Patricia A. Poulin

Background: Chronic pain (CP) affects approximately 8 million people in Canada. Access to CP care is challenging, and there is no robust monitoring system to support patient care and decision-making. The Power Over Pain (POP) Portal was developed by people living with CP, health care providers, researchers, health system decision-makers, policymakers, and community partners to address these concerns. The POP Portal is a comprehensive web-based platform that provides rapid access to a continuum of free, evidence-informed resources for the self-management of CP, mental health, and substance use health. The POP Portal also offers self-assessment tools that enable users to track their progress and receive personalized recommendations. Objective: This hybrid implementation-effectiveness type III pilot study aimed to determine the feasibility (ie, recruitment, integration, facilitators and barriers, patient engagement, usability, and acceptability) of the POP Portal’s implementation for people waiting for care at a tertiary pain clinic. Methods: A cohort of 80 adults living with pain was recruited from the waitlist of a tertiary care pain clinic over a 3-month period. Following an orientation on the POP Portal, participants were encouraged to use it according to their needs and preferences. They were also asked to complete questionnaires at baseline (0 months) and the 3-month follow-up. Primary feasibility measures included recruitment and retention rates and portal acceptability using the Acceptability E-scale. We also measured usability using the System Usability Scale, evaluated engagement through portal analytics, and identified facilitators and barriers via semistructured interviews with 12 to 15 study participants. These interviews further assessed the acceptability and usability of the portal for participants. Exploratory measures included pain severity, pain-related interference, self-efficacy, coping strategies, and symptoms of anxiety and depression. Results: We will present descriptive data on the cohort’s sex and gender, age, rural or urban status, and ethnic background, as well as the acceptability, usability, and feasibility of the portal. Measures of central tendency will be reported for continuous variables, and frequencies and proportions will be reported for categorical variables. We will also present change in clinical outcomes across time and a synthesis of qualitative and thematic data. Conclusions: We anticipate that most patients awaiting care at a tertiary pain clinic recruited will use the POP Portal and find it to be acceptable for addressing some of their pain and associated health concerns. If the feasibility of recruiting and retaining patients is demonstrated as anticipated, we will be able to move forward with a multisite study to evaluate the implementation and effectiveness of the POP Portal among patients waiting for a tertiary care consultation. International Registered Report Identifier (IRRID): DERR1-10.2196/64801

BACKGROUND Chronic pain (CP) affects approximately 8 million people in Canada. Access to CP care is challenging, and there is no robust monitoring system to support patient care and decision-making. The Power Over Pain (POP) Portal was developed by people living with CP, health care providers, researchers, health system decision-makers, policymakers, and community partners to address these concerns. The POP Portal is a comprehensive web-based platform that provides rapid access to a continuum of free, evidence-informed resources for the self-management of CP, mental health, and substance use health. The POP Portal also offers self-assessment tools that enable users to track their progress and receive personalized recommendations. OBJECTIVE This hybrid implementation-effectiveness type III pilot study aimed to determine the feasibility (ie, recruitment, integration, facilitators and barriers, patient engagement, usability, and acceptability) of the POP Portal’s implementation for people waiting for care at a tertiary pain clinic. METHODS A cohort of 80 adults living with pain was recruited from the waitlist of a tertiary care pain clinic over a 3-month period. Following an orientation on the POP Portal, participants were encouraged to use it according to their needs and preferences. They were also asked to complete questionnaires at baseline (0 months) and the 3-month follow-up. Primary feasibility measures included recruitment and retention rates and portal acceptability using the Acceptability E-scale. We also measured usability using the System Usability Scale, evaluated engagement through portal analytics, and identified facilitators and barriers via semistructured interviews with 12 to 15 study participants. These interviews further assessed the acceptability and usability of the portal for participants. Exploratory measures included pain severity, pain-related interference, self-efficacy, coping strategies, and symptoms of anxiety and depression. RESULTS We will present descriptive data on the cohort’s sex and gender, age, rural or urban status, and ethnic background, as well as the acceptability, usability, and feasibility of the portal. Measures of central tendency will be reported for continuous variables, and frequencies and proportions will be reported for categorical variables. We will also present change in clinical outcomes across time and a synthesis of qualitative and thematic data. CONCLUSIONS We anticipate that most patients awaiting care at a tertiary pain clinic recruited will use the POP Portal and find it to be acceptable for addressing some of their pain and associated health concerns. If the feasibility of recruiting and retaining patients is demonstrated as anticipated, we will be able to move forward with a multisite study to evaluate the implementation and effectiveness of the POP Portal among patients waiting for a tertiary care consultation. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/64801

Indigenous Peoples in Canada experience health disparities, including higher rates of chronic pain. Many report distrust of the health system due to factors such as racial discrimination. A lack of appreciation and respect for Indigenous knowledges further contributes to feelings of alienation. In 2022–2023, we offered the first Project Extension for Community Healthcare Outcomes (Project ECHO) Indigenous Chronic Pain and Substance Use Health (ICP&SU) to health care providers interested in improving chronic pain care with and for Indigenous Peoples in Canada. The program reflects a Two-Eyed Seeing approach weaving together Indigenous and Western approaches to chronic pain and substance use health care. We describe the development and implementation of Project ECHO ICP&SU. Following guidance from the project Elder, we use storytelling, centered around the metaphor of weaving, to discuss the conception and implementation of Project ECHO ICP&SU. We also describe our engagement in sharing circles and ceremonies to share stories, knowledges, and lessons learned. With strong Anishinaabe leadership, the program was implemented as intended and reached 121 health care professionals. Lessons learned included an overt recognition of the influence of different structures and institutions on programs and for a culturally safer development and evaluation frameworks for future Project ECHOs to improve care with and for Indigenous Peoples. Project ECHO can be a vehicle to enact Truth and Reconciliation Calls to Action through weaving relationships and knowledges to create culturally safer institutions and practices to improve chronic pain, substance use health, and wellness, with and for Indigenous Peoples.

Objective: Chronic pain affects approximately 7.6 million Canadians and access to care remains an issue. The Power Over Pain (POP) Portal offers immediate access to evidence-based resources ranging from low- (e.g. education, self-management), to high- (e.g. individual counseling) intensity. We explored the POP Portal's acceptability, usability, and perceived usefulness among patients newly referred to a tertiary care pain clinic. Methods: We used a descriptive, qualitative approach with a prospective cohort of 60 adult patients recently referred to The Ottawa Hospital Pain Clinic. Patients were offered an orientation session and asked to participate in a seven-week follow-up interview. Data were thematically analyzed in an iterative process, whereby responses were reviewed and coded by two members of the research team. Results: Of the 60 patients referred to the POP Portal by clinic clerks, 45 participated in the orientation session, and 40 completed a four-week follow-up. All 40 patients had used the POP Portal and recommended that we continue to offer the POP Portal to patients awaiting care. We identified overarching themes of acceptability (five subthemes), usability (ten subthemes), accessibility (three subthemes), and patient value of the POP Portal (three subthemes). This includes (1) the POP Portal provides easy access to chronic pain resources; (2) the POP Portal is helpful in developing an understanding of chronic pain; and (3) improvements to the POP Portal are needed to increase usability and foster a user-friendly experience. Conclusions: The POP Portal offers accessible and diverse resources for people living with pain awaiting a tertiary care consultation; however, patients would like to see resources specific to diagnosis. Improvements are suggested to allow greater increase the POP Portal usability.

Introduction. Due to the COVID-19 pandemic, healthcare centers quickly adapted services into virtual formats. Pain clinics in Canada play a vital role in helping people living with pain, and these clinics remained essential services for patients throughout the pandemic. This study aimed to (1) describe and compare the transition from in-person to virtual pain care services at Canadian pain clinics during the onset of the COVID-19 pandemic and (2) provide postpandemic recommendations for pain care services to optimize the quality of patient care. Materials and Methods. We used a qualitative participatory action study design that included a cross-sectional survey for data collection and descriptive analysis to summarize the findings. Survey responses were collected between January and March of 2021. The survey was administered to the leadership teams of 11 adult pain clinics affiliated with the Chronic Pain Centre of Excellence for Canadian Veterans. Responses were analyzed qualitatively to describe the transition to the virtual pain services at pain clinics. Results. We achieved a 100 response rate from participating clinics. The results focus on describing the transition to the virtual care, current treatment and services, the quality of care, program sustainability, barriers to maintaining virtual services, and future considerations. Conclusions. Participating clinics were capable of transitioning pain care services to the virtual formats and have in-person care when needed with proper safety precautions. The pandemic demonstrated that it is feasible and sustainable for pain clinics to have a hybrid of virtual and in-person care to treat those living with pain. It is recommended that moving forward, there should be a hybrid of both virtual and in-person care for pain clinics. Ministries of Health should continue to develop policies and funding mechanisms that support innovations aimed at holistic healthcare, interdisciplinary teams, and the expansion of clinics geographical reach for patient access.

Balance between benefits and harms of using opioids for the management of chronic noncancer pain (CNCP) must be carefully considered on a case-by-case basis. There is no one-size-fits-all approach that can be executed by prescribers and clinicians when considering this therapy. The aim of this study was to identify barriers and facilitators for prescribing opioids for CNCP through a systematic review of qualitative literature. Six databases were searched from inception to June 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias was rated, and confidence in evidence was graded. Twenty-seven studies reporting data from 599 health care providers were included. Ten themes emerged that influenced clinical decision making when prescribing opioids. Providers were more comfortable to prescribe opioids when (1) patients were actively engaged in pain self-management, (2) clear institutional prescribing policies were present and prescription drug monitoring programs were used, (3) long-standing relationships and strong therapeutic alliance were present, and (4) interprofessional supports were available. Factors that reduced likelihood of prescribing opioids included (1) uncertainty toward subjectivity of pain and efficacy of opioids, (2) concern for the patient (e.g., adverse effects) and community (i.e., diversion), (3) previous negative experiences (e.g., receiving threats), (4) difficulty enacting guidelines, and (5) organizational barriers (e.g., insufficient appointment duration and lengthy documentation). Understanding barriers and facilitators that influence opioid-prescribing practices offers insight into modifiable targets for interventions that can support providers in delivering care consistent with practice guidelines.

Chronic pain affects approximately 1 in every 5 Canadians and has a substantial impact on psychological well-being, relationships, ability to attend work or school, and overall functioning.The Otta...