Book of Abstracts

Professor Winfried Hauser Medical Center Pain Medicine and Mental Health Saarbrücken - St. Johann Abstract The role of cannabis-based medicines (CbMs) for the management of chronic pain is under debate, with conflicting conclusions from systematic reviews and recommendations from medical associations. I will argue that it is necessary to differentiate between different types of CbMs, e.g. THC-dominant, CBD-dominant, THC/CBD-balanced or synthetic cannabinoids versus full spectrum cannabis extracts. Lumping all types of CbMs in a quantitative analysis, as the Neuropathic SPIG of the IASP did recently, underestimates the potential of THC-dominant and THC/CBD-balanced medicines for the management of chronic neuropathic pain. I will justify this statement by a Cochrane review on CbMs for chronic neuropathic pain which will be published in February 2026. In addition, the significance of systematic reviews of randomised controlled trials of CbMs for chronic pain is limited because most studies included had small sample sizes and a short study duration. I will present two recent European studies with an oral THC-dominant full spectrum cannabis extract in patients with chronic low back pain. One study included 820 patients in a double-blind 12-week treatment phase compared to placebo, a 6-month open-label extension, followed by either a 6-month continuation or randomized withdrawal. The other study included 384 patients and compared during 24 weeks of double - blind treatment against opioids. Based on the findings of the studies, I will discuss the potential role of this medication in the management of chronic low back pain. Finally, I will give a short overview of the availability of CbMs for the management of chronic pain in European countries and will outline some obstacles for physicians to prescribe CbMs in Germany. At the end of this session, participants will be able to : Recognize there are different types of cannabis-based medicines that differ in their efficacy to reduce pain and pain-related symptoms. Evaluate reasons for conflicting conclusions of systematic reviews and recommendations from medical associations on cannabis-based medicines for chronic pain. Consider the use of cannabis-based medicines based on the dominant mechanism (nociceptive, neuropathic, nociplastic, mixed types) of pain and the non-pharmacological therapies available. Recognize there are different types of cannabis-based medicines that differ in their efficacy to reduce pain and pain-related symptoms. Evaluate reasons for conflicting conclusions of systematic reviews and recommendations from medical associations on cannabis-based medicines for chronic pain. Consider the use of cannabis-based medicines based on the dominant mechanism (nociceptive, neuropathic, nociplastic, mixed types) of pain and the non-pharmacological therapies available. Plenary Learning and Brain Plasticity in the Development and Persistence of Chronic Pain: Differential Mechanisms an Implications for Patient-Tailored Treatment Professor Herta Flor Central Institute of Mental Health, Mannheim Heidelberg University Abstract There is ample evidence that learning mechanisms such as sensitization, learning about reward and punishment or emotional learning related to appetitive and aversive stimuli are altered in subacute and chronic pain and predict chronicity. These behavioral mechanisms are related to changes in structure, function and connectivity in many brain regions such as the primary somatosensory cortex, insula, prefrontal, orbitofrontal and striatal networks. We discuss how these mechanisms differ between early and later stages of clinical pain and propose to differentially target these mechanisms in a patient-specific manner using assessment batteries with behavioral and neurobiological biomarkers. We propose modular interventions that involve, for example, sensory or sensorimotor training, brain-based interventions, virtual and augmented reality applications, extinction and exposure training, pharmacologically aided behavioral and cognitive interventions and digital ecological interventions based on individual patient profiles. At the end of this session, participants will be able to: Outline learning mechanisms that contribute to pain chronicity. Define core brain regions involved in risk for pain chronicity. Recognize novel mechanistic interventions for chronic pain. Outline learning mechanisms that contribute to pain chronicity. Define core brain regions involved in risk for pain chronicity. Recognize novel mechanistic interventions for chronic pain. Plenary Insights into neuropathic pain mechanisms from human tissue studies Professor Theodore (Ted) Price University of Texas Abstract Dr. Price’s talk will focus on his lab’s and the PRECISION Human Pain Network’s work on human dorsal root ganglion (DRG), peripheral nerves, and spinal cord tissues obtained from either rare surgeries or organ donors. The focus will be on comparing control tissues to those with clear medical histories of chronic neuropathic pain disorders like painful diabetic neuropathy. Dr. Price will present evidence that human nociceptors become hyperexcitable in these conditions, exhibiting spontaneous electrical activity even after days in culture. He will link these physiological findings to -omic and biochemical studies that give insight into the mechanisms that cause these effects in humans and how we might target them with therapeutics. He will also highlight evidence demonstrating that neuropathic pain in humans is often accompanied by neuronal degeneration in the DRG that primarily affects certain kinds of sensory neurons. Collectively, these findings will give the audience a new insight into why patients have neuropathic pain and how new treatments might be able to target the underlying cause of the disease. At the end of this session, participants will be able to : Explore factors that may underlie spontaneous activity in nociceptors of humans suffering from neuropathic pain. Recognize how non-neuronal cells like satellite glia and adipocytes produce ligands that act on sensory neurons within the the DRG to cause pathology in neuropathic pain. Identify that painful diabetic neuropathy is associated with wide-spread neuronal degeneration in the DRG that might be linked to the production of pain. Explore factors that may underlie spontaneous activity in nociceptors of humans suffering from neuropathic pain. Recognize how non-neuronal cells like satellite glia and adipocytes produce ligands that act on sensory neurons within the the DRG to cause pathology in neuropathic pain. Identify that painful diabetic neuropathy is associated with wide-spread neuronal degeneration in the DRG that might be linked to the production of pain. Hot Topics Presentations Session Chair: Bradley Kerr University of Alberta Learning Objectives At the end of this session, participants will be able to: Describe the latest research in pain mechanisms and clinical care; and Critique and evaluate emerging topics in pain research. Pain - Universally Experienced, Unevenly Distributed Jax Norman 1 , Matthew Fillingim 1 , Christophe Tanguay-Sabourin 2 , Azin Zare 1 , Lindsay Neuert 1 , Gianluca Guglietti 1 , Etienne Vachon-Presseau 1 1 McGill University, 2 Université de Montréal Introduction : While pain represents a leading cause of global disability, its burden is not equally distributed. Marginalized populations consistently report higher pain prevalence, yet most research remains thematically and geographically siloed. This study leverages data from 10 international cohorts (n=1.28 million) to examine how multiple dimensions of identity, including race/ethnicity, sex/gender, sexuality, caste, immigration status, and rurality, shape pain experiences globally. Methods : This study used a two-stage harmonized consortium approach across 10 cohorts. In stage one, we create weighted logistic regression models within each cohort to examine associations between marginalization status and pain outcomes (general pain and burdensome pain defined as multisite, moderate/severe, or chronic). In stage two, we will use Multilevel Analyses of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to examine the intersectional effects of different dimensions of identity. Results : Across cohorts, socially disadvantaged groups consistently demonstrated greater odds of experiencing pain, especially for more burdensome pain phenotypes. For example, in the Longitudinal Aging Study in India (LASI), participants living in rural areas and participants from Scheduled Castes were significantly more likely to report experiencing multisite pain (OR=1.48 [1.37-1.60]; OR=1.14 [1.06-1.23]). Similar results were found in the Chinese Health and Retirement Longitudinal Study (CHARLS), where women and participants from ethnic minority groups were significantly more likely to report experiencing multisite pain (OR=1.83 [1.62-2.06]; OR=1.81 [1.50-2.20]). Analyses of the other cohorts are forthcoming. Discussion/Conclusions : These initial findings support the hypothesis that marginalization, regardless of its specific form, transduces into pain, with intersecting identities potentially compounding the odds of experiencing pain. At-home blood collection for proteomic and transcriptomic analysis of chronic pain Mara Majer 1 , Oliver Schott 2 , Doriana Taccardi 1 , Hailey Gowdy 1 , Vina Li 1 , Amanda Zacharias 1 , Élisabeth Lamoureux 3 , M. Gabrielle Pagé 3, 4, 5 , Hanno Steen 2 , Nader Ghasemlou 1, 6 1 Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada, 2 Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States, 3 Department of Psychology, Université de Montréal, Montreal, Quebec, Canada, 4 Centre hospitalier de l’Université de Montréal (CHUM) Research Center, Montreal, Quebec, Canada, 5 Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada, 6 Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada Introduction : Pain intensity is variable between people and within individuals across the day. Circadian (24-hour) rhythms influence RNA and protein expression in the healthy state and across diseases. Whole blood samples are commonly used to detect disease biomarkers. Our group recently identified circadian rhythmicity in immune cell numbers and whole-blood RNA in people with chronic low back pain (cLBP). Venipuncture was used for this analysis; however, this method is costly and complicates the implementation of repeated sampling protocols. Thus, there is a need for efficient, minimally invasive ways of collecting blood; we used dried blood spots (DBS) as a potential solution. Methods : To investigate whether daily changes in RNA and protein levels can be captured using DBS, two commercially available devices were tested in 23 participants. Collection kits were sent via mail for participants to complete blood collection up to six times across 48 hours, for a total of 251 samples. Results : Liquid chromatography-mass spectrometry was conducted with >1,400 proteins included for analysis. A harmonic regression model identified eight proteins with significant regression coefficients (FDR<0.01), indicating a potential rhythmic expression pattern. RNA extraction shows limited quantity (average total RNA per blood spot = 486 ng, SEM = 47.8) and quality (average A260/280 = 1.52, SEM = 0.02), though we continue optimizing protocols. Discussion/Conclusion : Implementing these blood collection tools in people with cLBP to assess potential rhythmic biomarkers is underway. Our methodological development has the potential to revolutionize pain research by facilitating more efficient collection of biological samples across multiple timepoints. Solace, a Therapeutic Conversational Agent for Management of Chronic Pain: Acceptability and Usability Study Stephanie Buryk-Iggers 1 , P. Maxwell Slepian 1,2,3,4 , Anna Lomanowska 1 , Binh Nguyen 2 , Tahir Janmohamed 2 , Hance Clarke 1,2,3,4 , Joel Katz 1,2,3,4,5 , Nils Niederstrasser 6 1 Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, 2 ManagingLife, Inc., Toronto, ON, 3 Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, 4 University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, 5 Department of Psychology, York University, 6 School of Psychology, Sport, and Health Sciences, University of Portsmouth Background : Access to efficacious treatment for chronic pain is limited by geography, economics, and scale. Digital health interventions offer an easily scaled solution. Whereas autonomous conversational agents powered by generative artificial intelligence (AI) represent a new frontier in this treatment domain, they have yet to be developed or examined for treatment of chronic pain. Objectives : We sought to develop and test Solace, a first-of-its-kind, expert trained generative AI conversational agent, delivering support grounded in principles of evidence-based pain psychology. Methods : We conducted an acceptability and usability study of Solace in individuals with chronic pain. Participants (n=175) interacted with Solace for 25 minutes. Self-report measures of system usability, treatment acceptability, and therapeutic alliance were completed after the interaction and clinically relevant pain related measures were completed before and after the interaction. Safety guardrails designed to identify and manage instances of suicidal ideation, injury, or requests for medication recommendations performed appropriately. Results : Participants rated the usability of Solace to be excellent (System Usability Scale, mean = 85.04) and that Solace is acceptable as an intervention for chronic pain. Therapeutic alliance between participants and Solace was rated highly (Working Alliance Inventory, mean = 188.03). Participants demonstrated statistically significant improvements in anxiety, pain interference, kinesiophobia, and pain resilience ( p’s <0.02). Discussion/Conclusion : Solace is a usable and acceptable expert-trained generative AI conversational agent for pain management. Its use is associated with improvements in clinically relevant domains. Randomized clinical trials are needed to evaluate the efficacy of Solace as a strategy for treatment of chronic pain. Characterization of IL-1R1+ nociceptors in pain associated with neuroinflammation Dominic Bélanger 1, 2 , Camille Illiano 1, 2 , Nicolas Vallières 2 , Nadia Fortin 2 , Steve Lacroix 1, 2 1 Département de médecine moléculaire, Faculté de médecine, Université Laval, Québec, QC, Canada, G1V 0A6, 2 Axe neurosciences, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada, G1V 4G2 Introduction : Pain affects about 20% of adults worldwide, and its prevalence exceeds 50% among patients with inflammatory autoimmune diseases such as multiple sclerosis. Painful signals are transmitted from the periphery to the spinal cord and brain via the dorsal root ganglia (DRGs), where nociceptors reside. Interleukin-1β (IL-1β) is a proinflammatory cytokine capable of independently triggering both inflammation and pain, yet the neuronal subtypes mediating its effects remain poorly defined. Methods : Confocal immunofluorescence microscopy was used to characterize the expression of the interleukin-1 receptor type 1 (IL-1R1) in mouse and human DRGs. Spatial transcriptomics and single-cell RNA sequencing (scRNA-Seq) were integrated to define the molecular identity of IL-1R1+ nociceptors. Behavioral analyses were conducted in C57BL/6J mice and IL-1R1-deficient mice following intra cisterna-magna (i.c.m.) administration of IL-1β to assess the contribution of the IL-1β/IL-1R1 signaling pathway to pain. Results : IL-1R1 was found to be highly expressed in a distinct subpopulation of TRPV1+ nociceptors, representing approximately 5-10% of all DRG neurons in both species. Transcriptomic analyses revealed that IL-1R1+ neurons correspond to a subset of non-peptidergic type 3 (NP3) small-diameter, unmyelinated sensory neurons previously associated with inflammation-induced itch. However, deletion of Il1r1 did not affect itch behaviors triggered by inflammatory mediators such as serotonin, histamine, or chloroquine. In contrast, i.c.m. IL-1β injection selectively upregulated several genes within the NP3 population, many of which are implicated in pain. Discussion/Conclusion : This study identifies IL-1R1+nociceptors as a distinct neuronal subset involved in neuroinflammation-induced pain and reveals novel molecular markers that link IL-1 signaling to pain mechanisms. “CARING in Action”: A Knowledge Mobilization Case Report on Communication Training for Chronic Pain Care Doriana Taccardi 1 , Nataly R Espinoza Suarez 2 , Swapnil Shah 3 , Jennifer Daly-Cyr 3 , Annie LeBlanc 2, 4, 5 , Nader Ghasemlou 1, 6, 7 , Lynn Cooper 3 , Rachael Bosma 8, 9 , Rachel Roy 3 1 Department of Biomedical & Molecular Sciences, Queen’s University, Kingston, Canada, 2 VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Québec, 3 Chronic Pain Network, McMaster University, Ontario, Canada, 4 Knowledge Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA, 5 Faculty of Medicine, Laval University, Quebec, Canada, 6 Department of Anaesthesiology & Perioperative Medicine, Queen’s University, Kingston, Canada, 7 Centre for Neuroscience Studies, Queen’s University Kingston, Canada, 8 Centre for the Study of Pain, University of Toronto, 9 Toronto Academic Pain Medicine Institute, Women’s College Hospital Introduction : Communication gaps between clinicians and people with lived and living experience (PWLLEs) persist as a major barrier to effective, patient-centered care. Supporting the education of clinicians is essential to improving patient satisfaction and the overall experience of care for both clinicians and PWLLEs. The CARING framework was co-created to address this gap in pain management and communication in pain care. Methods : CARING in Action was a collaborative project hosted by the Chronic Pain Network’s (CPN) Training and Capacity Building Committee. This work took place from August 2024 to May 2025 via a “Hack-a-thon” project that brought together approximately 25 participants, including PWLLEs of chronic pain, trainees, clinicians, knowledge brokers, and pain researchers, to form interprofessional teams through iterative, virtual and in-person workshops that emphasized consensus-building, inclusivity, and validation. Results : The co-creation process produced an eight-module educational resource structured around six principles summarized by the acronym CARING: Connect, Ask, Respect, Inform, Nurture, and Generate trust. Each module integrates testimonials, reflective exercises, and practical communication examples. This aligns with the national priorities for chronic pain knowledge mobilization and with the recommendations of the Action Plan for Pain in Canada, developed by the Canadian Task Force. Discussion/Conclusions : CARING in Action exemplifies a patient-oriented knowledge mobilization approach that bridges research, clinical practice, and lived experience. By embedding co-created narratives and theory-informed pedagogy, this initiative lays the groundwork for transforming pain communication education and promoting equity, empathy, and patient partnership in chronic pain care across Canada. This work is supported by CIHR-IMHA and CIHR-SPOR-CPN. Investigation of Transcriptomic Changes in the Anterior Cingulate Cortex in a Mouse Model of Chronic Neuropathic Pain Ana Leticia Simal 1 , Xinrun Liu 1 , Ian Tobias 1 , Giannina Descalzi 1 1 University of Guelph Introduction : Chronic pain impacts 25% of Canadians aged 15 and above, disproportionately impacting women, who constitute 67% of individuals with chronic pain. Despite this, preclinical research has historically used male rodents. Neuropathic pain, one of the most devastating subtypes of chronic pain, afflicts up to one-third of those experiencing persistent pain. The anterior cingulate cortex (ACC) is believed to be a hub for pain-induced long-term changes, with studies showing neuroplastic changes in the ACC rapidly after injury. Understanding the mechanisms involved in pain in the ACC and the biological processes driving the transition from acute to chronic pain are essential for improving diagnosis and treatment. This study investigated differential gene expression (DGE) in the ACC of female and male mice using the spared nerve injury (SNI) model of neuropathic pain. Methods : Adult (8 weeks old) C57BL/6 female and male mice underwent SNI and sham surgery. Mechanical allodynia was assessed using the Von Frey test before injury, and prior to ACC sample collection at 5, 14, 30, and 60 days post-injury. Bulk RNAseq was employed, and DGE analysis of SNI over sham was performed using DESeq2. Results : Despite comparable levels of mechanical allodynia in response to SNI, RNAseq analysis (p 0.5) revealed distinct sex-dependent transcriptional patterns over time. Discussion/Conclusions : These findings indicates that neuropathic pain induces sexually dimorphic transcriptional changes in the ACC, highlighting the importance of including both females and males in chronic pain research to better understand the molecular mechanisms underlying pain chronification.

Session Title: Conversations about the biopsychosocial model of pain: Barriers, facilitators, and experiences from clinical practice Session Chair: Cynthia Thomson University of the Fraser Valley Session Abstract A significant evidence-to-practice-gap remains with respect to treating pain through a biopsychosocial lens. Definitions for pain long ago shifted away from the biomedical model that associates pain with tissue damage, to a model that views pain as a dynamic exchange between our biology, thoughts, emotions, social factors, and relationships. Owing largely to societal misconceptions, many people hold strong beliefs that pain is primarily associated with structural and physical abnormalities, thus perpetuating a fear of movement leading to increased disability and lower quality of life. Further, providers cite patient expectations for biomedically focused treatments as a barrier to adhering to the clinical guidelines. Shifting public and provider understanding towards a multifactorial conceptualization of pain has potential to increase acceptance of self-management practices like education, cognitive behavioural therapy, and movement as first-line treatments. We will present recent findings that explore: 1) patient-reported views on psychosocial treatments and perspectives from pain psychology, 2) how to talk about the complexities of pain in a patient-centred way, and 3) share experiences from a program to guide providers towards a biopsychosocial treatment approach. At the end of this session, participants will be able to: Describe barriers and facilitators to applying the biopsychosocial model of pain to practice. Explain why sharing knowledge about the biopsychosocial model is critical to promote uptake of psychosocial strategies for pain management. Summarize effective knowledge translation approaches that support sustainable practice change and that may support a patient-centred dialogue about the complexities of chronic pain. Explain why sharing knowledge about the biopsychosocial model is critical to promote uptake of psychosocial strategies for pain management. Summarize effective knowledge translation approaches that support sustainable practice change and that may support a patient-centred dialogue about the complexities of chronic pain. Speaker One Title: If you build it, who will come? Intentions to attend online psychosocial interventions for pain Susan Holtzman University of British Columbia Okanagan Abstract Introduction: A biopsychosocial approach to pain care optimizes treatment outcomes. In recent years, pain education and psychosocial supports are increasingly offered online to decrease barriers to access. However, engaging with these services requires an awareness of, and openness to, a holistic approach to pain care. The current study examined intentions to engage with psychosocial services for chronic pain, with a key goal of identifying factors that may facilitate and prevent engagement with these services. Methods: Individuals (n = 996) receiving outpatient care from a pain clinic completed a survey inquiring about physical and mental health. Participants were also asked about their likelihood of accessing online pain education and pain management programs via the clinic and barriers to doing so. Results: Approximately three-quarters of participants did not intend to engage with the clinic’s free online pain education and support services. Notably, 20% did not think these resources would help their pain. Men were over two times more likely to endorse this belief, and this finding was not accounted for by gender differences in pain, loneliness, or mental health concerns. On the other hand, people with fibromyalgia expressed a greater interest in psychosocial supports but were more likely to report pain and fatigue as barriers to participation. Discussion/Conclusions: Findings highlight the need for enhanced communication between clinicians and people with lived experienced with pain (PWLE) regarding the potential benefits of pain education and psychosocial supports, and for tailoring those conversations, and the services themselves, to meet the diverse needs and preferences of PWLE. Speaker Two Title: Let’s talk about pain! Interest holder engagement to inform the co-development of a toolkit to support the introduction of the biopsychosocial model of pain Cynthia Thomson University of the Fraser Valley Abstract Introduction: Clinical guidelines recommend treating chronic pain using a biopsychosocial model (BPSm), yet the biomedical model remains dominant and public knowledge of the BPSm is low. Many people understand that pain is complex, but to our knowledge, patient-centred ways to introduce the BPSm have not been explored. Our study series identified patient and provider recommendations to inform the co-development of an implementation bundle aimed at supporting patient-centred knowledge sharing of the BPSm of pain. Methods: We facilitated two focus groups studies: Study 1 with people living with persistent pain (n = 21) and Study 2 with health care professionals (n = 26). Each employed reflexive thematic analysis to identify themes, followed by researcher and data triangulation. Results: We identified several convergent themes that pertained to the current state of knowledge (or lack thereof), the predominance of the biomedical model, and the importance of listening to the individual’s story. We highlight barriers and facilitators related to knowledge delivery and knowledge reception to inform toolkit development. Interest holders described a need for both active and passive knowledge exchanges with patient-facing resources (e.g., posters, videos, pamphlets) to “plant the seeds” in combination with clinician-facing resources to support conversations with the patient. Discussion/Conclusions: Our results confirmed knowledge gaps, identified key messages, and potential techniques to support knowledge sharing. The value of BPSm knowledge sharing was evidenced by the “hope” and “agency” patients described following the exchanges. Shifting the public understanding towards a multifactorial conceptualization of pain can increase the acceptance of self-management practices. Speaker Three Title: Implementing the Biopsychosocial Model: Driving Innovative Pain Care Transformation in Resource-Limited Settings Ahmad Qayyam Alberta Health Services Abstract Introduction: Chronic pain is a leading cause of disability, and allied health therapists play a key role in its management. Treating pain using a biopsychosocial approach is considered best practice for chronic pain management. This session highlights the importance of integrating the biopsychosocial model into practice particularly in resource-limited settings and demonstrates how therapists can lead scalable, evidence-informed, and patient-centered care that improves access, outcomes, and system-level impact. Methods: We implemented an initiative that integrated the biopsychosocial model into rural public physiotherapy and occupational therapy outpatient practice to improve chronic pain care in limited-resource settings (50 providers, 20 sites). Guided by evidence-based principles from the IASP, national pain frameworks and research on rural knowledge translation, the program focused on enhancing clinical reasoning, provider confidence, and continuity of care. Implications: Our team developed structured training, clinical tools, a triage system, and a community of practice to support ongoing learning and sustainability. Allied health leadership supported the shift in paradigm through stakeholder engagement, knowledge translation and practice innovation. Our program reinforces the role of therapists as leaders in delivering innovative, evidence-based chronic pain care, especially in rural and resource-limited settings. By embedding the biopsychosocial model into daily practice, physiotherapists and occupational therapists can advance equitable, evidence-based care while contributing to health system resilience and sustainability. The project also highlights the profession’s expanding role in health system transformation, education, and patient-centered care delivery. The session is relevant to clinicians, managers, educators, and health system leaders interested in advancing equitable, evidence-based pain care. Session Title: Going Deeper: Arts-based Research Approaches to Chronic Pain Session Chair: Heather Noga University of British Columbia Session Abstract Arts-based research approaches have recently become integrated into chronic pain (CP) research. Arts-based research, in various contexts beyond the field of CP, has proven to be an effective approach for facilitating communication, building researcher-participant relationships and deepening our understanding of people’s lived experiences with illness. Arts-based research presents a unique opportunity for widespread knowledge translation and relatable content is developed by people with lived and living experience (PWLLE) for PWLLE. This symposium will focus on the rational for art-based research and its potential application in CP research specifically. We will demystify a wide range of artistic approaches including digital storytelling, photovoice and painting. We will examine the value of arts-based research, not only as a research methodology, but also for its therapeutic potential and its effectiveness as a strategy for knowledge translation. Through the eyes of PWLLE we will discuss how, at times, pursuing alternative pathways, different traditional research approaches, can provide new perspectives, enrich understanding, and promote meaningful and impactful collaborations. Finally, the panel will address limitations, challenges and considerations for involving people in CP in arts-based research practices. Chaired by H. Noga, a coordinator of arts-based research projects with over 10 years of experience, we will share a range of perspectives in a panel discussion. Our panel will include Dr. Howard, a leading researcher in arts-based methodologies and knowledge translation, K. Penfold, a PWLLE who participated in a digital storytelling project and J. Desrosiers, a trainee who incorporated art workshops into her doctoral research. At the end of this session, participants will be able to: Define art-based approaches and their potential for chronic pain research. Outline key aspects of the lived experience of chronic pain, with a focus on the experience of participating in an arts-based research project. Outline key aspects of the lived experience of chronic pain, with a focus on the experience of participating in an arts-based research project. Address the strengths, limitations, challenges and opportunities of using art in research. Speaker One Title: Arts-based research for exploring the complex and multidimensional experiences of chronic pain Fuchsia Howard University of British Columbia Abstract Introduction: Traditional research methods (e.g., surveys, interviews, focus groups) often capture only the surface of the experiences of chronic pain and typically lead to conventional outputs like scientific publications. Arts-based research fosters co-creation of knowledge and meaningful engagement between researchers and participants, generating untapped insights into chronic pain and its lived realities. These creative approaches may be therapeutic and generate exceedingly rich findings and unique media for knowledge translation. Methods: Our team conducted a scoping review to assess the breadth and scientific potential of arts-based research in chronic pain research. We also applied several arts-based research approaches to explore chronic pain, including Photovoice, where participants conveyed their experiences through photography and narrative reflection, and Digital Storytelling, which used script writing, images and sound to create a personal video. Results: This symposium will provide key insights from our review of 14 studies employing arts-based methods in chronic pain research. We will share Photovoice study findings depicting the experiences of 22 people, visually illuminating experiences of life with endometriosis. Lastly, we will discuss the therapeutic and ethical implications of Digital Storytelling participation, noting that 28/36 people opted to share their story widely. Discussion/Conclusions: Arts-based research practices are not only acceptable scientific methods of knowledge inquiry but also offer highly desirable mediums of research participation for people with chronic pain that open new pathways for understanding, healing, and connection. Speaker Two Title: Finding Connection and Meaning Through Arts-Based Research: Reflections from a Patient Partner Katherine Penfold Person with Lived Experience Abstract Introduction/Aim: This presentation reflects on how arts-based research can create connection and meaning for those living with chronic pain, particularly in the period after medical treatment when visibility and support often fade. Drawing from my experience as a patient partner of The University of British Columbia (UBC) following a hysterectomy, bilateral salpingo-oophorectomy, and nearly 20 years of undiagnosed endometriosis, I explore how creative and collaborative research provided space to process and contribute after the acute phase of my illness had ended. Methods: Through my participation in arts-based workshops with UBC, I engaged in creative practices such as writing, audio, and visual storytelling. These methods supported reflection on identity, loss, and healing, offering language for experiences that clinical frameworks (or the loved ones around me) couldn’t capture. Results: Participating in this work allows me to feel seen within the “after,” a stage where pain has lessened but the emotional and social impact remain. Collaboration with researchers and peers fosters recognition, camaraderie, and a renewed sense of agency in the desperate world of chronic pain. Discussion/Conclusions: This personal account highlights how arts-based research can bridge medical and lived experience. While each participant’s story is unique, creative collaboration offers a powerful way to honour the ongoing process of healing and meaning-making beyond a diagnosis. Speaker Three Title: Painting the Invisible: A Story of Decolonial and Collaborative Research Exploring Indigenous People’s Meanings of Chronic Pain Joséanne Desrosiers Université du Québec en Abitibi-Témiscamingue Abstract Introduction: The prevalence and consequences of chronic pain are not equally distributed across populations. In Canada, Indigenous People are disproportionately affected, with an estimated 38.9% living with chronic pain, the highest prevalence among all population groups. Despite this reality, Indigenous People are often invisible in chronic pain research and face multiples barriers to healthcare access due to systemic racism, discrimination, and persistent stereotypes. Methods: Grounded in these realities and as a part of my doctoral studies, a decolonial, collaborative research project began in spring 2021, involving partners from the Val-d’Or Indigenous Friendship Centre and academic researchers. The objective was to use art workshops to explore the meanings of chronic pain among Anicinapek and Eeyouch participants. Results: In this session, I will describe how this art-based approach, anchored in the knowledge and priorities of Indigenous research partners, helped create a culturally relevant and safe space for sharing meanings of pain to transform research and healthcare practices. Discussion/Conclusions: As a trainee, I will reflect on my experience of exploring a new path through arts-based research, highlighting both the benefits and challenges encountered by our collaborative team. I will also discuss how this approach supported the co-creation of concrete knowledge and tools for partners, participants, and the Centre’s community. Session Title: From Insight to Action: Redesigning Pain Care in the Community Session Chair: Carolyn A. Harrison Patient Partner Session Abstract Biopsychosocial, multimodal pain care has long been recognized as the optimal approach to address the diverse impacts of chronic pain across the lifespan. Yet most people living with chronic pain do not get referred to chronic pain clinics or have long waits to access tertiary care services. Therefore, the majority of pain care takes place in community settings. Patient and provider perspectives are powerful drivers of innovation in pain care. These perspectives do more than describe problems, they offer essential evidence for redesigning care and building more responsive, equitable systems. This symposium will explore how understanding pain care from multiple levels, the patient experience, the clinician experience and system processes and information flow, can guide meaningful change. Presentations will offer multidisciplinary perspectives from three provinces (British Columbia, Alberta, and Saskatchewan) using research and clinical/health systems data and experience about the role of primary and community-based pain management. Specifically, they will highlight how patient and caregiver journey mapping can inform new care pathways, how we need to address clinician training and education, and how these insights can be mobilized into concrete practice and policy reforms. By engaging with health system leaders and advocacy organizations, we can strengthen how health care provider knowledge and system-level strategies are aligned, ensuring that clinicians across primary care are equipped to meet the complex needs of people living with pain. Together, we can move from insight to action, shaping a health system that truly responds to those it serves. At the end of this session, participants will be able to : Interpret patient and family journey maps as a strategy to understand lived experience perspectives on navigating chronic pain care in the community and identify how these insights can inform more equitable and person-centred care pathways. Describe process mapping as a tool for primary care health system design that integrates patient and provider experiences with chronic pain. Identify common gaps in knowledge and challenges faced by providers in navigating and delivering pain care and explore approaches to enhance provider capacity to educate and support patients living with chronic pain. Interpret patient and family journey maps as a strategy to understand lived experience perspectives on navigating chronic pain care in the community and identify how these insights can inform more equitable and person-centred care pathways. Describe process mapping as a tool for primary care health system design that integrates patient and provider experiences with chronic pain. Identify common gaps in knowledge and challenges faced by providers in navigating and delivering pain care and explore approaches to enhance provider capacity to educate and support patients living with chronic pain. Speaker One Title: Journeys Through Chronic Pain Care: Mapping Family Experiences in Community-Based Settings Megan MacNeil University of Calgary, University of Alberta Abstract Introduction/Aim: Most youth and families living with chronic pain receive care in primary and community settings rather than specialized clinics. Understanding their journeys is essential for shaping care that is timely, equitable, and responsive. This presentation examines how journey mapping can make visible family experiences and needs, and how these insights can guide knowledge mobilization and engagement processes to strengthen primary care pathways. Methods: Patient journey mapping was co-developed with youth with chronic pain and their caregivers across Canada (n=18) through semi-structured interviews and collaborative map validation. Qualitative analysis identified touchpoints with providers, barriers and facilitators to care, and the influence of social determinants of health such as geography, income, and school or work demands. Results: Journey maps revealed recurring challenges in how families accessed and navigated pediatric chronic pain care in primary and community settings. Families frequently described cycles of repeated visits, diagnostic investigations, and delays in connection to biopsychosocial supports. These patterns were shaped by gaps in provider knowledge, lack of coordinated pathways, and broader structural factors. Families also described moments when supportive providers validated their experiences and improved navigation. Discussion/Conclusions: Family journeys highlight how chronic pain care in primary and community settings is influenced by provider knowledge, care coordination, and structural barriers linked to social determinants of health. Current models of primary care often lack the team-based, interdisciplinary approaches known to support evidence-informed pain management. This presentation will demonstrate how journey mapping can generate insights to strengthen coordination, provider preparedness, and equity in community-based pain care. Speaker Two Title: Pathways and possibilities: Process mapping for health system co-design of primary care pain management Susan Tupper Saskatchewan Health Authority Abstract Introduction/Aims: People living with pain may receive care across multiple service lines including primary care, acute or surgical services, emergency or urgent care, physician specialists, community-based multidisciplinary providers, homecare, and tertiary pain clinics. Process mapping is a tool to improve healthcare quality, efficiency, and user experience. By engaging patients and families, community interest holders, multidisciplinary healthcare providers, and operational decision-makers in process mapping, we make visible the individual steps of pain care, barriers to workflow, wastes, and redundancies. In session two of this symposium, the Saskatchewan experience of process mapping to co-design patient navigation for chronic pain in primary care will be described. Methods: Seven primary care health networks in Saskatchewan and their community partners were engaged in patient journey mapping and health services process mapping. Champions from these networks are engaged in working groups to co-design new tools, resources, and patient navigation processes for primary care chronic pain management. Results: New tools identified for development include screening tools and guidelines, provincial routing maps, triage tools, pathways to guide primary care decision making, and geo-mapping of pain management resources. To demonstrate process mapping for health system co-design, symposium participants will be invited to take part in a rapid-fire interactive mapping activity. Discussion/Conclusions: Primary care is the foundation of pain management. Health system design is required to ensure care navigation and treatment supports are in place and operational for people living with pain throughout their healthcare journey. Speaker Three Title: Redesigning Pain Care: Building Competence, Confidence, and Connection Across Disciplines Tori Etheridge University of British Columbia Abstract Introduction/Aim: Nearly every health care provider will encounter people living with pain, yet many continue to feel underprepared to deliver effective, evidence-informed care. This presentation shares findings from a provincial engagement initiative that explored the experiences and learning needs of clinicians working in chronic pain care across British Columbia. Methods: Pain Care BC engaged over 100 clinicians and conducted six focus groups with 29 professionals from physiotherapy, occupational therapy, nursing, mental health, and chiropractic care. Discussions examined clinician preparedness to work in pain, access to training and mentorship, knowledge gaps, onboarding experiences, and the competencies needed for effective interdisciplinary pain care. Results: Most pre-licensure programs offer minimal pain education, and there are currently no standardized interdisciplinary competencies to guide practice, resulting in wide variation in clinician confidence, knowledge, and quality of care across the province. Key themes from the focus group revealed notable variability in clinician preparedness, access to mentorship, and confidence in delivering pain care. Participants identified multiple barriers that limit consistency and quality of care across disciplines and practice settings Discussion/Conclusion: By identifying these educational and systemic gaps, this initiative is informing a coordinated, province-wide effort to formalize pain care competencies and strengthen professional development. The goal is to move beyond physician-centered models toward an integrated, team-based approach that builds capacity across disciplines, creating a more connected, confident, and responsive health care system for people living with chronic pain. Session Title: Chronic craniofacial/orofacial pain: Perspectives from Dental Professionals and Patients Session Chair: Sripriya Jayaraman Mount Sinai Hospital Session Abstract Healthcare professionals are no strangers to acute and chronic pain conditions; dentistry is no different. In a typical dental office, patients present for care for a wide variety of reasons. Chief among the reasons is pain from odontogenic (teeth and gums) origin. These pains are managed in a short order by manipulating teeth (like root canal treatment or extractions) and supporting structures (for instance abscess drainage by mucosal incision). Besides odontogenic pain there exist a plethora of other pain states including mucocutaneous disorders encountered in a dental office that result in acute and chronic non-odontogenic/mucocutaneous pain. Chronic orofacial pain typically requires multidisciplinary approach. This lecture takes a bird’s eye view of some of the common etiologies of orofacial pain, along with diagnostic and management considerations. A strong emphasis is placed on integrating medicine, dentistry and allied health professionals. We hope to bring it all together by listening to a person with lived experience. At the end of this session, participants will be able to: Familiarize themselves with the complex nature of orofacial and craniofacial facial pain. Outline the role of oral and maxillofacial surgeons. Appreciate how social determinants of health can impact pain patients’ experiences of pain and their ability to access resources. Appreciate how social determinants of health can impact pain patients’ experiences of pain and their ability to access resources. Title: Potpourri of Orofacial Pains Speaker One Sripriya Jayaraman Mount Sinai Hospital Abstract Toothache or even face pain conjures up visions of painful root canal treatments and/ or extractions. But, what if the pain felt in the tooth is caused by sources outside the dento-alveolar structures? This lecture takes a panoramic view of non odontogenic causes of teeth/face pain with a particular stress on integrating dentistry with medicine and allied health professionals. At the end of this presentation, participants will be able to: Elucidate the different causes of orofacial pain Clarify the roles of dental and medical professionals in treating these complex conditions Foster interprofessional communication and collaboration for better patient outcomes Title: Surgical Management in Temporomandibular Pain Speaker Two Ross Linker Private Practice Abstract Temporomandibular joint (TMJ) disorders are a broad category of chronic pain conditions affecting millions of people worldwide. Management of these patients’ pain symptoms often requires multidisciplinary integration between physicians, dentists and other healthcare professionals. Within the scope of treatment, oral and maxillofacial surgeons have a distinct role. Oral surgeons can perform a range of procedures for treatment of temporomandibular dysfunction ranging from intra-articular steroid injections to total joint replacements. Furthermore, they can help distinguish temporomandibular pain from pathological mimics. In this lecture, I will discuss temporomandibular arthrocentesis and its role in treating temporomandibular dysfunction. I will also talk about other surgical treatments for more complex TMJ pathologies. Finally, I will briefly address intraoral pathology and the oral surgeon’s role in distinguishing these lesions from TMJ conditions. At the end of this presentation, participants will be able to: Recognize the role of oral surgeons in management of temporomandibular pain Know several surgical options for management of temporomandibular pain Understand that pain in the TMJ may be caused by other intra oral issues Title: Chronic orofacial pain: a patient’s journey in navigating this complex world Speaker Three Chloe Foisy-Marquis Person with Lived Experience Abstract My entry into this world began three years ago with a nagging, growing pain in my jaw and neck area. Within 6 months I was completely incapacitated, unable to work and in too much pain to perform basic tasks. I sought out several public and private treatment options and was eventually referred to oral and maxillofacial surgery service for pain alleviation. This took me on a years-long journey from diagnosis, to coping, to pain management modalities. This talk offers a view of my ongoing journey into this complicated world navigating different professionals, therapies, hopes and fears. My reflections are informed by my professional experience as a social worker however this talk is rooted in my experience as a patient navigating orofacial pain resources. The talk will also include a glimpse about my privileges and lack thereof along with some recommendations for better patient outcomes. At the end of this presentation, participants will be able to: Appreciate the intricate world of orofacial/craniofacial pain from a patient point of view Better understand the need for inter professional collaboration Receive suggestions for better outcomes from a patient’s standpoint Session Title: Percutaneous Epidural Adhesiolysis for Chronic Low Back and Lumbosacral Radicular Pain: Comparative Effectiveness of Conventional Catheter Technique Versus Balloon Assisted Epidural Decompression. The Evolving Role of Patient Cloning AI and Immersive Digital Twin for Spine Interventions. Session Chair: Yuvaraj Kotteeswaran NOSM University Session Abstract Chronic refractory low back pain with or without lower extremity pain that does not resolve after conservative therapy or even surgical treatment can present a therapeutic dilemma with limited options for proper management. Low back and lower extremity pain recalcitrant to conservative management and epidural injections may be secondary to post surgery syndrome, spinal stenosis, and disc herniation. Disc herniation and spinal stenosis are often managed with surgical interventions and post-surgery syndrome may also be managed with repeat surgical interventions or implantable therapies. However, for those patients who are not responsive to or candidates for surgical interventions and/or have not adequately responded to epidural injections, percutaneous adhesiolysis may be an option. Epidural steroid injections have been used extensively in managing low back and lower extremity pain. While results of studies of epidural injections continue to be debated and differ, the proportion of patients who failed to respond to epidural steroid injections are candidates for percutaneous epidural adhesiolysis. Causes of chronic radicular pain include mechanical compression of nerve roots, as well as different proinflammatory substances that trigger ectopic neuron firing. The mechanism described in percutaneous adhesiolysis is the combined effect of local lavage of proinflammatory cytokines, reduction of swelling, lysis of adhesions, desensitization and modification of neuromodulation, and local anesthesia. The presence of epidural adhesions may be diagnosed with magnetic resonance imaging (MRI), followed by epidurography based on filling defects. These filling defects by epidurography are minimized in size after successfully performing epidural lysis of adhesions. Conventional epidural adhesiolysis techniques are broadly classified into chemical adhesiolysis using hypertonic saline and mechanical adhesiolysis using steerable catheters. Although these approaches often yield short-term analgesic benefits, functional improvement has generally been limited. Spinal epidural balloon decompression was developed to overcome this challenge in treating spinal stenosis and post lumbar surgery syndrome. Balloon decompression can achieve more extensive adhesiolysis by expanding the marginal space surrounding the affected nerve root, potentially achieving superior neural decompression, improved walking tolerance, enhanced functional recovery, and reduced need for repeat procedures in selected patient populations. The impact of these therapies including indication and benefits will be addressed at the symposium along with the implications for cost and adverse events. In parallel, the session will explore the transformative potential of Patient Cloning AI and Immersive Digital Twin for spine intervention. Current image-guided procedures rely primarily on two-dimensional fluoroscopic visualization. However, these approaches present inherent limitations in difficult scenarios, including the misalignment between the operator’s hand movements and the direction of visual attention toward the monitor, as well as difficulties in achieving an intuitive three-dimensional understanding of internal anatomy. To address these challenges, we present newer techniques and strategies for developing artificial intelligence models and demonstrate their application to volumetric medical imaging in spine intervention. The integration of patient cloning AI and immersive digital twins represents a frontier in precision interventional spine care. At the end of this session, participants will be able to: • Describe the pathophysiological mechanisms underlying epidural fibrosis and chronic low back and lower extremity pain. • Review of literature on the efficacy and complications of percutaneous epidural adhesiolysis in managing chronic low back and lumbosacral radicular pain. • Review of clinical experience of the efficacy, durability of response, and complication of spinal epidural balloon decompression. Title: Spinal Epidural Balloon Decompression and Adhesiolysis Speaker One Jin-Woo Shin University of Ulsan and Asan Medical Center Abstract Balloon decompression and adhesiolysis is an advanced interventional technique designed to overcome the limitations of conventional epidural nerve blocks and traditional neuroplasty in patients with severe epidural adhesions or lumbar foraminal stenosis. Standard nonsurgical treatments often provide only short-term relief due to mechanical barriers and impaired epidural drug distribution. In a randomized controlled trial of patients with intractable lumbar foraminal stenosis unresponsive to transforaminal epidural steroid injections, balloon dilatation combined with steroid injection produced significantly greater pain reduction and functional improvement than catheter insertion alone. Clinical benefits were sustained for 3–4 months, and 18.8% of patients maintained more than 50% pain relief for over one year. Three-dimensional contrast analysis demonstrated significant expansion of the foraminal marginal space after balloon dilatation, supporting its mechanical decompressive mechanism. Based on these findings, the ZiNeu balloon-inflatable neuroplasty catheter was developed to enhance mechanical adhesiolysis while minimizing neural injury and enabling targeted drug delivery. Since 2013, 18 SCI(E)-indexed publications have supported this technique. The procedure is currently used in Singapore, Australia, Thailand, Italy, Malaysia, and Hong Kong, and its international adoption continues to expand. This lecture will address clinical indications, technical considerations, and practical applications in refractory spinal disorders. Title: Patient Cloning AI and Immersive Digital Twin for Spine Interventions. Speaker Two Jae Chul Koh Korea University College of Medicine. Abstract This lecture will be delivered from within an immersive extended reality (XR) environment rather than a conventional presentation setting. Instead of viewing static slides, the audience will observe a live demonstration in which I explore a digital clinical space and performing AI-generated pain procedures in real time. Pain procedures require precise instrument placement guided by imaging modalities such as fluoroscopy and ultrasound. However, two-dimensional visualization limits intuitive three-dimensional understanding and demands extensive operator experience. To address these challenges, I combined my background in pain medicine and computer science to develop AI- and XR-based solutions. First, I present a Patient Cloning AI system that automatically extracts and segments anatomical structures from CT and MRI volumetric data, transforming radiodensity and signal-based datasets into semantically meaningful anatomical models. Second, I introduce an immersive digital twin platform that enables one-click patient cloning and real-time procedural simulation. Within this environment, vascular puncture produces simulated bleeding, spinal access reveals cerebrospinal fluid, and intra-procedural X-ray images are dynamically generated according to instrument position. This session will demonstrate how AI-driven volumetric modeling and immersive visualization can expand the future of training and procedural practice in pain medicine. Session Title: The Evolution of Transitional Pain Services – 10 Years in Review Session Chair: Max Slepian University of Toronto Session Abstract Chronic Post Surgical Pain accounts for one quarter of patients presenting to chronic pain clinics. Patients who develop chronic post-surgical pain are at increased risk for persistent opioid use. Ontario data demonstrates that 50% of patients are discharged with opioid analgesics following major surgery and 3% of previously opioid-naïve patients continue to take these medications 6 months later. Significant gaps in the continuity of care after major surgery are responsible for unrelieved pain, hospital re-admissions, and ongoing opioid use among complex pain patients discharged without appropriate follow-up plans or care, and without pain specialists able to manage their postsurgical pain and/or successfully wean them from opioid medications. Transitional Pain Services have now been adopted in several major Canadian centres and internationally in the United States, Norway, UK, and Australia. At the end of this session, participants will be able to: • Provide an overview of the evolution of Transitional Pain Services over the past 10 years. • Gain an appreciation of the PWLE perspective who manage their complex pain, mental health and sometimes, substance use. • Outline the differences between the US and Canadian models and experience a glimpse into the future of Transitional Pain Programs. Title: The Experience of being cared for by a Transitional Pain Service Speaker One Graham Lord Person With Lived Experience Abstract Mr. Graham Lord will describe his person journey follow a major motor vehicle accident. Mr. Lord had brachial plexus avulsions of his C5, 6, 7 & 8 nerve roots, a fractured radius and fractured vertebrae. He will tell an unfortunately common story of entering into an overreliance on medications and substances in general. He was desperate and he will then describe when his trajectory started to change for him upon the intersection with the Toronto General Hospital Transitional Pain Program. His story is one of hope and triumph. Title: The Evolution of Transitional Pain Services: The American Perspective Speaker Two Marie Hanna Johns Hopkins Hospital Abstract Dr. Hanna will discuss the evolution of Transitional Pain Services and describe her successful creation of her perioperative pain program at Johns Hopkins. She will present data looking at both pain and opioid related outcomes. Dr Hanna perioperative transitional pain program has borne witness to glimmers of hope amidst the current opioid epidemic. Every patient in the program represents a success story in weaning opioids even in the most stressful period. These programs effectively reduced opioid usage without negatively influencing patient-reported outcomes, such as physical pain score and health-related quality of life Title: Transitional Pain Services: The Canadian Perspective and next steps Max Slepian Speaker Three University of Toronto Abstract Dr. Slepian will review the evidence for the efficacy of Transitional Pain Services in reducing opioid use in the short and long term after a variety of surgical procedures. He will also describe recent evidence from the TGH-TPS for novel risk factors for CPSP and how these may impact TPS effectiveness. A discussion regarding the integration of digital health technologies and the use of big data to improve outcomes in the years ahead, in addition to recommendations for future research related to the prevention and management of CPSP will be brought forward for discussion.