of an interventional study at pain care clinics in ontario Rifat Rehmani a and Hany Demian b a Pain Care Clinics, Mississauga; b McMaster University; Pain Care Clinics Introduction/Aim : To evaluate the effectiveness of nerve blocks in improving pain and function among adults with chronic headaches, neck pain, and low back pain. Methods : The study was conducted prospectively at Pain Care Clinics in Ontario. A one-group pretest and post-test design to determine the analgesic and functional effects of 8- treatments of bupivacaine injection in patients with chronic low back pain, headaches, and chronic neck pain. A sample size of 597 subjects was calculated by using PASS software. Primary outcomes were assessed utilizing the numeric pain rating scale and disease-specific functional status questionnaires. Secondary outcome measures were studied by Brief Pain Inventory, Pain Disability Index, Anxiety and Depression by Hospital Anxiety and Depression Scale, and Short Form 36 (SF-36) physical and mental health component scores. Descriptive statistics was performed. The difference amongst the pretest and post-test groups was analyzed by two-sided paired t-test. Results : To date, 343 patients completed the study. Of those, 271 had back pain, 61 has neck pain and 11has chronic headaches. 80% of the patients were females. The numeric pain rating scale was 7.2 ± 0.6 in the pretest while it was 2.1 ± 0.5 in the post-test group (P=< .001). There was also significant improvement in the disease-specific functional status scores. The analyses of secondary outcome also revealed functional status improvement (P=< 0.001). Discussion/Conclusions : In this preliminary analyses, 8-treatments of bupivacaine injection in patients with chronic low back pain, headaches and chronic neck pain provide a greater reduction in pain and improve function. Demographic and baseline measures of patients entering a tertiary pain center Magali Robert a , Eliane Domingue b , Andrea Bezuidenhout b and Andrew Walker b a University of Calgary; b Alberta Health Services Introduction/Aim : Understanding the characteristics of the referral base of patients entering a tertiary care chronic pain center is paramount in addressing both external and internal unmet needs. Methods : All patients entering the Calgary Chronic Pain Program (a tertiary level care program with three streams: Neuro-musculoskeletal (NMSK) pain, pelvic pain or post-concussion headache) are sent a battery of questionnaires to fill online through RedCap. Data was extracted to provide an overview of demographics and intake measures at time of participant program initiation. Summary statistics were compiled from patients entering the program from February 2020 to February 2022. Results : Summary intake statistics were collected for 1125 patients, including intake demographics. Length of chronic pain experienced ranged from 8.4 ± 10.8 years to 11.7 ± 10.9 years in post-concussion headache and NMSK patients, respectively. Across all streams, most patients were female, Canadian and in a relationship. Superior scores for intake measures were noted for pelvic patients. Discussion/Conclusions : Demographic information is not reflective of the Calgary population and weighted to a Canadian common law/married population. The means of the intake measures were similar amongst the streams with a trend showing pelvic pain patients as having less dysfunction. However, intimacy and sexual function were not measured. The wide confidence intervals surrounding the intake measures reveals a diversity of presentations. This study informs changes to target the referral base to vulnerable populations and consider intake criteria for participation that characterizes a tertiary level pain program. Exploratory evaluation of patient trajectory through a one-year tertiary care chronic pain program Magali Robert a , Andrea Bezuidenhout b and Andrew Walker b a University of Calgary; b Alberta Health Services Introduction/Aim : The Calgary Chronic Pain Clinic (CPC) is a one-year interdisciplinary pain clinic. Following patient trajectories could identify patients who are not thriving earlier and allow mitigating strategies. Methods : Patients entering (CPC) enter the same measures on intake, at six months and on exit. At completion they are asked about their perceived success. This outcome was dichotomized to improved or no change/worse. Measures include: Short Musculoskeletal Function Assessment, Chalder Fatigue Questionnaire, Pain Catastrophizing Scale, Brief Pain Inventory (BPI), Pain Self-Efficacy Questionnaire (PSEQ), Satisfaction with Life, Patient Health Questionnaire 4, EQ-5D. Scatter plots were generated for each intake measure and trajectories explored using a polynomial curve fit. A sensitivity analysis was completed whereupon missing data was imputed using predictive mean matching. Results : Ninety-six patients completed the one-year program and provided outcome measures of their perceived success. 75 patients (78.1%) reported improvement. Specifically, at the 6-month time point, no discernable/clinically important difference in measures can be observed between patients who improved and those who reported no change/worse outcomes. This was seen for all measures. Although imputation served to reduce the width of the 95% confidence interval, no appreciable separation of trajectories was noted at 6 months. Discussion/Conclusions : This exploratory study recognizes the importance of using measures to inform care. Using available and imputed data, no discernable difference was seen for all measures at 6 months with respect to patients who will improve or report no change/worse outcomes upon discharge. The paucity of data at 6 months lends itself to such a finding. On-going analysis will continue as patients progress through the program. Comparison of outcome measures and perceived improvement following completion of a one-year interdisciplinary chronic pain program Magali Robert a , Eliane Domingue b , Andrea Bezuidenhout b and Andrew Walker b a University of Calgary; b Alberta Health Services Introduction/Aim : All outcome questionnaires measure different domains and aspects of health. Changes from baseline may not represent an impression of improvement. This study looks at changes in domain questionnaires with perceived success, which was dichotomized into improved and no change or worse. Methods : Upon discharge patients complete a questionnaire to assess their status satisfaction (scored from 1 to 7) compared to intake. Responses were dichotomized as improvement or no change/worse status. This was compared to the outcome measures at discharge. Missing data was imputed using predictive mean matching for sensitivity analysis with complete cases. Independent samples t-tests were used to compare outcome measures between groups. Results : 96 patients complete the outcome measures and were included in analysis. Missing data was up to a maximum of 20% for outcome measures. Appreciable differences were noted for SMFA daily activities and bothersome scores, Satisfaction with Life scores, PSEQ scores and PCS scores. Imputed results (not shown) were similar to those presented for complete case analysis. Discussion/Conclusions : This exploratory study begins to establish norms for individuals who report improvement and individuals who report no change or worsening following completion of a one year interdisciplinary program. Even those who considered themselves improved presented with outcome values below population normals in the EQ5D-5L, Short Musculoskeletal Function Assessment, Chalder Fatigue Scale. However, those who improved showed Satisfaction with Life scores that were comparable to normal population values. One-on-one care distribution amongst providers in an interdisciplinary pain clinic Magali Robert a , Kimberly Musselwhite b and Eliane Domingue b a University of Calgary; b Alberta Health Services Introduction/Aim : Distribution of care in an interdisciplinary pain clinic is critical for strategic planning and improving delivery of care. Methods : Measurement of time and number of patients seen by providers at the Calgary Chronic Pain Center was undertaken between Jan 1, 2022 and Sept 30, 2022. The time does not include leading group activities or indirect patient care (such as planning or meetings). The nurses take on a coordinator role and their direct patient time is thus not reflective of their other responsibilities. Results : The direct time for one-on-one care is similar for physicians, physiotherapists and psychologists. Less social worker time was likely a result of a gap in filling the position rather than less need during the study period. Most providers have a 1:4 new to follow up appointment ratio. Nursing time was also on a 1:1 ratio. Total rehab time compared to physician time was in a 1:2. Discussion/Conclusions : The Calgary Chronic Pain Clinic functions at a 1:1:1 ratio between physician:physiotherapist:psychologist one-on-one time. A 2:1 time ratio for rehabilitation and physician is seen. This does not include time spent in delivering group sessions. Similarly nursing time is similar to physician time. This data can guide strategic planning and recruitment. Bias in pain care: What factors do providers report as influencing their treatment decisions? Margaret A. Rose-McCandlish a , Tracy M. Anastas b , Megan M. Miller c and Adam T. Hirsh a a Indiana University-Purdue University Indianapolis; b University of Washington School of Medicine; c Cincinnati Children’s Hospital Medical Center Introduction/Aim : Providers often treat pain differently based on patient race and socioeconomic status (SES). Whether providers perceive these factors as influencing their decisions remains to be known. We examined a) which patient factors providers report as influencing their treatment decisions, and b) whether providers who exhibit racial or SES biases in their decisions (“biased providers”) report different factors as influencing these decisions compared to providers who do not exhibit biases (“non-biased providers”). Methods : Physician residents/fellows (N=434; “providers”) in the US made treatment decisions for 12 computer-simulated patients with chronic pain who differed by race and SES. Providers then rated the extent to which 15 different patient factors influenced their treatment decision-making. Results : Providers rated patient demographic factors (e.g., race, sex/gender, age) as significantly less influential in their treatment decision-making than other, pain-specific factors (e.g., etiology, duration; p < 0.05). Biased and non-biased providers significantly differed in their self-reported ratings of treatment influences (F(1,430)=4.44, p=0.04). Although none of the pairwise comparisons were significant, the largest differences were observed for biased providers giving higher ratings for demographic (sex/gender, race, age) and social (occupation, interference with social relationships) factors, as well as for provider intuition. Discussion/Conclusions : Providers reportedly placed less weight on patient demographic factors than on pain-specific factors when deciding which pain treatments to recommend. Providers who exhibited racial or SES biases in their treatment decisions reported being more influenced by a range of factors than did non-biased providers; however, the extent to which this reflects self-aware intentional behavior requires future study. Pediatric pain and mental health trajectories over the course of interdisciplinary pain treatment Brittany N. Rosenbloom a , Gabrielle M.G. Pagé b , Vina Mohabir a , Fiona Campbell c and Jennifer Stinson c a The Hospital for Sick Children; b Université de Montréal; c The Hospital for Sick Children; University of Toronto Introduction/Aim : Interdisciplinary pediatric chronic pain clinics (pedCPC) have shown good outcomes, but little is known about individual trajectories through treatment. The aim of this study was to follow youth attending a pedCPC in a major tertiary care hospital to identify and describe pain and mental health trajectories from the time of initial clinic appointment to 12 months after commencing treatment. Methods : Youth (n=386; Female n=302 (78.3%); Mage=14.42, SDage=2.52, 8-19 years) were followed in a pedCPC over the course of their treatment (2018-2022). Youth who had two or more appointments were included [initial consultation and follow-up appointment(s)]. Youth completed questionnaires on pain intensity, pain interference, pain catastrophizing, anxiety, and depression. Growth mixture modeling was used to characterize trajectories on each variable over three timepoints (7 linear trajectory models, 7 linear + quadratic trajectory models). Model selection was based on Bayesian Information Criterion (BIC) and a minimum of 5% of participants classified in each trajectory. Results : Each of the five variables had different associated trajectory models: Average pain intensity had two linear trajectory groups (BIC=3629.72); Pain interference had five linear trajectory groups (BIC=6029.1); Pain catastrophizing had two quadratic trajectory groups (BIC=6485.04); Anxiety had three linear trajectory groups (BIC=6435.2); and Depression had three linear trajectory groups (BIC=6389.88). Discussion/Conclusions : Youth attending a pedCPC have differing trajectories over the course of a year of treatment on measures of pain intensity, pain interference, pain catastrophizing, anxiety and depression. While most youth improved on these metrics, there is a subset who have high scores throughout their treatment. Outcomes of triphasic trials of spinal cord stimulation Tamiris Soares a , Pranab Kumar b , Jamal Kara a , Victoria Bains a and Anuj Bhatia a a TWH, University of Toronto, UHN; b TWH, University of Toronto, UHN Introduction/Aim : We conducted a prospective observational study on patients undergoing SCS trials to evaluate long terms outcomes based on decisions made using the triphasic SCS trial protocol. The three trial SCS phases were low-frequency, paresthesia-based stimulation (PB), high-frequency paresthesia-free stimulation (PF), and placebo (PL) stimulation. The study phases were randomized, and the participants were blinded to the allocation of high-frequency or placebo modes. Methods : IRB approval was obtained (UHN REB # 18-5864). 196 patients diagnosed with refractory back and lower limb neuropathic pain received SCS percutaneous trials between July 2017, to February 2022. The percutaneous trial lasts 12 days and is divided into 3 phases. During the trial, patients were assessed at the end of each phase, which included pain intensity (NRS), DN4, NPSI, PSQ3, GAD-7, PHQ9, and PCS. We also do QST, functional MRI, and magnetoencephalography before, at the end of the trial, 6 months, and 1 year after the implantation. A positive response was defined as at least a 50% reduction in pain intensity from their baseline. Results : 196 patients proceeded to the trial. Demographic data are detailed. There were 134 responders to the triphasic SCS trials and 62 non-responders. Eighty (80) patients responded to PB and or PF but not with the placebo mode, and only four of 196 responded solely to placebo. Discussion/Conclusions : The findings of our observational prospective study show that active SCS modes (PB and PF) are associated with a decrease in pain intensity when compared with a placebo intervention. Implementing CARD (Comfort Ask Relax Distract) for university-based influenza vaccination pop-up clinics: Client and staff feedback Anna Taddio a , Victoria Gudzak a , Charlotte Logeman b , Natalie Crown a , Joshua LeBlanc a , Lisa Dolovich a , C. Meghan McMurtry c and Lucie Marisa Bucci d a University of Toronto; b Hospital for Sick Children; c University of Guelph; d Bucci-Hepworth Health Services Inc. Introduction/Aim : CARD (Comfort Ask Relax Distract) is an evidence-based vaccination delivery framework that promotes person-centred care. No studies have evaluated its implementation in mass influenza vaccination clinics. The objective was to integrate CARD in university-based influenza vaccination pop-up clinics and evaluate client and staff experiences. Methods : Mixed methods before-and-after quality improvement study. A baseline (control – usual care) phase preceded CARD implementation in one popup clinic. Then CARD was implemented incrementally in two subsequent clinics. Changes to the environment (delineating waiting and aftercare areas, providing privacy, obscuring needles from view), education (clients given CARD coping checklist at check-in), and interactions (defining discrete clinic roles and processes, using coping-promoting behaviours, removing alcohol skin antisepsis prior to vaccine injection) were made. Clients provided feedback using standardized surveys. Staff, including pharmacy student vaccinators, participated in clinic debriefs. Feedback informed real-time process changes during and between clinics. Results : Clinics were held Nov 17 (control), Nov 22 and Nov 24 (both CARD). Feedback from 298 adult vaccine clients, including university students and staff (representing > 98% of all vaccinated individuals) demonstrated an incremental increase in the percent of clients with an improved experience compared to the last vaccination (34% baseline, vs. 49% and 57% in CARD clinics, respectively; p=0.003). Ten percent reported CARD influenced their decision to attend by a moderate amount to a lot. Staff liked the changes. Sample quotes after the final clinic included: “very organized” and “best clinic ever.” Discussion/Conclusions : This study demonstrated improvement in vaccination delivery after CARD implementation as reported by vaccine clients and staff. Self-selected favourite music induces analgesia in healthy participants Rossi Tomin, Stephanie Bourke, Nilina Mohabir, Majid Saberi, Liat Honigman and Massieh Moayedi University of Toronto Faculty of Dentistry Introduction/Aim : There is a growing body of literature investigating music-induced analgesia (MIA) as a non-invasive and low-cost option for self-management of pain. Previous methodological approaches exploring MIA have used standardized music to assess their modulatory effects on experimental acute pain and chronic pain. The aim of this study was to investigate the effect of self-selected favourite music on experimental pain intensity compared to pink noise in healthy individuals. Methods : Nineteen healthy participants (9 female, 10 male; 27 ± 4.3 years) were recruited and consented to approved procedures by the University of Toronto research ethics board. Participants received a fluctuating tonic heat stimulus, with a baseline of 32°C and peaks ranging between 43-47°C, on the volar forearm for the duration of the sound stimuli. The order in which participants received the music or pink noise was counterbalanced and randomly assigned. Heat pain intensities were continuously recorded using an electronic visual analog scale (eVAS). The overall pain intensities for each condition were calculated as area under the curve. A two-way repeated measures ANOVA was performed using two factors: music type (two-levels: ‘pink noise’ vs. ‘favourite’) and sex (two-levels: ‘male’ vs ‘female’). Results : Favourite music resulted in significantly lower pain intensity scores compared to pink noise (favourite music: 2129.48 ± 1904.11, Pink Noise: 3026.21 ± 2580.46, p=0.03). Two-way repeated measures ANOVA resulted in a main effect of sex (p=0.866; sex-by-music type interaction: p=0.968). Discussion/Conclusions : This exploratory study supports the hypothesis that self-selected favourite music reduces subjective pain intensity ratings, compared to pink noise. Development of the chronic pain pathway, regina area pilot: Resource documents for healthcare providers and patients to support chronic pain management in primary care Susan M. Tupper a , Jason Vanstone a , Crystal Larson a , Warren Berry a and Amir Azizian b a Saskatchewan Health Authority; b Saskatchewan Health Authority, University of Saskatchewan Introduction/Aim : Primary care providers play a key role in chronic pain management due to the high prevalence of pain and limited access to specialized pain services. Healthcare providers and people living with chronic pain report lack of awareness of treatment resources, high reliance on medication management approaches, and difficulty navigating care. To address these barriers, the Saskatchewan Health Authority (SHA) Department of Clinical Excellence designed resource documents for healthcare providers and patients to support chronic pain management in primary care settings. The iterative patient- and provider-engaged development process is described. Methods : Pathway development began in November, 2019 with a key stakeholder facilitated dialogue with multidisciplinary healthcare providers, patient partners, health services decision makers, and representatives from the Saskatchewan Ministry of Health. Targeted literature reviews and five cycles of feedback informed organization and refinement of the pathway documents. Feedback was integrated from physician specialists, multidisciplinary health care providers with expertise in pain management, family physicians, nurse practitioners, and patient partners. Results : Pathway documents are a Regina area pilot, with plans to scale to other locations across Saskatchewan. Documents contain hyperlinks to assessment tools, health services, pain education resources, and practice support tools. On December 1, 2022, pathway documents were published on the SHA website with a 22-question evaluation survey, education support materials, and electronic medical record upload instructions. Implementation efforts are focused on raising awareness. Evaluation is focused on informing content, clarity, and usability improvements. Discussion/Conclusions : The Chronic Pain Pathway documents support primary care management of chronic pain. Implementation and evaluation are ongoing. Virtual or in-person mode of delivery of chronic pain management: What’s your preference? Anthony Tutunjian a , Jennifer Anthonypillai b and Eleni G. Hapidou c,d a McMaster University; b Michael G. DeGroote Pain Clinic, Hamilton Health Sciences; c Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, Department of Psychiatry and Behavioural Neurosciences, McMaster University; d Department of Psychology Neuroscience and Behaviour, McMaster University Introduction/Aim : The COVID-19 pandemic necessitated alternate modes of delivery of chronic pain management programs. The aim of this study was to examine virtual and in-person programs during the pandemic. Methods : Data were collected from the five-week intensive interdisciplinary pain management program (adapted for the pandemic) at the Michael G. DeGroote Pain Clinic, Hamilton Health Sciences (n=100, 69% Virtual, 62% Veterans, 44% females). Participants completed psychometrics on pain intensity (PIS), pain disability (PDI), kinesiophobia (TSK), anxiety (CAS), depression (CES-D), catastrophizing (PCS), sensitivity to pain traumatization (SPTS), pain stages of change (PSOCQ), pain acceptance (CPAQ), and likelihood estimates of return to work (RTW) at admission and discharge, and self-evaluations of program benefit and satisfaction at discharge. 2x2x2X2 mixed ANOVAs on outcomes and 2x2X2 ANOVAs on satisfaction measures were conducted. Results : Both programs produced highly significant outcomes in all (but CAS) measures. Discussion/Conclusions : Results show that virtual delivery of chronic pain management is just as effective as in-person delivery. Previous findings on the benefits of interdisciplinary chronic pain management for all patients are replicated. Results point to the need to have both programs available for patients so as to maximize benefit in all patients. How people living with chronic pain and the health system care providers, managers and decision-makers perceive access to integrated care Regina Visca a , Jeannie Haggerty b , Krista Brecht c , Yoram Shir a and Alayne Adams b a McGill University, McGill University Health Centre; b McGill University; c McGill University Health Centre Introduction/Aim : Although chronic pain centres in Quebec offer multidisciplinary services, access is a challenge due to unacceptably long wait times from excessive patient demand, limited resources, and system inefficiencies. With the broader goal of redesigning care, this study describes challenges in accessing integrated care from the perspectives of patients, providers, managers and policymakers. Methods : We employed an exploratory qualitative study design with diverse stakeholders (N=12) from Quebec pain clinics. Nominal group technique (NGT) was used to analyze patient trajectories with the aim of prioritizing and discussing challenges to accessing integrated care. A structured priority ranking process was applied, and framework analysis was used to synthesize discussions of challenges impacting patient and provider experience, outcomes, and costs. Results : Five overarching challenges were prioritized: 1) inadequate referral structure; 2) failures in ensuring the right service at the right time by the right person; 3) lack of continuity of clinical information; 4) weak service integration; and 5) insufficient patient navigation. Specific challenges that emerged during the discussions acknowledged cross-cutting relationships between the clinical interactions, the design of the delivery system (professional and organizational context), and the larger health system. Discussion/Conclusions : Study findings point to multi-level challenges impeding access to integrated care. Referral processes to needed services must be aligned with integrated care. Actionable information must be available to patients, providers, and decision-makers to ensure resources, structures, and policies support access to integrated care. Using multistakeholder perspectives to understand care gaps, contributes to ensuring the responsiveness of health systems. Clinical hypnosis protects against low frequency heart rate variability-associated increases in postsurgical opioid use: Secondary outcome analysis of a randomized controlled trial Anna Waisman a , Maxwell Slepian b , Muhammad Abid Azam b , Aliza Weinrib b , Brittany Rosenbloom c , Hance Clarke b and Joel Katz a a York University; b Toronto General Hospital; c The Hospital for Sick Children Introduction/Aim : Heart-rate variability (HRV) is an index of parasympathetic nervous system (PNS) activity inversely related to pain. Postsurgical opioid consumption (POC) is considered a proxy for severe pain. A recent RCT identified that clinical hypnosis (CH) reduces POC and preserves HRV after major oncological surgery. The current study conducts a secondary analysis to examine whether presurgical HRV predicts POC in the context of the CH trial. Methods : Following Toronto General Hospital REB approval, 92 oncological surgery patients randomly received CH before and 1-3 days after surgery or treatment-as-usual (TAU). LF-HRV, a measure of low PNS activity, was assessed before surgery. Opioid dosage in milligram morphine equivalents (MME) was assessed 1-5 days post-surgery. Results : A linear mixed-effect model was conducted with MME as the outcome; group (CH, TAU), LF-HRV, postsurgical timepoint (days 1-5), and a group x LF-HRV interaction for fixed effects; and a random intercept for participants. The main effect of time, F(4,250.07)=7.08 p < 0.001, and the group x LF-HRV interaction were significant, F(1,82.87)=6.90, p=0.01. Post-hoc analyses revealed a significant positive trend of MME for LF-HRV only in the TAU group (simple slope estimate for LF-HRV=0.01; 95%CI=0.003, 0.02; p=0.004). Following a median split of LF-HRV, pairwise contrasts showed that MME in the high, but not low, LF-HRV classification was significantly greater for the TAU vs CH group (p < 0.01). Discussion/Conclusions : The finding in the TAU but not CH group of greater MME in participants with lower PNS tone suggests perioperative CH may have protected against the negative effects of lower PNS tone. Diverse forms of social presence in VR for chronic pain Yuemei Wu a , Timothy Kagiri a , Kit-Ying Angela Chong a , Chris Shaw b , Diane Gromala c , Ruoyu Li a and Owen Williamson d a Simon Fraser University; b Professor, Simon Fraser University; c Distinguished Professor, Simon Fraser University; d Adjunct Professor, Simon Fraser University Introduction/Aim : Virtual Reality has been demonstrated to be useful for acute pain distraction, managing chronic pain, changing somatosensation, enhancing graded motor imagery, and helping motivate physical activity. However, until recently, the social aspects of chronic pain have been explored far less often. Moreover, most research has been primarily limited to the short-term use of VR. However, given the technology industry’s focus on social interaction in VR, the primacy of biopsychosocial methods in pain research, and the importance of social isolation among chronic pain patients, explorations of the social aspects of VR are highly salient. Methods : We conducted a retrospective analysis of the qualitative findings from our existing studies, analyzing the impact of the social aspects of our VR systems. One component was a mixed methods study of 16 participants (ages 56-89, 8 females; during COVID) diagnosed with chronic pain to measure to what extent a sense of social presence in a virtual environment affected participants’ feelings of welcomeness, safety, and loneliness. Results : In one of our VR systems, we found meaningful increases in welcomeness and safety; Impersonality and Immersion remain unchanged, with a decrease in loneliness. From these study components, we developed a taxonomy of diverse aspects of social presence in VR for the purpose of inferring its utility in addressing social isolation among chronic pain patients. Discussion/Conclusions : While most’ social presence’ in VR implies synchronous interaction with another person, our taxonomy identifies numerous other ways to use asynchronous social presence in VR that may also help alleviate social isolation in Chronic Pain patients. Transcranial alternating current stimulation is associated with lower ratings of both tourniquet ischemic pain and low back pain Dominic Ysidron and Christopher France Ohio University Introduction/Aim : Transcranial alternating current stimulation is a promising non-invasive and non-pharmacological approach to pain management, but its effects have yet to be examined in the same sample for both experimental and clinical pain. Methods : In a within-subject design, young adults completed a 5 minute tourniquet ischemia pain task on two counterbalanced testing sessions held one week apart. During one session forearm ischemia was accompanied by active treatment (transcranial alternating current stimulation at 10Hz) while the other was accompanied by sham stimulation (transcranial random noise stimulation at 10Hz). For the full sample (n=24), continuous forearm pain ratings were averaged for minutes 1-5 of ischemia. In addition, for a subsample of participants with chronic low back pain (CLBP, n=15), Brief Pain Inventory ratings of low back pain were assessed before and after stimulation. Results : A repeated measures analysis of forearm pain ratings revealed a significant effect of stimulation, F(1,22)=8.91, p < 0.01, Wilks’ Λ=0.712, with follow-up tests revealing lower pain ratings for active vs. sham stimulation during minute 1, t(23)=-3.02, p < 0.01, and minute 2, t(23)=-2.97, p < 0.01 of ischemia, but not during minutes 3-5. Among those with CLBP, back pain ratings did not differ before stimulation, t(14)=-0.70, p=0.50, but were significantly lower immediately after active versus sham stimulation, t(14)=-2.83, p < 0.05. Discussion/Conclusions : The present findings indicate that transcranial alternating current stimulation may induce temporary reductions in both experimental and clinical pain, suggesting that further testing is needed to better understand now this intervention may be used as an adjunctive approach to pain management. Pain relief achieved by pharmacological, physical and psychosocial treatments: A real-world portrait of people living with chronic pain Meriem Zerriouh a , Sylvie Beaudoin b , Christian Bertrand b , M. Gabrielle Pagé c , Line Guénette d , Lucie Blais e and Anaïs Lacasse a a Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada, Laboratoire de recherche en épidémiologie de la douleur chronique, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada; b Laboratoire de recherche en épidémiologie de la douleur chronique, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada; c Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada, Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; d Faculté de pharmacie, Université Laval, Québec, Québec, Canada,, Centre de recherche du CHU de Québec - Université Laval, Québec, Québec; e Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada Introduction/Aim : The efficacy of individual pain treatment approaches is often evaluated in randomized clinical trials and few observational studies have portrayed the overall relief experienced by persons living with chronic pain (CP) in the community. We aimed to describe relief brought by pain treatments used in real-world clinical settings and identify clinical and sociodemographic factors associated with greater pain relief. Methods : We have used the COPE Cohort, a database of adults living with CP across Quebec (Canada) which included a self-reported measure of the overall pain relief brought by the different treatments currently used by participants (0-100% numeric rating scale). A multivariable logistic regression model was used to identify factors associated with ≥70% pain relief. Results : Mean age of participants was 50 years and 83.7% self-identified as women (n=1419); 21.8% reported ≥70% pain relief. Adjusting for potential confounders, the following variables were associated with greater chances of reporting ≥70% pain relief: less severe pain characteristics, reporting a stressful event as the circumstance surrounding the onset of pain, living with CP for ≥10 years, access to a trusted healthcare professional for pain management, receiving disability benefits, and greater self-perceived general health. Variables associated with lower chances of ≥70% pain relief included repetitive work as the cause of pain, using non-pharmacological approaches or over-the-counter pain medications, being born in Canada, feminine personality traits, and greater psychological distress. Discussion/Conclusions : Despite our cross-sectional design, our results still allow us to emphasize and focus on modifiable factors as priorities for improving patient well-being. Peripheral magnetic stimulation in the treatment of postoperative pain: A systematic review and meta-analysis Stephanie Park M.Sc a , Rex Park M.D b , Duncan Westwood B.A b,c , Massieh Moayedi Ph.D d,e,f and James S. Khan M.D M.Sc b,c a Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; b Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; c Mount Sinai Hospital, Toronto ON, Canada; d Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, ON, Canada; e University of Toronto Centre for the Study of Pain, Toronto, ON, Canada; f Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada Introduction/Aim : Management of postoperative pain continues to be a major challenge. There is a pressing need for novel therapies that are both safe and effective. One promising modality is peripheral magnetic stimulation (PMS). Here, we aimed to systematically review the effects of PMS on postoperative pain management. Methods : MEDLINE, CENTRAL, EMBASE, ProQuest Dissertations, and clinicaltrials.gov were searched up to May 2021. We included studies of any design with (1) patients ≥18 years, (2) undergoing any surgery, (3) had PMS within the perioperative period and (4) assessed for postoperative pain outcomes. We conducted a meta-analysis of RCTs if ≥2 trials reported pain outcomes at the same follow-up. Results : Eighteen studies (17 RCTs, 1 nonrandomized) were included and we found that PMS was more effective than controls within the first 7 postoperative days (mean difference [MD] -1.64 on a 10-point numerical rating scale, 95% confidence interval [CI] -2.08 to -1.20, I2=77%, 6 studies [231 patients]), 1-month post-surgery (MD -1.82, 95% CI -2.48 to -1.17, I2=0%, 3 studies [104 patients]), and 2-months post-surgery (MD -1.96, 95% CI -3.67 to -0.26, I2=84%, 3 studies [104 patients]). There was no effect on pain at 6 and 12-months post-surgery. Ten studies reported no major differences in adverse events between PMS and control groups. Discussion/Conclusions : Our findings suggests that PMS is effective at reducing postoperative pain up to 2 months post-surgery. Results are limited by heterogeneity and small sample sizes. Larger trials are needed to identify the definitive effects of PMS in the perioperative period. Peripheral magnetic stimulation in the treatment of postoperative pain: A systematic review and meta-analysis Stephanie Park MSc a , Rex Park MD b , Duncan Westwood BA b,c , Massieh Moayedi PhD d,e,f and James S. Khan M.D MSc b,c a Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; b Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; c Mount Sinai Hospital, Toronto ON, Canada; d Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, ON, Canada; e University of Toronto Centre for the Study of Pain, Toronto, ON, Canada; f Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada Introduction/Aim : Management of postoperative pain continues to be a major challenge. There is a pressing need for novel therapies that are both safe and effective. One promising modality is peripheral magnetic stimulation (PMS). Here, we aimed to systematically review the effects of PMS on postoperative pain management. Methods : MEDLINE, CENTRAL, EMBASE, ProQuest Dissertations, and HYPERLINK “ http://clinicaltrials.gov ” clinicaltrials.gov  were searched up to May 2021. We included studies of any design with (1) patients ≥18 years, (2) undergoing any surgery, (3) had PMS within the perioperative period and (4) assessed for postoperative pain outcomes. We conducted a meta-analysis of RCTs if ≥2 trials reported pain outcomes at the same follow-up. Results : Eighteen studies (17 RCTs, 1 nonrandomized) were included and we found that PMS was more effective than controls within the first 7 postoperative days (mean difference [MD] -1.64 on a 10-point numerical rating scale, 95% confidence interval [CI] -2.08 to -1.20, I2=77%, 6 studies [231 patients]), 1-month post-surgery (MD -1.82, 95% CI -2.48 to -1.17, I2=0%, 3 studies [104 patients]), and 2-months post-surgery (MD -1.96, 95% CI -3.67 to -0.26, I2=84%, 3 studies [104 patients]). There was no effect on pain at 6 and 12-months post-surgery. Ten studies reported no major differences in adverse events between PMS and control groups. Discussion/Conclusions : Our findings suggests that PMS is effective at reducing postoperative pain up to 2 months post-surgery. Results are limited by heterogeneity and small sample sizes. Larger trials are needed to identify the definitive effects of PMS in the perioperative period.