Pain In Canada Research Articles

Outcomes After Surgery at an Interdisciplinary Centre of Expertise for Endometriosis and Pelvic Pain in Canada: A Prospective Cohort Study

ObjectivesTo prospectively evaluate pain-related quality-of-life (Endometriosis Health Profile-30 [EHP-30] pain subscale) after surgery at an interdisciplinary centre of expertise for endometriosis and pelvic pain. MethodsA prospective cohort study was completed of persons undergoing surgical management for pelvic pain between December 2013 and July 2016 at an interdisciplinary tertiary referral centre for pelvic pain and endometriosis. We compared the change in EHP-30 scores for the following scenarios: (1) type of surgery (conservative surgery vs. hysterectomy), (2) stage of endometriosis (stage I/II vs. III/IV), and (3) age (age <40 vs. age ≥40 years). We used mixed-effects models to evaluate changes in pain during follow-up after surgery. ResultsOverall, 595 individuals met our inclusion criteria; the follow-up rate was 65.9% (392/595). In total, 436 (73.3%) underwent conservative surgery, while 159 (26.7%) underwent hysterectomy. Improvements in pain-related quality-of-life were seen for both conservative surgery and hysterectomy but greater improvements were seen with hysterectomy (P < 0.001). For conservative surgery, similar improvements in quality-of-life were observed regardless of endometriosis stage (I/II vs. III/IV) (P = 0.84) or age (<40 or ≥40 years old) (P = 0.87). We also observed similar improvements in quality-of-life regardless of stage (P = 0.24) or age (P = 0.71) after hysterectomy. ConclusionsAt an interdisciplinary centre of expertise, there were significant improvements in quality-of-life after endometriosis surgery. These improvements were seen for both conservative surgery and hysterectomy (although greater improvement with the latter), for early and advanced stage disease, and younger and older patients.

Ensuring Equity and Inclusion in Virtual Care Best Practices for Diverse Populations of Youth with Chronic Pain.

Poor access to care is a top patient-oriented research priority for youth with chronic pain in Canada, and the COVID-19 pandemic has exacerbated these concerns. Our patient-oriented project team engaged with marginalized and racialized youth with chronic pain (Black youth with sickle cell disease, Indigenous youth and youth with complex medical needs) and their families to ensure that best practice recommendations for virtual care are inclusive and equitable. Input provided through virtual round-table discussions improved recommendations for leveraging, implementing and selecting best platforms for virtual care for youth with chronic pain and identified new gaps for future research, practice and policy change.

Top resources and tools for physician management of chronic pain in the Canadian Armed Forces

LAY SUMMARYDiagnosis and management of chronic pain in Canada by primary care clinicians is a challenging and changing field with new approaches, evidence, and tools emerging in the past few years. For a busy clinician, it is vital to integrate and become aware of new tools that can improve the care delivered to patients. This article summarizes new evidence-based tools, key guidelines and research, algorithms, and simplified prescription practices, in addition to continuous medical education resources that will allow busy clinicians to rapidly be brought up to speed on the latest in chronic pain management in the Canadian military context.

Impact of the Opioid Epidemic and Associated Prescribing Restrictions on People Who Live With Chronic Noncancer Pain in Canada.

Little is known about the consequences of the opioid epidemic on people living with chronic noncancer pain (CNCP). This study examined this issue in people who lived in the most impacted province by opioid overdoses in Canada (British Columbia [BC]) or one of the least impacted (Quebec [QC]), and examined the factors associated with opioid use. This cross-sectional study was carried out in adults living in BC (N=304) and QC (N=1071) who reported CNCP (≥3 months) and completed an online questionnaire that was tailored to their opioid status. Almost twice as many participants in BC as in QC were proposed to cease their opioid medication in the past year (P<0.001). The proportion who reported having hoarded opioids in fear of not being able to get more in the future was also significantly higher in BC (P<0.001) compared with QC. In addition, they were significantly more likely to have had their opioid dose decreased than those in QC (P=0.001). No significant association was found between opioid discontinuation and province of residence. Two-thirds of the BC participants felt that the media coverage of the opioid crisis was very to extremely detrimental to CNCP patients in general, this percentage being significantly higher than in QC (P<0.001). The opioid epidemic and associated prescribing restrictions have had harmful effects on Canadians with CNCP. The clinical community, the general public, and the media need to be aware of these negative consequences to decrease patients' stigmatization and minimize inadequate treatment of CNCP.

Conversations About Opioids: Impact of the Opioid Overdose Epidemic on Social Interactions for People Who Live With Chronic Pain

The objective of this study was to understand the impact of the opioid overdose epidemic on the social lives of people suffering from chronic pain, focusing on interactions within their personal and professional circles. The study was based on 22 in-depth interviews with people living with chronic pain in Canada. Using thematic analysis, we documented three main impacts of the opioid overdose epidemic: (a) increased worries of people in pain and their families regarding the dangers of opioids; (b) prejudices, stigma, and discrimination faced during conversations about opioids; and (c) stigma management attempts, which include self-advocacy and concealment of opioid use. This study represents important knowledge advancement on how people manage stigma and communicate about chronic disease during everyday life interactions. By showing negative effects of the epidemic's media coverage on the social experiences of people with chronic pain, we underscore needs for destigmatizing approaches in public communication regarding opioids.

Partnering For Pain: a Priority Setting Partnership to identify patient-oriented research priorities for pediatric chronic pain in Canada.

Chronic pain affects 1-3 million Canadian children and adolescents and their families. The primary objective of the Partnering For Pain project was to collaboratively identify the top 10 research priorities in pediatric chronic pain. Partnering For Pain took a patient-oriented research approach and followed a modified James Lind Alliance Priority Setting Partnership (PSP) to identify the top research priorities in pediatric chronic pain according to people with lived experience (patients), family members and health care providers (clinicians). The PSP was completed in 4 phases between May and December 2018: 1) national survey of stakeholders, including those with lived experience with pediatric chronic pain, family members and clinicians who treat children with chronic pain, to gather priorities, 2) data processing, 3) interim prioritization by invited patients, family members and clinicians (former research participants or identified through pediatric chronic pain programs, patient partner organizations and steering committee member networks) and 4) in-person priority-setting workshop involving patients, family members and clinicians identified via steering committee networks and partner organizations, with evaluation of patient engagement. The process was led by a national steering committee of patient and parent partners, researchers and clinicians engaged in codesign, analysis and translation of project findings. In phase 1, 215 Canadians (86 patients [40.0%], 56 family members [26.0%] and 73 clinicians [34.0%]) submitted 540 potential priorities that were developed into 112 unique research questions (phase 2). Of the 112 questions, 63 were rated for importance by 57 participants (19 patients [33%], 17 family members [30%] and 21 clinicians [37%]) in phase 3. In phase 4, 20 participants (6 patients [30%], 6 family members [30%] and 8 clinicians [40%]) discussed the 25 most highly rated questions and reached consensus on the final top 10. The final priorities address pediatric chronic pain prevention, impact and treatment, as well as delivery, access and coordination of care. The priorities reflect a directed and collaborative call to action to improve existing pediatric pain research and care. Chronic pain affects 1 in 5 children and teens. This means that 1-3 million Canadian youth deal with pain lasting months to years. This pain gets in the way of being active, sleeping, going to school, and getting along with friends and family. Youth with chronic pain and their families are experts on what it's like to live with pain, but, until now, research has not asked what issues they care about most. The goal of the Partnering For Pain project was to develop a list of the 10 most important things we still need to learn about chronic pain during childhood according to people who live with it, their families and health care providers. We did this in 4 steps: 1) a survey with 215 people who shared 540 concerns they have about chronic pain in childhood, 2) turning those concerns into questions that can be answered by research, 3) a survey with 57 people who ranked how important each research question was and 4) an in-person discussion with 20 people who chose the top 10 research priorities. Each step included Canadians who have had chronic pain during childhood, their families and health care providers. The final top 10 list has questions about how to better prevent and care for children and teens with chronic pain. These priorities make sure that future research focuses on what is most important to people who will use it in their everyday lives. Project video: https://youtu.be/wA-RwrFiSPk. Project website: www.partneringforpain.com.

Paediatric pain education for health care professionals.

Paediatric pain education for health care professionals.

Moving on: Transition experiences of young adults with chronic pain

ABSTRACT Purpose The purpose of this study was to explore the transition experience of young adults with chronic pain in Canada from the pediatric health care setting to the adult health care setting. Materials and Methods A qualitative descriptive approach using semistructured interviews was used to capture the transition experiences of young people with chronic pain who have recently transferred from the pediatric setting to the adult health care setting. Participants were recruited from west, central, and the east coast of Canada to situate the findings within the context of Canada. Interviews were transcribed and analyzed using qualitative inductive content analysis. Results Nine participants were interviewed, three from each part of Canada (west, central, and east). Five common categories were determined to describe the transition experience of young adults with chronic pain which include (1) independence (I can do it, maybe?), (2) pain trajectory (stress and pain along for the ride), (3) social support networks (need a shoulder to lean on), (4) parental support (obviously they are there), and (5) collaborative systems (the bridge). Conclusion Young people with chronic pain experience unique challenges when faced with transitioning to the adult health care setting. Supporting the young person and his or her family in preparation and readiness and collaboration between the pediatric and adult health care settings are essential to ensure a smooth transition and avoid negative transition outcomes. Further research is needed to determine the best ways to prepare young people for transition and the care activities required in both pediatric and adult health care settings to improve pain-related outcomes posttransition.

Pan-Canadian Estimates of Chronic Pain Prevalence From 2000 to 2014: A Repeated Cross-Sectional Survey Analysis

Recent temporal trends in the population prevalence of chronic pain in Canada on a national and provincial level are unknown. Five cycles of the Canadian Community Health Survey (2000/2001, 2007/2008, 2009/2010, 2011/2012, and 2013/2014) were used to derive population-based estimates of the self-reported prevalence of chronic pain. Sensitivity analyses examined chronic pain prevalence among those reporting no other chronic health conditions. The prevalence of chronic pain among the general Canadian population increased by almost 4.0% (to 21.0%) in 2011/2012, after being in the range of 15.7 to 17.2% from 2000 to 2009/2010. The sudden increase in prevalence was observed 1) across all provinces in Canada, 2) in all age categories, and 3) among Canadians with no other chronic health conditions. Increasing chronic pain prevalence in Canada, most significantly occurring between 2010 and 2012, and including among healthy and young individuals, emphasizes the need for targeted research and resources to help alleviate chronic pain. PerspectiveThis study uncovers a significant increase in chronic pain prevalence in Canada between 2009/2010 and 2011/2012, driven by younger Canadians that are free of the most common chronic health conditions. This discovery emphasizes the importance of further directed research and resources to help mitigate the trend of increasing chronic pain.

The cost of pain

Prescription opioid use has historically been a regular component of the management of chronic nonmalignant pain in Canada. However, the economic implications of high rates of addiction and abuse have motivated consideration of more cost-effective management strategies for chronic pain. The economic burden imposed by prescription opioid use relates in part to lost workplace productivity, increased addiction treatment program costs, and increased overall healthcare expenditure for these patients. In this article, we present research on the economic implications of the current rates of opioid prescription, and report on the specific economic advantages realized in alternative therapeutic approaches to pain management.

OP92 Non-Opioid Therapy For Pain Management – Health Technology Assessment In A Time Of Crisis

Introduction:North America is facing a public health epidemic – the opioid crisis – part of which is attributed to the inappropriate use of opioids in pain management. As such, the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain recommends optimizing non-opioid pharmacotherapy or non-pharmacological therapy to treat chronic pain, before a trial of opioids. However, the Guideline itself is not designed to provide evidence on the effectiveness of these non-opioid alternatives, leaving a gap for those attempting to put the recommendation into practice.Methods:In collaboration with its partners, including clinicians and policymakers, the Canadian Agency for Drugs and Technologies (CADTH) identified the gaps in evidence, and developed an action plan to bridge the evidence gaps to support the optimization of non-opioid alternatives in pain management.Results:Since the release of the Guideline, CADTH produced over 20 Rapid Response reports that synthesize and appraise evidence on non-opioid alternatives in the management of a wide range of pain, both acute and chronic. Additionally, CADTH has also reviewed evidence on multidisciplinary pain treatment programs, and is developing environmental scan reports on the availability and access to non-pharmacological treatments for pain in Canada, and on drugs for emerging non-opioid pain. Further, CADTH developed knowledge mobilization tools based on the evidence reviews. The evidence reviews and tools are used as a resource by CADTH partners, including the Coalition of Safe and Effective Pain Management and McMaster University National Pain Center.Conclusions:This presentation will discuss the role of HTA and CADTH to fill the gaps in evidence for a crucial clinical practice guideline recommendation in a time of public health crisis, and help put the evidence into action. It will present the evidence synthesized by CADTH on various non-opioid alternatives for pain management, while highlighting the remaining gaps in evidence. Understanding the evidence on non-opioid alternatives will inform clinical and policy decisions and potentially reduce inappropriate use of opioids in pain management.

Moving on: A survey of Canadian nurses’ self-reported transition practices for young people with chronic pain

ABSTRACT Background Practices to support the transition of a young person from the pediatric to the adult health care setting have been examined for many chronic illness populations. However, specific transition practices to support young people with chronic pain have not been examined. Aim The aim of this study was to describe the current nursing practices used in the pediatric and the adult health care to support transition of young people with chronic pain in Canada. Methods An online survey of pediatric and adult chronic pain nurses’ self-reported transition practices was conducted. Results Twenty-two nurses completed the survey, 10 (45.5%) from the pediatric chronic pain setting and 12 (54.4%) from the adult chronic pain setting. Of the pediatric nurses surveyed none reported using a psychometrically valid tool to assess a young person’s readiness of general transition skills; however, one reported using a tool to assess understanding of chronic pain. Most health care facilities in which these pediatric nurses worked offered a general transition clinic, but only one of these facilities also had a chronic pain transition clinic. Nurses in both settings perceived that young people experience increased levels of distress during transition yet most did not report using formal transition practices in their care. Conclusion Nursing practices and clinic resources to support the transition of young people with chronic pain may not meet the needs of this population. Practices may benefit from the use of psychometrically validated tools to assess general transition preparedness. Research is needed to adapt tools and determine best transition practices for the chronic pain population.

Cannabis for Pain and Headaches: Primer.

Marijuana has been used both medicinally and recreationally since ancient times and interest in its compounds for pain relief has increased in recent years. The identification of our own intrinsic, endocannabinoid system has laid the foundation for further research. Synthetic cannabinoids are being developed and synthesized from the marijuana plant such as dronabinol and nabilone. The US Food and Drug Administration approved the use of dronabinol and nabilone for chemotherapy-associated nausea and vomiting and HIV (Human Immunodeficiency Virus) wasting. Nabiximols is a cannabis extract that is approved for the treatment of spasticity and intractable pain in Canada and the UK. Further clinical trials are studying the effect of marijuana extracts for seizure disorders. Phytocannabinoids have been identified as key compounds involved in analgesia and anti-inflammatory effects. Other compounds found in cannabis such as flavonoids and terpenes are also being investigated as to their individual or synergistic effects. This article will review relevant literature regarding medical use of marijuana and cannabinoid pharmaceuticals with an emphasis on pain and headaches.

Pain Management Strategies and Health Care Use in Community-Dwelling Individuals Living with Chronic Pain.

To describe factors associated with high clinic and emergency room (ER) use among individuals with chronic pain. This study is part of a larger cross-sectional survey on the epidemiology of chronic pain in Canada. The current analysis was guided by the Andersen-Newman Service Utilization Model. Respondents (N = 702) were grouped into high (top 10%) and low (bottom 90%) users based on the number of visits made to clinics and ERs over the past year. The two groups were compared on predisposing (e.g., pain self-efficacy and sociodemographic characteristics), enabling (e.g., income and education), and need (e.g., pain characteristics and number of comorbidities) factors as well as personal health behaviors (e.g., use of medications). Binary logistic regression analysis was used to identify characteristics associated with high use in each setting. High users were defined as 30 or more clinic visits or one or more ER visits. The factors associated with high clinic use in the adjusted analysis were low pain self-efficacy (odds ratio [OR] = 2.60, 95% confidence interval [CI] = 1.50-4.51), two or more comorbidities (OR = 2.13, 95% CI = 1.23-3.69), five or more pain sites (OR = 2.30, 95% CI = 1.28-4.14), and having an "other" pain diagnosis (OR = 1.78, 95% CI = 1.01-3.20). Factors that increased ER use were low pain self-efficacy (OR = 2.01, 95% CI = 1.28-3.15) and two or more comorbidities (OR = 2.31, 95% CI = 1.48-3.59), while use of alternative pain management strategies reduced ER use (OR = 0.42, 95% CI = 0.21-0.84). Longitudinal studies are needed to confirm if modifiable factors such as pain self-efficacy and use of alternative therapies reduce health care use.

Hospital-associated Costs of Chronic Pelvic Pain in Canada: A Population-based Descriptive Study.

To determine the hospital-related costs incurred by women requiring surgery or inpatient admission for chronic pelvic pain in Canada. We conducted a population-based, cross-sectional study, focusing on women ages 15-59 with a most responsible International Classification of Diseases diagnosis of pelvic and perineal pain, dysmenorrhea, or dyspareunia who had surgery or inpatient admission with a discharge date between April 1, 2008 and March 31, 2012. This study was based on the Canadian Institute for Health Information Discharge Abstract database and the National Ambulatory Care Reporting System. Clinical diagnoses and interventions and resource intensity weights (RIW) were extracted. Hospital costs were estimated by multiplying cost per weighted case (CPWC) calculated at the national level with respective RIWs. Over four years, there were 34 346 cases of surgery or inpatient admission for chronic pelvic pain amounting to $100.5 million with an average cost of $25 million per year. Pelvic and perineal pain accounted for 61.5% (n= 21 127) of the cases, while dysmenorrhea accounted for 31.8% (n= 10 936), and dyspareunia accounted for 6.6% (n= 2283). The vast majority of the cases (92.9%, n= 31 923) were associated with surgical interventions, with the most common surgeries being hysterectomy (47.1%, n=16 189), followed by laparoscopy (25.8%, n= 8850), adnexal surgery (6.8%, n= 2349), and other procedures (11.6%, n= 3968). While these estimates do not take into account non-hospital related costs, such as outpatient treatment, loss of productivity, and impact on quality of life, this study demonstrates that chronic pelvic pain represents a considerable economic burden to Canada's health care system.

Perceptions of Community-Dwelling Patients and Their Physicians on OxyContin® Discontinuation and the Impact on Chronic Pain Management.

OxyContin, formerly one of the most commonly prescribed medications for chronic pain in Canada, was discontinued, delisted from the Ontario Drug Formulary, and replaced by a tamper-resistant formulation in 2012. The impact of discontinuing OxyContin on patients formerly prescribed it to treat chronic pain was unreported. Patients with chronic pain aged 45 years and over (n = 13) were recruited from two primary care and one specialty practice sites and interviewed using a semistructured guide to capture their experiences with discontinuing OxyContin, the efficacy of alternate medications, and relationships with physicians. Additional interviews were conducted with their physicians (n = 7) to obtain physician perceptions on discontinuation and to expand understanding of the patients' experiences. Aspects of patients' pain and medical care through the discontinuation process revealed emergent themes that both converge and diverge from that of treating physicians. Areas of divergence include the motive for discontinuation, which was condemned by most patients but supported by all physicians, and the perceived impact of discontinuance on pain control, with the majority of patients experiencing a negative impact and most physicians describing it as insignificant. Perceptions of patients and physicians coincided on the need to optimize pain management practices.

Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis.

Opioids are associated with higher risk for ataxic breathing and sleep apnea. We conducted a systematic literature review and meta-analysis to assess the influence of long-term opioid use on the apnea-hypopnea and central apnea indices (AHI and CAI, respectively). A systematic review protocol (Cochrane Handbook guidelines) was developed for the search and analysis. We searched Embase, Medline, ACP Journal Club, and Cochrane Database up to November 2014 for three topics: (1) narcotics, (2) sleep apnea, and (3) apnea-hypopnea index. The outcome of interest was the variation in AHI and CAI in opioid users versus non-users. Two reviewers performed the data search and extraction, and disagreements were resolved by discussion. Results were combined by standardized mean difference using a random effect model, and heterogeneity was tested by χ(2) and presented as I(2) statistics. Seven studies met the inclusion criteria, for a total of 803 patients with obstructive sleep apnea (OSA). We compared 2 outcomes: AHI (320 opioid users and 483 non-users) and 790 patients with CAI (315 opioid users and 475 non-users). The absolute effect size for opioid use was a small increased in apnea measured by AHI = 0.25 (95% CI: 0.02-0.49) and a medium for CAI = 0.45 (95% CI: 0.27-0.63). Effect consistency across studies was calculated, showing moderate heterogeneity at I(2) = 59% and 29% for AHI and CAI, respectively. The meta-analysis results suggest that long-term opioid use in OSA patients has a medium effect on central sleep apnea.

Outcomes and reflections on a consensus-building workshop for developing a spinal cord injury-related chronic pain research agenda

Context/ Objective: Chronic pain following spinal cord injury (SCI) is a prevalent secondary health condition that significantly impacts quality of life (QoL). Although growing, the number of available effective pain management approaches for SCI is limited. Recognizing the need to “kick-start” activity on this topic, a consensus-building workshop on developing a research agenda for SCI-related chronic pain was held in 2006 with an expert panel. The present paper describes the processes of the consensus-workshop and its associated outcomes towards advancing the research agenda for SCI-related pain in Canada. A commentary on the current state of knowledge regarding SCI-related pain is also provided.Methods: Thirty-nine stakeholders (researchers, clinicians, policy-makers, SCI advocates, and people with SCI) attended the consensus-workshop. A modified Delphi approach was employed to gain consensus on identifying the top five SCI pain research priorities for improving QoL post-SCI. As well, project planning along with infrastructure support opportunities were discussed.Results: The top five pain research priorities were: 1) pain management and treatment; 2) measurement tools; 3) health services policy and advocacy; 4) knowledge transfer; and 5) mechanisms of pain. Recommendations related to the priorities and related resources were generated, and pilot work was initiated.Conclusions: The consensus workshop provided an initial roadmap for research on SCI-related chronic pain, and supported five pilot projects on the identified priorities. Reflections on the current research landscape in Canada and abroad suggest increased activity towards addressing pain post-SCI but evidence-based approaches are still lacking.

An Epidemiological Study of Neuropathic Pain Symptoms in Canadian Adults.

The reported prevalence of neuropathic pain ranges from 6.9% to 10%; however the only Canadian study reported 17.9%. The objective of this study was to describe the epidemiology of neuropathic pain in Canada. A cross-sectional survey was conducted in a random sample of Canadian adults. The response rate was 21.1% (1504/7134). Likely or possible neuropathic pain was defined using a neuropathic pain-related diagnosis and a positive outcome on the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) or the Douleur Neuropathique 4 (DN4) Questions. The prevalence of likely neuropathic pain was 1.9% (S-LANSS) and 3.4% (DN4) and that of possible neuropathic pain was 5.8% (S-LANSS) and 8.1% (DN4). Neuropathic pain was highest in economically disadvantaged males. There is a significant burden of neuropathic pain in Canada. The low response rate and a slightly older and less educated sample than the Canadian population may have led to an overestimate of neuropathic pain. Population prevalence varies by screening tool used, indicating more work is needed to develop reliable measures. Population level screening targeted towards high risk groups should improve the sensitivity and specificity of screening, while clinical examination of those with positive screening results will further refine the estimate of prevalence.

165: Paediatric Chest Pain in the Emergency Department

Chest pain is a frequent chief complaint of paediatric patients presenting to the emergency department (ED). Despite the low risk of a cardiac cause in the paediatric population, chest pain is a worrisome presentation for patients and their families, and sometimes serious underlying pathology can occur. There is no evidence based diagnostic approach, and this results in significant practice variation often with extensive investigations, both in the ED and in follow-up. To establish poor predictive value and over-use of diagnostic testing in pediatric patients presenting with chest pain. After REB approval, a chart review was conducted of all patients presenting to an urban paediatric tertiary care ED with the chief complaint of chest pain over a three year period. Charts were analyzed for sex, age at presentation, associated symptoms, past cardiac history, investigations in the ED, discharge diagnosis, and outpatient echocardiogram and Holter monitor findings. Of the 473 visits, 50 were repeat visits. The mean age at visit was 12.1 years, and mean duration of pain was 53.4 minutes. 16.9% (n=80) of patients reported past cardiac-related medical history. 64.9% (n=307) of patients received chest x-ray, but only 2.9% (n=9) had an abnormal finding. Electrocardiogram was done in 75.7% (n=358) of the patients, and 23.7% (n=85) of the results were abnormal. Troponin was done in 9.5% (n=45) of the cases, with only one abnormal result unrelated to cardiac etiology. 96.0% of patients (n=454) were discharged, and 4% (n=19) were admitted to hospital. Most causes were idiopathic (n=282, 59.6%), followed by musculoskeletal causes (n=145, 30.7%). Within six months following discharge, 75 (15.9%) patients received echocardiogram, 45 (60%) of whom had no reported cardiac history or previous investigations, and 25 had normal ECG in the ED. The echocardiograms yielded only two cases of newly diagnosed mitral valve prolapse, and one case of small patent ductus arteriosus. 50 patients (10.6%) received Holter monitoring within six months following discharge, 20 of whom had no previous cardiac history, and had normal ECGs in the ED, and the arrhythmias found on Holter monitor correlated poorly with the presenting symptoms. This is the largest paediatric review of chest pain in Canada in published literature. Chest pain in the paediatric population are rarely due to cardiac causes, but most patients still receive unnecessary investigations in the ED, and in their follow-up visits. An evidence based diagnostic algorithm would be useful to improve resource utilization in children presenting with chest pain.