Clinical Innovation Poster Abstracts

Purpose:We compared local infiltration analgesia (LIA) to the gold standard using the 3 in 1 nerve block in postoperative pain management after total knee arthroplasty. Methods: We conducted a retrospective trial by analyzing the data of 202 patients, which were separated in two groups. Group 1 treated by 3-in-1 femoral nerve block included 100 patients whereas 102 patients were treated by LIA. The pain intensity was measured objectively with a numeric rating scale in the morning and evening. The pain medication was given according to two protocols with a fix opioid dose for the first 3 days only, additional pain medication could be requested by the patient at any time. Results: The pain intensity showed statistical difference between the groups, with the LIA group showing a lower pain intensity in the early postoperative phase, especially in the first days and in the morning. On the 1 postoperative day the average of numeric pain scale for the nerve block group was 2,3 (SD = 1,6), which was significant higher than the average of the LIA group 1,5 (SD = 1,1). The average dose of Oxycodon received on the first postoperative day was 17,8mg (SD = 9,1) in the nerve block group and 11,5mg (SD = 6,2) in the LIA group, on the 6 day the dosage received was 10,9mg (SD = 11,3) respectively 6,0mg (SD = 7,3). Conclusion: The LIA group showed in this study a significant lower consumption dose of opioid then the 3 in1 nerve block group.

computer-based application (app) evaluating telescoping in amputees has been developed using Adobe Flash animation to reliably explore its association to phantom limb and stump pain. The app allows the participant to identify the limb and level of amputation, the nature of the phantom limb, and the extent of telescoping (from normal length to completely telescoped). In addition, it collects information related to participants' age, sex, date of amputation(s), and intensity of their stump and/or phantom pain on average on a numeric rating scale using a slider that moves from 0-10. This tool is intended to fulfill the need for a reliable measure of telescoping which can be used to document its prevalence and further under-stand its implications for the optimal management of phantom limb and stump pain. A fully-functional demo version of the app can be found at http://phan tomlimbs.ca/demo.html In the immediate term, pain research may greatly benefit from active collaboration with other fields of research with more highly developed research infrastructure, as well as exploration of existing registries and biobanks from other fields, before embarking upon the creation of pain specific resources. The CPN Registry Working Group, and genetic analysis undertaken through the Quebec Low Back Pain project, are positioned to lead novel pain specific activities. Further discussion can be directed towards identification of a unified process for sampling, analysis and data sharing and seeking funding.
Background: Coronary heart disease affects over 2.4 million Canadians annually, resulting in an increase in cardiac and major vascular surgeries. Unrelieved postoperative pain is of one of the top 5 reasons for hospital readmission following surgery; however little is done to address this postoperative complication. Barriers to effective pain assessment and management following cardiac and major vascular surgery have been conceptualized on patient, health care provider, and system levels.
Purpose: (1) To review commonly identified patient, healthcare provider, and system-level barriers that prevent effective postoperative pain assessment and management in cardiac and major vascular surgical populations.
(2) Outline the SMArTVIEW clinical trial intervention, describing how postoperative pain is addressed in hospital, as well as 30 days post-hospital discharge by a specialized nursing team, known as SMArTVIEW Nurses.
Methods: By identifying existing barriers within the literature, the SMArTVIEW intervention seeks to address a number of these barriers by meeting the following design objectives: 1) orchestrating a structured process for regular postoperative pain assessment and management; 2) ensuring adequate clinician preparation for postoperative pain assessment and management in the context of virtual care; and 3) enfranchising patients to become active selfmanagers and to work with their healthcare providers, to manage their pain postoperatively.
Conclusions: SMArTVIEW is an innovative approach that has been developed to address common barriers that interdict postoperative pain assessment and management. SMArTVIEW utilizing accessible formats (i.e., digital health solutions) to actively engage both patients and healthcare providers to ensure continuity of care following hospital discharge.
CONTACT Carley Ouellette ouellc1@mcmaster.ca Acetaminophen is widely used to reduce pain. While the mechanism of action of this pain medication is still unclear, recent observations suggest that it could involve descending inhibitory pain mechanisms. Furthermore, it seems that this mechanism might be influenced by sex, with past studies suggesting that acetaminophen potentiates inhibitory circuits differently in men and women. This study aimed to assess the effect of acetaminophen on the efficacy of inhibitory pain mechanisms in humans, and to determine whether this effect is influenced by sex. In this double-blind randomized controlled trial with a crossover design, 34 healthy volunteers (17 men, 17 women) were recruited and completed 3 experimental sessions: control (no medication), oral acetaminophen (1 g per os) and placebo (cornstarch). Conditioned pain modulation (CPMa psychophysical measure reflecting descending pain modulating mechanisms) was assessed during each session, using heat pain stimulation (HPSthermode) before and after conditioning stimulation (cold pressor test [CPT]); the difference in pain intensity induced by the HPS before and after CPT was used as a metric to evaluate CPM effectiveness. The pain induced by the HPS decreased significantly after the CPT, as supported by the significant main effect TIME (p < 0.001). However, we observed no TIME x CONDITION interaction (p = 0.38), indicating that acetaminophen did not affect CPM effectiveness, and no interaction with sex was noted (all p-values > 0.47). Altogether, these results indicate that acetaminophen does not enhance CPM effectiveness; a finding that will contribute to a better understanding and utilization of this pain medication. Introduction/Aim: The gold standard of pain management treatment is an interdisciplinary group approach. Unfortunately, young adults (YA) often fall through the cracks of the adult healthcare system. As such, the Michael G. DeGroote Pain clinic piloted a pain management program geared specifically to meet the needs of this demographic. The aim of this poster is to describe the development and initial results of the pilot of the YA pain management program. Program Description: Six Young Adults (4 females and 2 males) aged 17.9 to 20.1, attended the program. The program occurred 5 hours daily for 1 week, and consisted of participating in daily fitness, relaxation, psychoeducational classes, goal setting and functional activities. The program also included a parenting session, and a follow-up session 6 weeks post-treatment.
Preliminary Results: At the 6-week follow-up session, all YA reported meeting the short-term goals they set at the end of the program. Four of the six YA returned to school with the goal of obtaining college diplomas, and 2 found jobs with plans to attend college in the near future. All YA noted the benefits of connecting with other YA who struggle with chronic pain. Parents reported observing improvements in their YA's activity levels, eating habits, independence, motivation, communication, socialization, and helping out around the house.
Discussion/Conclusions: The preliminary results suggest that YA benefit from engaging in group pain management programming with their peers. Future research could examine the outcomes of YA attending the regular adult group program compared to the YA only program.
Introduction/Aim: The aim of this study is to provide preliminary comparative data on the relationship between healthy infants' pain behaviour (FLACC) and commonly used cardiac indicators (i.e. heart rate [HR], respiratory sinus arrhythmia [RSA]) during 12-month vaccinations.
Methods: Caregiver-infant dyads were part of an ongoing cohort followed at 12-, 18-and 24-month vaccinations. Behavioural and cardiac data were simultaneously collected, and later coded/analyzed for FLACC and HR/RSA during four 30-s epochs (30-s pre-needle, immediately post-needle, 1-minute and 2-minutes post-needle). Two cross-lagged path models examined directional and reciprocal relationships between FLACC and HR or RSA during the 12month vaccination (n = 82).
Discussion/Conclusions: Preliminary analyses suggest behaviour and cardiac indicators converge during most concurrent epochs. There were also strong indica-tions of within-measure prediction and cross-lagged relationships between behaviour and cardiac indicators. Results suggest that behavioural and cardiac indicators may be capturing unique aspects of the nociceptive response.
CONTACT Jordana Waxman waxmanja@yorku.ca An important component of healthcare transition is the coordinated movement of adolescents and young adults (AYA) with chronic medical conditions from pediatric to adult-oriented health care, leading to secure attachment to adult health services 1 . Transition is more than sending and receiving a referral: it is an explicit process that includes organizational processes, AYA preparation, transfer, and attachment to the adult care setting 2 . Chronic pain is defined as pain lasting longer than three months or beyond usual expected healing time 3 . Research has shown that, without preparation, AYA with conditions such as chronic pain are often unable to name their relevant medical history or prescriptions, adherence to care is lower, and medical complications increase 4 . Discontinuity of care is also common, leading to diminished quality of life for AYA 4 . A standardized approach to transition in care for adolescents must define responsibilities and roles for family, providers, and clients in order to provide AYA with the support necessary to achieve an optimal transition to adult care 5 . To address this need, pediatric and adult chronic pain clinics, as well as client and family partners, from across the province of Ontario collaborated to develop recommendations for transition of AYA from pediatric to adult chronic pain services. These recommendations are a starting point to support policy development, advocacy, and improved service delivery. This poster describes the guidelines created, adult and pediatric partnerships to develop and implement transition programs, and client experiences of transition from pediatric to adult chronic pain services. Introduction: Educating patients following cardiac surgery has become a challenge for healthcare providers given the need to deliver complex information, limited resources, the shortened length of hospital stay, and the shift in healthcare model delivery to community-based care. As a result, patients are ill-prepared to self-manage their postoperative pain and other postoperative complications following cardiac surgery. Aim: To design an e-Health curriculum, SMArTVIEW Restore and Recover (R&R), which combines postoperative education and self-management training to optimize pain and related recovery outcomes following cardiac surgery in Canada and the United Kingdom.
Method: Using a health engagement platform, customized modules were co-designed into an interactive digital solution. As an innovation approach, an iterative usercentered framework featuring participatory design was used to develop the web-based solution optimized for a tablet. Participants will engage in R&R, a virtual interactive self-management curriculum delivered weekly over a 5-week postoperative period. The curriculum is based on seniors needs, identified during patient journey mapping and previous self-management experience. Both content and process elements of R&R are grounded in the fear avoidance beliefs model, which shows how catastrophic pain perceptions can lead to fear, hypervigilance, avoidance, disability and depression. The curriculum is designed to provide patients with requisite cognitive, emotional, and behavioural skills to manage their postoperative pain experience in a productive and positive way, leading to optimal functioning and recovery.
Conclusion: SMArTVIEW R&R self-management curriculum is designed to empower seniors to communicate their postoperative pain experience and utilize effective pain management strategies. It is currently deployed as a core component of an international randomized-controlled-trial. Methods: This retrospective study was conducted on 121 well selected chronic pain patients who completed a 3-4 month intense customized interdisciplinary pain program during 2017-18. Data collected included demographic information, pain characteristics, emotional/ functional status obtained by validated instruments and Global Impression of Change (GIC). Means of pre-and post-program variables were compared to assess effectiveness of each patient's "journey".
Results: Male/female ratio was 1:2 (p < 0.5); mean age 47 ± 17 years (18-85 yrs); Canadian-born patients constituted 68% (p < 0.05); 49% were employed; 28% consumed marijuana over the past year and 1/3 had received multiple injections in the past. Pain originated from MVAs, work and sports injuries in 50% of patients. Mean pain ratings and pain duration were 6.1 ± 1.6 and 5 ± 6 years respectively. Outcome data indicated substantial improvement (48% in selfefficacy, 44% in pain catastrophizing, 44% in GAD, 33% in BPI pain severity and 43% in BPI interference score, 56.5% in CESD and 79% much improved in Global Impression of Change). Detailed further analysis and 6 and 12-month outcome data will be presented.
Discussion/Conclusions: Our high rate of success results from: Strict inclusion/exclusion criteria for patients unable to afford the program; patientcentered one-to-one care; strong interdisciplinary communication and treatment coordination; and regimented and highly structured program. Our experience so far has taught us that such intense programs are appropriate for select pain patients only. As the prevalence of opioid use disorder (OUD) in Canada increases, there is a greater demand on hospitals to provide more specialized and coordinated care to patients with OUD who require surgery or have an acute medical condition involving pain. Patients at high risk for significant opioid withdrawal or those receiving current treatment for OUD and at risk for relapse during their recovery period from surgery or acute medical condition are identified early and offered coordinated and comprehensive care. Our experience to date suggests that patients in both groups require highly individualized care and expertise from a range of hospital and community-based services in order to achieve optimal pain relief peri-operatively while minimizing harm from either abrupt opioid withdrawal or relapse due to repeated opioid exposure required to manage surgical pain. This includes the multidisciplinary team consisting of pain physicians, nurse practitioners, addiction specialists, psychologists and psychiatrists.
Additionally, (1) pre-operative assessments identifying patients with opioid use disorder including risk assessment for the same (2) peri-operative analgesia including harm reduction interventions and (3) successful transition to the community and sustain effective pain management while reducing opioid-related harm are all considered. This poster will illustrate, through a process mapping diagram, the key touch points along the patient's surgical and non-surgical admission continuum at a quaternary care facility. The illustration will identify resource requirements used sequentially at each phase of the patient's journey, including key health care professionals and interventions at each point of the preoperative, peri-operative and post-discharge phases.
CONTACT Salima Ladak salima.ladak@uhn.ca Introduction/Aim: The intention of this presentation / poster is to open up a conversation about engagement of patients as partners within research projects. As such the need to change the way researchers and clinicians have learned to work with each other may not be applicable when inviting people living with chronic pain to participate. I offer from perspectives found in education and philosophy relational communication approaches that can co-create a community of researchers rather a research team.
Methods: A philosophical hermeneutic approach was used to interpret my personal experiences as a person living with chronic pain and as a qualitative researcher.
Results: Changes in how we understand how to relate to each other means reconceptualizing labeling, expectations and modes of practice.
Discussion/Conclusions: Humanizing research offers a genuine initiation for everyone in the research team. This presentation offers insight into how to cocreate such an approach which is inclusive, relational and hospitable.
Currently within the Canadian research landscape, inclusion of patients as partners, research ambassadors have become part of the fabric for research funding; "nothing about me without me". My recent personal experiences at pain conferences and from research team meetings as a patient or more precisely, a person living with chronic pain (PLCP), who is also an academic researcher, suggest we need to evolve a philosophy of engagement that serves both the PLCPs as research ambassadors, rather than patent partners. This presentation is intended to open up conversations about the role of patient experience and the interconnections needed to build strong research communities, through a consideration of a whole person care relational model. In order to meaningfully locate and describe the role of the patient within the structure of a scientific research community I turn to Merleau-Ponty who aptly described the two main perspectives from which we research as, "[t]he world and man [human-beings] are accessible through two kinds of investigations, in the first case explanatory [scientific] and in the second case reflective [philosophical]". Suggesting, that the language and relationships the emerge and nurtured within research communities need a shared understanding derived from a relational approach rather than a business model of efficiency, experts and teams. A relational approach works toward cocreating a sense of belonging and purpose rather than mere inclusion to meet research funding application criteria. The focus of this presentation is to explore how to co-create a relational approach for researchers with people living with chronic pain. Pain is an embodied experience that is perceived based on a person's body schema. Neuroimaging advances suggest maladaptive plasticity of cortical somatosensory and motor representations of the body in clinical pain presentations, resulting in potential compromise of body perception across proprioceptive, exteroceptive, and interoceptive systems. This case presents a nineyear-old female with persistent right upper extremity pain secondary to a fall on outstretched hand injury and consistent with nociplastic mechanism. On initial assessment, the patient reported significant pain (6/10). The patient was cleared of neurological and orthopedic trauma. Immediate post injury pain was localized to the lateral and distal half of the right upper arm which had subsequently spread to include the right dorso-radial aspect of the hand, posterior shoulder, cervical region, and temporal and parietal regions of the head at the time of initial visit. The patient presented with normal upper extremity range of motion, no sensory deficits, positive right upper limb neurodynamic test, and pain related functional limitations. Treatment consisted of a neural mobilization program over four sessions with resultant return to full function and pain reduction to 1/10. On intake and discharge the patient was asked to draw a self-portrait and an image analysis was conducted. The intake self-portrait showed an affected arm significantly smaller than the unaffected side. The discharge self-portrait was symmetrical, suggesting normalization of her interoceptive sensitivity which correlated with her symptom resolution. This case highlights the novel consideration of body perception disturbance in clinical assessment through patient artistic conceptualizations of self.   The group met to address pain care needs, research needs, training and mentoring opportunities, and develop a knowledge translation strategy addressing pain care in the hemophilia community.
The group reviewed a scoping review of pain management in hemophilia, current best practice for pain care and established a work plan. A survey was administered at the annual meeting of AHCDC and by email to CPN affiliated pain clinics; another has been developed for patients with hemophilia.
The scoping review found little high quality clinical trials evidence for pain care in hemophilia. The surveys identified a lack of pain knowledge and training amongst hemophilia clinicians, including opioid prescribing and the role of medical cannabis, and interest in augmenting knowledge. Additional meetings to review survey results and plan next steps has led to plans for interdisciplinary health team members from AHCDC to undergo a pilot training program at the DeGroote Pain Clinic. The goal is to transfer existing experience in complex pain care from pain clinic to hemophilia clinic interdisciplinary team members, create clinical pathways, and establish referral strategies to address complex problems beyond the scope of the hemophilia clinic.
Next steps identified are surveying patients, evaluating the experience with interdisciplinary training programs, and creating online resources. Methods: The CSI was completed by female patients attending their first and last day of the CPP Program, along with demographics and subjective physical and pelvic functioning. Data were analyzed using descriptive statistics and a paired sample t-test.

Use of Central Sensitization Inventory in Females with Chronic Pelvic Pain
Results: Eight females completed the first CPP Program and were 33.3 ± 6.2 years old. In terms of functional characteristics, 42.9% reported a strong uncontrollable urge to urinate, 84.6% reported constipation, 84.6% reported pain during/after bowel movements, and 99.9% reported pain during/after intercourse or insertion of an object. The majority of the women reported exercising 3-5 times per week (41.7%). The mean CSI total score at admission was 85.0 ± 15.0 and 77.8 ± 17.7 at discharge. A paired sample t-test was not significant (t= 2.6, p= 0.43), although this is to be expected given the low N.
Discussion/Conclusion: Preliminary results of this new interdisciplinary CPP Program demonstrate a pattern of high functioning females that have moderate to high levels of central sensitization. Moreover, the change in CSI post-Program encourage further analysis.
CONTACT Adria Fransson fransson@hhsc.ca Methods: Primary care clinics were randomized in three groups: 1) CMM by primary care physicians, 2) CMM plus Knee-KG-based treatment recommendations (including a personalized home exercise program), and 3) CMM, Knee-KG-based recommendations including exercises, a self-management education session, and two followup supervised meetings. Primary outcomes were performances on reliable physical examination tests for KOA: 2 objective tests (quadriceps strength/30 seconds chair stand test) and 6 subjective tests (e.g. flexion contracture, visual quadriceps atrophy…). Intention-to-treat and per-protocol analyses (patients who followed the recommended exercises for 6 months) were used to assess between-group differences.
Results: 231 patients completed the study (Group1: 76; Group2: 73; Group3: 82). At 6-month follow-up, patients from Group3 reported statistically significant improvement on functional objective tests compared to other groups (both p < 0.001). Patients in both Knee-KG groups improved compared to Group1 on the flexion contracture test (both p < 0.05). Patients in Group3 improved more than patients in Group2 (p = 0.03). Considering only patients from Group2 (32%) and Group3 (74%) who followed the exercises, all these differences with Group1 increased. Group2 further improved on visual quadriceps atrophy assessment compared to Group1 (p = 0.02).
Conclusions: Results support the clinical added value of a Knee-KG exam to personalize conservative treatment strategies for KOA patients in terms of performance on objective and subjective physical tests. Reinforced adherence through education and supervised sessions further improves performance. An important component of healthcare transition is the coordinated movement of adolescents and young adults (AYA) with chronic medical conditions from pediatric to adult-oriented health care, leading to secure attachment to adult health services. Transition is more than sending and receiving a referral: it is an explicit process that includes organizational processes, AYA preparation, transfer, and attachment to the adult care setting. Chronic pain is defined as pain lasting longer than three months or beyond usual expected healing time Research has shown that, without preparation, AYA with conditions such as chronic pain are often unable to name their relevant medical history or prescriptions, adherence to care is lower, and medical complications increase. Discontinuity of care is also common, leading to diminished quality of life for AYA. A standardized approach to transition in care for adolescents must define responsibilities and roles for family, providers, and clients in order to provide AYA with the support necessary to achieve an optimal transition to adult care. To address this need, pediatric and adult chronic pain clinics, as well as client and family partners, from across the province of Ontario collaborated to develop recommendations for transition of AYA from pediatric to adult chronic pain services. These recommendations are a starting point to support policy development, advocacy, and improved service delivery. This poster describes the guidelines created, adult and pediatric partnerships to develop and implement transition programs, and client experiences of transition from pediatric to adult chronic pain services. Chronic pain affects an estimated 1 in 5 adults and is a leading contributor to years lived with disability, high healthcare costs, and lost work productivity. Systematic review evidence demonstrates that physical activity and exercise can decrease pain severity and improve physical function in adults with chronic pain. Despite the benefits, participation in physical activity and exercise is low. One potential reason for low participation is that many adults with chronic pain are not sure how to access communitybased physical activity and exercise programming that is tailored to meet their unique health and well-being needs. The Chronic Pain Clinic at Kingston Health Sciences Centre (KHSC) in Kingston, Ontario is a tertiary care hospital-based service in Southeastern Ontario. In order to facilitate increased participation in physical activity and exercise, the Chronic Pain Clinic at KHSC has begun to form partnerships with municipal recreation centers, the YMCA, not-for-profit agencies, and local communitybased physical activity and exercise programs. In addition to simply educating patients about community-based programs, physiotherapists within the Chronic Pain Clinic at KHSC physically go into the community to participate in programs with patients to ensure appropriate connections are formed. While it has been challenging to create linkages with programs across our entire geographic catchment area, the Chronic Pain Clinic at KHSC has been successful at forming partnerships with diverse community-based physical activity and exercise programs across the greater Kingston area. Next steps include creating formalized referral pathways for patients regarding participation in community-based physical activity and exercise programming. Inter-professional Spine Assessment and Education Clinics (ISAEC) is an innovative, upstream, shared-care model of care in which patients receive rapid low back pain assessments, education and evidence-based self-management plans. It is funded by the MOHLTC and is designed to decrease the prevalence of unmanageable chronic low back pain, reduce unnecessary diagnostic imaging as well as unnecessary specialist referral. Low back pain care pathways often involve the requirement of an interventional injection to treat or diagnose low back pain. Patients are given the option of trialing injection therapy in order to avoid surgery or as a component of therapy while awaiting surgery. Unfortunately, the waitlists for these procedures may be just as long as the wait times for surgery. These wait times render this important modality useless. The Toronto Academic Pain Medicine Institute (TAPMI) is a program that received ministry funding in 2016. The program is a partnership amongst five teaching hospitals across the GTA. The program works as a hub to provide a biopsychosocial model of pain care delivery to chronic pain patients. The TAPMI partnership includes three interventional anesthesia sites that offer evidence based interventions to manage low back pain. TAPMI also has the benefits of a central triage system that allows for patients to be triaged to the shortest waitlist possible.

Establishing Linkages between a Hospital-Based Chronic Pain Clinic and
ISAEC and TAPMI have partnered to ensure seamless pathways for patients to obtain therapeutic or diagnostic block injection therapy. Introduction: Chronic pelvic pain (CPP) is a significant issue for women, with approximately 14% of women experiencing CPP at least once in their life. CPP is chronic and debilitating associated with significant costs and morbidity, and its etiology is multifactorial often complicating medical treatment and symptom management. Best practice guidelines recommend an interdisciplinary and biopsychosocial approach to treatment. The aim of this poster is to describe the ongoing development and evaluation of a novel Interdisciplinary CPP Program at the Michael G. DeGroote Pain Clinic. Methods: Female patients were referred to the Program from community gynecologists and urologists, and were scheduled for an orientation to learn about the Program. Patients were then scheduled for an interdisciplinary assessment (psychology, physiotherapy, internal pelvic examination), and if appropriate were scheduled for the Program. The Program occurs once a week for 8 weeks, and each day consists of physiotherapy, psychoeducation, goal setting, and mindfulness.
Preliminary Results & Discussion: Ninety-four referrals have been received since January 2018. Eight out of nine patients completed the first Program, and assessments and programs are ongoing. In terms of the demographics of the first sample of patients, the mean age was 33.3 ± 6.2, they last worked 2.8 ± 2.2 years ago, their pain started 10.1 ± 7.5 years ago, with predominantly an underlying diagnosis of endometriosis (77.8%). Ninety percent reported a history of anxiety/panic and depression. Upon discharge, all outcomes measures showed improvements. As the Program develops, future research will evaluate the statistical changes in outcomes, and will continue to support women coping with CPP.  Toronto Academic Pain Medicine Institute (TAPMI) is an interdisciplinary academic pain program serving as a hub for chronic pain in Toronto. The TAPMI Young Adult Clinic (YAC) started in 2018 as a transition program to guide paediatric chronic pain patients into the adult healthcare system. Currently, this is the only transitional aged chronic pain clinic in Ontario. Long-term sleep disruption is associated with increased chronic pain. The degree of pain relief can directly impact the quality and disruption of sleep. Data on the association in the young adult chronic pain population and sleep is scarce.
The YAC serves patients aged 17-25 years. its core clinical team comprises of an occupational therapist, physical therapist, and chronic pain physicians. It was noticed that YAC patients had problems with their sleep health, ranging from sleep initiation, sleep maintenance, circadian disturbances, primary intrinsic disorders such as apnea or restless legs syndrome. Patients also reported significant interaction between the pain quality, pain control and medications with their sleep health and overall quality of life.
In view of our recent findings, we recently expanded this program by creating a multi-disciplinary program integrating systematic evaluation of sleep health disruption, coordinating treatment strategies in consultation with the chronic pain physician, and occupational therapist with the goal to improve overall health, and quality of life of this vulnerable patient population. Various validated subjective and objective measures of sleep health, pain condition, pain perception, self-efficacy and quality of life will be measured prospectively in this novel inter-professional clinic.

Inagene Targeted Pain Panel: A New Pain-Focused Genotyping Platform to Guide Personalized Pain Management Decisions
Ben Pinder and Kathy Siminovitch R&D Division, Inagene Diagnostics Inc., Toronto, Ontario, Canada Pain is among the most common reasons for seeking medical attention, yet pain management remains challenging and ineffective for many patients. Poor pain management severely reduces quality of life and incurs significant socioeconomic burden, causing loss of productivity and increased healthcare costs.
Cumulative data suggests that up to 60% of the variable responses to pain medications relate to genetic polymorphisms in genes involved in the absorption, distribution, metabolism and/or excretion of these drugs. An individual's response to pain medications and also propensity for addiction to such drugs, may therefore be significantly influenced by the composite of variants present in such genes and, by extension, knowledge of each individual genotype profile enables more informed drug/ dose selection so as to more effectively alleviate pain and reduce frequency of adverse drug reactions.
To provide pharmacogenetic profiles specifically related to pain medications, Inagene Diagnostics has developed a pain treatment-focused, state-of-the art genotyping platform. Unlike other pharmacogenetics panels, the Inagene test is specifically tailored to address the needs of individuals suffering from different types of pain, comprehensively assaying the greatest number of genes/gene variants validated as having significant effects on efficacy of pain medications.
The Inagene testing service is available to prescribing physicians, pharmacists, and direct to consumers to guide healthcare providers and patients in the choice of analgesics, opioids, cannabinoids, and many other pain relief medications. This uniquely comprehensive assay serves as a novel guidance platform for difficult therapy decisions, heralding a more effective personalized approach to pain management.