Comprehensive Pain Research Articles

Interprofessional Pain Curriculum for an Academic Health Science Center

AIMThe aim of this project is to develop a comprehensive pain curriculum to educate a diverse group of students across health care disciplines who care for those in pain. The outcome goals for participants of this educational program are to have increased knowledge and skills associated with the management of pain. This poster will describe the process of team development, development of the grant proposal, conducting a gap analysis, designing and developing the content of the program, and finally the integration of technology as we prepare for program delivery. METHODSThe team developing the program include representatives from the disciplines of nursing, physical therapy, social work, and psychology. The curriculum is based on the Interprofessional Pain Curriculum developed by the International Association for the Study of Pain. Holographic technology will be used to optimize participant engagement and interest. Additional modes of content delivery include synchronous video meetings, asynchronous discussions, and the use of case studies in both modes, all completed in multidisciplinary teams. RESULTSContent has been developed and loaded into a Canvas course shell. Delivering parts of the program via hologram technology will be recorded within the next 3 months. CONCLUSIONSThis content will be delivered to student groups in the Spring 2023 semester during an Interprofessional Education (IPE) event focused on the management of pain. Health disciplines represented at the IPE event will include Medicine, Nursing, Physical Therapy, Psychology, Social Work, and Pharmacy. Outcome assessments related to knowledge, beliefs and attitudes about pain from IPE participants will be collected. Based on that data, further tweaking of the education program will be considered. ACKNOWLEDGEMENTThis project was made possible through funding from the Elizabeth Morse Genius Foundation, Grant number: AWD00001443

Efficacy of non-pharmacological interventions to reduce pain in children with sickle cell disease: A systematic review.

Pain is the clinical hallmark of sickle cell disease (SCD) leading to hospitalization, psychological sequelae and a decreased health-related quality of life. The aim of this systematic literature review is to evaluate the efficacy of non-pharmacological interventions in reducing sickle cell related pain in children with SCD. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive literature search up until October 2022 was performed to identify studies that investigated the efficacy of non-pharmacological interventions on (1) pain frequency and/or intensity, and (2) analgesic and health service use in children with SCD until the age of 21. Both randomized controlled trials (RCTs) and quasi-experimental designed (QED) studies were considered for inclusion. Ten articles (five RCTs and five QED studies) with 422 participants were included. They investigated cognitive behavioural therapy (CBT) (n=5), biofeedback (n=2), massage (n=1), virtual reality (n=1) and yoga (n=1). The majority of the interventions were psychological (n=7) and were performed in the outpatient clinic (n=6). CBT and biofeedback significantly reduced frequency and/or intensity of SCD-related pain in outpatient settings, while virtual reality and yoga significantly reduced pain in inpatient settings. Biofeedback also significantly reduced analgesic use. None of the included articles reported reduced health service use. Non-pharmacological interventions may be effective in reducing pain in paediatric patients with SCD. However, due to the heterogeneity of the included studies a quantitative analysis could not be performed. Awaiting further supporting evidence, healthcare providers should consider implementing these interventions as valuable part of a comprehensive pain management strategy plan.

The study of nurses’ knowledge and attitudes regarding pain management and control in emergency departments

BackgroundGiven the importance and pivotal role of nurses in pain management and control, this study was conducted to determine the nurses’ knowledge and attitudes toward in emergency departments.MethodsThis study was designed and conducted as a descriptive-analytical cross-sectional study. Nurses’ attitude and knowledge towards pain management and control and relationship between their demographic characteristics have been assessed. Nurse Attitude Survey (NAS) and Pain management and control principles assessment Test (PMPAT) questionnaires were used.ResultsTotally 400 volunteers, including 148 (37.2%) male and 250 (62.8%) female nurses recruited from 23 hospitals in East Azerbaijan, Iran, with a mean age of 30.88 years (± 6.04 SD) and age range between 22 and 53 years old. The crude mean score of participants’ knowledge of pain management and control was 12.51 (± 2.77 SD), and standardized mean score was 40.34 (± 8.92 SD), which was low at 84.8% and moderate in 15.3% of the participants. Older nurses and nurses who previously participated in pain retraining courses had significantly less knowledge about pain management and control (r= -0.104, P = 0.038), and (r= -0.148, P = 0.003) respectively. The crude mean score of participants’ attitudes toward pain control and management was 15.22 (± 2.56 SD), and standardized mean score was 60.87 (± 10.26 SD). Nurses’ attitudes have become more negative with the increase of their work experience (r = -0.168, P = 0.001), and previously participation in pain retraining courses (r =-0.207, P < 0.001). Older nurses and highly educated nurses had significantly more negative attitudes towards pain control and management (r = -0.153, P = 0.002), and (r= -0.126, P = 0.005), respectively.ConclusionsThe current study revealed that pain management and control knowledge in most emergency nurses was low, and most of them had a moderate attitude. We need more scientific and comprehensive pain management and control training courses to improve knowledge and attitude among health workers and nurses.

A Qualitative Examination of Opioid Sparing Anesthesia Practices Among CRNAs

PurposeThe purpose of this study was to examine the experiences of CRNAs using opioid sparing techniques in their perioperative anesthesia practice. DesignThis study used a qualitative descriptive methodology. MethodsSemistructured individual interviews were conducted with Certified Registered Nurse Anesthetists who use opioid sparing anesthesia in their clinical practice in the United States. FindingsSixteen interviews were completed. Thematic network analysis revealed two major themes: (1) perioperative benefits of opioid sparing anesthesia and (2) prospective benefits of opioid sparing anesthesia. Perioperative benefits described include reduction or elimination of postoperative nausea and vomiting, superior pain control, and improved short-term recovery. Prospective benefits described include higher surgeon satisfaction, superior surgeon-managed pain control, increased patient satisfaction, reduction of opioids in the community, and awareness of positive prospective benefits of opioid sparing anesthesia. ConclusionsThis study highlights the significance of opioid sparing anesthesia and its role in comprehensive perioperative pain control, reduction of opioids in the community, and patient recovery beyond the postanesthesia care unit.

Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients

ObjectivesCentral neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP. MethodsWe evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location. ResultsWe included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non- neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 μV ±464 μV) than non-neuropathic (478 ±489) and no-pain (765 μV ± 880 μV) patients, p < 0.001. Short-interval intracortical inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6±11.6) compared to no-pain (0.8±0.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allodynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses. DiscussionCNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to provide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.

Oral Health-Related Quality of Life among Chinese Chronic Orofacial Pain Patients with Psychological Health Problems: A Moderated Mediation Model.

Psychological therapies are important for comprehensive chronic orofacial pain (COFP) treatment. This study is to validate the effects of psychological factors on oral health-related quality of life (OHRQoL) among COFP patients in China. Pain catastrophizing, which is a subjective cognitive emotion used to manage the psychological aspects of pain among COFP patients, was examined in relation to COFP severity and OHRQoL. All 479 participants were recruited in Changsha, Hunan Province, China. Cronbach's alpha coefficients (0.868-0.960), composite reliability scores (0.924-0.969), and average variance extracted from each construct (0.555-0.753) all indicated a good model fit. Pearson's correlation analysis showed that age and education status have a positive correlation with COFP severity, pain catastrophizing, and anxiety. COFP severity was related to anxiety, depression, and COFP-OHRQoL. Pain catastrophizing was related to employment status. Anxiety and depression symptoms indirectly mediated the correlation between COFP severity and COFP-OHRQoL. As a second-stage moderator, pain catastrophizing moderated the mediating effects of anxiety symptoms and depression symptoms. Our findings suggest that anxiety, depression, and pain catastrophizing should be evaluated jointly to improve COFP-OHRQoL among COFP patients. This evidence will help therapists to comprehensively treat patients for the best treatment effect.

Neonatal pain assessment: Do we have the right tools?

The assessment and management of neonatal pain is crucial for the development and wellbeing of vulnerable infants. Specifically, neonatal pain is associated with adverse health outcomes but is often under-identified and therefore under-treated. Neonatal stress may be misinterpreted as pain and may therefore be treated inappropriately. The assessment of neonatal pain is complicated by the non-verbal status of patients, age-dependent variation in pain responses, limited education on identifying pain in premature infants, and the clinical utility of existing tools. We review research surrounding neonatal pain assessment scales currently in use to assess neonatal pain in the neonatal intensive care unit. We performed a systematic review of original research using PRISMA guidelines for literature published between 2016 and 2021 using the key words "neonatal pain assessment" in the databases Web of Science, PubMed, and CINAHL. Fifteen articles remained after review, duplicate, irrelevant, or low-quality articles were eliminated. We found research evaluating 13 neonatal pain scales. Important measurement categories include behavioral parameters, physiological parameters, continuous pain, acute pain, chronic pain, and the ability to distinguish between pain and stress. Provider education, inter-rater reliability and ease of use are important factors that contribute to an assessment tool's success. Each scale studied had strengths and limitations that aided or hindered its use for measuring neonatal pain in the neonatal intensive care unit, but no scale excelled in all areas identified as important for reliably identifying and measuring pain in this vulnerable population. A more comprehensive neonatal pain assessment tool and more provider education on differences in pain signals in premature neonates may be needed to increase the clinical utility of pain scales that address the different aspects of neonatal pain.

The Pain Medicine Curriculum Framework-structured integration of pain medicine education into the medical curriculum.

Medical practitioners play an essential role in preventing pain, conducting comprehensive pain assessments, as well as promoting evidence-based practices. There is a need for the development of innovative, interprofessional and integrated pain medicine curricula for medical students. The Pain Medicine Curriculum Framework (PMCF) was developed to conceptualise a purposeful approach to the complex process of curriculum change and to prioritise the actions needed to address the gaps in pain medicine education. The PMCF comprises four dimensions: (1) future healthcare practice needs; (2) competencies and capabilities required of graduates; (3) teaching, learning and assessment methods; and (4) institutional parameters. Curricula need to meet the requirements of registration and accreditation bodies, but also equip graduates to serve in their particular local health system while maintaining the fundamental standards and values of these institutions. The curriculum needs to connect knowledge with experience and practice to be responsive to the changing needs of the increasingly complex health system yet adaptable to patients with pain in the local context. Appropriate learning, teaching and assessment strategies are necessary to ensure that medical practitioners of the future develop the required knowledge, skills and attitudes to treat the diverse needs of patients' experiencing pain. The historical, political, social and organisational values of the educational institution will have a significant impact on curriculum design. A more formalised approach to the development and delivery of a comprehensive pain medicine curriculum is necessary to ensure that medical students are adequately prepared for their future workplace responsibilities.

Optimising the Distribution of Multi-Cycle Emergency Supplies after a Disaster

In order to achieve rapid and fair distribution of emergency supplies after a large-scale sudden disaster, this paper constructs a comprehensive time perception satisfaction function and a comprehensive material loss pain function to portray the perceived satisfaction of disaster victims based on objective constraints such as limited transport, multimodal transport and supply being less than demand, and at the same time considers the subjective perception of time and material quantity of disaster victims under limited rational conditions, and constructs a multi-objective optimisation model for the dispatch of multi-cycle emergency supplies by combining comprehensive rescue cost information. For the characteristics of the proposed model, based on the NSGA-II algorithm, generalized reverse learning strategy, coding repair strategy, improved adaptive crossover, variation strategy, and elite retention strategy are introduced. Based on this, we use the real data of the 2008 Wenchuan earthquake combined with simulated data to design corresponding cases for validation and comparison with the basic NSGA-II algorithm, SPEA-II and MOPSO algorithms. The results show that the proposed model and algorithm can effectively solve the large-scale post-disaster emergency resource allocation problem, and the improved NSGA- II algorithm has better performance.

Surgical Patients' Attitudes, Norms, and Behaviors Regarding Pain.

The study purpose was to examine the attitudes, norms, and behaviors of surgical patients of different ethnic/cultural backgrounds regarding pain and pain management. The study was a descriptive qualitative study guided by the Theory of Planned Behaviors and the Theory of Transcultural Nursing. The sample consisted of 12 postoperative patients on a surgical observation unit within 48 hours of surgery. The results indicated the majority of patients expected to feel pain after surgery and wanted pain to be treated completely. However, overall, pain indicates that something is wrong. Patients expect nurses to assess their pain frequently, view the pain site, and to act promptly to relieve pain, otherwise they feel ignored. Patients had limited knowledge about the pharmacological treatments, and prefer to combine medications with non-pharmacologic and complementary therapies. The clinical implications indicate the expectation of a comprehensive postoperative pain assessment, and education regarding pharmacological, non-pharmacological, and complementary pain treatments.

The use of wearable technology in a comprehensive chronic pain management programme

Technology is increasingly used to promote physical activity and reduce sedentary behaviour in the general population, but the possibility of using it to support physical activity in chronic pain patients is still sparse. Physical activity is crucial for improving quality of life of chronic pain patients. However, long-term physical activity goals widely depend on pain perception, actual or anticipated pain exacerbation, and lack of confidence when doing physical activity. We aimed to determine whether wearable technology can improve management of chronic pain. Full protocol of this 8-week clinical trial is available in the Clinical Trials Registry (NCT 03837080). In short, chronic pain patients enrolled in the 4-week multidisciplinary chronic pain management programme wore fitness wristbands during the 4-week programme (0-4 weeks) and during the follow-up (4-8 weeks). Fitness wristbands measured physical activity and sleep patterns. Additionally, anthropometric measurements and psychological condition of patients (by using Pain Catastrophizing Scale and Depression, Anxiety and Stress Scale – 21 Items questionnaires) was measured. The number of steps and average time of activity per day increased, as well as deep sleep time per day but without reaching statistical significance. Significant improvements in waist circumference and waist-to-hip ratio and waist-to-height ratio with longer deep sleep time were found. No significant correlation was found between physical activity, sleep quality and psychological characteristics or catastrophizing. By wearing fitness wristbands, patients feel actively involved in their chronic pain management. In a clinical/research setting, wristbands provide better, continuous oversight of patient’s progress end enables tailoring of individualized strategies. However, the use of wristbands requires some level of IT knowledge, and sudden malfunctions of the wristband and/or the software can be expected. Additionally, some individual characteristics (i.e., demographics, psychosocial factors, lack of motivation) can also be obstacles to their use.

Recognising Signs of Pain in Horses: A Checklist for Horse Owners and Caregivers

The recent publication of comprehensive equine pain and discomfort ethograms, such as the Equine Discomfort Ethogram,1 have the potential to be used as a management tool to improve the rate of diagnosis of mild acute and chronic conditions by enabling horse owners to better recognise indicators of pain in their animals. Ensuring that horses are not experiencing pain or discomfort is an important welfare consideration.2 In a study by World Horse Welfare (Horseman, et al., 2022), unresolved stress and pain behaviour was identified as one of the highest-priority welfare concerns for domestic horses in the U.K. due to poor recognition of pain indicators amongst the equestrian population.3 A template for an observation-based record can equip a horse owner or caregiver with the tools to monitor their horse during standard non-ridden activities and could help to identify behavioural changes which may be driven by underlying pain or discomfort which is not yet diagnosed. The resulting portfolio of credible evidence of possible pain indicators can be presented to a vet or other professional and may help to better direct where investigations might begin with the overall aim of producing a more effective, targeted and therefore positive outcome for both horse and owner. The template is designed specifically for the observation of horses during day-to-day husbandry (i.e., non-ridden activities) and is based on the Equine Discomfort Ethogram by Catherine Torcivia and Sue McDonnell. This particular ethogram was chosen because it is the most comprehensive catalogue of behaviours affecting the whole body rather than just those seen in the face or while ridden.

The use of wearable technology in a comprehensive chronic pain management programme

Technology is increasingly used to promote physical activity and reduce sedentary behaviour in the general population, but the possibility of using it to support physical activity in chronic pain patients is still sparse. Physical activity is crucial for improving quality of life of chronic pain patients. However, long-term physical activity goals widely depend on pain perception, actual or anticipated pain exacerbation, and lack of confidence when doing physical activity. We aimed to determine whether wearable technology can improve management of chronic pain. Full protocol of this 8-week clinical trial is available in the Clinical Trials Registry (NCT 03837080). In short, chronic pain patients enrolled in the 4-week multidisciplinary chronic pain management programme wore fitness wristbands during the 4-week programme (0-4 weeks) and during the follow-up (4-8 weeks). Fitness wristbands measured physical activity and sleep patterns. Additionally, anthropometric measurements and psychological condition of patients (by using Pain Catastrophizing Scale and Depression, Anxiety and Stress Scale – 21 Items questionnaires) was measured. The number of steps and average time of activity per day increased, as well as deep sleep time per day but without reaching statistical significance. Significant improvements in waist circumference and waist-to-hip ratio and waist-to-height ratio with longer deep sleep time were found. No significant correlation was found between physical activity, sleep quality and psychological characteristics or catastrophizing. By wearing fitness wristbands, patients feel actively involved in their chronic pain management. In a clinical/research setting, wristbands provide better, continuous oversight of patient’s progress end enables tailoring of individualized strategies. However, the use of wristbands requires some level of IT knowledge, and sudden malfunctions of the wristband and/or the software can be expected. Additionally, some individual characteristics (i.e., demographics, psychosocial factors, lack of motivation) can also be obstacles to their use.

Nonpharmacologic Pain Management for Patients in Ambulatory Extended Recovery After Minimally Invasive Gynecologic and Urologic Surgery.

To determine the effectiveness of an evidence-based postoperation nonpharmacologic pain management bundle for patients recovering from minimally invasive gynecologic and urologic surgeries. This study focused on patients recovering from minimally invasive gynecologic and urologic surgery at a comprehensive cancer center. The first cohort consisted of patients three months preimplementation (n = 96) and the second consisted of those three months postimplementation (n = 86). The project used a pre- and postintervention design and deployed the bundle as a nursing order. Nurses and patients were educated about the bundle and comprehensive postoperation pain management strategies. Postimplementation, the documented use of nonpharmacologic pain management interventions significantly increased and postoperation opioid use significantly decreased without negatively affecting pain scores or lengths of stay. Nonpharmacologic pain interventions can decrease the need for postoperation opioids, and ordering a bundle of interventions alongside analgesia is an effective way patients can manage pain.

Distinct Worst Pain Profiles in Oncology Outpatients Undergoing Chemotherapy.

While pain is a significant problem for oncology patients, little is known about interindividual variability in pain characteristics. The aims of this study were to identify subgroups of patients with distinct worst pain severity profiles and evaluate for differences among these subgroups in demographic, clinical, and pain characteristics and stress and symptom scores. Patients (n = 934) completed questionnaires 6 times over 2 chemotherapy cycles. Worst pain intensity was assessed using a 0- to 10-point numeric rating scale. Brief Pain Inventory was used to assess various pain characteristics. Latent profile analysis was used to identify subgroups of patients with distinct pain profiles. Three worst pain profiles were identified (low [17.5%], moderate [39.9%], severe [42.6%]). Compared with the other 2 classes, severe class was more likely to be single and unemployed and had a lower annual household income, a higher body mass index, a higher level of comorbidity, and a poorer functional status. Severe class was more likely to have both cancer and noncancer pain, a higher number of pain locations, higher frequency and duration of pain, worse pain quality scores, and higher pain interference scores. Compared with the other 2 classes, severe class reported lower satisfaction with pain management and higher global, disease-specific, and cumulative life stress, as well as higher anxiety, depression, fatigue, sleep disturbance, and cognitive dysfunction scores. Unrelieved pain is a significant problem for more than 80% of outpatients. Clinicians need to perform comprehensive pain assessments; prescribe pharmacologic and nonpharmacologic interventions; and initiate referrals for pain management and psychological services.

Interprofessional pain management for adults with substance use disorders through an academic-community partnership

The high prevalence of chronic pain and the relationship between pain self-management and dependence on substances necessitates exposing health care practitioners to opportunities that incorporate comprehensive interprofessional pain assessment, management, and intervention strategies as part of their clinical training. The Student Health Outreach for Wellness (SHOW), a multi-university interprofessional education and practice organization, aimed to provide these meaningful interprofessional experiences for the current and future healthcare workforce while concurrently addressing needs in the local community. This curricular resource describes how SHOW partnered with Crossroads Inc. To create a model of interprofessional academic-community partnership that provided community-based direct patient care and health promotion services, including non-pharmacological approaches to interprofessional pain management, to adults living with substance use disorders (SUDs) in residential treatment facilities. By year two of this grant funded project, this partnership model improved resident experiences of care and population health measures, expanded services at reduced cost, developed interprofessional skills for faculty and students through collaborative integrated team-based care, and resulted in post-graduation employment in SUDs and the development of an integrated state licensed clinic.

Perioperative pain control represents the primary concern for patients considering outpatient shoulder arthroplasty: a survey-based study.

Outpatient (OP) total shoulder arthroplasty (TSA) with same-day discharge can now be performed safely in appropriately selected patients. Patient knowledge and perspectives regarding OP TSA are yet unknown and such information may inform surgeon decision-making and provide a framework for addressing patient concerns. The goal of this study was to understand and quantify patient knowledge of and concerns for OP TSA, with a working hypothesis that majority of patients are unaware of OP TSA as a realistic option and that their primary concern would be postoperative pain control. This was a retrospective cohort study at a tertiary care academic medical center including patients who underwent anatomic or reverse shoulder arthroplasty and completed an OP TSA expectations questionnaire/survey. This survey was provided preoperatively and included demographic factors, self-rated health evaluation, and perioperative expectations. Surveys evaluated whether patients undergoingTSA had any prior awareness of OP TSA and evaluated their primary concern with same-day discharge. Secondary questions included an assessment of patient expectations of outcomes of outpatient vs. inpatient surgery as well as their expected length of inpatient stay. A total of 122 patients who underwent anatomic and reverse shoulder arthroplasty completed the questionnaire and comprised the study cohort. Fifty-two (42.6%) of the patients were unaware that OP TSA was an option, and 26 (50%) of these were comfortable with the idea of OP TSA. Comfort with OP TSA was significantly associated with higher subjective patient-reported health status. Fifty-eight patients (47.5%) expected that following TSA they would require <24 hours of in-hospital postoperative care. The primary concern for patients considering OP TSA was postoperative pain control, endorsed by 44.3% of patients, compared with 13.1% of patients stating this would be their primary concern if admitted as an inpatient postoperatively. Pain control being a primary concern was significantly different between those considering outpatient vs. inpatient TSA. Most patients anticipated that OP shoulder arthroplasty would lead to a better (36%) or comparable (53%) outcome, whereas only 11% had concerns that it would lead to a worse outcome. Expanding OP TSA crucially depends on awareness and education. Perceived ability to control pain is an importantconcern. Patients may benefit from preoperative counseling, including emphasizing a comprehensive postoperative pain management strategy.

Communication tools and strategies for interprofessional teamwork in a comprehensive pain assessment clinic in primary care

The Comprehensive Pain Assessment Clinic (CoPAC) is a grant-funded clinic embedded in a family medicine residency center providing care to an under-resourced urban population. This interprofessional clinic brings together 10 professions, including healthcare professionals, university faculty, and learners to assess patients with chronic pain. The focus of the clinic is to develop a functional and dynamic model of teamwork including communication strategies to facilitate assessment. The communication/teamwork tools and strategies include pre-visit preparation sheets, pre-visit team huddles, “teamlet” visits, handoff communication tools, care plan development, patient education, follow-up care coordination, and post-clinic debriefs, which are used for continuous quality improvement. The process model for the clinic, communication tools, and qualitative comments from learners are described. Lessons learned are discussed, including time management, intentional mentoring, interprofessional education and collaborative practice (IPECP) coordination, and implementation of best practices.

The Lived Experience of Pain Following a Spinal Cord Injury: A Qualitative Thematic Analysis

<h3>Objective(s)</h3> To synthesize the findings of qualitative studies examining the lived experience of pain following spinal cord injury (SCI). <h3>Data Sources</h3> CINAHL, Cochrane, Medline, ProQuest, PsychInfo, and Web of Science were searched from 1980 until 2021, excluding studies not available in English. Reference lists of selected studies were hand searched to source additional articles. <h3>Study Selection</h3> Eligible qualitative studies focused on the lived experience of pain, as reported by adult individuals with SCI. Only studies including the first-person narrative of living with a SCI were included. A total of 427 articles were screened, of which 68 articles were read in full, resulting in a final selection of 19 studies based on inclusion criteria. <h3>Data Extraction</h3> Using qualitative thematic synthesis methodology, data (author interpretations and quotes) from each included article were coded line-by-line to develop descriptive and analytical themes by two investigators. Characteristics of the studies and sample participants were also extracted. <h3>Data Synthesis</h3> Three overarching themes emerged with respect to the lived experience of pain: (1) characteristics of pain (i.e., augmenters, descriptors, distribution, onset, patterns, type) (2) physical and psychosocial impacts of pain (e.g., activities of daily living, interpersonal, or vocational consequences), and (3) pain management modalities (i.e., pharmacological and non-pharmacological interventions). As pain is a subjective experience, participants outlined varying descriptions of the nature of pain. Despite this variation, pain was reported as physically, psychologically and socially debilitating, impacting everyday life. Pain management was identified as a priority, although participants felt that their pain was often not being adequately managed. <h3>Conclusions</h3> The findings from this study uncovered the unique experience of pain among individuals' following SCI, which may be useful to health care professionals and family members. Importance should be placed on listening to the patient's experience, shifting the focus from pain relief to needs-based, comprehensive pain management. <h3>Author(s) Disclosures</h3> The authors have no conflicts to disclose.

Behavioral Health, Telemedicine, and Opportunities for Improving Access.

The purpose of this review is to summarize advances in behavioral treatments for pain and headache disorders, as well as recent innovations in telemedicine for behavioral treatments. Research for behavioral treatments continues to support their use as part of a multidisciplinary approach to comprehensive management for pain and headache conditions. Behavioral treatments incorporate both behavioral change and cognitive interventions and have been shown to improve outcomes beyond that of medical management alone. The onset of the COVID-19 public health emergency necessitated the rapid uptake of nontraditional modalities for behavioral treatments, particularly telemedicine. Telemedicine has long been considered the answer to several barriers to accessing behavioral treatments, and as a result of COVID-19 significant progress has been made evaluating a variety of telemedicine modalities including synchronous, asynchronous, and mobile health applications. Researchers are encouraged to continue investigating how best to leverage these modalities to improve access to behavioral treatments and to continue evaluating the efficacy of telemedicine compared to traditional in-person care. Comprehensive pain and headache management should include behavioral treatments to address a variety of behavior change and cognitive targets. Policy changes and advances in telemedicine for behavioral treatments provide the opportunity to address historical barriers limiting access.