Pain Program Research Articles

A Multidisciplinary Rehabilitation Approach to Chronic Pain Patients in the Post-COVID-19 Era

BACKGROUND: The global health care system has been shaken by the unprecedented pandemic. Chronic pain management has suffered through the pandemic due to lack of access and challenges in care delivery only to be faced by a new set of chronic pain conditions resulting from prolonged and persistent COVID-19 symptoms referred to as “long COVID syndrome.” OBJECTIVES: Long COVID is emerging as a complex and debilitating condition that occurs in a subpopulation of patients following acute COVID-19 infection. Our goals were to explore how to best treat and manage long COVID syndrome based on current experience. METHODS: This is a perspective rather than a systematic review. It is based on the limited available literature and current clinical experience. RESULTS: Although a few pharmacological agents have been proposed to mitigate symptoms, none have emerged to provide meaningful, long-term pain relief. Long COVID is associated with numerous and diverse symptoms. Risk factors for developing long COVID subsequent to acute COVID-19 remain unknown. Due to the multidimensional impact of long COVID chronic pain, a structured interdisciplinary rehabilitation model has been proposed to relieve pain, restore function, and maximize quality of life. LIMITATIONS: This is a perspective with an editorial point of view rather than a systematic literature study. Long COVID syndrome is a new condition, with which no clinicians have extensive experience. This is not a systematic review so there is no Preferred Reporting Items for Systematic reviews and Meta-Analyses diagram. This is not a clinical study so there was no need for institutional review board approvals. CONCLUSIONS: Treatment goals for the postviral syndrome of long COVID are multifaceted. In addition to pain control, patients may have functional deficits, cognitive issues, mental health issues, and reduced quality of life. Thus, a structured interdisciplinary rehabilitation model seems most appropriate to manage long COVID. KEY WORDS: Chronic pain, long COVID, pandemic, COVID-19, brain fog, fatigue, pain program, functional restoration, back pain, joint pain

Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation: A Proposal for Standardization in Fellowship and Training Programs.

The need to be competent in neuromodulation is and should be a prerequisite prior to completing a fellowship in interventional pain medicine. Unfortunately, many programs lack acceptable candidates for these advanced therapies, and fellows may not receive adequate exposure to neuromodulation procedures. The American Society of Pain and Neuroscience (ASPN) desires to create a consensus of experts to set a minimum standard of competence for neurostimulation procedures, including spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), and peripheral nerve stimulation (PNS). The executive board of ASPN accepted nominations for colleagues with excellence in the subject matter of neuromodulation and physician education. This diverse group used peer-reviewed literature and, based on grading of evidence and expert opinion, developed critical consensus guides for training that all accredited fellowship programs should adopt. For each consensus point, transparency and recusal were used to eliminate bias, and an author was nominated for evidence grading oversight and bias control. Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation sets a standard for neuromodulation training in pain fellowship training programs. The consensus panel has determined several recommendations to improve care in the United States for patients undergoing neuromodulation. As neuromodulation training in the United States has evolved dramatically, these therapies have become ubiquitous in pain medicine. Unfortunately, fellowship programs and the Accreditation Council for Graduate Medical Education (ACGME) pain program requirements have not progressed training to match the demands of modern advancements. PEAK sets a new standard for fellowship training and presents thirteen practice areas vital for physician competence in neuromodulation.

Response to: Commentary by Dr. Wahezi et al., "The importance of interventional pain research in academic settings: a call for change to fortify our future. A message from the Association of Pain Program Directors (APPD)".

Response to: Commentary by Dr. Wahezi et al., "The importance of interventional pain research in academic settings: a call for change to fortify our future. A message from the Association of Pain Program Directors (APPD)".

Prevalence and services for the treatment of chronic pain at residential substance treatment centers

Introduction: Studies suggest that a large proportion of patients with substance use disorders (SUDs) also have underlying chronic pain. There is limited data on prevalence of chronic pain treatment as a component of residential substance use treatment. This initiative sought to investigate the prevalence and type of chronic pain services offered at these residential programs.Methods: This study was a retrospective review of information obtained from residential substance use treatment facility websites contained in SAMHSA’s treatment navigator. Nine hundred-fifty out of 2952 websites were randomly selected for analysis. The primary outcome was prevalence of facilities that had chronic pain programs. Services offered were specified as available. Descriptive statistics were used to summarize data.Results: Nine-hundred nine websites (95.7%, [94,97]) were accessible. Twenty-six facilities (2.9%,[1.9,4.2]) had a chronic pain program and of these 22 (84.6%, [64.3,95.0]) specified services offered. Common services included physical therapy (6, 27.3%), massage (12, 54.6%), and acupuncture (10, 45.5%). Of the remaining sites, 630 (69.3%, [66.2,72.3]) specified services offered, including yoga (122, 19.4%) and exercise (199, 31.6%).Conclusion: Our study demonstrated that despite most facilities offering adjunctive services, few had chronic pain programs. This suggests that there is a possible need for better updating of facility websites or possibly an area for improvement in residential substance use treatment settings.

The importance of interventional pain research in academic settings: a call for change to fortify our future. A message from the Association of Pain Program Directors (APPD).

The importance of interventional pain research in academic settings: a call for change to fortify our future. A message from the Association of Pain Program Directors (APPD).

The Timing and Magnitude of Improvements in Depression, Anxiety, Disability, and Pain Intensity During an Internet-delivered Program for Chronic Pain

Numerous studies have found that pain management programs are an effective treatment option for people with chronic pain. However, little is known about when people experience improvements during these programs and why they are effective. Using a secondary analysis, the current study examined the timing and magnitude of symptom change during an 8-week internet-delivered psychological pain management program for people with chronic pain. The change in 4 outcomes was examined: depression (n = 881), anxiety (n = 561), disability (n = 484), and pain intensity (n = 484). The largest improvements in depression, anxiety, and disability were reported during the first half of treatment (ie, 4 weeks), whereas the largest reductions in pain intensity were reported during the second half of treatment. Half the participants had experienced a clinically meaningful improvement in depression or anxiety, and a third of participants had reported such an improvement in disability by midtreatment (ie, 5 weeks after baseline). In a subgroup analysis (n = 397), this pattern of change in depression and anxiety symptoms did not differ based on the level of therapist guidance. This study highlights the importance of the first few weeks of psychological pain management programs and encourages future work to examine how the mechanisms underpinning rapid change may be harnessed to optimize care for people with chronic pain. PerspectiveThis study found that depression, anxiety, and disability improved rapidly during the first half of an 8-week internet-delivered pain management program, and most of the prepost change had occurred by midtreatment. This work highlights the therapeutic potential of the first few treatment sessions and prompts future research into a rapid responding.

Randomized-controlled trial assessing a digital care program versus conventional physiotherapy for chronic low back pain

Low back pain (LBP) is the world’s leading cause of years lived with disability. Digital exercise-based interventions have shown great potential in the management of musculoskeletal conditions, promoting access and easing the economic burden. However, evidence of their effectiveness for chronic LBP (CLBP) management compared to in-person physiotherapy has yet to be unequivocally established. This randomized controlled trial (RCT) aims to compare the clinical outcomes of patients with CLBP following a digital intervention versus evidence-based in-person physiotherapy. Our results demonstrate that patient satisfaction and adherence were high and similar between groups, although a significantly lower dropout rate is observed in the digital group (11/70, 15.7% versus 24/70, 34.3% in the conventional group; P = 0.019). Both groups experience significant improvements in disability (primary outcome), with no differences between groups in change from baseline (median difference: −0.55, 95% CI: −2.42 to 5.81, P = 0.412) or program-end scores (−1.05, 95% CI: −4.14 to 6.37; P = 0.671). Likewise, no significant differences between groups are found for secondary outcomes (namely pain, anxiety, depression, and overall productivity impairment). This RCT demonstrates that a remote digital intervention for CLBP can promote the same levels of recovery as evidence-based in-person physiotherapy, being a potential avenue to ease the burden of CLBP.

Physiotherapists should apply health coaching techniques and incorporate accountability to foster adherence to a walking program for low back pain: aqualitative study.

What motivates individuals to start a walking program for the prevention of low back pain? What strategies optimise short-term and long-term adherence to a walking program? What strategies can physiotherapists incorporate into clinical practice to facilitate commencement of and adherence to a walking program? Qualitative study. Twenty-two adults recently recovered from an episode of non-specific low back pain who participated in a 6-month, progressive and individualised walking program that was prescribed by a physiotherapist trained in health coaching. Semi-structured focus groups conducted online following completion of the walking program. Interview questions explored: primary motivations for starting a walking program, identification of which elements were useful in optimising adherence to the program, and identification of the barriers to and facilitators of engagement with the program. Audio recordings were transcribed and thematic analysis was conducted. Three major themes were identified. Theme one identified that strong motivators to start a walking program were anticipated improvements in low back pain management and the added general health benefits of a more active lifestyle. Theme two identified that fear of high-impact exercises led to avoidance; however, walking was considered a safe exercise option. Theme three identified accountability, enjoyment of exercise and health benefits were critical to adherence. Participants recently recovered from low back pain reflected positively on a physiotherapist-prescribed walking program. Participants described what elements of the program were crucial to starting exercise and optimising adherence. These findings have informed a list of practical recommendations for physiotherapists to improve patient commencement and adherence to exercise.

Effect on orofacial pain in patients with chronic pain participating in a multimodal rehabilitation programme- a pilot study.

Orofacial pain in patients taking part in a multimodal rehabilitation programme (MMRP) due to chronic bodily pain is common but it is not known whether such a rehabilitation programme can also have an effect on the presence of orofacial pain. The first aim of this study was to evaluate the effect of an MMRP on orofacial pain frequency. The second aim was to evaluate differences in the effect on quality of life and on psychosocial factors related to chronic pain. MMRP was evaluated through validated questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Fifty-nine patients participating in MMRP filled out the two screening questions for orofacial pain in addition to the SQRP questionnaires before and after participation in MMRP during the period August 2016 to March 2018. Pain intensity decreased significantly after the MMRP (p=0.005). Fifty patients (69.4 %) reported orofacial pain before MMRP and no significant decrease after the programme (p=0.228). Among individuals with orofacial pain, the self-reported level of depression decreased after participation in the programme (p=0.004). Even though orofacial pain is common among patients with chronic bodily pain, participation in a multimodal pain programme was not enough to reduce frequent orofacial pain. This finding implies that specific orofacial pain management including information about jaw physiology could be a justified component of patient assessment prior to a multimodal rehabilitation programme for chronic bodily pain.

National review of acute pain service utilization, models of care, and clinical practices within the Veterans Health Administration

IntroductionThe Veterans Health Administration (VHA) is the largest healthcare network in the USA and has been a national leader in opioid safety for acute pain management. However, detailed information on...

Blinded Pain Cocktails: A Reliable and Safe Opioid Weaning Method.

Weaning opioids in patients with noncancerous chronic pain often poses a challenge when psychosocial factors complicate the patient's chronic pain syndrome and opioid use. A blinded pain cocktail protocol used to wean opioid therapy has been described since the 1970s. At the Stanford Comprehensive Interdisciplinary Pain Program, a blinded pain cocktail remains a reliably effective medication-behavioral intervention. This review (1) outlines psychosocial factors that may complicate opioid weaning, (2) describes clinical goals and how to use blinded pain cocktails in opioid tapering, and (3) summarizes the mechanism of dose-extending placebos and ethical justification of its use in clinical practice.

Online Chronic Pain Program Led to Reduced Opioid Dosage—Without an Increase in Pain

Online Chronic Pain Program Led to Reduced Opioid Dosage—Without an Increase in Pain

Machine learning clinical decision support for interdisciplinary multimodal chronic musculoskeletal pain treatment.

Chronic musculoskeletal pain is a prevalent condition impacting around 20% of people globally; resulting in patients living with pain, fatigue, restricted social and employment capacity, and reduced quality of life. Interdisciplinary multimodal pain treatment programs have been shown to provide positive outcomes by supporting patients modify their behavior and improve pain management through focusing attention on specific patient valued goals rather than fighting pain. Given the complex nature of chronic pain there is no single clinical measure to assess outcomes from multimodal pain programs. Using Centre for Integral Rehabilitation data from 2019-2021 (n = 2,364), we developed a multidimensional machine learning framework of 13 outcome measures across 5 clinically relevant domains including activity/disability, pain, fatigue, coping and quality of life. Machine learning models for each endpoint were separately trained using the most important 30 of 55 demographic and baseline variables based on minimum redundancy maximum relevance feature selection. Five-fold cross validation identified best performing algorithms which were rerun on deidentified source data to verify prognostic accuracy. Individual algorithm performance ranged from 0.49 to 0.65 AUC reflecting characteristic outcome variation across patients, and unbalanced training data with high positive proportions of up to 86% for some measures. As expected, no single outcome provided a reliable indicator, however the complete set of algorithms established a stratified prognostic patient profile. Patient level validation achieved consistent prognostic assessment of outcomes for 75.3% of the study group (n = 1,953). Clinician review of a sample of predicted negative patients (n = 81) independently confirmed algorithm accuracy and suggests the prognostic profile is potentially valuable for patient selection and goal setting. These results indicate that although no single algorithm was individually conclusive, the complete stratified profile consistently identified patient outcomes. Our predictive profile provides promising positive contribution for clinicians and patients to assist with personalized assessment and goal setting, program engagement and improved patient outcomes.

A scalable 12-week exercise and education programme reduces symptoms and improves function and wellbeing in people with hip and knee osteoarthritis.

Osteoarthritis is a chronic musculoskeletal condition that impacts more than 300 million people worldwide, with 43 million people experiencing moderate to severe disability due to the disease. This service evaluation provides the results from a tailored blended model of care on joint health, physical function, and personal wellbeing. 1,593 adult participants with osteoarthritis completed the Nuffield Health Joint Pain Programme between February 2019 and May 2022. The 12-week programme included two 40-min exercise sessions per week. All exercise sessions were conducted face-to-face and were followed by 20 min of education to provide information and advice on managing osteoarthritis. The 12-week joint pain programme significantly improved Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global scores (Week 0: 37.5 [17.2]; Week 12: 24.0 [16.6]; p < 0.001), as well as subscales for pain (Week 0: 7.6 [3.7]; Week 12: 4.9 [3.7]; p < 0.001), function (Week 0: 26.0 [13.0]; Week 12: 16.3 [12.4]; p < 0.001), and stiffness (Week 0: 3.9 [1.6]; Week 12: 2.8 [1.7]; p < 0.001). Significant improvements in health-related outcomes including systolic and diastolic blood pressure (Week 0: 139 [18] mmHg; Week 12: 134 [17] mmHg, and Week 0: 82 [11] mmHg; Week 12: 79 [19] mmHg; both p < 0.001), body mass index (Week 0: 29.0 [4.5] kg/m2; Week 12: 28.6 [4.4] kg/m2; p < 0.001), waist to hip ratio (Week 0: 0.92 [0.23]; Week 12: 0.90 [0.11], p < 0.01) and timed up and go (Week 0: 10.8 s [2.9]; Week 12: 8.1 s [2.0]; p < 0.001) were also observed. On completion of the joint pain programme, participants also reported significant improvements in all assessed aspects of self-reported wellbeing (all p < 0.001). With reductions in physical symptoms of osteoarthritis and improvements in personal wellbeing, the joint pain programme delivered by personal trainers in a gym-setting offers a nationally scalable, non-pharmacological treatment pathway for osteoarthritis.

P070 Results of a consensus process to determine the elements of a complex digital intervention for distal upper limb musculoskeletal disorders

Abstract Background/Aims Painful distal upper limb (DUL) musculoskeletal disorders (MSDs), including hand, wrist and elbow problems, are common but lack effective self-management tools. The Digital-My Arm Pain Programme (D-MAPP) aims to develop and test a digital self-management intervention for DUL-MSDs. This project aimed to determine the elements required for the D-MAPP intervention package. Methods A review of self-management interventions for DUL-MSDs identified 31 potential intervention elements. Subsequently, the elements were grouped into three overarching categories; Information and self-management advice, Information on treatment options, and Features of an exercise programme. Next, we employed Delphi methodology to develop consensus on the intervention elements from key stakeholders: Healthcare professionals who manage DUL-MSDs and people with a DUL-MSD (pwDUL-MSDs). A three-round modified online/postal Delphi questionnaire was used, with collation and presentation of results in subsequent rounds. Participants scored the importance of including each element in the D-MAPP intervention using a 9-point Likert scale; 1-3 limited importance, 4-6 important but not critical, 7-9 critical. Consensus was pre-defined as &amp;gt; 70% of both healthcare professionals and pwDUL MSDs scoring an element in the same category. During each round, participants could suggest additional intervention elements for inclusion in the subsequent round. Results 23 healthcare professionals from a range of disciplines (including occupational therapists, physiotherapists, rheumatologists and orthopaedic surgeons) and 19 pwDUL-MSD completed round one; 83% and 89%, respectively, completed all three rounds. Round 1, consensus was achieved for 24 of the 31 elements, which were all deemed as critical to include in the D-MAPP intervention (Table 1). Two elements were suggested by participants and added to round 2. Two additional elements reached consensus as being critical in Round 2, and one further element reached consensus for inclusion in the third round. Six potential intervention elements did not reach a consensus. Conclusion Healthcare professionals and patients reached consensus on 27 elements, all of which were deemed as critical to include in the D-MAPP intervention. However, agreement among stakeholders on the importance level was not achieved for six potential elements. Following this work, the critically important elements will be developed through a co-design process to build the D-MAPP digital intervention. L. Brading: None. K. Kane: None. G. McHugh: None. K. Dziedzic: None. J. Adams: None. S. Chopra: None. L. Swaithes: None. K. Walker-Bone: None. G. Macfarlane: None. P. Conaghan: None. S. Kingsbury: None.

The Recovery Factors of Drug Addiction in Malaysia: A Case of Ex-Drug Addicts Registered with National Anti-Drug Agency

Drug addictions have become a global issue due to malpractices of drug consume. In Malaysia, the National Anti-Drug Agency or Agensi Antidadah Kebangsaan (AADK) becomes an important agency in eradicating drugs addiction through treatment and rehabilitation, prevention, enforcement, and security. The objective of this study was to identify the factors that could influenced the recovery of drug addictions, focusing on the ex-drug addicts which registered with AADK Kerian, Perak, Malaysia. This study highlighted on three major factors for recovery, which include self-development effort, physical pain, and spiritual programs. Direct questionnaires were given to the respondent in AADK Kerian with both physical questionnaire and online questionnaire. The results demonstrated that the self-development effort is the most influenced factors for the drug recovery since most of the respondent agreed that their own awareness to have self-changes have a significant influence on the lifestyle, emotional, awareness and getting well without taking the drug.

MHealth Coping Skills Training for Symptom Management (mCOPE) for colorectal cancer patients in early to mid-adulthood: Study protocol for a randomized controlled trial

BackgroundColorectal cancer (CRC) patients in early to mid-adulthood (≤50 years) are challenged by high symptom burden (i.e., pain, fatigue, distress) and age-related stressors (e.g., managing family, work). Cognitive behavioral theory (CBT)-based coping skills training interventions reduce symptoms and improve quality of life in cancer patients. However, traditional CBT-based interventions are not accessible to these patients (e.g., in-person sessions, during work day), nor designed to address symptoms within the context of this stage of life. We developed a mobile health (mHealth) coping skills training program for pain, fatigue and distress (mCOPE) for CRC patients in early to mid-adulthood. We utilize a randomized controlled trial to test the extent to which mCOPE reduces pain, fatigue and distress (multiple primary outcomes) and improves quality of life and symptom self-efficacy (secondary outcomes). Methods/DesignPatients (N = 160) ≤50 years with CRC endorsing pain, fatigue and/or distress are randomized 1:1 to mCOPE or standard care. mCOPE is a five-session CBT-based coping skills training program (e.g., relaxation, activity pacing, cognitive restructuring) that was adapted for CRC patients in early to mid-adulthood. mCOPE utilizes mHealth technology (e.g., videoconference, mobile app) to deliver coping skills training, capture symptom and skills use data, and provide personalized support and feedback. Self-report assessments are completed at baseline, post-treatment (5–8 weeks post-baseline; primary endpoint), and 3- and 6-months later. ConclusionsmCOPE is innovative and potentially impactful for CRC patients in early to mid-adulthood. Hypothesis confirmation would demonstrate initial efficacy of a mHealth cognitive behavioral intervention to reduce symptom burden in younger CRC patients.

Editorial introductions.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 16 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Catherine M. KuzaCatherine M. KuzaDr Catherine M. Kuza, MD, FASA is an Associate Professor of Anesthesiology in the Department of Anesthesiology, Division of Critical Care at the Keck School of Medicine of the University of Southern California (KSOM USC), Los Angeles, USA. She completed her anesthesiology residency training at the University of Massachusetts School of Medicine in Worcester, MA, USA and went on to complete a critical care fellowship at Brigham and Women's Hospital in Boston, MA, USA. She has been faculty at KSOM USC since 2016, where she served as the Director of Resident Research and Quality Improvement from 2017–2019, and in 2019 became the Director of Trauma Researcher. In 2021 she was appointed Associate Director of the Surgical Intensive Care Unit. Her areas of research include trauma anesthesiology, emergency preparedness and mass casualties, burns, critical care delirium, and post-intensive care unit syndrome. She enjoys teaching and has served as a mentor in research, anesthesiology, and critical care to numerous medical students, residents, and fellows. She has published a number of journal articles and book chapters related to trauma, burns, critical care, and emergency preparedness. She is an active member of numerous professional societies including the American Society of Anesthesiologists (ASA). While serving on the ASA Committee of Trauma and Emergency Preparedness, she has spearheaded several multicentre trauma studies. Edoardo De RobertisEdoardo De RobertisEdoardo De Robertis is Professor of Anaesthesiology at the University of Perugia, Italy, where he coordinates the Division of Anaesthesia, Analgesia, and Intensive Care. He is the Director of the clinical university department of Anaesthesia and Intensive Care and director of the Residency Program and School in Anaesthesia, Intensive Care and Pain. He is President of the European Society of Anaesthesia and Intensive Care (ESAIC) for the two years term 2022–23. Prof Edoardo De Robertis graduated with honour in Medicine and Surgery at the University of Napoli Federico II, Italy, where he completed his anaesthesiology residency. At the University of Lund, Sweden he received his PhD. Leader of a research group at the University Federico II, Italy, and more recently at the University of Perugia, Italy, Prof De Robertis has been involved in the planning, management and coordination of experimental studies in complex animal models and clinical studies on mechanical ventilation. An innovative system of ventilation aimed at the reduction of airway dead space (ASPIDS) was developed. Prof De Robertis has been actively involved in numerous collaboration and research projects with European partners and in the drafting of guidelines of the European Society of Anesthesiology (ESA/IC). He coordinated for Italy the ESA multicentric study PROVHILO and the ESICM consensus study WELPICUS. Prof De Robertis has focused his research activity on mechanical ventilation in critically ill patients and on the management of peri-operative massive bleeding, with particular attention to postpartum haemorrhage. He is also interested in the preoperative evaluation of the obstetric patient, and in the management of neuromuscular block in pelvic laparoscopic surgery.

The use of telemedicine for perioperative pain management during the COVID-19 pandemic

Introduction Using a human factors engineering approach, the Johns Hopkins Personalized Pain Program adopted telemedicine for perioperative pain management in response to the COVID-19 pandemic. This study examines the impact of telemedicine adoption on the quality and outcomes of perioperative pain management. Methods A mixed-methods study with a convergent parallel design was conducted. From June 2017 to December 2021, 902 patients participated in the Personalized Pain Program. Quantitative data on daily opioid consumption, pain severity and interference, physical and mental health status, and patient satisfaction and engagement were continuously collected with all patients using chart review and patient surveys. Beginning 23 March 2020, the Personalized Pain Program transitioned to telemedicine. A pre–post quasi-experimental design was used to examine the impact of telemedicine. In addition, qualitative interviews were conducted with 3 clinicians and 17 patients to explore their experience with telemedicine visits. Results The monthly number of new patients seen in the Personalized Pain Program did not significantly change before and after telemedicine adoption. Compared to patients having in-person visits before the pandemic, patients having telemedicine visits during the pandemic achieved comparable improvements in daily opioid consumption, pain severity and interference, and physical health status. While telemedicine helped overcome many challenges faced by the patients, the limitations of telemedicine were also discussed. Conclusion The COVID-19 pandemic stimulated the use of telemedicine. To facilitate telemedicine adoption beyond the pandemic, future research is needed to examine best practices for telemedicine adoption and provide additional evidence on the effectiveness of telemedicine.

"Working Together": Perspectives of Healthcare Professionals in Providing Virtual Care to Youth with Chronic Pain during the COVID-19 Pandemic.

The onset of the coronavirus disease in 2019 necessitated a rapid transition to virtual care for chronic pain treatment. A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Interviews were conducted in February 2021 with a sample of healthcare professionals (HCPs; n = 6) who had provided multidisciplinary treatment (MDT) through an outpatient hospital pediatric chronic pain program. Satisfaction surveys were distributed to all MDT professionals employed by the clinic in April 2021 (n = 13 of 20 eligible; 65% response rate). Participants represented medicine, rehabilitation, and mental health professionals. Analysis of interviews generated five themes: (1) adaptation to virtual care, (2) benefits of virtual care, (3) limitations of virtual care, (4) shifting stance on virtual care over time, and (5) considerations for implementing virtual care. The satisfaction survey data revealed that respondents were able to effectively provide appropriate diagnoses, recommendations, and/or care plans for pediatric chronic pain via virtual care (n = 12, 92.3%). Detailed survey responses are presented by discipline. This study provides a rich exploration of HCPs' experiences in providing MDT for pediatric chronic pain within a virtual care model. The current results may contribute to the future development of guidelines for virtual care delivery with pediatric chronic pain populations.