Understanding Pain: From Cells to Brain to Individual Perceptions

Introduction/Aim: Cardiac surgeries rank among the most frequent surgical procedures and present a risk of chronic post-surgical pain (CPSP). As a first step in preventing CPSP, a tailored Web-based intervention was developed and successfully tested to tackle pain management during hospitalization. Before proceeding to further development, preliminary acceptability of the intervention must be evaluated. The purpose of this study was to examine clinicians’ perception of a Webbased tailored intervention for pain management in the early recovery phase. Methods: A parallel mixed methods approach was used to assess clinicians’ acceptability of the intervention in the early recovery phase (first month after surgery). Results: 249 participants completed an online survey and 10 participants were individually interviewed. Overall, the intervention was rated as acceptable for the early recovery phase. No difference was found in acceptability ratings by demographics. The intervention was rated as appropriate by 79% of participants. Although clinicians seemingly would recommend it to their patients, they did not perceive that their patients would be as highly willing to use it. Interviews highlighted several strengths of the intervention, such as postoperative pain awareness, customization of content, and flexible dosage and schedule. However, the main weakness was related to patient adherence. Discussion/Conclusions: Opting for a hybrid format and integrating individual treatment preferences could enhance the coaching experience. Considering that the intervention has demonstrated positive effects on the pain experience in the first week after cardiac surgery, it seems logical to explore its potential impact after discharge on the transition to CPSP.

Introduction/Aim: Cardiac surgeries rank among the most frequent surgical procedures and present a risk of chronic post-surgical pain (CPSP). As a first step in preventing CPSP, a tailored Web-based intervention was developed and successfully tested to tackle pain management during hospitalization. Before proceeding to further development, preliminary acceptability of the intervention must be evaluated. The purpose of this study was to examine clinicians' perception of a Webbased tailored intervention for pain management in the early recovery phase.
Methods: A parallel mixed methods approach was used to assess clinicians' acceptability of the intervention in the early recovery phase (first month after surgery).
Results: 249 participants completed an online survey and 10 participants were individually interviewed. Overall, the intervention was rated as acceptable for the early recovery phase. No difference was found in acceptability ratings by demographics. The intervention was rated as appropriate by 79% of participants.
Although clinicians seemingly would recommend it to their patients, they did not perceive that their patients would be as highly willing to use it. Interviews highlighted several strengths of the intervention, such as postoperative pain awareness, customization of content, and flexible dosage and schedule. However, the main weakness was related to patient adherence.
Discussion/Conclusions: Opting for a hybrid format and integrating individual treatment preferences could enhance the coaching experience. Considering that the intervention has demonstrated positive effects on the pain experience in the first week after cardiac surgery, it seems logical to explore its potential impact after discharge on the transition to CPSP.
Introduction/Aim: Alternative intervention formats have been implemented for people with pain. Several systematic reviews on Web-based interventions for pain have been conducted but the contribution of tailored Web-based interventions has not been evaluated.
The aim was to examine the effects of tailored Webbased interventions for adults compared to usual care, face to face and standardized Web-based interventions on pain intensity? The effects on physical and psychological functions were also assessed.
Methods: A systematic review was conducted (January 2000-December 2015. The DerSimonian-Laird random effects models were used to calculate effect estimates. Five outcomes were evaluated: pain intensity, painrelated disability, anxiety, depression and pain catastrophizing. Three time intervals were selected: short [<1 month], medium [1-6 months], and long-term [6-12 months] effects. Results: After full-text review, 17 studies were eligible. Only one study concerning acute pain was removed from the meta-analysis. When compared to usual care, benefits were observed immediately after with small effect sizes (<0.40) for pain intensity (N = 1310, P = 0.003) and pain-related disability (N = 953, P < 0.001). No improvements were observed at followup. When compared to the active control group, no improvements were found, except for a small effect size on pain catastrophizing (N = 333, P < 0.001) immediately after the intervention.
Discussion/Conclusions: Tailored Web-based interventions did not prove to be more efficient than standardized Web-based interventions. Some efficacy was shown on pain catastrophizing when compared to active control interventions. Considering the diversity of tailored Web-based interventions for chronic pain, their efficacy is yet to be explored. Moreover, their contribution to acute pain management is embryonic.
Introduction/Aim: To test the reliability and validity of the Critical-Care Pain Observation Tool (CPOT) to detect oropharyngeal pain in critically ill mechanical ventilated adults during routine oral care procedures.
Methods: We conducted a prospective observational study in two intensive care units (ICU) in a universityaffiliated hospital in Toronto, Canada. Two trained research coordinators independently observed patient behaviors during 2 non-painful (rest and gentle touch) and 3 potentially painful (oral suctioning, tooth brushing, and swabbing with a sponge toothette) oral procedures using the CPOT. Patients were stratified by level of consciousness. We used standard procedures to evaluate criterion validation, discriminative validation, and inter-rater reliability.
Discussion/Conclusions: The CPOT is valid and reliable for the detection of oropharyngeal pain during tooth brushing and oral suctioning procedures in adults experiencing invasive mechanical ventilation.  (4):238-244.) in a single dose just one hour before formalin test. Statistical analysis was done by ANOVA, followed by Bonferroni post hoc test. In the interpretation of results, p ≤ 0.05 was considered as significant.
Results: B 12 lowered only the jerking frequency and KT lowered both jerking frequency and flexing-licking duration significantly (p ≤ 0.001) in the late phase of formalin test. On the other hand, combination of B 12 and KT significantly (p ≤ 0.001) lowered both the study variables in all 3 phases of formalin test.
Conclusion: From this study it may be concluded that, vitamin B 12 possess analgesic effects and combination of B 12 with KT is more effective than those of their individual administration.

Disclosure statement
No potential conflict of interest was reported by the authors. While indicated for use in adult populations, small studies have shown promising results in reducing pain in children with few, if any, adverse effects. The objective of this study was to evaluate the safety of a Butrans (buprenorphine) Transdermal System patch for analgesia in a palliative paediatric setting. Studies of this drug have been mostly limited to adult populations and information regarding transdermal administration of buprenorphine in a paediatric population is predominantly found in case reports. Given this, our aim was to retrospectively assess the safety of buprenorphine in a palliative paediatric care setting. In our patient population, 27.3% of patients experienced only mild adverse drug reactions in the form of skin irritation (erythema in combination with pruritus), which was resolved with topical steroid treatment. The development of skin irritation led to Butrans treatment cessation in only 9.1% of subjects. Given these promising results, Butrans was found to be appropriate for analgesic use in a palliative paediatric setting and hope to see it's use expanded in the future. Introduction/Aim: Buprenorphine is an opioid medication used for the treatment of moderate to severe pain. In Canada, buprenorphine is not indicated for use in the pediatric population and literature surrounding its use in pediatrics is limited. Our aim was to evaluate the safety of buprenorphine in a pediatric palliative care setting.
Methods: Our study was performed at the IWK Health Centre. Medical records of 11 patients were examined for specific clinical characteristics. The study focused primarily on descriptive results; standard data analyses were not performed.
Results: Buprenorphine was found to be well tolerated in our patient population. There were no adverse effects reported in 8 of 11 patients during their treatment with buprenorphine. The remaining 3 patients described mild adverse effects in the form of skin irritation which resolved with topical steroid treatment. Efficacy was reported as anecdotal quotes from patient records.
Discussion/Conclusions: Currently in medical literature, there is limited data on the safety of buprenorphine in children suffering from pain in a palliative care setting. In our study, the use of buprenorphine in control of pain in this setting was safe in a small group of patients (3 patients exhibited a contact dermatitis which quickly resolved upon removal of the patch; no other adverse effects noted). Other studies have also demonstrated buprenorphine to be a safe and an effective opioid for the treatment of severe pain at the end of life in a pediatric population. The implementation of buprenorphine in pediatrics may be safe and provide proper analgesia. CONTACT Michael Smyth m.smyth@dal.ca Introduction/Aim: The McGill pain questionnaire serves as a basis for initial consultation assessment tools used by pain clinics throughout Canada. The effectiveness of pain evaluations using multi-page, text-heavy questionnaires has been recognized as less than ideal for patients for a number of reasons (such as reliance on literacy, the format not facilitating patient self-expression or conversation with physicians). Various novel methods of assessing pain have been suggested, including those that use pictograms and photographs and results have shown that this is a valuable area of research to pursue further. However, researchers to date have only trialed newly-designed models on patient populations and have not consulted patients in their design. Patient input on how they could best express their pain to health care professionals is a critical resource in furthering this area of research and innovation. The goal of this study was to gauge patient opinions on current pain assessment modalities and learn their opinions on future areas of improvement.
Methods: Thirty patients were interviewed following their initial consultation appointments at the Pain Management Unit in Halifax. Interviews were transcribed verbatim and analyzed using NVivo Software to look for themes among patients.
Results: The study yielded a total of twenty-five themes, such as the questionnaires were repetitive but of appropriate length. The use of a body template was valued. Participants provided perspectives on the use of technology and art for pain assessment.
Discussion/Conclusions: Recommendations are proposed based on the themes to help guide the creation or modification of pain assessment tools.
Introduction/Aim: Proactive immediate treatment of acute pain is critical in the first hours of acute coronary syndrome (ACS) onset to prevent transition to persistent cardiac pain. Aim: The purpose of this research was to design the Acute-Heart PAiN-APP. There are no known digital health technologies (DHTs) (APPs) developed or evaluated to treat acute cardiac pain during an emergency hospital admission for ACS that are designed by patients and health care providers (HCPs).
Methods: In Phase I we conducted qualitative interviews with individuals with ACS and HCPs to determine the preferred content and format for the APP.
Results: 18 patients and 4 HCPs suggested that the APP consist of four interactive parts: 1) Coaching through the acute heart pain, 2) Symptom tracking of pain and anxiety, 3) SMART goals to manage the acute symptoms: a) choice of diversion: relaxation-paced breathing, b) guided imagery c) music and d) forms of gaming, and 4) immediate visual Introduction/Aim: Parent traits relate to child pain outcomes; however, less clear is how these factors affect parent responses, such as heart rate variability (HRV), which provides continuous information about parents' emotional states. We examined how parent traits relate to changes in parent HRV before and after their child's completion of the cold pressor task (CPT).
Methods: Children between 7 and 12 years of age completed the CPT in the presence of a primary caregiver (n = 43). Parents completed trait measures of State-Trait Anxiety Inventory, Pain Catastrophizing Scale-Parent, and the Emotion Regulation Questionnaire. Parental HRV [assessed by the high-frequency component of HRV (HF-HRV) and the root mean square of the successive differences (RMSSD)] were monitored during 3 × 2 minute time periods: 1) neutral video (resting), 2) prior to the CPT (pre-CPT), and 3) recovery after the CPT (post-CPT). Resting HRV was examined as a trait variable. HRV reactivity was calculated by subtracting resting HRV from HRV pre-CPT. HRV recovery was calculated by subtracting HRV pre-CPT from HRV post-CPT.
Results: four hierarchical regression analyses were conducted in which parent traits were entered as predictors of parent HRV reactivity and recovery (HF-HRV, RMSSD). Resting HRV and trait anxiety predicted HRV reactivity; while resting HRV and trait catastrophizing predicted HRV recovery.
Discussion/Conclusions: Findings contribute to existing social communication models of pain. This novel study examined how parent traits relate to changes in parent HRV before and after child acute pain. Clarifying the factors contributing to parent responses has implications for pain management interventions.
Introduction/Aim: Pediatric chronic pain is prevalent, affecting 25% of Canadian youth, and can have devastating effects on functioning and well-being. In order to improve psychological treatments for youth with chronic pain, which are often ineffective, a better understanding of factors that contribute to pediatric chronic pain, and which may be effective targets for treatment, is needed. Parent chronic pain and trauma have been found individually to contribute to chronic pain in offspring. However, chronic pain and trauma often co-occur. As such, this study aimed to examine the cumulative risk of parent chronic pain and trauma symptoms on pediatric chronic pain outcomes.
Methods: To date, 172 youth (68% girls) aged 8-18 (M = 13.26, SD = 2.59) referred for tertiarylevel treatment of chronic pain and one of their parents (92% mothers) completed self-report measures of parent chronic pain status and trauma symptoms and child pain interference and health-related quality of life (HRQoL). Hierarchical multiple regressions were conducted.
Discussion/Conclusions: Parents' own chronic pain and trauma symptoms predicted greater pain interference and lower HRQoL in youth with chronic pain. These findings suggest that parents' mental and physical health may be important targets for the treatment of pediatric chronic pain. Future research should examine modifiable mechanisms (e.g., parenting behaviours) that may underlie these relationships. no differences 30 with respect to the type of intervention (psychoeducation about the mind-body connection being endorsed as the top intervention across diagnoses). Inductive content analyses revealed substantial complexity in participants' perceptions of the advantages and disadvan-35 tages of using SS+ diagnoses in YCP (e.g., whether or not the diagnoses appropriately conceptualize the symptoms).
Discussion/Conclusions: Future research is needed to develop guidelines and training initiatives for professionals about the use of SS+ diagnoses in youth with chronic pain.
Introduction/Aim: While parents can impact child pain outcomes via verbal and nonverbal communication, parents often have difficulty knowing how to respond to their child's pain. Further, most pain management interventions focus on the child. Determining what parent responses facilitate child coping can inform interventions for parents. This study examined parent emotional and cognitive presence (mindfulness, emotion regulation), parent perceptions of child outcomes, and child pain outcomes during child pain to better understand protective parent factors.
Methods: Fifty-six children (7-12 years) underwent the cold pressor task (CPT) alongside their parent. Parents completed trait measures of mindfulness and emotion regulation (Cognitive Affective We conducted a preliminary evaluation to review the scope and quality of evidence surrounding transdermal buprenorphine use in the paediatric setting for nonsurgical pain. Our review revealed limited data available on the use of transdermal buprenorphine in paediatric patients. Most studies surrounding this subject involve accidental ingestion of buprenorphine and it use in treatment of neonatal abstinence syndrome. While indicated for use only in adult populations, small studies have shown encouraging results in reducing pain in children with few, if any, adverse effects. This is reassuring from a clinical perspective, as we hope to highlight the available evidence and invite researchers to expand future studies. Through this review, we have identified significant gaps in the literature surrounding the safety and use of buprenorphine in the paediatric population. To our knowledge, there are no major studies investigating this subject and it is our hope, from a patient perspective, that future studies will explore the use of transdermal buprenorphine as an alternative pain mangement technique in paediatrics. The intent of our research is to help opioid naïve patients, patients experiencing inadequate analgesia, adverse effects from traditional opioid therapies, or as an alternative route of administration when the enteral or intravenous routes are not available.
Introduction/Aim: In Canada and the USA, transdermal buprenorphine is not indicated in the paediatric population despite literature being devoid of any major adverse drug reactions among participants. This study aims to address current gaps in the literature and provide greater understanding of transdermal buprenorphine in the pediatric population.
Methods: In this scoping review, PubMed, Embase and CINAHL databases were screened. All studies including case reports (n = 1) were included. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), an evidencebased guideline to advance the execution of systematic and scoping reviews. We employed Covidence software, the current gold standard used for Cochrane systematic reviews to screen and filter available literature.
Results: Of the 2587 studies screened for transdermal buprenorphine use in the paediatric population, we found that only a small number of studies were eligible for further analysis based on our exclusion criteria. Of the studies analyzed, buprenorphine was found to be a safe and effective treatment for pain in a paediatric population. Furthermore, these studies also found that sustained release of buprenorphine was well tolerated by patients with few adverse reactions (most commonly erythema and allergic contact dermatitis). Other side effects included nausea, vomiting and headache.
Discussion/Conclusions: This scoping review has demonstrated that buprenorphine may be able to be safely implemented into pain management strategies in the paediatric population. Along with other analgesic treatments, it also provides an alternative for patients who do not respond well to traditional opioid therapies. Moving forward, additional research will be required in order to further demonstrate the safety and efficacy of buprenorphine in pain management.
Introduction/Aim: The purpose of this research was to explore the experiences of adults with chronic pain when they participate in physical activity and exercise and to understand perceived barriers and facilitators to participation.
Methods: We conducted an interpretive descriptive qualitative study. We recruited adults who self-identified as living with chronic pain from primary care teams and a hospital-based chronic pain clinic in Kingston, Ontario. An audit trail, reflexive dialogue, and thick description were used to maintain analytical rigor.
Results: 16 participants took part in an interview between October 2017 and January 2018. The majority of participants identified as female (11/16) and had a median age of 53 years. Three themes and subsequent sub-themes emerged: (1) unique features of physical activity and exercise in the context of chronic pain (physical activity through daily tasks, low intensity physical activity is best, flaring up after physical activity), (2) factors influencing participation in physical activity and exercise (access to fitness equipment/facilities, motivation to participate, uncertainty/fluctuating responses, social supports, perceived benefits, competing demands for time, knowledge, fears, physical abilities, environment, pain/fatigue, and confidence, and (3) potential outcomes of participating in physical activity and exercise (improved pain management, mental and emotional changes, social connections, functional gains, and other aspects of health)" should be deleted and replaced with the following sentence "Three major themes (and sub-themes) emerged: (1) the challenge of staying active (decreased activity levels due to pain, discomfort during physical activity, and uncertain and fluctuating abilities); (2) factors influencing participation (pain, fatigue, perceived risks, beliefs about physical activity, competing demands, social support, motivation, other health conditions, and access to supports for physical activity or exercise); and (3) perceived outcomes (pain management, functional improvements, social participation, mental health, and overall wellbeing).
Discussion/Conclusions: A combination of factors were perceived as influencing participation in physical activity and exercise in adults with chronic pain. Potential outcomes of physical activity and exercise focused on overall health and well-being among adults with chronic pain. Introduction/Aim: Repetitive transcranial magnetic stimulation (rTMS) can modulate heat pain thresholds (HPT) in health and disease. One obstacle of rTMS however is the number of sessions required to induce a significant effect on pain. We aimed to examine whether conditioninga physiological response elicited through unconscious association of stimulican be used to optimize the effect of rTMS on HPT.
Methods: Twenty healthy subjects were randomly assigned to: 1) conditioning (n = 10;6F;23y±2) or 2) nonconditioning (n = 10;4F;23y±3) groups and took part in two laboratory visits (one with active rTMS the other with sham). For the active visit, two rTMS sessions of 20 min with a 20 min resting period in between were conducted over the left motor cortex (10Hz at 80% RMT). For sham visit, same parameters were used with a sham coil. HPT were evaluated over the right wrist area at baseline and after each rTMS/sham session. For the conditioning procedure, heat temperature eliciting moderate pain was determined at baseline. Then, in the conditioning group, the thermode temperature was decreased by 3°C during the resting period. Introduction/Aim: Many chronic pain patients suffer from other chronic health conditions, which can lead to increased burden of symptom self-management. This increased perceived burden can negatively impact on patients' beliefs, behaviors and treatment adherence. This study aims to identify predictors of perceived medical burden among chronic pain patients suffering from ≥1 additional medical condition.
Methods: A transversal observational study design was used. A total of 137 individuals with chronic pain (≥3 months) and ≥1 other medical condition were recruited from patient associations and social and conventional media and completed online questionnaires. A linear regression model using backward selection process was used to identify pain characteristics (duration, interference, average and worst pain intensities), patient (age, sex, gender, self-efficacy, patient engagement in healthcare), and medical (number and severity of comorbidities) characteristics associated with perceived medical burden.
Results: The final regression model included 3 variables: patient engagement in healthcare (b = −.25, p < .05) and pain interference (b = .48, p < .05), but not severity of comorbidities (p = 0.069) were significantly associated with perceived medical burden. Results showed the less individuals are engaged in their healthcare, the greater the burden perceived. In addition, the more pain interferes with daily activities, the more their medical conditions is perceived as burdensome.
Discussion/Conclusions: Results revealed that objective measures of severity of conditions, as evaluated by the Self-Administered Comorbidity Questionnaire and comorbid-ity count, are not associated with perceived medical burden. Targeting patient and pain characteristics might prove beneficial to reduce perceived medical burden and facilitate symptom self-management.

Funding
This work was supported by the Natural Science Fund of Shandong Province, China (No. ZR2012DM014) and the People's Livelihoods Science and Technology Project of Qingdao, Shandong Province, China (13-1-3-73-nsh).
Introduction/Aim: Chronic pain after moderate-tosevere traumatic brain injury (TBI) could be affected by age. Still, pain presentation in adult TBI has never been investigated across a large age range. We examined whether age contributes to chronic pain presentation after moderate-to-severe TBI.
Methods: N = 54 adults between 18-85 years (36 males, 46 ± 19 years) were recruited 23 ± 14 months after moderate-to-severe TBI. Chronic pain was assessed with the Brief Pain Inventory. Thermal and mechanical detection/pain thresholds were gathered using Quantitative Sensory Testing (QST). Data were transformed into z-scores to account for variation in gender and pain sites.
Results: Participants were categorized into three groups: n = 18 young (<35 years), n = 17 middle-aged (36-55 years), n = 19 older adults (≥55 years). Chronic pain was reported by n = 30 (56%) participants with an average intensity of 5 ± 2/10. Overall, young and middle-aged participants (≤55 years) with pain presented higher cold detection z-scores when compared to same age participants without pain (t = 2.28, p = 0.03). In contrast, older participants (≥55 years) suffering from chronic pain exhibited a lower heat pain z-score when compared to pain participants of the other age groups (F = 8.82, p = 0.001), but not when compared to same age participants without pain (t = 0.28, p = 0.79). Correcting for gender and time elapsed since TBI, age was not significantly related to chronic pain status (X 2 = 0.347, OR = 1.01, p = 0.57).
Discussion/Conclusions: Our results support previous ones showing thermal hypoesthesia in young TBI with chronic pain. For the first time however, we show that being over 55 years could predispose to thermal hyperalgesia after TBI, suggesting possible agerelated differences in neuroplasticity following adults.
Parent Perspectives on the Benefits and Limitations of a Social Media Campaign to Disseminate Evidence-Based Information on Pediatric Cancer Pain Introduction/Aim: #KidsCancerPain is a social media campaign that partnered with the Cancer Knowledge Network to disseminate evidence-based information on pediatric cancer pain directly to parents. Parent perspectives on the use of social media as a tool to translate research remain unclear. The purpose of this study was to explore parent-perceived benefits and limitations of the #KidsCancerPain campaign.
Methods: At the conclusion of the #KidsCancerPain campaign parents of children with cancer who viewed the campaign content were recruited to complete an online survey. Parents were asked to provide openended responses describing their perspectives on the benefits and limitations of the campaign. Data were analyzed using content analysis.
Results: A total of 120 parents (94% mothers) provided responses. Parent-perceived benefits of the #Kids-CancerPain campaign clustered into three categories: (1) provision of practical pain management strategies (e.g., new techniques to manage their child's pain), (2) reinforcement of pain management practices they were already using, and (3) provision of confidence and support to manage their child's pain, fear and distress. Parent-perceived limitations of the campaign were its applicability (e.g., child not experiencing pain or completed treatment) and visibility (e.g., some parents only recently became aware of the campaign, and some reported limited social media use).
Discussion/Conclusions: Parents described both benefits and limitations of the #KidsCancerPain campaign related to managing their child's pain. Strategies to optimize the reach of social media content should be made in consultation with parents prior to future campaigns. These data will help guide broader parent-directed dissemination efforts using social media.

Funding
This work was supported by the Natural Science Fund of Shandong Province, China (No. ZR2012DM014) and the People's Livelihoods Science and Technology Project of Qingdao, Shandong Province, China (13-1-3-73-nsh).
Introduction/Aim: Peripheral neuropathy is a common cause of chronic pain among patients with diabetes, and acupuncture has been suggested as a therapeutic option.
To determine the effectiveness of acupuncture for chronic diabetic peripheral neuropathy (DPN).
Methods: We searched MEDLINE, EMBASE, CENTRAL, AMED, CINAHL, PsychINFO, trial registries, and reference lists of relevant articles up to February 2017. Pairs of reviewers, independently and in duplicate, screened articles for inclusion, assessed risk of bias and extracted data. We conducted metaanalyses when possible and used the GRADE approach to assess the quality of evidence.
Results: Among 4443 potentially eligible studies 4 with 244 patients proved eligible to be included for review. Overall all four studies were at high risk of bias. Compared to sham acupuncture, we found very low quality evidence that acupuncture reduces pain ( CONTACT Ngai Chow chown7@mcmaster.ca In the present study we just report the results of 4 eligible studies published in English. In the updated study, we have also included 52 articles published in Chinese with the assistance of our Chines colleagues. We will report the results of our new analyses in the near future. Introduction/Aim: Early childhood vaccination is painful and distressing for infants and parents. Clinical practice guidelines recommend effective evidence-based pain management strategies during vaccination (breastfeeding, upright holding, sucrose). This study aims to identify and quality appraise publicly accessible online information regarding parent-targeted resources for pain management during vaccinations of infants.
Methods: An environmental scan for electronic resources containing parent-targeted information on infant vaccination were included, using internet sources in English i) Google search and ii) Social Media networks. Characteristics of the resources were collected. The quality of resources was evaluated by Center for Disease Control (CDC) Clear Communication Index (CCI) (score range 0-100%, higher than 90% are acceptable). Descriptive statistics were used to analyze the data.
Results: 65 eligible resources were identified. The mean resources' CCI score was 60% (± 0.19) with most resources scoring as low to moderate quality (score 33% to 87%). Only 5% of resources were considered to be acceptable quality, almost all requiring revisions. Pain management information was presented in 30 (46%) resources; 24 (37%) included breastfeeding, 27 (42%) holding, and 22 (34%) sweet solutions. No statement regarding pain management strategies were found in over half (54%) of the resources. In resources describing pain management, distraction and holding were the most frequently suggested strategies.
Discussion/Conclusions: Most online parenttargeted vaccination resources are of low quality and do not include evidence-based pain management strategies. Thus, there is a need for researchers, policy makers, and educational institutes to develop Introduction/Aim: An estimated 35% of all Inflammatory Bowel Disease (IBD) patients in remission continue to experience chronic abdominal pain. Despite the negative impact on quality of life, minimal research effort has been devoted to addressing this issue. IBD patients often seek alternative therapies to manage persistent pain including the use of cannabis, without evidence to support its use. This study describes the characteristics of pain, mood and cannabis use in IBD patients.
Methods: This is a cross-sectional survey evaluating a cohort of ambulatory patients, age ≥16 years with a diagnosis of IBD for over one month.
Results: A total of 206 surveys were collected with initial results reported on 123. Constant pain was present in 26.8%% of IBD patients with 34.9% reporting at least moderate levels of pain (NRS>4). Opioid use for more than 30 days was reported by 13% of all patients with 31.3% and 34.7% actively using cannabis in Crohn's Disease (CD) and Ulcerative Colitis (UC), respectively.
Of active cannabis users, 67% used less than 2.5 g/d of dried cannabis. History of recreational use was greater in active cannabis users versus non-users but was only significant in UC. Average scores on the cannabis use disorder-short form were >4 in active cannabis users. The PHQ-9 and GAD-7 documented moderate depression and anxiety in all groups with significant levels of depression (18.0 vs. 14.4, p < .05) between active cannabis users versus non-users in CD. Only 14.9% of active cannabis users endorsed subjective improvement in pain or mood.
Discussion/Conclusions: Constant pain of at least moderate intensity and associated depression and anxiety is common in IBD. While cannabis use is prevalent, few report subjective improvement.
Inflammatory pain is a result of complex and dynamic interactions between the immune and the nervous systems, and includes the orchestrated recruitment and activation of tissue-resident and circulating immune cells. Our previous studies have identified a central role for Ly6C-lo myeloid cells in the pathogenesis of inflammatory pain. We now show that CCL17 and CCL22, chemokines expressed preferentially by these cells, and their cognate receptor CCR4 are key mediators of this response. CCL17 and CCL22 are both upregulated significantly early after tissue injury and elicit a robust acute pain response when administered subcutaneously. Pharmacological blockade of CCR4 using a specific antagonist abrogates this effect. Acute post-surgical pain is also significantly reduced in both transgenic mice lacking CCR4 and wildtype animals treated with a CCR4 receptor antagonist. Together, these results suggest an essential role for the CCL17/CCL22:CCR4 axis in the genesis of inflammatory pain and opens new therapeutic avenues for its control.
Introduction/Aim: We designed an experiment to evaluate the potential adaptive significance of chronic pain in mammals, by measuring vigilance behaviour to predator odour. We hypothesized that mice in pain will become hypervigilant to predation threat.
Methods: To test threat avoidance behaviour, we developed an octagonal apparatus in which odour can be infused into a single arm. Mice were trained to seek food reward (a Fruit Loop) via the short route around the maze. Once trained, fox urine was infused such that taking the short route would entail encountering the fox odour. The number of short versus long routes chosen was recorded in five trials, in mice in the following conditions: 1) control, 2) 0.6% acetic acid, and 3) 0.6% acetic acid plus 20 mg/kg carprofen.
Results: Mice in all groups showed vigilance (I.e., avoidance of the short route) when fox urine was present compared to when it was not. Pain increased vigilance behaviour, and analgesia reversed this hypervigilance.
Discussion/Conclusions: We conclude that pain produces hypervigilance against predation. If chronic pain produces the same effect, as has been demonstrated in squid, this may represent the adaptive significance of chronic pain hypersensitivity.
CONTACT Kevin Lister kevin.lister@mail.mcgill.ca Introduction/Aim: The Global Burden of Disease study (2015) reported that chronic low back pain (CLBP) is the most prevalent and disabling condition amongst numerous chronic illnesses. According to the guidelines provided by Airaksinen and colleagues (2006), a supervised physical exercise intervention is an important first-step treatment of nonspecific chronic low back pain. Here, we investigated the impact of a 14-week long personalized physical exercise training program on pain intensity, perceived disability and several psychological factors in people suffering from CLBP. Methods: Twenty-three participants (female -16, male -7, age range 22-72 years old) suffering from chronic low back pain were recruited to complete 14 weeks of cardiovascular and muscle strengthening program. At the beginning and at the end of this intervention, we assessed their pain intensity following the NIH (2017) guidelines, and asked participants to complete several psychosocial questionnaires (Beck Depression Inventory, Pain Catastrophizing Scale, and Oswestry Disability Index).
Discussion/Conclusions: Our findings suggest that a long-term physical exercise training regimen substantially contributes to the reduction of pain intensity levels and improves psychological factors in patients with chronic low back pain. In order to further support our hypothesis, we are looking forward to including the results from a wait-list control group in our future analysis.
Introduction/Aim: Wide dynamic range (WDR) neurons of the spinal dorsal horn respond to a wide range of innocuous and noxious mechanical stimulation and encode the intensity of mechanical stimuli as changes in firing rate. However, there are inconsistent findings regarding whether WDR neuron activity is altered in pathological pain states. Additionally, there is still ambiguity regarding which stimulus parameters drive WDR firing. The aim of the current investigation was to review the available literature in order to ascertain whether WDR neuronal firing in rats is better predicted by pressure or force of a mechanical stimulus (von Frey filaments) and to assess possible mediating factors.
Methods: A systematic search was performed on PubMed. All papers were screened on the basis of a certain inclusion criteria and selected publications had a number of variables extracted from text, tables and figures. Forces of the von Frey filaments were converted to pressure by constructing a conversion equation based on manufacturer reported force and diameters. Statistical analyses were performed on the pooled data.
Results: We observed that WDR firing rate was better predicted by the calculated pressure of von Frey stimulation rather than applied filament force, as reported in all studies. The pressure-evoked firing rate of WDR neurons was not altered by any experimental pain model except for arthritis and inflammation models, where mechanical stimuli evoked a higher firing rate than controls. Conversely, there was a consistent increase the spontaneous firing rate of WDR neurons in neuropathic pain, arthritis and inflammation, and chemoneuropathy pain models.
Discussion/Conclusions: Evidence suggests that pressure of a mechanical stimulus, compared to force, is a better predictor of WDR neuronal firing. Additionally, these data indicate that changes in WDR encoding of applied pressure are unlikely to significantly contribute to pathological sensory processing but indicate a possible role for these neurons in spontaneous pain.
Introduction: Attachment insecurity (i.e., anxiety and avoidance in relationships) is associated with a wide range of negative outcomes, including the experience of pain and pain-related disability. To date, research on this topic has utilized samples of individuals and has examined "actor effects" (i.e., relationships between individuals' own attachment characteristics and their own pain variables). The current study investigates attachment and pain within dyads of romantic partners in order to investigate "partner effects" (i.e., relationships between individuals' attachment characteristics and the functioning of their partners).
Method: An online survey was administered to both members of 173 heterosexual romantic couples. They provided self-reports of attachment and pain experienced over the past four weeks. The Actor-Partner Interdependence Model, a statistical method that accounts for interdependence within dyads, was used.
Results: Males' attachment anxiety was associated with higher levels of self-and partner-reported pain (i.e., both actor and partner effects). Females' attachment anxiety was associated with higher levels of self-reported pain, but there was not a significant partner effect. Attachment avoidance was generally unrelated to pain reports. However, there was a significant partner effect for females' avoidance (i.e., attachment avoidance reported by women was positively associated with the pain reports of their male partners. Conclusion: Results highlight the importance of considering dyadic relationships when investigating the potential impact of attachment insecurity on the experience of pain. CONTACT Dyana Castillo dyana.castillo@usask.ca Introduction: Despite being the most common cause of disability worldwide, the etiology of back pain remains unknown, but is often associated with intervertebral disc (IVD) degeneration. Epidemiological studies have highlighted obesity as a major contributor to both IVD degeneration and back pain, yet the underlying biological mechanisms remain elusive. Our study aimed to investigate if dietinduced obesity accelerates age-induced IVD degeneration, and/or back pain.
Methods: Ten-week-old, male C57BL/6 mice were fed a western diet (high fat/high sugar), a high fat diet, or standard chow (control) for 12, 24 or 40 weeks. Prior to endpoint, behavioral tests were performed to assess indicators of pain. Following sacrifice, joint tissues were examined through histological, radiological and molecular analysis.
Results: The consumption of the high-fat and western diets significantly increased body weight over time compared to control. Behavioral analysis showed reduced thresholds to mechanical stimulus (Von Frey) in both experimental diet groups, suggesting mechanical hypersensitivity of the hind limbs. Grip force strength during axial stretch was also reduced in both experimental diet groups, suggestive of axial discomfort. The velocity and distance traveled in the open field assay were decreased in both experimental diet groups, suggesting motor impairment. Preliminary histological analysis of the lumbar spines revealed accelerated IVD degeneration in both experimental diet groups compared to control.
Conclusions: Our findings suggest that diet-induced obesity accelerates age-related IVD degeneration and back pain associated behaviors in the mouse. Ongoing analysis will examine neuroplastic changes to the sensory nervous system and circulating systemic factors to identify pathways involved.
CONTACT Geoffrey John Kerr gkerr7@uwo.ca Introduction/Aim: The neuro-functional basis of pain chronification is not yet understood. Altered brain activity associated with pain symptoms has been identified in neuropathic pain patients. The extent to which brain networks may be altered in persons with acute neuropathic pain remains unclear.
Methods: Participants included patients with ankle sprain (n = 24, Age = 16.1years, SD = 4.1) with clinically confirmed neuropathic pain and a group of age-matched healthy controls (n = 12, Age = 16.1, SD = 2.95). Participants completed questionnaires about pain symptoms and underwent a resting-state fMRI (rs-fMRI) scan. Graph theory was applied on rs-fMRI data using the CONN toolbox implemented in Matlab. Individual brain regions were evaluated based on global and local efficiency, betweenness centrality, cost, average path length, clustering coefficient and nodal degree.
Results: Patients reported higher scores than healthy controls on the Pediatric Pain Screening Tool (p < 0.001) and Functional Disability Inventory (p < 0.001) suggesting a significant impact of pain on physical and psychological functioning. No group differences were observed for global and local efficiency, cost, average path length, clustering coefficient or nodal degree (p-FDR>0.05). The ankle sprain cohort exhibited higher betweenness centrality in the posterior aspect of the left parahippocampal gyrus compared to healthy controls (t(30) = 4.20,p-FDR = 0.029).
Discussion/Conclusions: Findings suggest that functional brain network properties may be affected in persons with acute neuropathic pain. The increased betweenness centrality in the parahippocampal cortex in persons with neuropathic pain may pertain to changes in memory encoding due to the presence of pain. Perturbed network configuration from acute neuropathic pain relating to memory formation may underlie a component of pain chronification. Chronic low back pain (CLBP) is the most prevalent and problematic of all chronic pain syndromes. In addition to enduring persistent pain, they also experience a reduction in cognitive abilities. This is because CLBP patients have more difficulty summoning the cognitive resources necessary to meet professional and personal responsibilities, often providing them with a major obstacle in every day functioning. While almost all cognitive domains appear to be compromised, executive functioning seem to be one of the most affected abilities. Despite this, such cognitive deficits are rarely the focus of therapeutic interventions since they are widely viewed as secondary to chronic pain. Thus, an effective treatment for them is still unknown. Fortunately, physical exercise has been shown to be beneficial throughout the lifespan by optimizing overall physical and cognitive health and is one of few interventions that reliably improves pain management in CLBP. The present study aimed to test the impact of a physical exercise intervention on executive functioning in patients with CLBP. Twenty-three patients with non-specific CLBP completed a 14-week aerobic and muscular exercise program. Before and after the program, they performed a dual task that assessed their ability to identify different stimuli while simultaneously using their left and right hand. Our findings showed that after the exercise program, the patients' ability to perceive multiple stimuli and coordinate the execution of two motor responses was improved. These results suggest that higher-order cognitive behavior, such as executive functioning, can be ameliorated with the help of exercise in these patients.
Introduction/Aim: Besides having to live in constant pain and limited mobility, patients with chronic low back pain (CLBP) have a constellation of symptoms that further contribute to their disability, such as cognitive impairment. While almost all cognitive domains appear to be compromised, executive functions seem to be one of the most affected abilities. Currently, physical exercise is one of the few interventions that reliably improves the management of pain in CLBP. However, since the cognitive deficits seen in CLBP patients are widely viewed as a secondary to pain, the impact of exercise therapy on such deficits have yet to be investigated. The present study sought to examine the effects of exercise training on dual task performancea measure of executive functioningin CLBP patients.
Methods: Twenty-three patients (15 female, 8 male, age range 22-65) with non-specific CLBP participated in a 14-week aerobic and muscular exercise program. Before and after the program, patients completed a dual task that required them to perform an identification task while simultaneously using their left and right hand. Reaction times were recorded.
Results: Preliminary results revealed a significant three-way interaction between time, task, and side (left and right hand), F(1,22) = 4.126, p = .054. After exercise training, patients showed a nearsignificant reduction in reaction time difference between the two hands suggesting that patients' ability to perceive multiple stimuli and coordinate the execution of two motor responses improved, F(1,22) = 3.775, p = .065.
Discussion/Conclusions: Our findings indicate that patients' task coordination ability required to execute multiple tasks is improved with exercise. Further, it provided insight into a feasible intervention that has the potential to enhance the cognitive health and subsequently, the functionality and quality of life of chronic pain sufferers. Introduction/Aim: In the nervous system, neurons and glial cells are embedded within an extracellular matrix (ECM), whose components not only provide structural support, but also regulate synapse formation and function, and modulate neuronal excitability. The ECM restricts synaptic and structural plasticity, and enzymatic digestion of ECM affects acquisition of memories, and promotes cognitive flexibility and extinction. In this study, we investigated how remodeling of ECM components, specifically perineuronal nets (PNNs) contributes to the sensitization of spinal nociceptive circuits after injury.
Methods: Immunohistochemical analysis was used to assess varying components of PNNs in the spinal cord, as well as microglial engulfment. To label projection neurons, AAV2/9-CMV-CRE-eGFP virus was injected into parabrachial nuclei of TdTomato reporter mice. Behavioural studies were performed after intraspinal delivery of AAV2/9-CMV-chABC on 6-8-week-old C57BL/6 mice. Both sexes were used in all studies.
Results: In the dorsal horn of the spinal cord, perineuronal nets are preferentially found around projection neurons in the lamina I, and the lateral spinal nucleus. After spared nerve injury (SNI), microglia mediate removal of components of PNNs via engulfment processes. Viral delivery of an enzyme that degrades PNNs (AAV 2/9-CMV-chABC) promotes hypersensitivity in mice in both SNI and CCI (chronic constriction injury) models.
Discussion/Conclusions: Nerve injury causes robust microglia-mediated remodeling of the ECM in the dorsal horn of the spinal cord. Removal of perineuronal nets promotes hypersensitivity in mice, suggesting that PNNs are involved in regulation of spinal nociceptive circuits. Ongoing studies are aiming to assess the role of PNNs in chloride regulation after nerve injury.
Introduction/Aim: Perineuronal Nets (PNNs) are netlike structures that are found around the cell soma and proximal dendrites of neurons. PNNs play a role in regulating neuronal plasticity in the cortex and hippocampus. In the spinal cord, previous studies have characterized PNNs around motor neurons in the ventral horn, however, they have not been described in the dorsal horn. In this study, we aim to characterize PNNs in the spinal cord dorsal horn and investigate developmental changes in PNNs formation. We also aim to establish the subtypes of neurons in the dorsal horn surrounded by PNNs.
Results: In the spinal cord dorsal horn, WFA staining (chondroitin sulfate sugar chains) is present exclusively in lamina I. A small subset of neurons are labeled with Aggrecan and WFA in lamina I of the dorsal horn and lateral spinal nucleus. PNNs are not present in the spinal cord of P2 mice but were found in adult animals.
Discussion/Conclusions: Our study has shown that PNNs are present in spinal cord lamina 1 and the lateral spinal nucleus. These areas are involved in nociceptive processing. We propose that PNNs in the spinal cord dorsal horn are involved in regulation of spinal nociceptive circuits.
CONTACT Shannon Tansley shannon.tansley@mcgill.ca Introduction/Aim:Practice guidelines recommend the use of validated behavioral scales such as the Critical-Care Pain Observation Tool (CPOT) for pain assessment in the nonverbal critically ill. While evidence has shown the sustainable use of the CPOT up to 12 months post-implementation, long-term use of the tool had never been studied. This study aimed to evaluate the sustainability of the CPOT use at three-and five-years post-implementation. Methods: Medical charts documenting a 24-hour period within the first 48 hours of the ICU stay were reviewed. Included patients were 18 years or older with a Glasgow Coma Scale of 4-12, without spinal cord injury or neuromuscular blockade. Data collected included documentation of pain assessments with the CPOT, administration of opioids, and pain reassessments.
Results: A total of 60 files were included (30 for each time point). The mean age was 63.35 (20-89) years, with 38.3% being male (no difference between samples). Pain assessments done using CPOT were reported on average 7-8 times per 24 hours, ranging from 0-20 assessments (median of 1.00 to 3.00 per shift). There was an average of 1.0-2.5 bolus of opioids administered over the same period. Following an opioid bolus, pain was reassessed <60% of the time. Based on pain reassessments, 59.1% (three years) and 29.4% (five years) of administered opioids were effective in reducing pain scores by two points on the CPOT.
Discussion/Conclusions: These findings support that CPOT is still used on a regular basis three and five years after its implementation. Pain reassessments should be improved.
Introduction: There is a higher risk of behavioral and emotional symptoms (e.g., anxiety) in children of parents with chronic pain compared to their peers. This qualitative study investigated the challenges that children of parents with chronic pain face in their daily life and the coping strategies that they use to overcome these challenges.
Method: Fifteen children (9 females; 12-17 years old) who live with parents with chronic pain (pain > 3 months) participated in an individual semi-structured interview over the phone. Children answered questions regarding their understanding of their parent's pain, its impacts on their daily life and their coping strategies. The interviews were transcribed verbatim and analyzed using the phenomenologic approach.
Result: Five categories emerged from the data: 1) child's incomplete understanding about their parent's chronic pain, 2) noticing something is different when the parent is in pain, 3) growth of personal and interpersonal skills because of living with a parent with pain, 4) parent's pain limits child's social life, and 5) experiencing emotional distress because of parents' pain.

Discussion:
The results enhance our knowledge on the impact of parental chronic pain on their children and the variety of coping strategies that children use to overcome these challenges. Moreover, the interviews revealed certain positive impacts of living with parents with chronic pain including the development of good personal and interpersonal skills. These findings can be used to develop interventions to support parents and their children to better understand the pain and its multidimensional consequences on the children.
Methods: Rats were orally infected with Blastocystis subtype 4 cysts. Colonic sensitivity was evaluated by colorectal distension one month post-infection. Animal behavior was assessed using a behavioral recognition system (PhenoTyper®), Elevated Plus Maze and Forced Swimming test. Feces were collected to study microbiota composition by 16S Illumina® sequencing and for metabolite analyses.
Results: We found that Blastocystis ST4 induced non inflammatory CHS in infected rats. We have demonstrated an increase in fecal serine protease activity in infected rats which may explain development of CHS. In addition infected rats developed anxiety-and depressive-like behaviors correlated with CHS. Infection induced intestinal dysbiosis was characterized by increased bacterial richness and decreased Firmicutes/Bacteroidetes ratio. Interestingly, we correlated the CHS with the increase in the relative abundance of the genus of Bacteroides and the decrease in the relative abundance of the family of Clostridiaceae, some bacteria producing Short Chain Fatty Acids (SCFAs). Indeed, fecal SCFAs levels were decreased in infected rats.
Discussion/Conclusions: Our data suggest that Blastocystis infection in rat mimics IBS with the establishment of a CHS linked to microbiota and metabolic shifts. Thus, this new infectious model could therefore contribute to a better diagnosis and development of new therapeutic strategies for chronic gastrointestinal disorders.
Introduction/Aim: Treatment options for chronic pain are limited owing in large part to individual allelic, sex, and microbiota differences. Indeed it is likely that multiple factors together determine individual differences.
Methods: To explore whether a sex difference exists in the role of microbiota in different painful conditions, we subjected male and female mice to broad-spectrum oral antibiotics for three weeks prior to either a hindpaw incision or a spared nerve injury (SNI). We then assessed pain using a battery of nociceptive behavioural tests: mechanical hypersensitivity, dynamic weight bearing, and thermal hypersensitivity.
Results: While all mice responded to the antibiotics as each developed a grossly enlarged caecum, antibiotic treatment alone did not alter mechanical or thermal sensitivity. However, after hindpaw incision we found that mechanical withdrawal thresholds of male mice showed slower recovery to baseline than those of vehicle-treated males. Antibiotic-treated males also showed an increased rear-load in dynamic weight bearing testing compared to vehicle-treated males. Thermal hypersensitivity did not differ between vehicle-and antibiotic-treated males. After SNI, vehicle-and antibiotic-treated male mice showed no behavioural differences using this battery of tests. Antibiotic-treated female mice were not different than vehicle-treated females in any assay after either hindpaw incision or SNI.
Discussion/Conclusions: Thus, long-term antibiotic treatment affects behavioural responses in an acute pain model in a sex-specific manner.
CONTACT Katherine Halievski k.halievski@gmail.com 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 indications 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.
Introduction/Aim: Previous studies have shown that infant temperament (Stevens et al., 2013) and parental psychopathology (Moscardino, Axia, & Altoe, 2006) are independently associated with infants' pain-related distress. The present study aimed to examine whether infant temperament moderates the association between parental psychopathology and infant pain-related distress reactivity and regulation during routine vaccinations.
Methods: The study included parent-infant dyads (n = 58) from the 12-month wave of an ongoing longitudinal study in which dyads were videotaped during infants' routine vaccinations. Infant pain-related distress was coded from 15-second epochs of video footage collected immediately post-needle (reactivity) and at one minute (regulation 1) and two minutes (regulation 2) postneedle using the Face, Legs, Activity, Cry, Consolability Scale (FLACC; Merkel, Voepel-Lewis, Shayevitz, & Malviya, 1997). Infant negative affectivity and parental psychopathology were assessed using the Early Childhood Behavior Questionnaire (ECBQ; Putnam, Jacobs, Gartstein, & Rothbart, 2010) and the Brief Symptom Inventory 18 (Derogatis, 2001), respectively. Moderated regression models examined the contribution of infant negative affectivity, parental psychopathology, and their interaction, to the prediction of infant pain-related distress.
Results: The regression model did not account for a significant proportion of variance in infant painrelated distress behaviour during the reactivity or regulation phases. No main effects or moderation effects were found.
Discussion/Conclusions: Parent reports of psychopathology and infant temperament did not predict infants' pain-related distress behaviours. This may be due to limitations associated with using a normative sample. It is critical to replicate this study in a higher risk or clinical sample. Chronic pain (CP) is a major public-health problem. Many patients with CP are increasingly prescribed opioids, which have led to an opioid crisis. Integrative Medicine (IM) which combines pharmacological and complementary and alternative medicine (CAM) has been proposed as opioid alternative for CP treatment. Nevertheless, many CAM therapies have been viewed with prejudice and skepticism based on claims of limited or low-quality evidence. To explore the true effectiveness of the IM approach or any of the CAM therapies to reduce or cease opioid use in CP patients An online search of MEDLINE and Embase, CINAHL, PubMed supp. and Allied and Complementary Medicine Database (AMED) for studies published in English from inception until February 15th, 2018 was conducted. The Mixed Methods Appraisal Tool (MMAT) was used to critically appraise selected studies.
\The electronic search yielded 5200 citations. Twentythree studies met all eligibility criteria and underwent data extraction. The majority of studies showed that opioid use was reduced significantly after using IM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use followed by multidisciplinary approaches, cognitive-behavioural model and acupuncture. The majority of the studies had limitations with sample size, duration and study designs.
There is a small, but defined body of literature demonstrating positive preliminary evidence that IM approach including CAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it's vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/CAM therapies for CP.
Introduction/Aim: Chronic pain (CP) is a major public-health problem. Many patients with CP are increasingly prescribed opioids, which have led to an opioid crisis.
Integrative Medicine (IM) which combines pharmacological and complementary and alternative medicine (CAM) has been proposed as opioid alternative for CP treatment. Nevertheless, many CAM therapies have been viewed with prejudice and skepticism based on claims of limited or lowquality evidence. To explore the true effectiveness of the IM approach or any of the CAM therapies to reduce or cease opioid use in CP patients Methods: An online search of MEDLINE and Embase, CINAHL, PubMed supp. and Allied and Complementary Medicine Database (AMED) for studies published in English from inception until February 15th, 2018 was conducted. The Mixed Methods Appraisal Tool (MMAT) was used to critically appraise selected studies.
Results: The electronic search yielded 5200 citations. Twenty-three studies met all eligibility criteria and underwent data extraction. The majority of studies showed that opioid use was reduced significantly after using IM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use followed by multidisciplinary approaches, cognitive-behavioural model and acupuncture. The majority of the studies had limitations with sample size, duration and study designs.
Discussion/Conclusions: There is a small, but defined body of literature demonstrating positive preliminary evidence that IM approach including CAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it's vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/CAM therapies for CP.
Introduction/Aim: Canada is in the middle of a public health crisis related to opioids that shows no signs of abating. The social and legislative landscape around cannabis in Canada is evolving. A synthesis of the data on the potential intersection between cannabis use and opioid outcomes is urgently needed at this pivotal time. The aim of this study was to conduct a scoping review to develop a broad understanding of the relationship between cannabis and opioid use and related outcomes Methods: We used scoping review methods to search, select, and summarize published studies conducted in the past 20 years.
Results: We included 81 studies that reported on the relationship between a variety of cannabis measures and a range of opioid-related outcomes. Within the Prevention Pillar, a total of 30 studies showed no association for prescription synthetic cannabinoids, as well as mixed results for medical cannabis, cannabis legislation, and non-medical cannabis use. Within the Treatment Pillar, a total of 17 studies showed mixed results for prescription synthetic cannabinoids, medical cannabis use, and non-medical can-nabis use. Within the Prevention/Harm Reduction Pillar, a total of 34 studies showed no studies for synthetic cannabinoids or cannabis legislation, and mixed results for medical cannabis and non-medical cannabis use.
Discusson/Conclusions: As this is a scoping review, we cannot make policy or practice recommendations; however, the findings of this review can point to gaps in research that should be addressed in order to make future recommendations based on high-quality evidence. Introduction/Aim: Recently developed measures for sensitivity to physical activity (SPA) use brief physical tasks and monitor evoked pain-related responses. However, these measures have not yet been studied prospectively. The purpose of this study was to estimate the extent to which SPA predicts pain and disability among adults with recent onset low back pain (<6 months), cross-sectionally and prospectively (3-month follow-up).

Funding
Methods: SPA was assessed using a repeated lifting task with difficulty tailored to personal pain responses. SPA-related measures included evoked pain (single lift, 10 repeated lifts), pre-post pressure pain threshold (hands, lower back), and task-specific questions (catastrophizing, fear, pain self-efficacy). Otherwise, participants answered questionnaires (Demographic, Pain Catastrophizing Scale, 11-item Tampa Scale of Kinesophobia, Brief Pain Inventory, Pain Disability Index). 3-month follow-up was completed by telephone (pain and disability questionnaires).
Discussion/Conclusions: This is the first study which prospectively analyzed the predictive value of SPA. Also, this is among the first studies to consider task-specific evoked psychological responses as part of a physical task-based SPA measure.
Introduction/Aim: Children with cancer have reported pain and distress during needle insertion into a subcutaneous port (SCP) despite numbing with a topical anesthetic.1-4 Virtual reality (VR) has shown to reduce acute pain in adults and children.5,6 Research is limited surrounding the use and safety of VR for procedural pain management for children with cancer. 7 This study aims to determine the feasibility (i.e., accrual rate, reasons for non-participation, safety, acceptability) of implementing a randomized controlled trial (RCT) of VR for SCP needle insertion in children with cancer and provide estimates of the impact on pain and distress.
Methods: A pilot RCT comparing an intervention (VR headset) to an active control group (iPad) during SCP needle insertion in children 8-18 with cancer. Feasibility data will be analyzed through descriptive statistics.
Results: Recruitment and data analysis are ongoing. Currently, 119 patients were screened for eligibility, 48 were eligible, 36 were approached, and 22 enrolled. Participants cited "not interested", or "comfortable without distraction" as reasons for non-participation. Average age of participants is 12.8 years (SD = 3.2). Nine (75%) participants enjoyed using the VR, 7 (58%) found the VR headset a helpful distraction, and 11(91.7%) nurses were satisfied with the overall experience of using VR during port access. No safety issues were reported.
Conclusion: Preliminary results suggest that VR during port insertion for children with cancer is feasible, safe, and acceptable for children with cancer and their nurses. Next steps include analyzing feasibility and effectiveness outcomes before completing a definitive trial. Results: The Network currently has twenty-seven projects that align with identified patient priorities in the areas of:

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• Clinical trials testing new ways to prevent, detect or manage diseases (9) • Basic science encompassing the fundamental work to advance knowledge (8) • Population Studies addressing groups who share a common characteristic such as sex or health conditions (6) • Behavioural Science in multiple contexts (4) Discussion/Conclusions: Some projects have modified due to budget restrictions; all are on track logistically; new initiatives have arisen including providing a strategy for pain management in hemophilia (underway), and a national discussion on biomarkers (Feb 2019). CPN patient groups have been recognized as a national resource for Health Canada in its Opioid Response, and support for furthering the Canadian Pain Strategy has arisen from CPN activities. Introduction/Aim: Practice guidelines recommend that pain be assessed on a regular basis (q 2-3 h) in the intensive care unit (ICU) We aimed to describe pain assessment documentation in adult ICUs. 1 Methods: A retrospective cohort design was used in this multi-site study of four ICU settings in the province of Quebec. Pain assessment tools (i.e., 0-10 Numeric Rating Scale and Critical-Care Pain Observation Tool) were available in all ICUs. Medical charts of patients admitted to the ICU for a minimum of 48 hours in 2017 and 2018 were reviewed and we extracted data from the second 24-hour period following ICU admission. Information related to socio-demographic (age, sex), clinical (diagnosis, ICU length of stay, mechanical ventilation duration), pain assessments, and opioid administration was collected.
Results: A total of 297 patient charts (31% male, mean age = 60 y, SD = 18.1) were reviewed. Admitting ICU diagnosis was medical (38%), surgical (26%) and trauma (36%). Median ICU length of stay was 6.6 days and median duration of mechanical ventilation (80% of patients were mechanically ventilated) was 74.7 hours. Pain assessments were documented in only 51% of reviewed charts, and when present the median number was 4 assessments/ 24 hours. Pain reassessments following opioid administration were documented in only 22% of patients who received opioids.
Discussion/Conclusions: Documentation of pain assessments in the ICU is suboptimal and opioid administration is not monitored with regular pain reassessments. Improvement strategies must be deployed to improve optimal documentation and to ensure pain management practices for relieving pain in the ICU.

Disclosure statement
No potential conflict of interest was reported by the authors. Introduction/Aim: The relationship between pain catastrophizing (PC) and pressure pain threshold (PPT) is not clear as of existing controversy and insufficient studies. Although, both are evidence-based risk factors measuring tools in research and clinical practice. A cumulative impact evaluation may help us to understand this relationship and their clinical usability. The aim of this study is to evaluate the cumulative impact of psychological and sensitization risk factors on painrelated outcomes (activity avoidance, pain severity and disability). We hypothesized people with both high catastrophizing and high sensitivity most vulnerable. Methods: We included 109 participants (70.60% women; mean ± SD age 53.6 ± 12.3 years) with chronic musculoskeletal pain for data analysis who completed all measures of this study.

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Participants completed a single testing session that included measures of risk factors (PC and PPT) and pain-related outcomes (self-reported avoidance, functional avoidance, disability and pain severity). Subgroups were constructed by dichotomizing (median split) of PC and PPT scores, resulting in 4 groups: 1. high catastrophizing and low sensitivity (N = 27), 2.
Results: Onaway ANOVA revealed significant group differences (p < .05, η 2 = .08 to .14) on all outcomes of this study (except functional avoidance) and post hoc analysis indicated the significance differences are between group 2 and 3 (p < .05). ANCOVA identified gender as the significate covariant for the functional avoidance (p < .01, ηp 2 = .19).
Discussion/Conclusions: The study suggests both higher level of pain catastrophizing and pressure sensitivity has a cumulative impact in risk screening for pain-related outcomes, considering gender in functional avoidance (task related outcome). This finding has important clinical and theoretical implications. Introduction/Aim: Measuring pain in mechanically ventilated infants is challenging. The measurement of skin conductance (SC) is based on the sympathetic nervous system response to stress. The study aimed to evaluate the validity of SC for assessing pain and stress in mechanically ventilated infants.
Methods: A prospective cross-sectional observational design to study SC and its relation to: 1) type of procedure (painful or non-painful), 2) phase of procedure (before, during and after procedure), and 3) referent pain measures (the Premature Infant Pain Profile-Revised (PIPP-R) and Neonatal Facial Coding System (NFCS)). Eligibility criteria: Infants up to 12 months, in the intensive care units, who were mechanically ventilated, and required a painful and non-painful procedure.
Discussion/Conclusions: The study showed the validity of SC in relation to the type of procedure, the phase of procedure and the referent pain measures. SC is a potential approach to assessing pain and stress in sick infants requiring machinal ventilation. Background: The reason some diabetic polyneuropathy (DPN) patients develop neuropathic pain while others present with painless symptoms is unknown. Altered central pain processing has been associated with neuropathic pain. Previous EEG studies found unique cortical patterns in patients with neuropathic pain however these studies were limited to univariate analysis of locally activated areas of cortex. It has been proposed that pain is encoded by complex activity and connectivity patterns which can be explored by application of Machine Learning techniques on the EEG signal. We aimed to investigate whether EEG based functional connectivity can be a potential biomarker for distinction between painful and non-painful DPN. Methods: We recorded contact-heat pain evoked potentials (CHEPs) of 120 painful DPN patients (33F, 63.2 ± 9.9 yrs) and 38 non-painful DPN patients (7F, 64.3 ± 9.5 yrs). Connectivity analysis was conducted based on a measure of synchrony (Phase Locking Value) between the recording sites. We then applied a data-driven analysis scheme to identify the most differentiating functional connections in each frequency band. These connections were validated and used to predict neuropathic pain.

ORCID
Results: We found overall higher cortical functional connectivity between areas of the pain matrix among painful DPN patients. In alpha and theta bands, the connectivity values were significantly different, and differentiated between the two groups with fair-to-excellent specificity (0.797) and sensitivity (0.9).
Conclusion: Patients with DPN can be successfully classified into painful and non-painful based solely on EEG functional connectivity data. Increased connectivity between areas of the pain matrix in alpha and tetha band might be a biomarker for neuropathic pain.
Interleukin-1β is a Therapeutic Target  Introduction/Aim: Low back pain secondary to disc herniation is a major health problem. Proinflammatory cytokines have been implicated in the pathogenesis of disc herniation. Here, we assessed the contribution of interleukin-1β (IL-1β) to the development of pain behaviours in a recently developed model of non-compressive disc herniation.
Methods: Nucleus pulposus (NP), collected from littermate tail intravertebral discs, was placed on the sciatic nerve of male C57BL/6 mice. In sham animals, only the sciatic nerve was exposed. von Frey algesiometry was used to assess mechanical allodynia. In separate cohorts, immunohistochemistry and PCR were performed on day 7 to respectively study the infiltration of inflammatory cells and IL-1β gene expression in nerve. The effect of the caspase-1 inhibitor, VX-765 (200 mg/kg i.p; days 0-3), on NPinduced pain hypersensitivity was studied. To gain mechanistic insight, we developed an in vitro assay to test the effect of VX-765 on IL-1β secretion from cultured human macrophages.
Results: We found that mechanical allodynia appeared on day 1 and persisted to day 7 following NP exposure to the sciatic nerve. We detected an increase in macrophage (F4/80) infiltration in and around the nerve at 1-week post-surgery in NP animals, compared with sham controls. We identified increased IL-1β gene expression in the sciatic nerves treated with NP compared with sham controls. Treatment of NP animals with VX-765 prevented mechanical allodynia as compared to vehicle-treated animals. It was observed that VX-765 prevented the release of IL-1β from cultured macrophages.
Discussion/Conclusions: These results indicate an important role for IL-1β secretion from macrophages during the development of pain associated with non-compressive disc herniation. Blocking IL-1β may be a viable strategy in treating pain associated with disc herniation. Introduction/Aim: Inhibitory synapse loss in the dorsal horn of the spinal cord strongly correlates with pain hypersensitivity in animal models of neuropathic pain. This selective synapse loss potentially contributes to disinhibition of spinal cord nociceptive circuits and maintenance of neuropathic pain. The present study aims to elucidate the key mechanism underlying this inhibitory synapse loss. Specifically, we investigate the role of microglia and the complement system, a well characterized synaptic pruning pathway, in neuropathic pain.

Funding
Methods: In a mouse model of neuropathic pain, using immunohistochemistry in combination with high resolution light and electron microscopy, we analyzed the integrity of inhibitory and excitatory synapses and their colocalization with complement factors. To investigate microglial involvement in phagocytosing inhibitory presynaptic inputs we performed an engulfment assay. Lastly, we depleted spinal microglia and complement factors in neuropathic and control mice then assessed the effect of these manipulations on dorsal horn synapse loss and pain-related behaviour.
Results: In neuropathic mice, we found a reduction in the number of intact inhibitory synaptic structures. A significant proportion of the remaining synapses colocalized with complement factors C1q and C3. The engulfment assay showed that microglia phagocytosed inhibitory presynaptic compartments. Furthermore, microglia and complement depletion prevented inhibitory synapse loss and pain hypersensitivity.
Discussion/Conclusions: Together, these findings suggest that microglia contribute to disinhibition of spinal nociceptive circuits in neuropathic pain through engulfment of inhibitory synapses in the spinal dorsal horn. The selectivity of microglia-mediated synapse pruning in neuropathic pain is likely dependent on complement factors.
CONTACT Sabrina Noosha Yousefpour noosha.yousefpour@mail. mcgill.ca Introduction/Aim: Pediatric chronic pain co-occurs at a high rate with both PTSD symptoms (PTSS) and sleep impairments. Noel et al. (2017) showed that sleep quality partially mediated the relationship between PTSS and pain intensity and interference in youth with chronic pain. To date, little is known about this cooccurrence and the potential mechanisms that underlie it. In a recent model, Holley et al. (2016) proposed that hyperarousal, a symptom of PTSD, is incompatible with sleep and may lead to worse pain outcomes in children with chronic pain. Thus, the aim of this study was to examine the mediating role of PTSS in the relationship between pre-sleep arousal and pain outcomes in children with chronic pain.
Methods: Eighty-four adolescents (10-18 years; 73% female) receiving tertiary-level treatment for chronic pain completed questionnaires that assessed PTSS, pre-sleep arousal, pain intensity, and pain unpleasantness. Mediation analyses were conducted using bootstrapping.
Discussion/Conclusions: PTSS mediated the relationship between pre-sleep arousal and pain intensity and unpleasantness. These findings suggest that PTSS may be a factor underlying the sleep-pain relationship in pediatric chronic pain. Therefore, PTSS is an important target for future interventions involving children with chronic pain. Longitudinal examination of these relationships is needed with the use of objective sleep measures. Introduction/Aim: There is an imperfect correlation between joint changes and pain in arthritis, suggesting that there may be mechanisms other than just overt inflammation or damage involved in arthritis pain. In neuropathic pain disinhibition and microglial effects have been welldescribed. Recently, complement-mediated microglial synapse removal has been described in development and CNS disorders. Here, we aim to demonstrate in models of arthritis that complement-mediated synaptic pruning of inhibitory terminals by microglia occurs. Methods: We used monoiodoacetatate (MIA) and complete Freund's adjuvant (CFA) to induce ankle-joint arthritis in rats combined with immunohistochemistry and microscopy.
Results: We observed: microgliosis in the ipsilateral dorsal horn, upregulated complement factors, decreased number of inhibitory terminals and more inhibitory terminal signal in the cytoplasm of phagocytic microglia in tissue from arthritis animals compared to control. Interestingly, complement initiating factor C1q co-localized at more inhibitory terminals than excitatory terminals.
Discussion/Conclusions: These data demonstrate that there are spinal changes in arthritis models that may alter the balance of spinal excitation and inhibition and contribute to pain in this disease.
CONTACT Samantha Locke samantha.locke@mail.mcgill.ca Introduction/Aim: Youth with chronic pain are at risk of experiencing co-occurring internalizing mental health symptoms and insomnia which are associated with poorer quality of life and increased healthcare utilization. Preliminary research suggests that sleep problems precede chronic pain and that anxiety may mediate this relationship. However, little is known about the relationship over time. This study aimed to examine anxiety as a mediator in the insomnia-pain relationship in youth with chronic pain at baseline and 3-month follow-up. Methods: Eighty-four youth (10-18 years; 73% female) with chronic pain completed self-report measures of anxiety symptoms, insomnia, and pain interference at baseline and 3-month follow-up. Participants also underwent 7 days of actigraphy monitoring to assess sleep efficiency at baseline. Three mediation models were tested: Model 1 (baseline insomnia, anxiety, and pain), Model 2 (3-month insomnia, anxiety, and pain), and Model 3 (baseline insomnia, anxiety, and sleep efficiency).
Results: Model 1 revealed that the relationship between insomnia and pain interference was mediated by anxiety (n = 84, ab = 0.22, CI BCa = 0.05 to 0.44). Anxiety also mediated the relationship between insomnia and pain interference in Model 2 (n = 65, ab = 0.26, CI BCa = 0.09 to 0.53). Anxiety did not mediate the relationship between sleep efficiency and pain interference in Model 3.
Discussion/Conclusions: Findings suggest that insomnia may worsen pain through alterations in anxiety symptoms and that this relationship is maintained over time. Further investigation using self-report versus actigraphy is warranted to better understand the cooccurrence of pain, sleep impairment, and anxiety. Background and aim: Pathological pain can arise from plastic changes in nociceptive networks of the spinal dorsal horn. We have previously shown that the reactivation of sensitized nociceptive networks triggers a process that parallels memory reconsolidation: a protein synthesisdependent process in which memory traces are rendered labile and modifiable. However, it is unclear how this memory trace disruption is initiated or what its underlying mechanisms are. Here, we examine the role of noncanonical, non-ionotropic NMDA (NI-NMDA) receptor in the regulation of spinal synaptic plasticity and hyperalgesia, and whether NI-NMDA contributes to pain reconsolidation.
Methods: Mechanosensitivity was assessed in mice using von Frey filaments. In vitro electrophysiological studies of afferent input to spinal dorsal horn was assessed by measuring field post-synaptic potentials induced by electrical stimulation of dorsal roots in an isolated lumbar spinal cord preparation.
Results: The induction of NI-NMDA signalling reversed hyperalgesia induced by plantar injection of capsaicin or CFA. Similarly, in vitro electrophysiological studies of afferent input to the spinal dorsal horn showed that NI-NMDA signaling could reverse spinal LTP but had no effect in the absence of LTP. Finally, we linked NI-NMDA signaling to pain reconsolidation by demonstrating that the reversal of hyperalgesia and LTP through reconsolidation blockade and NI-NMDA involve similar downstream mechanisms to reverse hyperalgesia.
Conclusions: These findings reveal a novel role for NI-NMDA signalling in the regulation of spinal sensitization and hyperalgesia. We further demonstrate intriguing links between NI-NMDA signalling and pain reconsolidation that indicate a role of NI-NMDA signalling in pain reconsolidation. Results: Preliminary analyses found that 46.7% of parents reported having chronic pain. Parents reported a 2.26 (SD = 1.21) mean pain frequency (scale of 0-4), mean pain severity of 4.27 (SD = 1.49) (scale of 0-7), and mean PTSS score of 8.55 (scale of 0-80). Bivariate correlations showed that parents' chronic pain was not related to parent PTSS (r = .249, p = .371) nor was parent PTSS related to parents' pain frequency (r = .190, p = .480), severity (r = .344, p = .301), or interference (r = .230, p = .410). Parent PTSS was related to parent catastrophizing about their child's pain (r = .813, p < .001); greater PTSS was related to greater catastrophizing.
Discussion/Conclusions: The relationship between parent pain, PTSS, and how this might influence children's pain experiences requires further elucidation. Future research should also investigate trajectories of pain and PTSS beginning at child's diagnosis into survivorship. Introduction/Aim: Virtual Reality (VR) shows great promise in creating testing and treatment environments where virtual representations can be precisely controlled and guided according to therapy needs. Therefore, the goal of this pilot study was to explore how arthritis pain patients like our VR environment and how effective it was at promoting physical activity (PA).
Methods: A mixed-method study was conducted. The inclusion criteria are arthritis patients who are older than 19 years old. Five participants with limitations of physical movement were recruited via convenient sampling, including 3 females (M = 61.5 years old, SD = 11.01). First, the participants were given a tutorial and then they explored the VR game for 15-20 mins. The participants' real-time Heart Rate (HR) was measured, and they were asked to fill in the Rating of Perceived Exertion Scale questionnaire.
Results: We found there was an increase in HR variation as participant's age increases. Patients reported perceived physical exertion (M = 75.78, SD = 8.45) is lower than their real exertion (M = 82.25, SD = 7.05). This indicated that our VR game was able to immerse and distract the patients from the amount of PA without noticing they were in an aerobic state. Besides, all participants had their average HR above or close to their 50% threshold.
Discussion/Conclusions: Results presented a great promise of using our VR game to promote patients' movement and enlarge their RoM. Our future work includes a longitudinal study to measure the effect on chronic pain patients' PA level and pain.
CONTACT Xin Tong tongxint@sfu.ca Introduction/Aim: Breastfeeding, skin-to-skin care, and oral sucrose are extensively studied interventions for effectively managing procedural pain in newborns. We aimed to assess Canadian parents' knowledge and use of these strategies. Methods: In partnership with an award-winning Canadian digital publisher (YummyMummyClub.ca/ YMC), we shared an evidence-based YouTube video about breastfeeding, skin-to-skin contact, and sucrose via Facebook as part of the #ItDoesntHaveToHurt initiative. Participants were prompted with the following questions: 1) have you ever used any of these strategies before, and 2) which new strategy did you learn that you'll use in the future. Responses were summed and categorized for analysis.
Results: Within 24 hours, the post received 136 engagements (50 likes, 25 shares, and 61 comments). Of commenting parents, 25% had never used the strategies, 75% used at least one, and 27% used more than one. Breastfeeding (64%) and skin-to-skin contact (52%) were most common, while few respondents used sucrose in previous pain management (21%). 30% of parents expressed that they learned new information and that they will share or try at least one of the strategies. Sucrose generated the most interest (89%), followed by breastfeeding (44%), and skin-to-skin (39%). Parents commented on their experiences with pain management education from health professionals, alternative strategies for management of their infant's pain, and questions regarding clinical use of sucrose for procedural pain.
Discussion/Conclusions: Parents' knowledge of evidence-based pain management strategies for infants was enhanced through social media engagement. Health professionals should utilize science-media partnerships to reach parents and benefit parental involvement in pediatric pain management.

ORCID
Christine T. Chambers http://orcid.org/0000-0002-7138-916X CONTACT Lindsay Richter lrichter@bcchr.ca Introduction/Aim: The aim of this study is to determine the contribution of acute post-operative pain towards the development of neuropathic pain (NP) 3 months after breast cancer surgery (BCS). Methods: In this 3-month prospective cohort study, female breast cancer patients (≥18 years) who underwent first BCS were recruited from Segal Cancer Center, Jewish General Hospital, Montreal. The study outcome was NP occurrence at 3 months post-surgery.
Collected data was acute post-operative pain, anxiety, depression, type of surgery, axillary status, and NP. Presence of NP was assessed at 3 months by telephone using the Douleur Neuropathique-4 (DN-4) questionnaire. Linear and logistic regression analysis were used to assess risk factors for the outcome.
Discussion/Conclusions: NP at 3 months is associated with acute post-operative pain and its intensity. Pins and needles is associated acute pain, whereas numbness is associated with acute pain and its intensity.
About 25% of the population in Canada and at least 70 million people in North America are suffering from chronic non cancer pain (CNCP). Treating patients with CNCP has always been a major challenge. One of the important and useful findings in CNCP patients is Non-Dermatomal Sensory Deficit (NDSD), which is a functional deficit in contrast to structural sensory deficit that can be caused from a clear peripheral or central nervous system lesion. NDSD has shown to be associated with maladaptive neuroplasticity. The phenomenon has been described extensively since 2001 by Dr. Angella Mailis and her team at the university of Toronto in numerous publications. Study of 100 consecutive patients referred to CPMP by community physicians in 2018 showed NDSD in 23%. 78% of NDSD patients were suffering from severe and moderate Depression, 65% were suffering from moderate and severe anxiety, and 91% suffered from Insomnia.
Introduction/Aim: It has been shown that NDSD is often present in individuals experiencing both a physical trauma as well as a psychological trauma, thus requiring further assessments. In Southern Ontario, there have been studies examining patients' demographics and pain characteristics of patients with NDSDs. However, such studies have not been conducted for patients in Northern Ontario. We have been focused on studying not only chronic pain patients' demographics, inciting events, pain characteristics, psychological and physical, but also we have added questionnaires for evaluating depression, anxiety, and perceived injustice.
Methods: Retrospective cross-sectional study of 100 consecutive patients referred to CPMP by community physicians in 2018 showed 23% NDSD. Demographics, inciting event, sleep, fatigue as well as PHQ-9, GAD-7, and IEQ scores were collected and analyzed using charts review of the 23 patients with NDSDs.
Results: 23% of CNCP patients attending CPMP at SJCG had NDSD. 82% of them were female (F = 19), with mean = 47.73 and Range = 16-78 years old. 74% were referred for assessment of multisite, diffuse, or widespread body pain (17 cases). 22% (5 cases) reported Motor Vehicle Accident as the inciting event, 22% reported work-related injury, 13% reported sport-related injury, 13% reported a fall, 4% reported Head Trauma, 4% post-appendectomy infection, 4% sudden onset of low back, neck, ankle pain each. Based on PHQ-9 questionnaire, 35% of patients indicated severe Depression (8 cases), 26% moderately severe Depression, 17% moderate Depression. Regarding GAD-7, 43% of patients scored for severe Anxiety (10 cases), 22% moderate Anxiety (5 cases Introduction/Aim: The Patient-Rated Wrist Evaluation (PRWE) was developed as a wrist joint specific measure of pain and disability. Rasch analysis (RA) has been endorsed as a newer method for analyzing the clinical measurement properties of self-report outcome measures.
The purpose of this study was to evaluate the PRWE using Rasch modeling.
Methods: We employed the Rasch model to assess overall fit, response scaling, individual item fit, differential item functioning (DIF), local dependency, unidimensionality, and person separation index (PSI). A convenience sample of 382 patients with distal radius fracture was recruited from the hand and upper limb clinic at a large academic healthcare organization, London, Ontario. RA was conducted on the 3 subscales (pain, specific activities, and usual activities) of the PRWE separately.
Results: The pain subscale adequately fit the Rasch model when item 4 was deleted to eliminate nonuniform DIF by age group, and item 5 was rescored by collapsing into 8 intervals to eliminate disordered thresholds. After background rescoring of 2 items in pain subscale, 2 items in specific activities and 3 items in usual activities, all three subscales of the PRWE were well targeted and had high reliability (PSI = 0.86). These changes provided a unidimensional, intervallevel scaled measure.
Discussion/Conclusions: Like a previous analysis of the Patient-Rated Wrist and Hand Evaluation, this study found the PRWE could be fit to the Rasch model with rescoring of multiple items. However, the modifications required to achieve fit were not the same across studies, our fit statistics also suggested one of the pain items should be deleted.
Introduction/Aim: Chronic pain affects 1 in 5 Canadians and costs over $43B annually, yet effective and safe treatment options remain elusive. Recent discoveries have brought to the forefront sex differences in mechanisms of pain as a potential explanation why novel pre-clinical therapeutics have not translated into successfully in clinical trials.
Methods: To begin understanding how males and females differ in pain processing, we analyzed gene expression, using RNA sequencing, and DNA methylation, using reduced representation bisulfite sequencing (RRBS), in rodent models of neuropathic pain.
Results: Across both sexes, our data reveals peripheral nerve injury (PNI) caused upregulation of 61 genes involved in innate immune responses in spinal cord. In females specifically, we observed PNI-induced downregulation of 5 genes involved in neuronal function and upregulation of two classes of Cathepsins. (C and E). On the other hand, in males, we observed upregulation of 14 genes including those involved in metabolism of purines and glutathione. Additionally we found that PNI leads to methylome remodeling in a sexually dimorphic manner: 125 promoters in rat spinal cord that were differentially methylated in injured males versus females.
Discussion/Conclusions: Our data shows robust sex specific DNA methylation and transcriptome signature after PNI. Additionally, our findings leads to the hypothesis that remapping of DNA methylation, with subsequent alterations in the transcriptome, are critically involved in the development of neuropathic pain. We anticipate that future research directed at under-standing these differences may lead to effective drug development to combat chronic pain. Introduction/Aim: eHealth interventions provide a promising approach to promote the use of evidence-based pain practices among healthcare professionals (HCPs). The objectives of this scoping review were to (1) identify scientific peer-reviewed and publicly available eHealth interventions (including electronic toolkits, web-based resources) that aim to improve pain assessment and treatment practices, and (2) evaluate the validity, effectiveness and comprehensiveness of these eHealth interventions.

ORCID
Methods: MEDLINE, EMBASE, CINAHL, AMED, ERIC, PsycINFO, Cochrane, and Web of Science databases were searched from inception to May 2018 to uncover any peer-reviewed citations; Google engine was searched for publicly available eHealth interventions. Eligible eHealth interventions were targeted at HCPs and focused on an eHealth knowledge translation strategy (1) to support the integration of evidence into pain practice, and (2) to facilitate sharing of knowledge, building/promoting awareness and changing practice.
Results: Of 2979 retrieved citations, 22 (18 published reports, 4 conference abstracts) were included. Thirty-six publicly available eHealth interventions were identified. eHealth interventions aimed to improve pain across different healthcare practices including mental health, pediatrics, dental health, rehabilitation, primary care and neurology. Of the peer-reviewed citations, 75% of the eHealth interventions were not evaluated for effectiveness; of those that were, none reported on improving pain practice among HCPs, nor patient pain outcomes.
Discussion/Conclusions: Researchers should consider examining the relationship between use of eHealth interventions and whether HCP's pain practices improve. Investigation on why published eHealth interventions do not tend to move beyond the research phases of usability and feasibility testing to evaluate intervention effectiveness, is warranted.

Joy MacDermid
Western University, London, Ontario, Canada Introduction/Aim: Arthritis of the hand, particularly the carpometacarpal (CMC) joint is one of the most sex/gender differentiated health conditions. Therefore, incorporating sex and gender-based analysis in research is critical. Further standards for sex and gender-based reporting are increasingly being mandated in research. This study evaluated the extent to which clinical trials relating to the CMC arthritis were consistent with the SAGER guidelines for sex/gender considerations in design and analysis.
Methods: A systematic search was conducted to identify randomized clinical trials on CMC arthritis (surgery or rehabilitation). The methods used were compared to SAGER guidelines to assess compliance with quality criteria for design/reporting in relation to sex/gender. The evaluated quality criteria addressed sex/gender definitions, sampling, analysis and interpretation Results: Amongst the 21 clinical trials conducted on CMC arthritis, including surgery and rehabilitation interventions none adequately considered sex and gender in sampling, analysis or discussion of findings. Women form the majority of the sample in most studies, but studies typically included less than 100 people. None were explicit in how recruitment was designed to obtain adequate gender representation; stated how non-binary sex or gen-der were managed or specifically stated whether the results were equally valid for men and women.
Discussion/Conclusions: Many of the studies addressing CMC arthritis are small and too underpowered to address sex and gender as a disaggregated analysis. Nevertheless, dramatic improvements are needed in how sex and gender are considered in sampling, collection of sex and gender data, analysis and reporting.

Disclosure statement
No potential conflict of interest was reported by the author. Background and Objectives: Pain or fear associated with needles is a cited barrier to vaccination. There has been no quantitative synthesis of the research evidence regarding the impact of pain or fear of needles on vaccination compliance. Our objective was to determine the prevalence of pain or fear as a parent-reported barrier to vaccination of children. Methods/Description: A literature search was conducted for articles published January 1946 to July 2017.
The search strategy was developed and executed with the assistance of an academic librarian using relevant medical subject headings (MeSH terms) and free-text terms. We included studies that: i) addressed vaccine hesitancy and attitudes towards needles, ii) identified vaccinated and partially vaccinated/non-vaccinated groups, iii) identified reasons for partial and non-vaccination (barriers), and iv) inquired specifically about pain or fear of needles and reported information to enable determination of the proportion of parents that selected this response. Data was extracted, and meta-analysis was carried out.
Results: The overall prevalence of pain or fear as a barrier to vaccination was 21.25% (95% CI 11.35 to 33.25) for surveys using closed-ended questions to elicit reasons for vaccine non-compliance and 2.60% (95% CI 0.58 to 6.00) for those using open-ended questions.
Conclusion/Implications: Pain and fear contribute to parents' decisions to not vaccinate their children. We recommend interventions be utilized more widely to reduce pain and fear during vaccinations in children.
Limitations include a small number of included studies and lack of consistency with regards to definitions and procedures.
Lost for Primary Care. The Lessons from the TRAST Project Introduction/Aim:~17% of young Quebecers aged 18-35 suffer from a chronic non-cancer pain (CNCP) condition, 12-17% of sufferers report no pain relief. Transition of youth to adult care without primary care continuing guidance, extinct connection to children services, and new adulthood responsibilities could lead to missed medical appointments, poor pain management, self-medication practices, and increased risk of psychosocial comorbidities. Primary care practitioners (PCPs), following patients from the cradle to the grave and supported by specialized pain services, represent a safety net for this population. Objectives. Introduction/Aim: Pain catastrophizing scale (PCS) and pressure pain threshold (PPT) are two evidencebased outcome measures for both research and clinical practice. The relationship between PCS and PPT is not clear with existing controversy and insufficient studies. The aim of this study is to evaluate whether subgroups of chronic musculoskeletal pain patients defined by the relative congruence of PCS and PPT differed on the major constructs (predictor and outcomes) of the fearavoidance model (FAM) after controlling for covariates.
Methods: A total of 125 participants (68% women; mean ± SD age 53.5 ± 12.77 years) with chronic musculoskeletal pain participated in the study. Of these individuals who met the inclusion criteria, 103 participants completed all measures included in this study. Participants completed a single testing session that included measures of all of the major constructs of the FAM, including pain catastrophizing, pain-related fear, activity avoidance (self-report and functional measures), pain-related disability, depression and pain severity, as well as pressure pain threshold. Subgroups were constructed by dichotomizing (median split) of PCS and PPT scores, resulting in 4 groups: high-PCS/high-PPT (n = 26), high-PCS/low-PPT (n = 29), low-PCS/high-PPT (n = 24), and low-PCS/low-PPT (n = 24).
Results: Onaway ANOVA revealed significant group differences (p < .05) on all the FAM constructs of this study (except functional avoidance) and post hoc analysis indicated the most of the significance differences are for the high-PCS/low-PPT group (p < .05). Multivariate analyses also revealed significant group differences (p < .01) after adjusting for differences on all covariates (age, ethnicity, education level, comorbidity, BMI), except gender.
Discussion/Conclusions: The study suggest higher level of pain catastrophizing and lower level of pressure pain threshold are an indicator of higher level FAM constructs in predicting pain-related fear and outcomes considering gender and functional avoidance. This finding has important clinical and theoretical implications.
Background: Patients referred to Toronto Poly Clinic multi-disciplinary pain program are often receiving opioid therapy at high-doses (≥90 mg Morphine Equivalent Dose [MED]) than recommended by Canadian opioid prescribing guidelines. These patients are encouraged to gradually taper the dose to avoid risks associated with opioid therapy. Tapering is successful when the patient is carefully monitored and provided with appropriate pharmacological and psychological support. In this study, we observed the effect of medical cannabis and psychological support on opioid reduction and pain management.
Methods: Patients with chronic pain (N = 600) receiving high-dose opioids (range: 90-240 MED/daily) were included in this program. The rate of tapering opioid dose was individualised per patient (average reduction: 10% every 1-2 weeks). For each reduction, patients were authorized to increase medical cannabis dose by 0.5 g/day up to a maximum of 3 g/day, if needed. ZENDOSE, a validated web-based mental health and wellness tool, was used to track physical, and mental well-being of patient. Physicians monitored patients regularly, assessing their pain, sleep, function, and quality of life (QoL), every 1-2 weeks.
Results: After six months, 329 (55%) patients were able to reduce their daily opioid intake by 30%; 156 (26%) patients discontinued opioids. All patients expressed satisfaction with their pain control, sleep and QoL. Opioid dose remained unchanged and increased in 114 (19%) and 1 patient(s), respectively. Detailed results will be presented.
Conclusion: Results from this study warrants further investigation on medical cannabis as a potential alternative to prescription opioids for treating chronic pain and opioid-dose reduction CONTACT Kevin Rod krod@tpclinic.com Background: This randomized trial compared mini-open (MO) versus all-arthroscopic (AA) rotator cuff repair. Methods: People with rotator cuff tears were screened and consented to randomization to MO or AA repair at 9 centres by 23 surgeons. Random allocation was revealed in the operating room. The primary outcome -The Western Ontario Rotator Cuff Index (WORC); secondary outcomes: ASES, SPADI pain scale, SF-12, MRI imaging of cuff integrity, range of motion, strength, medication use and adverse events were assessed by a blinded evaluator 1-month before surgery; and 2 and 6-weeks, and 3, 6, 12, 18, and 24 months later. A single blinded radiologist evaluated MRIs at baseline and 2-years. Intention-to-treat ANCOVA with preoperative WORC score, age and tear size as covariates, assessed continuous outcomes; disaggregated by sex. A meta-analysis synthesized the current trial outcomes with prior studies.
Results   Introduction/Aim: Emerging data from qualitative studies demonstrates that parents wish to be involved in all aspects of their infant's care in the NICU, including pain management. The aim of this study was to complete a meta-synthesis evaluating the factors affecting parent participation in pain management. Methods: A literature search was conducted of studies published from 1976 to 2017 using MeSH terminology. All studies that utilized a qualitative methodology and evaluated parental participation and education in NICU were included. The Critical Appraisal Skills Programme (CASP) qualitative tool was used to assess the qualitative studies by two researchers. A thematic synthesis technique was used to collate the qualitative data.
Results: A total of 29,903 articles were returned. Once duplicates were removed, and the studies were limited to qualitative methodology, 47 studies remained. Forty studies were excluded for not being conducted with neonates, were evaluating comfort measures in neonatal palliative care, or were review/ opinion articles. This left seven studies applicable for inclusion.
Four themes were identified from the seven studies reviewed. How to parent, parental stress and anxiety, health care providers as gate keepers and NICU environment were identified as the key themes across the studies.
Discussion/Conclusions: Four main themes were identified in this qualitative meta-synthesis that impact parents ability to participate in their infant's pain management. Further research to evaluate how to improve parental participation in pain management in the NICU is needed to better understand this phenomenon. Methods: We used data from the National Cannabis Survey, Wave 1 (collected from February to March 2018) to explore the rate of, and characteristics associated with, initiating or increasing cannabis use due to legalization among the Canadian population aged 15 years and over. We applied bootstrap weights provided by Statistics Canada to extrapolate findings to the entire Canadian population. We constructed logistic regression models to calculate adjusted odds ratios (aORs) for predictors of new or increased use, and present adjusted risk increases (ARIs) for all significant associations.
Discussion/Conclusions: Cannabis use may increase following legalization for recreational use in Canada. Potential higher risk populations (adolescents and young adults, those with mental illness) should be carefully monitored post-cannabis legalization, and targeted for public health education. Introduction/Aim: Prior studies have shown that the representation and movement of a body in VR can increase heat pain thresholds. For instance, a reddened arm significantly decreased the pain threshold compared with normal/ blue skin color. Seeing one's arm alone in VR has significant analgesic affect and increase heat pain thresholds. We hypothesize comparing to a still hand in VR, synced arm movement can increase pain thresholds. This top-down modulation of pain through visual and motor input may suggest a potential use of altering embodied virtual body image for pain therapy and management. Methods: Ten subjects (8 females, 19 -29, mean = 25.2, SD = 5.4) were recruited. All participants went through the same three visual conditions and they were asked to perform the same movement task (1) no virtual body (2) a virtual body with right arm still, and (3) a virtual body with synced right arm movement. Heat pain and selfreported sense of ownership and sense of agency were measured in VAS. The heat pain stimulus was generated by a TSA-II Neuro Sensory Analyzer.

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Results: Comparing the still arm condition with synced arm group, significant differences (p < 0.01) were found in question (I felt the virtual arm was my own arm) and question (I felt my real arm was becoming virtual). The conditions with hands in VR had significant higher pain thresholds than the no-hand condition (p < 0.05). Nonetheless, we did not find significant differences in pain thresholds between the still and synced movement conditions. Discussion/Conclusions: We will continue the study with another 10-15 participants as 25 is a standard amount for pain thresholds investigation studies which will be done by Dec 2018.
CONTACT Xin Tong tongxint@sfu.ca Introduction/Aim: We observed while performing behavioral experiments on pregnant mice that male mice in the same testing room had elevated pain thresholds. The male mice also displayed more aggressive behaviors (e.g., biting an experimenter during handling). Based on this observation we hypothesized that male mice display stress-induced analgesia in the presence of pregnant mice. Methods: We tested whether exposure to female mice in different stages of their reproductive cycle (naïve, early pregnancy, late pregnancy, lactating and post-weaning) would affect thermal pain thresholds and systemic corticosterone levels in male mice. Further, we exposed male mice to different volumes of urinary volatiles known to be increased during pregnancy in mice (pentyl acetate and 4-heptanone) and compared the pain thresholds and corticosterone levels to a control group. Aggression levels were tested by using the Resident-Intruder paradigm test in mice exposed to pentyl acetate.
Results: Male mice exposed to both late pregnant and lactating mice showed increased pain thresholds, while increased levels of systemic corticosterone were only observed in males exposed to late pregnant mice. Exposure to pentyl acetate and 4-heptanone induced a dose-dependent reduction of pain threshold. Resident-intruder test revealed a trend for pentylacetate exposed mice to be more aggressive than control (reduced attack latency).
Discussion/Conclusions: We show for the first-time evidence for a chemical signal, released from pregnant and lactating mice, which may act as a stressor for male mice and affect their pain behaviors.
CONTACT Lucas Lima lima.lvl@outlook.com Introduction: Complex Regional Pain Syndrome (CRPS), previously regional sympathetic dystrophy, is a chronic severe pain condition characterized by continuing pain disproportionate in time or degree to the usual course of known trauma or lesion. The pain is regional and has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. In adults, annual incidence is 5.5-26.2 new cases per 100,000 annually. Pediatric incidence is unknown and diagnostic criteria have not been validated. Methods: The Canadian Paediatric Surveillance Program (CPSP) surveys approximately 2,700 pediatricians and pediatric subspecialists monthly. CPSP enables detection of CRPS cases that present in pediatric primary care, subspecialty care, and inpatient care. For the 2-year study period, Canadian pediatric pain clinics are included. Participating physicians signal cases to the CPSP then complete a follow-up questionnaire. Case definition: Any patient aged 2-18 years with a new diagnosis of CRPS, meeting the International Association for the Study of Pain clinical diagnostic criteria.
Conclusions: Study results will help determine the minimum incidence of CRPS, patient demographics, and risk factors in Canada. Results will be used to promote early recognition and treatment to benefit patient recovery.
Introduction/Aim: Migrainea disabling neurological pain disorder and the sixth biggest cause of disability worldwidewas declared a major public health problem by the WHO due to a paucity of knowledge about cause and effective treatment options. In incidence and severity, migraine disproportionately affects people occupying marginalized social locations (SL). Cost-prohibitive, ineffective, and unsustainable pharmacological treatment options have contributed to high levels of interest in complementary approaches by people with migraine. Little is known about their motivations, patterns of use or access, or whether these vary by SL.
Methods: Thematic qualitative content analysis of focus groups (n = 30) exploring most meaningful outcomes and goals in migraine treatment.
Results: Four themes: a more holistic, collaborative, long-term treatment approach; medication as a short-term solution; high personal and economic costs of medication, and; desire for more information and access to natural approaches. Across SL, participants expressed keen interest in integrative approaches and better access to complimentary modalities. Participants in marginalized SL described reliance on traditional/ folk remedies, including engagement with family and community healers, who they described as more affordable and culturally accessible.
Discussion/Conclusions: Holistic and integrative approaches were preferred over medication as long-term migraine management strategies. However, people in marginalized SL, while disproportionately disabled by migraine, did not feel as comfortable accessing integrative approaches in their current forms. Engaging these communities and using a critical lens to explore barriers to access can develop options to make complimentary modalities more approachable, while also attending to systemic blind spots that may unintentionally alienate socially marginalized groups. Introduction/Aim: Needle-related procedures are the most important source of pain in children. Time constraints and heavy workload are barriers to the use of available interventions for pain management during these procedures. Therefore, the use of a rapid and easy-to-use intervention could improve pain management practices. This study aimed to determine if a device combining cold and vibration (Buzzy) was non-inferior to a topical anesthetic (Maxilene) for pain management of children undergoing needle-related procedures in the Emergency Department (ED).
Methods: This study was a randomized, controlled, non-inferiority trial. We enrolled children aged between 4-17 years presenting to the ED and requiring a needlerelated procedure. The primary outcome was the mean difference in pain intensity during the procedure. The secondary outcomes were procedural distress and success of the procedure at first attempt.
Results: A total of 352 participants were enrolled and 346 were randomized (Buzzy = 172; Maxilene = 174). Mean difference in procedural pain scores between groups was 0.64 (95%CI −0.1 to 1.3), showing that the Buzzy device was not non-inferior to Maxilene according to a non-inferiority margin of 0.70. No significant differences were observed for procedural distress (p = .370) and success of the procedure at first attempt (p = .602).
Discussion/Conclusions: Non-inferiority of the Buzzy device over a topical anesthetic was not demonstrated for pain management of children during a needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting and require an application time, the Buzzy device seems to be a promising alternative as it is rapid, reusable, and easy-to-use.

Funding
This work was supported by the Natural Science Fund of Shandong Province, China (No. ZR2012DM014) and the People's Livelihoods Science and Technology Project of Qingdao, Shandong Province, China (13-1-3-73-nsh).
CONTACT Ariane Ballard ariane.ballard@umontreal.ca; ariane.ballard@ hotmail.com Introduction/Aim: Our laboratory recently demonstrated that mere olfactory exposure to male experimenters can trigger stress-induced analgesia in rodents. Male sweat, and certain volatile chemosignaling compounds found therein-(E)-3-methyl-2-hexenoic acid (3M2H), androstenone, and androstadienone-were shown to cause reduction in pain behaviours and increases in corticosterone. This stress response to male chemosignals was also found to be concentration-dependent and particularly robust in female rodents. Androstenone and androstadienone have also been shown to raise cortisol levels in human women but not in men, for approximately one hour following olfactory exposure. 3M2H's concentration in sweat is far higher than that of both androstadienone and androstenone, and although it has been studied far less than the other two compounds, it is reasonable to predict that 3M2H will produce a similar reaction effect: stress, and stressinduced analgesia in humans, particularly in women.
Methods: In the current stage of our study, we are confirming that 3M2H does indeed alter stress levels in a sex-dependent manner. Participants are exposed to 3M2H via an olfactometer, their mood and anxiety reported via visual analog scales, and their cortisol collected via saliva samples.
Results: We have observed significant sex differences, with males showing a drop in cortisol levels after exposure to high concentrations of 3M2H, while women's cortisol levels remain unchanged.
Discussion/Conclusions: We believe that the robust sex differences displayed in stress responses might have important implications for the design of all human laboratory experiments, and possible clinical relevance to a number of mental disorders ranging from anxiety to depression to post traumatic stress disorder, and thus its explication may make unique contributions to the pain field. Methods: Children and youth 10 to 18 years old enrolled in the Pediatric Chronic Pain Program at McMaster Children's Hospital complete a set of intake questionnaires including the PSOCQ-13, chronic pain acceptance (CPAQ), pain self-efficacy (PSE), and pain coping (PCQ). Correlations will examine the internal reliability (Cronbach's alpha) and concurrent validity of PSOCQ-13.
Results: Data from 60 children and youth will be obtained. It is expected there will be significant positive correlations between the action/maintenance subscale of the PSCOQ-13 and the CPAQ, PSE, and PCQ scores. There will be negative correlations between the precontemplation subscale of the PSCOQ-13 and the CPAQ, PSE, and PCQ scores. A subgroup of participants aged 10-12, when analyzed separately, is expected to produce results similar to the older (age 13-18) group.
Discussion/Conclusions: Patients are more satisfied with pain management when they integrate selfmanagement techniques in their lives, accept their pain more, and have better mood. They also recognize their ability to continue using these techniques post-treatment. Results are discussed within the patient satisfaction and pain program outcomes literature. Introduction/Aim: Intravenous (IV) induction can be a distressing experience for children receiving surgery. This randomized, controlled, two-armed study explored the effectiveness of a humanoid robot (MEDi®) programmed to deliver cognitive-behavioral strategies and teach deep breathing techniques to help children cope with IV induction. Methods: Children (n = 137) ages 4-12 years were recruited from a tertiary pediatric hospital, and were randomly assigned to obtain induction according to standard protocol or with preparation from MEDi® prior to induction. Procedural pain and fear ratings were collected from children, parents, anesthesiologists, and researchers. Follow-up interviews were conducted to assess the recall of pain-related memories.
Results: Although no group differences were found for pain or fear (ps > 0.05), children who received preparation were more likely to complete the induction without an inhalation mask, compared to standard care, Fisher's Exact Test X2(1) = 4.85, p = 0.04, φc = 0.22. Specifically, the odds ratio indicates that patients with MEDi® preparation were 5.04 times more likely to complete the IV procedure than children without MEDi®. Many children recalled interacting with the robot (n = 12, 46.2% families interviewed) and had positive memories about the IV procedure. Among them, 33.3% of children remembered MEDi® and breathing exercises performed during the procedure.
Discussion/Conclusions: Despite being a safe, effective sedation method, IV induction is a painful and fear provoking procedure for many pediatric surgical patients. This study was the first to examine how a robot can assist children in learning strategies to cope with IV induction and suggests that it may help them tolerate IV procedures.
CONTACT Rachelle Lee rcwlee@ucalgary.ca Introduction/Aim: Changes associated with the development of pain involve the reorganization of pain circuitry, and alterations in gene expression. mTOR is a highly evolutionarily conserved serine/threonine kinase that regulates cell homeostasis through key cellular processes, including cell growth and proliferation, translation, autophagy, and cytoskeleton organization. mTOR is present in two structurally and functionally distinct multiprotein complexes: mTORC1 (mTOR Complex 1) and mTORC2. mTORC1 regulates the rate of mRNA translation. Much less is known about mTORC2, which has recently emerged as a key signaling molecule in a variety of cellular processes. Methods: To study the role of mTORC2 in pain, we selectively ablated rictor, a key protein within the mTORC2, in Nav1.8-positive nociceptors. To ensure that behavioral effects are not a result of aberrant developmental changes from the conditional knockout of Rictor, immunohistochemistry and western blot analysis were performed. We also studied the effect of rictor conditional knockout (cKO) on intracellular signaling following inflammation and tissue injury. Furthermore, we used a drug compound, A-443654, that activates mTORC2.
Results: Our behavioral experiments demonstrate that rictor cKO mice exhibit reduced hypersensitivity in a model of inflammatory pain, complete Freund's adjuvant, but not in the model of neuropathic pain, spared nerve injury. Western blotting and immunohistochemistry confirmed that developmental effects do not contribute to the observed phenotype. Administration of the mTORC2 activator A-443654 induced mechanical and thermal hypersensitivity.
Discussion/Conclusions: Our study demonstrates for the first time the central role of mTORC2 in nociceptors in the development of pain hypersensitivity in response to inflammation.  Introduction/Aim: Pain is a common feature in persons presenting with hand conditions including acute injuries, emergent post-traumatic and planned reconstructive surgeries. Effective pain management promotes recovery by facilitating rehabilitation participation. This evidence synthesis compares interventions addressing acute pain to support research-informed decision-making for conservative pain management in hand therapy practice. Methods: Systematic reviews (SR) addressing effects on acute pain in hand or wrist injury and randomized clinical trials (RCTs) not captured previously were identified. The primary outcome of interest was pain reduction across short (<1), medium (1-6), and longterm outcomes (>6 months).
Results: Thirteen SRs and 16 RCTs met inclusion criteria. We grouped interventions into those using mobilization/immobilization, non-prescription medication, and modalities or supervised therapy. Robust findings were lacking to support exercise or early motion vs immobilization via casting or splinting for pain reduction. Pooled moderate quality studies supported topical NSAIDs compared to placebo. Few modalities were supported by more than a single trial, with the exception of transcutaneous electrical nerve stimulation, which demonstrated superiority to sham in pooled trials for acute and neuropathic pain. Supervised therapy attendance was not superior to tailored home exercise programs.
Discussion/Conclusions: No single treatment or approach emerged with high quality evidence to support effectiveness for acute pain management in hand therapy. How and when pain is measured in clinical studies varies greatly, and often lacks discussion around potential mechanisms of effect guiding treatment selec-tion for individual clients. Clinicians should consider multi-modal approaches to reducing targeted pain outcome, as well as the multiple actions each intervention might accomplish.
CONTACT Tara Packham packhamt@mcmaster.ca Introduction/Aim: Inflammatory arthritis (IA) is associated with an increased risk of coronary artery disease (CAD) morbidity and mortality but little is known about the clinical presentations associated with cardiac pain in women with IA. The aim of this study was to understand how women with IA understood, discussed, recognized and managed cardiac pain related to CAD. Methods: We utilized a mixed method design to combine evidence from a comprehensive review of the literature on the self-management of cardiac pain in women with IA with the results of interviews with women with IA and cardiac pain.
Results: In total, 519 studies were included for full text assessment. However, no study described the selfmanagement of cardiac pain or associated cardiac pain equivalents in women with IA. A total of five women were recruited for interviews; 80% (n = 4) had mild/moderate or high stress at home, reduced physical function (X = 4.6, SD = 2.1), moderate pain scores (X = 6.0, SD = 2.0, range 4.0-8.5), and had high IA disease activity (n = 3, 60%). Most women (n = 3, 60%) were also the primary person responsible for housework in the home, completing an average of 18.2 hours (SD = 8.0) of housework per week (range 8-30 hours per week).
Discussion/Conclusions: Our results suggest women with IA have a high burden of disease activity related to IA. More research is needed to better target treatment and follow-up support for these women. Introduction/Aim: Individuals with neurological diagnoses often have high rates of persistent pain; pain which does not subside over time. Psychological and physical interventions aimed at improving coping and acceptance of pain are successful at reducing pain and enhancing general well-being. The Living Engaged and Actively with Pain (LEAP) service provides therapy to clients with both a neurological diagnosis and chronic pain, offering a nine-week Pain Management Group (PMG). This pilot study was designed to explore the impact of the PMG on psychological and functional outcomes using mixed methods.

Evaluating the Impact of a Pain Management Group for Individuals with Neurological Diagnoses and Chronic Pain -A Pilot Study
Methods: A pre-and post-test design was used, with participants (n = 40) completing measures of subjective pain, quality of life, and occupational goal progress. Measures were completed at three time points (pre-PMG, post-PMG and follow-up) along with a qualitative exit interview post-PMG. Scores were analyzed using paired t-tests. Constant comparative analysis was conducted on qualitative data.
Results: Participants showed significant positive changes in measures of pain catastrophizing, pain acceptance, quality of life, and goal performance and satisfaction. Three themes emerged from qualitative analysis: "Pros and Cons of PMG Format," "The Importance of Peer Dynamics" and "Applying Group Content to Daily Life & Goals." Discussion/Conclusions: Results support that the PMG is a beneficial treatment plan for improving psychological status, functional abilities, and chronic pain management in persons with neurological diagnoses. Qualitative results highlight (1) that participants applied strategies learned in PMG to managing pain and meeting goals, and (2) potential areas of improvement to better tailor the group to client needs. Introduction/Aim: Exposing parents to the ABCD's of Pain Management psychoeducational video is effective at reducing children's pain-related distress in toddlers one-and two-minutes post-needle (Pillai Riddell et al., 2017). The effect of sex on these findings has yet to be explored. The aim of this analysis is to assess the interaction of treatment, age, and sex on young children's pain related distress post-needle. Methods: Parents of 6-and 18-month-olds (n = 64 each) were randomized to a video treatment -The ABCD's (Assess anxiety, Belly breathe, Calm close cuddle, and Distraction) of pain management or a placebo video. Pain-related distress was measured using the Modified Behaviour Pain Scale (MBPS;Taddio et al., 1995) at four distinct time points: immediately following the needle (1-15s), oneminute post-needle (61-75s), two minutes postneedle (121-135s), and three minutes post-needle (181-195s). Child sex was also recorded.
Results: Using a 2 (Treatment: ABCD vs. Control) X 2 (Age: 6-vs. 18-month) X 2 (Child Sex: Male vs. Female) MANOVA, a Treatment X Age interaction was found (F = 3.41, p = .01), such that 18-month-old toddlers in the treatment condition displayed less painrelated distress one-and two-minutes post-needle. However, there was no interaction found between treatment, age, and sex (F = 1.84, p = .13).
Discussion/Conclusions: Although the ABCD's of pain management video appears to reduce pain-related distress post-needle in toddlers, this does not appear to be influenced by sex. Future research should assess the impact of treatment, age, and sex or gender in older children. Introduction/Aim: This study aimed at identifying biopsychosocial characteristics associated with long-term opioid treatment in chronic non-cancer pain patients.

Predictors of Long-Term Opioid Use in Chronic Non-Cancer Pain Patients: A Quebec Pain Registry Study
Methods: This was a retrospective study from the Quebec Pain Registry. Consenting patients aged ≥ 18 years completed self-reported and nurse-administered questionnaires before their first visit (baseline) at one of five multidisciplinary pain treatment clinics and at 6-and 12months follow-up. Three opioid use profiles (OUP) were defined: non-opioid users (not using opioids during the follow-up period), non-lasting opioid users (using opioids but not during the whole follow-up period) and lasting opioid users (using opioids during the whole follow-up period). Multivariate multinomial logistic regression analysis was used to identify predictors of OUP.
Discussion/Conclusions: More severe pain and higher depression level were predictors of longterm OUP. Presence of neuropathic pain was associated with non-lasting opioid use. Further research is needed to identify which patients are most likely and least likely to benefit from long-term opioid use.
Introduction/Aim: The coordination of distress responding and recovery with one's caregiver plays an important role in structuring and consolidating an infant's ability to regulate their distress (Feldman, 2012). The aim of this study was to provide preliminary evidence of coordination between caregiver and infant cardiac indicators of pain-related distress (heart rate (HR), respiratory sinus arrhythmia (RSA)) during vaccination.
Methods: Caregiver-infant dyads for this study were followed as part of an ongoing longitudinal study at 12-, 18-, and 24-month vaccinations. Only 12-month cardiac data (n = 73) will be reported in the current investigation. HR and RSA were analyzed during sequential 30-second epochs (30 seconds before the needle, immediately after the needle, 1-minute post-needle, and 2-minutes post-needle). Cross-lagged path models were estimated to examine concurrent and directional relationships between caregiver and infant cardiac indicators across epochs.
Results: Results indicated: 1) Across the 4 epochs, caregivers' and infants' RSA (and HR) are predicted by their preceding RSA (and HR); 2) there are no concurrent relationships between caregiver and infant cardiac indicators across epochs; and 3) generally, caregiver RSA (and HR) did not predict subsequent infant RSA (and HR) and vice versa.
Discussion/Conclusions: Results suggest coordination of caregiver and infant pain-related distress in a vaccination context does not manifest at 12 months. Statistical modeling (e.g. growth curve modelling) that discern groups of caregiver-dyads and their response trajectories should be used to better elucidate patterns of coordination (or lack of coordination) between caregivers and their infants, and the factors that influence patterns of coordination. Introduction/Aim: Pain is a common symptom in intensive care unit (ICU) patients. Alternative pain measures are necessary as many patients are noncommunicative. Although behavioral pain measures (e.g., Critical-Care Pain Observation Tool or CPOT) are available, physiological measures are lacking The Nociception Level (NOL) TM index incorporates simultaneously multiple physiological parameters (i.e., heart rate and its variability, pulse plethysmograph amplitude, skin conductance level, number of skin conductance fluctuations) to measure pain, but its use in the ICU is new. We explored the NOL for pain assessment in mechanically ventilated ICU patients during endotracheal suctioning.

Exploration of the Nociception
Methods: A prospective cohort study was performed in a medical-surgical ICU in Montreal, Quebec. Data were collected at rest (T1), during endotracheal suctioning (T2), and 15 minutes post-procedure (T3). The NOL index ranges from 0 to 100 with values >25 indicative of pain The patient's self-report of 0-10 pain intensity and 0-8 CPOT scores were also obtained. Friedman tests were used.
Discussion/Conclusions: Consistent with pain intensity and CPOT scores, the NOL values were higher during endotracheal suctioning compared to pre/post-procedure. The NOL is an interesting pain assessment method requiring further validation testing in the ICU. Introduction/Aim: Canada is in the middle of an opioid crisis. The Ontario Ministry of Health and Long-Term Care funded a demonstration project of the first replication of Project ECHO in Canada to tackle the opioid crisis. ECHO Ontario Chronic Pain/Opioid Stewardship started in June 2014. Participants attending ECHO acquire knowledge related to chronic pain management with or without opioids. This study aims to assess prescribing behaviours among family physicians who attended ECHO compared to those who did not.

An Assessment of Opioid Prescribing Behaviors in Ontario Family Physicians before and after Participation in ECHO Chronic Pain/Opioid Stewardship
Methods: We conducted an observational study with two control groups: a matched cohort and a random sample of 3,000 primary care physicians in Ontario using the Narcotics Monitoring System.
Results: We found that the ECHO group significantly reduced (p = 0.0047) high-dose opioid prescriptions by 20.2% after attending ECHO, compared to a non-significant increase of 0.8% in the matched cohort, and a non-significant reduction of 1.5% in the Ontario group during the same comparable periods.
Discussion/Conclusions: Ontario family physicians who participated in ECHO Chronic Pain/Opioid Stewardship had a greater reduction in the number of patients on high dose of opioids than those who did not participate in ECHO.
CONTACT Santana Díaz santana.diaz@uhn.ca Introduction/Aim: Non-pharmacological therapies are recommended first line by Canadian guidelines as a part of the multi-modal approach for managing chronic non-cancer pain. Non-pharmacological approaches are burdened by long wait times, cost, and limited access to those who reside outside of urban settings. This poster presents the information regarding available services, factors affecting access, strategies to improve access and funding practices related to nonpharmacological therapies for chronic non-cancer pain.
Methods: A survey, direct stakeholder consultations, and a literature review were conducted to gather information on non-pharmacological treatment availability, funding practices, access, and strategies to improve availability and access.
Results: Most non-pharmacological treatments for chronic non-cancer pain are available in Canada, mainly in urban settings with lower availability in rural settings and the lowest in remote settings. While treatments are available, access is limited due to long wait times for publically funded services and lack of funding for community based-services. Survey respondents indicated various barriers and facilitators to providing treatment and, also reported a need for more guidance on providing non-pharmacological treatments for non-cancer pain.
Creating a national pain strategy helped other countries create plans for equity of access to nonpharmacological interventions. Efforts are underway to create a pain strategy in Canada.
Discussion/Conclusions: Non-pharmacological treatments for chronic non-cancer pain are available in Canada; however, access is impeded by wait times and funding availability. More guidance is needed to direct treatment.
CONTACT Colleen Donder colleend@cadth.ca Introduction/Aim: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pelvic pain condition characterized by urinary urgency, frequency, and dysuria. As the etiology of this condition is unknown, treatment focuses on symptom management. Previous research has demonstrated that helplessness mediates the relationship between depression and pain. The aim of this study was to understand the types of depressive symptoms driving the relationship, and whether this relationship was dependent on type of patient pain descriptors. Methods: 135 women diagnosed with IC/BPS recruited from tertiary care clinics completed demographic, depressive symptoms, catastrophizing, and pain questionnaires at baseline, six months, and one year. Six mediation models were run using baseline cognitive/somatic depressive symptoms to helplessness at six months to affective/acute sensory/chronic sensory descriptors of pain at one year.
Results: Baseline cognitive depressive symptoms led to helplessness at six months, which led to descriptions of affective pain, acute sensory pain, and chronic sensory pain at one year while controlling for baseline somatic depressive symptoms, catastrophizing and pain. When controlling for cognitive symptoms, baseline somatic symptoms did not significantly predict helplessness at six months or affective pain, acute sensory pain, and chronic sensory pain descriptions at one year.
Discussion/Conclusions: Cognitive symptoms of depression are the driving factor of the longitudinal relationship between depression, helplessness, and pain in women with IC/BPS. This relationship does not differ according to patient affective, acute sensory, or chronic sensory pain descriptors. These findings highlight the importance of addressing patient cognitions through psychological intervention for effective pain management.
CONTACT Alison Crawford alison.crawford@queensu.ca Introduction/Aim: Recent attention to the opioid crisis has identified the need for increased discussion, communication, and collaboration in health care and at the community level. Significant gaps currently exist in interdisciplinary pain education. Increasing opportunities for learners to explore topics related to pain at the undergraduate level may help address this deficiency.
Methods: A new inquiry-based course was created within the Bachelor of Health Sciences (Honours) Program at McMaster University in 2014-2015. The objectives of this limited-enrolment course are: to develop an understanding of theories and mechanisms of pain, to gain an appreciation for the wide range of pain management techniques, to gain an appreciation for what it means to live with pain (e.g. the psychosocial context), and to work collaboratively with peers and utilize community resources in learning.
Results: Since its inception, this course has enrolled 96 students over 5 years. Each year, students work independently and in groups on pain topics relating to their own interests. In addition to inclass and online discussions, guest speakers from a variety of disciplines introduce their own perspectives on pain.
Discussion/Conclusions: This popular course provides an example of how interdisciplinary pain education can be integrated at the undergraduate level. It offers a tremendous opportunity to start conversations, introduce interdisciplinary collaboration, and inspire learners to pursue interests in pain research, policy, and practice. Bringing together faculty, students, professionals, and the community, this course addresses the need to promote pain as a topic for discussion and further study.
CONTACT Jennifer Nash nashjv@mcmaster.ca Introduction/Aim: Over 25% of persons with rheumatic conditions reports frequent and severe joint pain. Access to multidisciplinary pain treatment facilities (MPTF) is critical. However, access to MPTF in Canada is limited by extensive waiting lists. Our aim was to assess, in patients with rheumatic conditions, associations between waiting time for MPTF and pain interference progression between the first MPTF appointment and the 6-month follow-up. Methods: We conducted a retrospective study using the Quebec Pain Registry, a database of patients who received services within five MPTF in Québec between 2008 and 2014. Waiting time between referral and the initial appointment was categorized as < 2 months, 2-6 months and > 6 months. The outcome was change in Brief Pain Inventory (BPI) scores from baseline to 6 months. Multivariate analyses included generalized estimating equations.
Discussion/Conclusions: These results suggest that waiting time for MPTF is associated with improvement in pain interference, with a greater improvement for patients with rheumatic conditions who waited < 2 months versus patients who waited > 2 months. To assess treatment response, 20 patients with sufficient follow-up data (i.e. > 6m) were examined. To assess the white matter properties of the brainstem lesions, a further subgroup of 12 LTN patients (5F, ages 43-79) and 12 matched healthy controls (5F, ages 39-78) with DTI scans were analyzed. White matter metrics of fractional anisotropy (FA), mean, radial, and axial diffusivities (MD, RD, and AD) were extracted from (1) the LTN brainstem lesions, (2) the contralateral, unaffected side, (3) and healthy controls.
Results: 19/20 LTN patients were non-responders to surgical treatment (mean no. of surgeries ± SD: 3.95 ± 2.33, range: 1-9), with the majority having undergone >3 procedures. The brainstem lesions demonstrated abnormal white matter microstructure, characterized by lower FA, and higher MD, RD, and AD.
Discussion/Conclusions: This study identifies a new, unique group of TN patients with a single brainstem lesion not in keeping with multiple sclerosis. Understanding their clinical and DTI features may help strategize therapeutic options, especially since these patients are non-responders to conventional surgical treatment.
Introduction/Aim: Falls and associated risk factors related to chronic pain (CP) have only been examined in older adults, yet falls are common regardless of age in this population. This study aimed to determine the prevalence of falls and associated risk factors in all adults living with CP.
Methods: This cross-sectional study used baseline data from the Kingston Health Sciences Centre Chronic Pain Registry extracted between November 2017 and October 2018, including sociodemographics, history of falls, and biopsychosocial measures of pain. Descriptive and bivariate analyses were performed to determine the prevalence of falls and to phenotype adults with CP who experienced a fall in the previous year. Using multivariate logistic regression, we examined age-and gender-adjusted factors associated with falls.
Results: Of the 317 adults with CP included in this study, 145 (45%) reported a total of 564 falls in the previous year. Among fallers, 81 (65%) had a recent fall (<3 months) and 91 (67%) had multiple falls. Prevalence of falls was independent of age. Fallers had greater pain severity and interference, lower physical function, greater depression and more pain sites compared to non-fallers. Pain severity (OR = 1.19 (95% CI: 1.03-1.38)) and physical function (OR = 0.960 (0.932-0.988)) were independently associated with falls.
Discussion/Conclusions: High prevalence of falls was found regardless of age for adults living with CP.
Risk of falls increased with greater pain severity and lower physical function. A better understanding of circumstances, predictors and consequences of falls in all adults with CP is warranted.
Introduction/Aim: Quantitative sensory testing (QST) refers to a group of procedures that assess perceptual responses to systematically applied and quantifiable sensory stimuli. QST has primarily been used to study pain in adults, but recently has also been used in pediatrics. The purpose was to examine the acceptability of QST from children's and parents' perspectives and to determine the feasibility of its use in future pediatric studies.
Methods: Children participated in 8 QST tasks (thermal detection and pain threshold, heat pain tolerance threshold, mechanical pain sensitivity, dynamic mechanical allodynia, and wind up ratio) and self-reported the discomfort they experienced (DISCOmfort in Research with Children questionnaire; DISCO-RC). To assess acceptability, parents and children reported on their satisfaction with the visit and experience with the QST protocol and questionnaires. The length of the visit and study completion rate were used to assess feasibility.
Discussion/Conclusions: The current protocol was acceptable and feasible for studying experimental pain and was associated with minimal discomfort in healthy children aged 8-15 years and their parents.
Introduction/Aim: Childhood trauma has been linked to increased incidence of inflammatory bowel disease (IBD) in adulthood, yet the mechanism by which trauma leads to IBD remains unknown. Considering that IBD is often accompanied by pain, and there is a relationship between childhood trauma and chronic pain, it is predicted that pain will mediate the relationship between childhood trauma and IBD symptom severity.
Methods: 103 individuals with IBD completed an online self-report survey. Childhood trauma was assessed using the Childhood Traumatic Events Scale. IBD symptom severity was assessed with a short version of the IBD Symptom Inventory. Pain was assessed using the pain body diagram from the McGill Pain Questionnaire; pain locations were quantified using a grid system.
Results: A simple mediation analysis revealed that childhood trauma indirectly influenced severity of IBD symptoms through its effects on body pain. Individuals who reported more severe childhood trauma rated their pain higher (a = .0672), and individuals with higher levels of pain report more severe IBD symptoms (b = 5.1279). A bootstrap confidence interval for the indirect effect (ab = .3447) based on 10,000 bootstrap samples was entirely above zero (.0868 to .6642). There was no evidence that childhood trauma influenced IBD symptom severity independent of its effect on body pain (c' = .2623, p = .2739).
Discussion/Conclusions: This finding highlights the importance of screening for childhood trauma and the need for future studies to identify appropriate strategies to better manage pain in individuals with IBD so as to decrease their symptom severity.

Introduction/Aim: The American Medical Association
Guides to the Evaluation of Permanent Impairment (AMA Guides) are commonly used for assigning impairment ratings to injured workers; however, the association of AMA Guides edition (there are 6) with impairment ratings is uncertain.
Methods: We used data from a consecutive sample of 249 injured workers referred for an independent evaluation, 10 months before and after assessors switched from the 5 th to the 6 th edition of the AMA Guides. We also surveyed all Workers' Compensation Boards (WCBs) in North America to determine what impairment rating system they used.
Results: Multivariable analysis showed a 36.4% relative reduction (95% confidence interval [CI] 17.2% to 57.3%) in impairment rating with the 6 th edition of the Guides vs. the 5 th edition. The majority of WCBs in North America (46 of 64; 71.9%) mandate use of the AMA Guides, including the 6th (n = 21; 32.8%), 5th (n = 11; 17.2%), 4th (n = 7; 10.9%), and 3rd (n = 3; 4.7%) editions. Two WCBs (3.1%) allow assessors to use any edition of the AMA Guides, and 2 (3.1%) allow assessors to use either the 5th or 6th edition. Ten Compensation Boards (15.6%) have developed their own impairment rating guides, and 8 WCBs (12.5%) allow assessors to use the impairment rating system of their choice Discussion/Conclusions: The 6 th edition of the AMA Guides provides systematically lower impairment ratings for injured workers than the 5 th edition. Impairment rating systems should be standardized across WCBs.
Introduction/Aim: Pain is common for children with developmental disabilities. Secondary caregivers (e.g., respite workers) who are less familiar with a given child and their unique pain expression may be at particular risk for underestimating pain. The objective of this poster is to present the research protocol for a randomized controlled trial which will investigate the effectiveness of a pain assessment and management training for respite workers who support children with developmental disabilities.
Methods: Participating children's respite organizations in Ontario will be randomly assigned to a pain or control (family centered care) training condition. Immediately prior to the training, participants will complete: (a) a demographics questionnaire, (b) ratings of feasibility and their perceived skill/confidence in pain assessment and management, (c) a knowledge questionnaire, and (d) a vignette. Following completion of the 3 to 3.5 hour long training, they will complete (b) and (c) described above. Follow up will occur approximately one month after completion of the training, and will include completion of (b), (c), and (d) above, as well as participation in a focus group.
Results: The research protocol will be presented in detail. Data collection for this randomized controlled trial is complete, and analyses are ongoing.
Discussion/Conclusions: A number of methods and protocol-related decision points need to occur when conducting a randomized controlled trial. This is particularly the case when collaborating with multiple sites for data collection. The pros and cons of aspects of the presented protocol will be reviewed (e.g., feasibility, follow up time points). Introduction/Aim: Growing attention has been given to considering sex and gender in pain clinical and epidemiological research. However, this remains a challenge in the context of retrospective studies where self-reported gender measures are often unavailable. We aimed to create a new gender index using data from the Canadian Community Health Survey (CCHS). Methods: The GENDER Index was created using potentially gender-related variables available in the CCHS (selection based on scientific literature and expert opinion). Among workers aged 15-75 years who had no missing data for our variables of interest (n = 29 470 participants), a propensity score was derived from a logistic regression model that included gender-related variables as covariates and where sex served as the dependent variable. Face and construct validity of the index were examined.
Results: When looking at the distribution of the gender index in men and women, gender scores appeared related but partly independent (e.g., incomplete histogram overlap, variability of gender scores within each sex group). Differences also appeared in the proportion of women between groups categorized according to gender scores tertiles (p < .0001). Construct validity was established through associations between gender index scores and gender-related variables identified a priori such as choosing/avoiding certain foods because of weight concerns (p < .0001), caring for children as the most important thing contributing to stress (p = .0309), and ability to handle unexpected/difficult problems (p = .0375).
Discussion/Conclusions: According to our results, the GENDER Index could be useful to enhance the Introduction/Aim: Hospitalized patients are frequently treated with opioids for pain control and receipt of opioids at hospital discharge may increase risk of chronic opioid use. We aimed to explore inpatient analgesic prescribing patterns and patients' perception of pain control between US and non-US hospitals.
Methods: Cross-sectional observational study conducted at 11 academic hospitals in the US and 7 other countries, including medical inpatients presenting with pain and analyzing the percent of patients given opioid and non-opioid analgesics during the first 24 to 36 hours of their hospitalization and at discharge and assessments of pain and beliefs about pain control Results: We acquired completed surveys 503 of 719 patients in the US and 478 of 590 patients in other countries (75% response rate). Compared with patients in other countries, US patients who did or did not report taking opioids prior to admission were given opioids more frequently during their hospitalization (92% vs 70% and 71% vs 41%, respectively, P < 0.05). Patients who did not report taking opioids prior to admission were prescribed opioids more frequently at discharge (34% vs 15%, P < 0.05). These findings were not associated with improved satisfaction with pain control for US patients.
Discussion/Conclusions: Physicians in the US prescribe opioids more frequently during hospitalization than physicians in other countries, but this was not associated with improvement in patients' satisfaction with pain control. Efforts to curb the US opioid epidemic should include inpatient analgesic prescribing practices as well as patients' expectations regarding pain control. Previous research has revealed the presence of caregivertoddler co-regulation (temporal coordination of biological states) during acute procedures. However, the impact of various dimensions of toddlers' temperament, such as effortful control, on the relationship between caregivers' and toddlers' co-regulation has not yet been explored. The aim of the current study was to determine the moderating effect of toddlers' effortful control on this relationship. The relationships between toddlers' and caregivers' heart rate variability (HRV), as well as toddlers' effortful control, were measured during children's 12-(n = 64) and 18-month-(n = 38) vaccinations. HRV, corresponding to respiratory sinus arrhythmia (RSA), was analyzed using the MindWare analysis system and it was determined for four different 30second epochs: immediately before the needle, immediately after the needle, 1-minute post-needle (i.e. 60-89 seconds post needle), and 2-minutes post-needle (i.e .120 to 149 seconds post-needle). Parents reported on their toddlers' effortful control using the Early Childhood Behaviour Questionnaire (ECBQ; Effortful Control subscale). At 12months of age, there was no link between parent-toddler co-regulation and toddlers' effortful control. At 18-months of age, toddler effortful control significantly moderated their co-regulation with their caregivers during the painrelated distress regulation phases at 1-minute (b = −.07, p < .01) and 2-minutes (b = −.07, p < .05) post-needle. Specifically, parent-toddler co-regulation only emerged in toddlers with low levels of effortful control. It appears that caregiver-toddler co-regulation may be achieved more readily in children exhibiting difficulties with effortful control during acute procedures, potentially due to their increased need for external sources of regulation.
Introduction/Aim: Previous research has revealed the presence of caregiver-toddler co-regulation (temporal coordination of biological states) during acute procedures. However, the impact of various dimensions of toddlers' temperament, such as effortful control, on the relationship between caregivers' and toddlers' coregulation has not yet been explored. The aim of the current study was to determine the moderating effect of toddlers' effortful control on this relationship.

Methods:
The relationships between toddlers' and caregivers' heart rate variability (HRV), as well as toddlers' effortful control, were measured during children's 12-(n = 64) and 18-month-(n = 38) vaccinations. HRV, corresponding to respiratory sinus arrhythmia (RSA), was analyzed using the MindWare analysis system and it was determined for four different 30-second epochs: immediately before the needle, immediately after the needle, 1-minute post-needle (i.e. 60-89 seconds post needle), and 2-minutes post-needle (i.e .120 to 149 seconds post-needle). Parents reported on their toddlers' effortful control using the Early Childhood Behaviour Questionnaire (ECBQ; Effortful Control subscale).
Results: At 12-months of age, there was no link between parent-toddler co-regulation and toddlers' effortful control. At 18-months of age, toddler effortful control significantly moderated their co-regulation with their caregivers during the pain-related distress regulation phases at 1-minute (b = −.07, p < .01) and 2-minutes (b = −.07, p < .05) post-needle. Specifically, parent-toddler co-regulation only emerged in toddlers with low levels of effortful control.
Discussion/Conclusions: It appears that caregivertoddler co-regulation may be achieved more readily in children exhibiting difficulties with effortful control during acute procedures, potentially due to their increased need for external sources of regulation.  Introduction/Aim: Tobacco smoking is associated with adverse health effects. Its relationship to pain is complex and previous studies have shown a bi-directional relationship. The longitudinal effect of smoking on patients attending a tertiary pain management center is not well-established. Methods: Using the Collaborative Health Outcomes Information Registry (CHOIR) of patients attending the Stanford Pain Management Center from 2013 to 2017, we conducted a propensity-weighted analysis to determine the independent effects of smoking on chronic pain patients. We adjusted for covariates including age, gender, body mass index, depression and anxiety history, ethnicity, alcohol use, marital status, disability, and education. We compared smokers and non-smokers on pain intensity, functional, sleep, and psychological and mood variables using selfreported NIH PROMIS outcomes at consultation and over time.
Results: A total of 12,368 patients completed the CHOIR questionnaire of which 8,584 patients had complete data for propensity analysis. Smokers at time of pain consultation reported significantly worse pain intensities, pain interference, pain behaviors, physical functioning, fatigue, sleep-related impairment, sleep disturbance, anger, emotional support, depression, and anxiety symptoms than non-smokers (all p < 0.001). In the mixed model analysis, smokers tended to have worse pain interference, fatigue, sleeprelated impairment, anger, emotional support, depression, and anxiety over time compared to non-smokers.
Discussion/Conclusions: Chronic pain patients who smoke tobacco have worse pain, functional, sleep, and psychological and mood outcomes compared to nonsmokers. Smoking also has prognostic importance for poor recovery and improvement over time. Further research is needed on tailored strategies and therapies to assist chronic pain patients who smoke.
CONTACT James Khan james.khan@medportal.ca Introduction/Aim: Canada is the 2nd highest per-capita prescriber of opioids in the world. A number of interventions have been explored to promote evidence-based opioid prescribing, but there is uncertainty regarding features of effective strategies. We conducted a systematic review of studies exploring interventions to improve opioid prescribing for chronic non-cancer pain. We used the Behaviour Change Techniques (BCTs) Taxonomy to identify the active components of effective interventions. Introduction/Aim: Parent-directed knowledge translation (KT) resources can inform and promote the use of evidence-based practices to manage children's vaccination pain. This study used a KT resource to inform and potentially influence parents' use of evidence-based pain management strategies for children's vaccination pain. This study aimed to assess the relationship between parent's attitudes toward childhood vaccines and intentions to use information from a vaccination pain management KT resource. Methods: Parents of children aged 0-17 years viewed the KT resource about vaccination pain management strategies, developed in partnership with a parenting magazine. Parents completed the Parent Attitudes about Childhood Vaccines survey (PACV) to measure vaccine hesitancy (vaccination delay/refusal), and the content-validated Information Assessment Method for Parents to measure relevance and intention to use the KT resource.
Results: 155 parents completed the online survey (91% mothers, n = 142). Parents demonstrated little to no vaccine hesitancy (83.1%, n = 128). PACV scores were negatively correlated with relevance of the KT resource (r s = −.185, p < .05) and intention to use the information (r s = −.221, p < .01). Parents with more positive attitudes towards vaccinations were more likely to be receptive to the KT resource and intended to use the strategies.
Discussion/Conclusions: In this primarily vaccineaccepting sample, positive attitudes towards childhood vaccination were associated with parents' intention to use the pain management strategies in the KT resource. Further research is needed to inform whether KT Introduction/Aim: Central post-stroke pain (CPSP) is characterized by constant or intermittent pain associated with sensory abnormalities. The utilisation of transcranial direct current stimulation (tDCS) for the management of chronic pain and the utilisation of graded motor imagery (GMI) for the improvement of the motor function are well documented, but the association of tDCS+GMI on CPSP remains unclear. The presented case investigates the effectiveness of a tDCS+GMI protocol in the treatment of CPSP to decrease pain and to improve motor function.
Methods: A consenting male patient with right upper-extremity impairment and with the diagnosis of CPSP performed the tDCS+GMI protocol. This protocol involves placing an anodal tDCS over the left M1 and a cathodal tDCS over the right M1 while using graded motor imagery for 20 minutes during 5 consecutive-days. We used the visual analogue scale (VAS) and the McGill pain question-naireshort form, for the pain measurement and the Nine Hole Peg Test (NHPT) for the motor function. The measures were taken at the beginning of the protocol, at the end of the protocol and 1 week after.
Discussion/Conclusions: For this patient the protocol combining tDCS+GMI was effective in decreasing pain and improving motor function.
Introduction/Aim: Sociodemographic factors in children and families, such as gender, ethnicity and socioeconomic status, are associated with a higher prevalence of chronic pain, and may affect equitable access to tertiary or resourceintensive care. Pediatric pain rehabilitation programs, which offer intensive outpatient interdisciplinary treatments based on the biopsychosocial model of pain, demonstrate cost-effectiveness and functional improvement for youth with pain and significant pain-related disability. However, few exist in North America, and their resourceintensive nature limits access to many children with chronic pain. We sought to examine sociodemographic data of youth enrolled in our intensive pain rehabilitation program (IPRP), and compare it to published sociodemographic characteristics of children with chronic pain.
Methods: A retrospective analysis of patients admitted to the IPRP over 3 years (N = 27, mean age 16.2 years) was performed.
Mean pain duration was 38.1 ± 28.1 months. Primary pain complaints in the IPRP were varied, with 44.4% listing neuropathic pain.
Discussion/Conclusions: Our findings reflect literature data that pediatric chronic pain is more prevalent in females than males, but show underrepresentation of low-income households despite lower socioeconomic status being associated with a higher prevalence of chronic pain. The findings also suggest underrepresentation of minorities, despite minority status being a risk factor for functional limitation from physical symptoms. These are similar to other North American pain rehabilitation programs. Continued focus in this area may involve diversifying referral bases and broadening exposure of our IPRP to more at-risk demographics. CONTACT Vishal Varshney vishal.varshney@ahs.ca Introduction/Aim: The impact of opioid dosing approaches for chronic non-cancer pain are uncertain, as is the effect of multidisciplinary support for those patients attempting to reduce their opioid dose. Methods: We searched Medline, EMBASE and Cochrane CENTRAL to the end of August 2018 for trials that explored the impact of opioid dosing, formulations, or supported tapering on patients with chronic noncancer pain.

Results:
We identified 24 eligible studies for our review (5 randomized and 19 observational studies). Moderate to very low-quality evidence showed that immediate vs controlled release opioids, or as needed vs. scheduled dosing does not affect pain relief, physical functioning or gastrointestinal-related side effects. Very low quality of evidence showed that opioid rotation may reduce pain (weighted mean difference [WMD] −27.1 on a 100 mm VAS for pain, 95%CI −37.1 to −17.1). Low and very-low quality evidence showed that multidisciplinary tapering support is associated with reduced pain (WMD −14.3 mm, 95% CI −20 to −8.6), increased physical functioning (WMD 10.38 points on the 100-point physical functioning subscale of the SF-36, 95%CI 2.65 to 18.1), and improved mental health (WMD 8.71 points on the 100-point SF-36 mental health subscale of the SF-36, 95%CI 7.61 to 9.8).
Our pooled analysis showed 88.0% (95%CI 83.0 to 93.0) of chronic pain patients successfully completed opioid withdrawal with multidisciplinary support.
Discussion/Conclusions: Limited evidence found no difference in outcomes for chronic pain patients when opioids were administered in different ways. Multidisciplinary support may be effective for assisting patients with chronic non-cancer pain with voluntary opioid tapering efforts. Introduction/Aim: Placebo analgesia is mediated and strengthened by learning such as conditioning. However, the neurobiological correlates of learning for pain remain elusive. Towards that goal, the central objective of the study is to delineate the neural pathways that contribute to conditioned analgesia using a mouse model of chronic neuropathic pain. Methods: Mechanical pain thresholds were measured using von Frey filaments in 6-8wk old male CD-1 mice, before and following spared nerve injury (SNI). The SNI mice then underwent a four-day conditioning phase where contextual (Plexiglas cubicles) and tactile (intraperitoneal injection) stimuli were coupled with an unconditioned drug stimulus (morphine, 10mg/kg). Following the conditioning period, the SNI mice were administered either saline or one of the opioid receptor antagonists. Following behavioral testing, neuronal activity was mapped in the spinal cord and brain by probing for c-fos expression using immunoblotting and immunohistochemistry.

ORCID
Results: After pharmacological conditioning, saline administration was analgesic comparable to that of morphine, which was reversed by naloxone. Upon immunoblotting, the observed conditioned analgesia was negatively correlated with neuronal activity in the dorsal horn of the spinal cord. Furthermore, immunohistochemical analyses revealed significant changes in neuronal activity in pain processing regions of the brain.
Discussion/Conclusions: Here, we demonstrate a novel animal model of conditioned analgesia within the context of chronic neuropathic pain. The changes in neuronal activity in the brain and spinal cord corresponds to those observed in humans, warranting further investigations in order to elucidate the underlying neural basis for conditioned analgesia.
Introduction/Aim: Sociodemographic factors in children and families, such as gender, ethnicity and socioeconomic status, are associated with a higher prevalence of chronic pain, and may affect equitable access to tertiary or resourceintensive care. Pediatric pain rehabilitation programs, which offer intensive outpatient interdisciplinary treatments based on the biopsychosocial model of pain, demonstrate cost-effectiveness and functional improvement for youth with pain and significant pain-related disability. However, few exist in North America, and their resourceintensive nature limits access to many children with chronic pain. We sought to examine sociodemographic data of youth enrolled in our intensive pain rehabilitation program (IPRP), and compare it to published sociodemographic characteristics of children with chronic pain.
Methods: A retrospective analysis of patients admitted to the IPRP over 3 years (N = 27, mean age 16.2 years) was performed.
Discussion/Conclusions: Our findings reflect literature data that pediatric chronic pain is more prevalent in females than males, but show underrepresentation of low-income households despite lower socioeconomic status being associated with a higher prevalence of chronic pain. The findings also suggest underrepresentation of minorities, despite minority status being a risk factor for functional limitation from physical symptoms. These are similar to other North American pain rehabilitation programs. Continued focus in this area may involve diversifying referral bases and broadening exposure of our IPRP to more at-risk demographics.
CONTACT Vishal Varshney vishal.varshney@ahs.ca Introduction/Aim: Chronic pain (CP) is defined as pain that persists for more than 3 months or beyond the expected healing time, CP affects 20-30% of the population worldwide. 1 Lack of community resources and primary care access can lead to frequent, costly, and avoidable emergency department (ED) visits and hospital admissions. In Ontario, utilization of the ED is highest in the North West LHIN, with the highest usage at the Thunder Bay Regional Health Sciences Centre (TBRHSC). 2 Approximately 70% of ED visits are prompted by pain. 3 Methods: Phase I included a retrospective analysis of 283 randomly selected high frequency users (HFU) of the ED, defined as having 8 or more visits to the TBRHSC ED in the 2014-2015 fiscal year.
Results: Preliminary results demonstrate that of the sample, 28% of individuals visiting the TBRHSC ED met the criteria as chronic pain high frequency users. Only 4.5% of these CP HFU were involved with other pain management services. CP HFU had a mean of 17 visits versus 12 for those without CP. Additionally, CP HFU were discharged from ED more often than non CP sufferers.
Discussion/Conclusions: Patients presenting to the TBRHSC ED often have complex concerns that are not fully addressed. A very small population of CP sufferers have access to interdisciplinary pain management. Improving community resources is a requirement to reduce the costly demand on the ED and CP sufferers. This poster presents the analysis of data derived from CP sufferers of the ED at the TBRHSC. This study's aim was to create a 3-dimensional biomechanical and morphological assessment to better quantify perioperative back pain in AIS patients.
Methods: Twenty patients with AIS scheduled for spinal fusion surgery were recruited. X-rays of the patient wearing sensory insoles standing upon a Cartesian plane were taken using EOS Imagery before and after surgery. Plantar pressure distribution was measured using Moticon insoles. Self-reported pain intensity and location were collected using a grid divided back diagram. Regression analyses to assess variables' correlations, and paired t-tests to identify timepoints differences were performed.
Discussion/Conclusions: Preliminary results suggest that surgical correction of AIS causes a normalization of the spine without affecting the plantar pressure distribution. Surgical correction alleviates pain, especially in the thoracolumbar/lumbar region possibly due to the reduction of lordosis.
CONTACT Maxime St-Georges maxime.st-georges@mail.mcgill.ca Introduction/Aim: Clinicians have access to multiple treatment options for acute musculoskeletal (MSK) pain. We assessed the comparative effectiveness and harms of available treatments for acute, non-low-back related MSK injuries. Methods: We searched MEDLINE, EMBASE, CINAHL, PEDro and CENTRAL, for trials that enrolled adult patients with acute, non-low-back related MSK pain, and randomized them to any intervention directed at pain relief or a control group (active or placebo/sham). We assessed certainty of evidence using the GRADE approach. We estimated summary odds ratios (ORs) using pairwise and network meta-analysis using random effects models.
Results: We identified 22,919 citations, of which 181 trials were eligible for review. Moderate to high quality evidence showed that, compared to placebo, transbuccal fentanyl, topical and oral NSAIDs, and acetaminophen alone or in combination with diclofenac provided significant pain relief at 30min to 120min posttreatment, ranging from 4.1cm on a 10cm VAS (95% CI: 2.6 to 5.6) for fentanyl to 0.9cm (95% CI: 0.4 to 1.5) for acetaminophen. Oral and topical NSAIDs were associated with significant improvement in physical function, patient satisfaction, and symptom relief (moderate to high quality evidence). Moderate to high quality evidence showed that opioids alone or in com-bination with acetaminophen were associated with gastro-intestinal and neurologic related adverse events, while oral NSAIDs were associated with gastrointestinal related adverse events.
Discussion/Conclusions: We found moderate to high quality evidence that oral and topical NSAIDs are among the most effective treatments for patients with acute, non-low-back related MSK pain, and that topical NSAIDs are the safest option. Introduction/Aim: Lowering opioid dosages in people with chronic non-cancer pain can be challenging and potentially hazardous. Recent Canadian guidelines suggest multidisciplinary care (MDC) can help with opioid tapering. However, MDC for this purpose is not well characterized. We therefore conducted a systematic realist review to understand what constitutes MDC for opioid tapering and by what mechanisms these programs operate.
Methods: We searched 5 academic databases (Ovid MEDLINE, PsycINFO, AMED, CINAHL Plus, and Cochrane Library) to identify studies that evaluated MDC and reported on changes in opioid doses. We also searched the grey literature, conducted iterative hand searches and consulted experts to identify the broadest possible literature. We identified 12,872 records and 96 studies were included in the final review.
Results: The studies spanned five decades and included 97 evaluations on 77 distinct programs from 12 different countries. Sustained dose reduction (≥ 12 months post intervention) is achieved in programs with the following key mechanisms: required opioid tapering as part of the program; included pain relief and behaviour change approaches; were at least 3 weeks in duration; and had group therapy and family involvement.
Discussion/Conclusions: The outcome of sustained opioid dose reduction in multidisciplinary care is facilitated by a small number of distinct mechanisms that are usually operationalized by specific members of an MDC team. Reconceptualizing medication taking and prescribing as behaviours are important drivers of change. Further research should focus on why these mechanisms typically operate in specialized care but not in primary care.
Introduction/Aim: Pain is often prevalent, severe, and chronic among youth with sickle cell disease (SCD). Proper assessment of SCD pain is essential to the provision of adequate pain management. Previous research examining pain rating concordance among youth with SCD and their caregivers, however, has been limited by small sample sizes, and has rarely examined the influence of child age on concordance. Therefore, we examined concordance between pain reports made by youth with SCD and their caregivers, while exploring agerelated differences in the degree of correspondence across three developmental stages: school-aged children (5-7 years), preadolescents (8-12 years), and adolescents (13-18 years).
Methods: Participants, 386 youth with SCD and their parents, completed the Pediatric Quality of Life Inventory Sickle Cell Disease Module (PedsQL-SCD).
Results: Utilizing intraclass correlation coefficients (ICCs), moderate agreement was found on the Pain and Hurt (PH) scale for preadolescents and adolescents and their caregivers (ICCs = 0.6; 0.47, respectively), and on the Pain Impact (PI) scale among preadolescents and their caregivers (ICC = 0.56). Poor to fair agreement was found on all other combinations of scales and age groups. On the PH and PI scales, analysis of covariances showed that smaller correlations between youth and parent ratings tended to be observed among younger in comparison to older children (ps ranging from < .05 to <.001).
Discussion/Conclusions: Concordance of pain rating scales among youth with SCD and caregivers was moderate at best, highlighting the importance of continued research on pain assessment strategies, particularly among younger children.
Introduction/Aim: Music has been used to treat pain for thousands of years, and its effect has been characterized in behavioural studies and with functional magnetic resonance imaging (fMRI). The aim of this study was to investigate the neural basis of music analgesia.
Methods: FMRI was carried out at 3 tesla and data spanned the brain and brainstem in order to investigate the effects of music on a network of pain-related areas. Twenty healthy participants (23 ± 3 years of age) each underwent a 1-hour training session in a sham MRI lab followed by a 1.5-hour session of repeated fMRI acquisitions while a noxious heat stimulation paradigm was applied to the hand. During 6 fMRI runs participants listened to music, and in 6 runs there was no music.
Results: Behavioural results show that the music induced a significant decrease in pain unpleasantness scores (p < 0.006, paired t-test), but not pain intensity.
Structural equation modeling (SEM) demonstrated networks of brain/brainstem regions with significant connectivity and revealed differences between runs with and without music. The results indicate that music influences pain perception via multiple brain regions which project to the thalamus which in turn provides input to the periaqueductal gray matter.
Discussion/Conclusions: This work will help to provide a new view of how human pain is regulated in healthy people. Moreover, it will provide a critical baseline of research for future studies into how pain processing is altered in chronic pain conditions.
CONTACT Jocelyn Powers jocelyn.powers@queensu.ca Introduction/Aim: In the adult patient population, acute pain trajectories are associated with long-term outcomes such as pain and functional disability. However, there is limited data that examines acute postoperative pain trajectories in the pediatric population. The aim of this study was to identify pain trajectories in the acute postoperative period, predictors of pain trajectory membership and associations between pain trajectories and long-term outcomes. Methods: Patients with adolescent idiopathic scoliosis (AIS) and scheduled to undergo spinal fusion were assessed before surgery for their medication use, pain, physical functioning, mental health, pain catastrophizing, anxiety and pain anticipation after surgery. Average 6-hour self-reported pain intensity scores were recorded in the medical charts and extracted for the entire hospital stay (5 days). At 6 weeks and 6 months after surgery, baseline variables were reassessed. Growth mixture modeling was used to conduct acute postoperative pain trajectory analysis.
Results: One hundred and one patients were included in the best fitted acute pain trajectory model (AIC = 6627.9, BIC = 6732.5) including 4 classes. Pain trajectory membership was significantly predicted by preoperative pain medication use, physical functioning, back pain and pain elsewhere in the body, mental health, helplessness and trait anxiety. Acute postoperative pain trajectories were associated with physical functioning (p = 0.0113) and pain (p = 0.00039) 6 months after surgery.
Discussion/Conclusions: Preoperative assessment of surgical AIS patients and analyzing their progression of pain in the acute postoperative period is clinically significant to predict the long-term outcomes and develop personalized pain management. Introduction/Aim: Interprofessional collaboration (IPC) occurs when learners/practitioners, patients/clients/families and communities develop and maintain interprofessional working relationships that enable optimal health outcomes. The St. Joseph's Care Group Chronic Pain Management program (CPMP) uses an IPC approach to help clients achieve their pain management and functional goals. The objective of this evaluation was to determine the effectiveness of an IPC approach to improving impairment associated with chronic pain.
Methods: Of the 155 clients attending the CPMP after November 2015 who completed an assessment, 96 clients (Mean age = 49.0, SD = 13.1; 64.6% female) completed measures related to their pain catastrophizing, pain interference, and kinesiophobia before and after attending the CPMP. Eighty-three clients (Mean age = 49.0, SD = 13.1; 67.5% female) also completed a measure of psychological functioning and 80 clients (Mean age = 50.9, SD = 14.1; 68.8% female) completed a fitness assessment before and after engaging in the program.
Discussion/Conclusions: The current findings support the effectiveness of a 6 week IPC CPMP for improving impairment associated with chronic pain.
CONTACT Andrew Koscielniak kosciela@tbh.net Introduction/Aim: A common symptom of endometriosis is chronic pelvic pain (CPP; ≥6 months; not including painful periods, sexual pain, or painful bowel movements). The objective of this study was to determine if CPP and painful bladder syndrome (PBS) were associated with central sensitization.
Methods: A cross-sectional study examining 256 women with endometriosis between the age of 18-50 years from a prospective patient registry (ClinicalTrials.gov#NCT02911090). Exclusion criteria: missing outcome variables and menopausal. Primary outcome: Central Sensitization Inventory scores (CSI; 0-100). Main variables of interest: 1) CPP (high [≥5], low [<5]), and 2) PBS (yes, no) using diagnostic criteria. Bivariate analyses identified variables significantly associated with the primary outcome. The cohort was divided into groups: 1) low CPP with or without PBS, 2) high CPP and no PBS, and 3) high CPP and PBS. ANOVA and post hoc testing identified differences between groups.
Results: The mean CSI score was 41.9 ± 18.5; 49.2% of the sample had PBS; 71.9% had a high severity of CPP. Mean CSI score was significantly associated with PBS (T = −7.40, p < .001) and severity of CPP (T = −6.14, p < .001). Group 3 had a significantly higher mean CSI score compared to the other two groups (p < .05).
Discussion/Conclusions: The group with high severity of CPP and PBS had the greatest CSI score, suggesting a potential role for central sensitization in this subgroup. Introduction/Aim: Chronic pain is a growing epidemic with substantial impact on the individual, family and society. The Intensive Pain Rehabilitation Program (IPRP) at the Alberta Children's Hospital (ACH) was developed to target youth with chronic pain and consequent functional disability who are not progressing in conventional outpatient pain therapies. IPRP involves participation in 3-to 6-weeks of day treatment rehabilitation, provided by a multidisciplinary team. While there is growing evidence that IPRP is effective in improving functioning for youth with chronic pain, little is known about its effectiveness for improving functioning in parents of youth in these programs. Therefore, the present study assessed parent outcomes following IPRP at ACH.

Improvement in
Methods: Twenty-four parents and their child participated in the IPRP. Measures assessing family functioning, pain catastrophizing, parent responses to child pain, pain acceptance and parent anxiety and depressive symptoms were administered to parents at baseline (before IPRP), discharge (end of IPRP) and 3-months post-IPRP. Repeated measures ANOVAs with Bonferonni correction were used to examine changes in parent outcomes between time points.
Discussion/Conclusions: Following IPRP, parents reported fewer behaviors that have been previously shown to contribute to the development and maintenance of chronic pain in youth. However, both parents and youth may benefit from more parent-directed interventions in IPRP.
CONTACT Laura Rayner laura.rayner@ahs.ca Introduction/Aim: The Intensive Pain Rehabilitation Program (IPRP) provides multidisciplinary 3-to-6-week day-treatment rehabilitation for youth with chronic pain who are not progressing in traditional pain therapies. This program focuses on self-management skills, but also addresses the role of the parent in pain management. Parental protective behaviours, as assessed by the Adult Responses to Children's Symptoms (ARCS) measure, have been shown to improve following cognitivebehavioral therapy (CBT) and influence child functioning. However, change in protective behaviours has not been well examined in relation to child pain acceptance or fear of pain, two factors that influence disability-related outcomes. The present study examined how changes in parent protective behaviours influence changes in child pain acceptance and fear of pain over the course of IPRP.
Methods: Twenty-four adolescents completed measures of chronic pain acceptance and fear of pain, and their parents completed a measure of their protective responses to their child's pain symptoms at baseline (pre-IPRP), discharge (post-IPRP) and follow-up (3-months post-IPRP).
Generalized estimating equations were used to examine change over time in parent behaviours and child outcomes.
Results: Greater acceptance of chronic pain (β = −0.505, p < 0.001) and lower fear of pain (β = 0.357, p = 0.017) in youth over the course of and following IPRP were associated with fewer parent protective behaviours, after accounting for child age, gender, and weeks in IPRP.
Discussion/Conclusions: Decreases in parental protectiveness was associated with greater child pain acceptance and less fear of pain over the course of IPRP, providing further evidence for the importance of targeting these operant parent behaviours in treatment. Introduction/Aim: It is currently unknown as to whether opioid consumption throughout the acute postoperative period is associated with long-term outcomes in paediatric patients. The aims of this study were to characterize opioid consumption trajectories in the acute postoperative period, identify predictors of trajectory membership and determine associations between acute opioid consumption and long-term patient outcomes. Methods: Medication use, pain and functional activity were assessed at baseline in adolescents with idiopathic scoliosis scheduled for spinal fusion surgery. Cumulative 6-hour opioid consumption was recorded for up to 5 days after surgery. At 6 months after surgery, medication use, pain and functional activity were re-evaluated. Growth mixture modelling was used to identify opioid trajectories.
Results: A total of 106 patients were included in the study. Mean cumulative opioid consumption 120 hours after surgery was 13.23 ± 5.20 mg/kg. The model with the best fit contained 5 acute postoperative opioid trajectories and a quadratic term (AIC = 6703.26, BIC = 6767.19). Two types of patient behaviours were identified: high opioid consumers (trajectories 4 and 5) and low opioid consumers (trajectories 1, 2 and 3). Intraoperative epimorphine dose was a predictor of trajectory membership (p = 0.0498). Opioid consumption during the acute postoperative period was not significantly associated with pain, functional activity or pain medication use 6 months after surgery.
Discussion/Conclusions: In paediatric patients, intraoperative epimorphine dose predicts opioid consumption in the acute postoperative period. Importantly, opioid consumption after surgery is not associated with long-term pain, functional activity or opioid and non-opioid pain medication use.
Impact of E-Learning Modules on Self-Efficacy regarding Chronic Regional Pain Syndrome (CRPS) in Family Physicians

Vicky Fournier and Anne Marie Pinard
Anesthesiology and Intensive Care Unit Department, Laval University, Québec, Canada Introduction/Aim: CRPS is a rare and largely unknown disease to family physician. Nevertheless, diagnosis is the key to patient recovery Continuing professional development (CPD) is a requirement for physicians and e-learning constitute an excellent option to promote asynchronous learning Aim of this study is to demonstrate self-efficacy improvement regarding CRPS in family physician by completing short e-learning modules, Modules' acceptability will also be evaluated.
Methods: 30 family physicians answered surveys about self-efficacy regarding CRPS before (T 0 ), immediately after (T 1 ) and 3 months after (T 2 ) completion of modules and about modules' acceptability at T 1 . Surveys were inspired from the CPD-reaction tool and LORI (Learning Object Review Instrument) A 5-points Likert scale was used to answer each statement. Data was dichotomously analyzed: the first 3 points were associated with a negative selfefficacy feeling; the 4th and 5th points with a positive feeling. The same structure was applied for modules' acceptability.
Results: Initially, self-efficacy was low. As the physician complete the module, it tends to improve. Modules were well received and therefore acceptable. Our analysis is currently in progress. T 2 questionnaires will be completed and analysed upon presentation.
Discussion/Conclusions: The modules were generally appreciated.
Short e-learning modules on rare but serious chronic pain conditions such as CRPS might be a simple and effective method to improve self-efficacy and in turn, patient care.

Disclosure statement
No potential conflict of interest was reported by the authors. Introduction/Aim: Pain changes the way people move. In chronic low back pain (CLBP), these changes are maintained in the long-term and contribute to ongoing pain and disability. Psychosocial factors have been identified as predictors of future disability and poor treatment outcomes in CLBP, but how such factors relate to movement is unclear. The purpose of this scoping review is to examine the relationship of pain catastrophizing and pain-related fear with trunk biomechanics, among adults with CLBP performing functional tasks.
Methods: Scoping review methodology was conducted based on the Arksey and O'Malley (2005) framework. Literature searches were performed in MEDLINE, PubMed, EMBASE, PsycINFO and CINAHL. Keywords and MeSH terms were included to capture relevant articles relating to pain-related fear, pain catastrophizing, and trunk biomechanics, in individuals with CLBP .
Results: Twenty-three studies met selection criteria, with a total of 26 biomechanical outcomes. 12 studies reported an association between pain catastrophizing and/or pain-related fear with trunk biomechanics during: the flexion-relaxation phenomenon (n = 4), gait cycle (n = 3), in response to perturbations (n = 3), and spinal mobility (n = 2). The remaining studies were classified as either inconclusive (n = 5/26) or demonstrating no association (n = 9/26).
Discussion/Conclusions: These findings might suggest an association between pain-related fear and/or pain catastrophizing with: (i) greater trunk activity, (ii) reduced spinal mobility and (iii) reduced trunk reflexes, which may indicate a form of protective guarding or bracing. Due to lack of study appraisal, our inferences should be interpreted with caution. A systematic review on this subject would be of great value to the field.
Introduction/Aim: Trajectory modelling approaches have been developed to determine subgroups within a given population and are increasingly used to better understand pain outcomes. With the purpose of enabling pain researchers to choose the technique that best suits their research questions, the objective of this narrative review was to explore various trajectory modelling approaches used in health research and discuss about their applications.
Methods: To establish and identify relevant peerreviewed literature, PubMed, Psych-Info and Google Scholar were used with no date of restriction. Approaches were compared in terms of definitions, rationale of use, assumptions, concrete clinical applications, and availability of statistical software programs.
LCM are based on a probabilistic modelling approach with a finite mixture distribution that describes an observed life course sequence of categorical values as resulting from the conditional probabilities that define membership of a latent class. LCM provides the contribution of every observed variable on the definition of classes.
CA is a tool to explore groups within a data set. When variables under study are continuous, CA is sometimes called latent profile analysis. When the variables are categorical, CA is sometimes called LCA.
SA is a fully nonparametric approach based on algorithmic, approaches aimed at making use of measures of distance between individual trajectories.
Discussion/Conclusions: Depending on the research question and the available data particularities, one or another of these approaches can be used for trajectory modelling.
Introduction/Aim: Juvenile Idiopathic Arthritis (JIA) affects approximately 24,000 children throughout Canada, many of whom report pain as the predominant symptom. Caregivers play an important role in managing JIA-related pain; not only are they the primary support, many are also tasked with administering potentially painful treatments at home. This study explored caregivers' confidence and information needs in managing their child's pain.
Methods: Recruitment took place worldwide by engaging partner organizations and sharing across online and social media platforms. 216 caregivers of children with JIA aged 0-17 participated in an online survey, completing questions about their child's arthritis and pain, and their own information needs. Participants were predominantly mothers (96%) residing in North America (77%).
Results: Caregivers reported lacking confidence in alleviating their child's arthritis-related pain (M = 4.11, SD = 2.60, range = 0-10). Although all participants reported wanting some information, regressions demonstrate that lower caregiver confidence related to a need for more information [t = −2.91, β = −0.34 (−0.57, −0.12)]. The most frequently identified needs included managing emotions related to painful experiences (60%) and differentiating arthritis pain from normal pain (56%). Caregivers strongly valued developing partnerships between researchers and parent organizations wherein evidence-based information related to arthritis pain could be shared (M = 4.25, SD = 1.05, range = 1-5).
Discussion/Conclusions: As caregivers of children with JIA are tasked with helping to manage their child's pain, it is important that they have the necessary tools to do so. This research demonstrates that although parents' lack confidence in pain management, they are keen to learn more. Implications will be discussed for knowledge translation within this community.
Intensive Care Pupillometry as A Predictor of Opioid Consumption following Intubation: A Preliminary Study in Moderate-To-Severe Traumatic Brain Injury Chloé Martineau, Sabrina Bouferguene, Léa Proulx-Bégin, Francis Bernard, and Caroline Arbour Introduction/Aim: Opioid use following intubation is associated to poorer outcomes after moderate-to-severe traumatic brain injury (TBI), but is difficult to predict. Emerging evidence in anesthesiology suggest the pupillary dilation reflex (PDR) can provide some insights about opioids consumption post-intubation. Yet, the utility of this metric in critically ill TBI patients is unknown. We investigated the preliminary utility of PDR during the first three days of ICU-admission to predict opioid consumption following intubation in the context of TBI.
Methods: Pupil measurements were performed once a day at fixed times and on both eyes during the first three days of ICU-admission using video-pupillometry. PDR was elicited by pressure algometry applied to the fingernails. Cumulative doses of opioids received within 72h post-intubation were collected.
Results: Twenty adults (15 male, 18-64 yr) with moderate or severe TBI participated. Overall, n = 9 (45%) TBI patients showed low pupillary reactivity (PDR <5%) and n = 11 (55%) TBI patients showed high reactivity (PDR ≥5%) during fingernail pressure. Subgroups were found similar in terms of TBI presentation and pharmacological management in the first three days of ICU-admission. Cumulative doses of Hydromorphone administered to TBI patients with low versus high pupillary reactivity within 72h postintubation were as follow: 4 ± 3mg vs. 15 ± 8mg (t = 3.20; p = 0.03). Correcting for age and gender, pupil variation in critically ill TBI was found a significant predictor of opioid consumption postintubation (adjusted R square = 87.5).
Discussion/Conclusions: Our results show for the first time that ICU pupillometry can provide accurate insights on TBI patients opioid requirements following intubation.
CONTACT Chloé Martineau chloe.martineau-lessard@umontreal.ca Introduction/Aim: Peripheral neuropathy is a common cause of chronic pain among patients with diabetes, and acupuncture has been suggested as a therapeutic option.
To determine the effectiveness of acupuncture for chronic diabetic peripheral neuropathy (DPN). Methods: We searched MEDLINE, EMBASE, CENTRAL, AMED, CINAHL, PsychINFO, trial registries, and reference lists of relevant articles up to February 2017. Pairs of reviewers, independently and in duplicate, screened articles for inclusion, assessed risk of bias and extracted data. We conducted meta-analyses when possible and used the GRADE approach to assess the quality of evidence.
Results: Among 4443 potentially eligible studies 4 with 244 patients proved eligible to be included for review. 1 Overall all four studies were at high risk of bias. Compared to sham acupuncture, we found very low quality evidence that acupuncture reduces pain (weighted mean difference [WMD] −1.95cm on a 10cm visual analogue scale, 95% CI −3.27 to −0.64; minimally important difference [MID] 1cm; risk difference (RD) for achieving the MID 52%; 95% CI 19% to 63%) and improves physical 1 In the present study we just report the results of 4 eligible studies published in English. In the updated study, we have also included 52 articles published in Chinese with the assistance of our Chines colleagues. We will report the results of our new analyses in the near future. functioning (WMD 3.68 points on the short form-36 [SF-36] physical component summary score; 95% CI 1.66 to 5.70; MID is 5-points; RD for achieving the MID 8%, 95% CI 3% to 18%), but does not affect emotional functioning (WMD 1.26 points on the SF-36 mental component summary score, 95% CI: −1.13 to 3.66).
Conclusions: Very low-quality evidence suggests that acupuncture reduces pain and improves physical functioning in patients with chronic DPN but does not affect emotional functioning. Introduction/Aim: Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy are prototypic autoimmune peripheral neuropathy (APN) which represent a serious neurological emergency. Although current treatment options have proven effective, many patients still present with a severe disease course, pain and residual deficits. We have reported that B7.2 transgenic L31 mice spontaneously develop inflammatory peripheral neuropathy. We also showed that an injury to peripheral nerve in L31 mice facilitates the development of APN. Both effector/memory CD8 T cells and B7.2+ macrophages are required for disease initiation. Here, we highlighted the importance of CX3CR1 expression in disease pathogenesis and in the development of pain like behavior in L31 mice.
Methods: L31 mice were crossed with CX3CR1KO mice, and the effect on macrophage phagocytic ability, activated CD8 T cells function and pathology were assessed.
Results: CX3CR1 expression was strongly upregulated in sciatic nerve of symptomatic L31 mice which correlated with increased phagocytic ability. Enhanced phagocytosis in L31 mice was impeded in L31/ CX3CR1 −/mice. Also, injury failed to trigger APN in L31 mice deficient of CX3CR1 expression. APN associated sensory deficits positively correlated with the amount of CX3CR1 expression. In addition, CX3CR1 deficiency led to a high number of dying monocytes, macrophages and activated CD8 T cells suggesting that CX3CR1 signaling may be crucial for their survival. Lastly, sciatic nerve histology showed no myelin and axon damage in L31/CX3CR1 −/mice.
Discussion/Conclusions: These data suggest that CX3CR1 expression are critical for the development of APN in L31 mice. CX3CR1 expressing macrophages contribute to disease pathogenesis via enhanced antigen phagocytosis and presentation.
Introduction/Aim: Spontaneous variations in activity of brainstem (BS) and spinal cord (SC) regions may arise from a number of functions such as autonomic regulation, sensory, and motor functions. Recent evidence suggests that changes in a person's cognitive/ emotional state are linked to changes in identified BS and SC resting-state networks, indicating that these networks likely play a role in the integration of homeostatic autonomic functions. The aim of this study was to investigate how these networks change when participants are specifically expecting pain.
Methods: Previously, data were obtained from the cervical SC and brainstem in 17 healthy participants during a stimulation paradigm that involved a predictable noxious heat stimulus. Blood oxygenation-level dependent (BOLD) fMRI data were obtained at 3 Tesla, with T2-weighted single-shot fast spin-echo imaging. For the current study we investigated functional connectivity in the entire 3D region with structural equation modelling (SEM) during the first two minutes of each run (baseline period, and after participants were told whether to expect a painful stimulus). This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Several interprofessional education programs have been developed to enhance primary care providers' (PCPs) competency in pain management. This project aims to develop a valid and reliable competency-based assessment tool, suitable for all professions, to evaluate the impact of these programs.

Development and Validation of a Pain
To develop a new pain competence assessment tool (PCAT), six clinical vignettes were created. Each vignette is followed by questions addressing one or more competencies derived from the core pain competencies developed by Fishman et al. in 2013. Experts in pain management representing different professions were asked to review and rate the appropriateness of the PCAT questions to confirm face validity through a modified Delphi study. The selected PCAT questions were mapped against the core competencies to ensure content validity. A pilot sample of PCPs was then asked to answer the PCAT through a cognitive interview study to assess feasibility. Currently, the PCAT was sent to a large sample of PCPs to assess its reliability through a cross-sectional study. The PCAT was also sent to healthcare prelicensure students to test for construct validity.
Based on the Delphi results, nineteen questions were rated as appropriate confirming its face and content validity. The PCAT also showed adequate feasibility based on the cognitive interview study. Psychometric testing is still in process.
Future implementation of a valid and reliable tool is necessary to reduce measurement error and produce results with high degree of credibility.
Introduction/Aim: Several interprofessional education programs have been developed to enhance primary care providers' (PCPs) competency in pain management. This project aims to develop a valid and reliable competency-based assessment tool, suitable for all professions, to evaluate the impact of these programs.
Methods: To develop a new pain competence assessment tool (PCAT), six clinical vignettes were created. Each vignette is followed by questions addressing one or more competencies derived from the core pain competencies developed by Fishman et al. in 2013. Experts in pain management representing different professions were asked to review and rate the appropriateness of the PCAT questions to confirm face validity through a modified Delphi study. The selected PCAT questions were mapped against the core competencies to ensure content validity. A pilot sample of PCPs was then asked to answer the PCAT through a cognitive interview study to assess feasibility. Currently, the PCAT was sent to a large sample of PCPs to assess its reliability through a cross-sectional study. The PCAT was also sent to healthcare prelicensure students to test for construct validity.
Results: Based on the Delphi results, nineteen questions were rated as appropriate confirming its face and content validity. The PCAT also showed adequate feasibility based on the cognitive interview study. Psychometric testing is still in process.
Discussion/Conclusions: Future implementation of a valid and reliable tool is necessary to reduce measurement error and produce results with high degree of credibility.
CONTACT Samah Hassan samah.hassam@uhn.ca Introduction/Aim: Pediatric chronic pain has a high economic burden. It is unknown what role parent factors have on healthcare utilization for pediatric chronic pain.
Our aim was to identify child and parent factors that predict greater healthcare visits for pediatric chronic pain. Methods: 111 8-to 17-year-olds (M = 13.28; SD = 2.73; 67% female) and caregivers (89% female) attending an outpatient multidisciplinary pediatric chronic pain program. Children self-reported pain catastrophizing (PCS-C), and mobility, anxiety, depression, fatigue, and pain interference (PROMIS). Parents self-reported parenting responses to their child's pain (ARCS), pain catastrophizing (PCS-P), and their own chronic pain, physical function, anxiety, depression, fatigue, sleep, ability to participate in social roles, and pain interference (PROMIS). Healthcare utilization was parent-reported child visits to general practitioners, specialists, non-physician providers, emergency, and/or inpatient stays over the past 3 months due to pain. A linear regression assessed child (Step 1) and parent factors (Step 2) as predictors of healthcare utilization.
Discussion/Conclusions: Greater healthcare utilization for pediatric chronic pain was primarily driven by child symptoms, with additional relations to parenting responses.
Outcomes measured across studies included parental knowledge, self-efficacy, parental involvement in procedural pain management, stress, anxiety, postnatal depression, role attainment, pain assessment documentation, and measure of social support. Discussion/Conclusions: Despite an area of high concern for parents of newborns, few studies addressed parent tar-geted educational interventions regarding infant pain. Of those that did, the educational interventions appear to improve parental knowledge, self-efficacy, and increased involvement in pain management activities. Future research examining the impact and efficacy of these educational interventions on parental and neonatal outcomes is warranted.
CONTACT Brianna Richardson brianna.richardson@dal.ca Introduction/Aim: The objectives of this systematic review and meta-analysis were to examine the relative frequency and risk factors (patient, surgical, medical, clinical) for prolonged opioid therapy among surgical and trauma patients. Methods: Studies published in English and French between 1998 and April 2018 examining risk factors for prolonged (3-6 months) or chronic (>6 months) opioid use after surgery/trauma were included. Literature search: seven databases were queried, empirical studies were identified via direct and back citation search, grey literature was also included. A minimum of two independent reviewers assessed studies for inclusion, extracted data and assessed studies quality.
Results: Thirty-five out of 10,003 screened articles were included. The median relative frequency of prolonged (50.9%) and chronic (58.5%) opioid therapy among pre-event patients already on opioid therapy was much higher compared to pre-event opioid naïve patients (4.1% and 2.6%, respectively). Tobacco use, depressive disorder and antidepressants use were significant risk factors for prolonged and/or chronic opioid therapy among pre-event opioid naïve patients. Tobacco use, depressive disorder and history of migraines were risk factors for prolonged opioid therapy among pre-event opioid-treated patients.
Discussion/Conclusions: Prevention initiatives to reduce the risk of prolonged opioid therapy after surgery or trauma should target specific health behaviors and psychiatric disorders; these interventions should be tailored based on patients' pre-event opioid status. Introduction/Aim: Pain-related mind-wandering (PRMW) may facilitate pain and disability in people with chronic pain. This study explored mindfulness skills that predict lower PRMW during mindfulness meditation (MM) Methods: 133 participants (Age M = 20.5 years, SD = 3.74; Male = 45) were classified into groups: 1-Chronic pain (CP; n = 35) based on self-reported CP diagnoses, 2-Depressive-anxious (DA; n = 67) based on severe symptoms on the Center for Epidemiological Studies-Depression subscale (≥21) or Beck Anxiety Inventory (≥36), or 3-Controls (n = 31) if neither CP nor DA criteria applied. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) assessing mindfulness skills: observing experiences, describing internal experiences (Describe), acting with awareness, non-judgement and non-reactivity. Participants practiced breath-focused MM on a smartphone (~12-minutes) and pressed "breath" or "other" buttons at the sound of tones if awareness was on breathing or another experience, respectively. The Mind-Wandering Inventory was completed post-MM using 3 items: awareness of bodily pain, thoughts about pain, and other unpleasant sensations. Pearson correlations were conducted between FFMQ and PRMW.
Discussion/Conclusions: The mindfulness skill of describing inner experiences may be a vital component of mindfulness-based pain treatments.
Introduction/Aim: Descending pain inhibitory system (DPIS) activation can moderate ascending pain signals and thus performs a critical role in regulating pain. Evidence from animal studies suggests that stress can lead to pain regulation dysfunction as indicated by DPIS changes. We investigated whether results observed in animal models generalize to humans using placebo analgesia (PA) as a means of assessing DPIS function.

Methods:
We measured stressful life events (Stress Life Event Scale, Student Stress Scale) and perceived life stress (Perceived Stress Scale) for 50 healthy participants using an online questionnaire. Subsequently, during a lab session, a hand cream was applied to participants' middle three fingers, who then experienced pressure induced pain stimuli before and after receiving a message regarding the cream. Participants who were randomized to the placebo condition (n = 23) were told that the cream contained a painkiller, promoting the expectation of reduced pain sensitivity; the control group (n = 27) was informed that the cream was a moisturizer.
Results: For pain tolerance, but not for pain threshold, stressful life experiences predicted 30% of the variance in PA effects, with greater exposure to stressful life events associated with diminished PA. Perceived stress, however, was not predictive of PA effects, suggesting a disconnect between stressor exposure and the subjective perception surrounding one's ability to cope with challenges.
Discussion/Conclusions: Exposure to stressful life events can account for a considerable proportion of inter-individual differences in subsequent PA effects, suggesting DPIS dysfunction. Given the critical role played by the DPIS in regulating pain, these findings have important clinical implications. Introduction/Aim: To study real-world benefits and risks of pain medications in large populations, administrative health and prescription drug databases are important data sources. However, claims data are not designed for research purposes and many benefits arise from the linkage of such data with patientreported clinical information. This narrative review aimed to document prospective studies reporting the acceptability of health insurance number (HIN) sharing to allow the linkage between self-reported and administrative data.
Methods: A search for peer-reviewed articles/government reports was performed in PubMed (which provides free access to MEDLINE) and Google. Were extracted the proportion of participants willing to share their HIN, and when reported, reasons/determinants of this choice.
Introduction/Aim: The quality of life of children with sickle cell disease (SCD) depends on the severity and number of vaso-occlusive crises (VOC). The objective of this study was to explore the experiences of pediatric patients and their families during VOC.
Methods: This qualitative study used semi-structured interviews, designed in partnership with two patients and one parent. Two groups of participants were interviewed independently: adolescent patients and parents of pediatric patients hospitalised within the last 2 years for VOC. Data was transcribed in full and analysed using NVivo12. Descriptive thematic content analysis was performed by coding themes emerging from participants' discourses and systematically compared. compared to patients who received ACB (2/10), and FNB (1.5/10) alone (p = 0.25). There was no difference between the groups regarding time to first opioid dose, pain or ambulation distance to POD 2.
Discussion/Conclusions: iPACK block was associated with decreased pain on POD 0 when combined with FNB and ACB, however this was not clinically significant. The lack of significant findings regarding other outcomes may be related to the reliance on chart data. A prospective study may report different findings. Introduction/Aim: The Functional Disability Inventory (FDI) and the Patient Reported Outcomes Measurement Information System (PROMIS) Pediatric Pain Interference Scale (PPIS) are commonly used measures of disability but the former is general whereas the latter is pain-specific. We compared the FDI and PPIS in children after major surgery and identified differential predictors for each scale.
Discussion/Conclusions: While the FDI and PPIS are highly correlated for children after major surgery, they represent different constructs and the one-year outcomes for each measure are predicted by different risk factors.
Introduction/Aim: Endometriosis is a gynecological condition that affects 10% of reproductive-age women. At least half of this population experience deep dyspareuniapain with deep penetration during sexual activity. The neglect of dyspareunia by endometriosis patients and providers is well documented and has been attributed to taboos about sexual intercourse or normalization of sexual pain.
Methods: Semi-structured interviews about the nature of sexual pain with participants in a clinical data registry who consented to be contacted for future research, had suspected or diagnosed endometriosis, were at least 18 years old, and had current or previous sexual pain alone or with a partner. Thematic analysis of the interview transcripts was conducted.
Results: Six participants were interviewed. In addition to predetermined themes about the nature of dyspareunia, four emergent themes were related to the neglect of endometriosis-associated sexual pain in the patient-provider relationship. These were normalization, self-management, acceptance, and limited definition.
Discussion/Conclusions: As suggested in previous research, participants considered pain a normal part of sexual intercourse. Participants also described selfmanagement techniques (changing positions, nonpenetrative sexual activities) that reduce the impact of dyspareunia. Furthermore, participants accepted sexual pain because of its brief duration. Finally, conventional definitions of endometriosis-associated dyspareunia Neuropathic pain caused by injury or disease of the somatosensory system occurs less frequently in children. Young children show better sensory recovery and are less likely to develop long-term chronic neuropathic pain than adults following nerve injury. These differences also appear to strongly correlate with developmental stage. To investigate the influence of development on neuropathic pain, we applied a nerve injury model to naked mole-rat subordinate adults, the majority of which do not experience puberty. Using adult mice for comparison, we measured responses to three stimuli: mild and strong mechanical and mild cold. We found similar mechanical responses, but there was a lack of response to mild cold in the naked mole-rat. We followed with assays using stimuli that target nociceptive pathway receptors implicated in cold perception: mustard oil, icilin, menthol, and a cold sensitivity dry ice assay. Our results show species differences in stimuli responses, likely reflecting the unusual evolutionary pressures experienced by the naked mole-rat.
Introduction/Aim: The nociceptive system of the African naked mole-rat contains unique adaptations that make the species insensitive to skin pain from some chemical stimuli. Sensitivity to thermal and mechanical stimuli are hallmark symptoms of adult chronic pain following nerve injury, yet young children are less likely to develop chronic neuropathic pain. The majority of adult naked mole-rats never undergo puberty due to the eusocial nature of each colony and are socially subordinate to a single queen naked mole-rat and 1 to 3 breeding males. Thus, to distinguish differences in evoked stimuli sensitivity development typically observed in an adult (post-pubertal) rodent neuropathic pain model, we compared nociceptive behavior of adult subordinate (pre-pubertal) naked mole-rats and mice.
Methods: We developed the Decosterd and Woolf spared nerve injury (SNI) model of neuropathic pain for the naked mole-rat and applied SNI and sham surgery to male and female subordinate naked mole-rats, and also applied SNI and sham surgery to CD1 adult mice. We then measured behavior across 4 weeks using a mild mechanical assay (Chaplan up and down method, von Frey), a strong mechanical assay (Tal and Bennett 1994, pin prick test), and a mild cold assay (Yoon et al. 1994, acetone droplet test) to the hind paw ipsilateral to surgery.
Results: Sensitivity to a mild mechanical stimulus and a strong mechanical stimulus were comparable between naked mole-rats and mice, despite the higher baseline threshold in naked mole-rats (a difference also observed between rats and mice). However, naked mole-rats showed no sensitivity to mild cold application before or after nerve injury whereas mice showed a marked increase in sensitivity to mild cold stimulus after nerve injury.
Discussion/Conclusions: All naked mole-rat subordinate (pre-pubertal) adults develop mechanical but not mild cold sensitivity after nerve injury. The mechanical sensitivity after nerve injury may be due to a developed adult peripheral nervous system separate from a lack of pubertal maturity. This study provides a unique glimpse into separating adult status from pubertal status with respect to evoked stimulus sensitivity after nerve injury. The lack of sensitivity development to mild cold stimulus observed in naked mole-rats may be due to a modification or expression difference in receptors of nociceptive fibers, considering other rare sensory adaptations observed in this species. We

Helene Bertrand
Department of family practice, University of British Columbia, Vancouver, British Columbia, Canada Introduction/Aim: topical mannitol was shown to down regulate the capsaicin pain receptor. How effective would it be for pain control in clinical practice?
Methods: a chart review of 235 patients who received a 30% mannitol, cream for pain. Each patient used the cream on whatever part of their body was painful. Their The Impact of a Pain Educational Intervention on Nursing Students' Knowledge, Attitudes, and Self-Efficacy regarding Pain Management Eid Aldossary, Monakshi Sawhney, Joan Tranmer, and Laurie Gedcke-Kerr Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada Introduction/Aim: Poor pain management can result from nurses' lack of knowledge, or personal beliefs or attitudes Recent studies report that nursing students have inadequate knowledge regarding effective pain management, and often perform poorly on pain knowledge and attitudes surveys Improving pain knowledge is an important step for nursing students to optimize ineffective pain management practices during their education and when in clinical practice. Therefor the purpose of this study was to examine nursing students' knowledge, attitudes, and self-efficacy in assessing and managing pain before and after participating in a pain educational intervention.
Methods: This study included a sample of 26 undergraduate nursing students who are in the second year of the 4-year Baccalaureate program. All consenting participants completed a pre-test prior to the intervention. The superior frontal gyrus, and contralateral caudal middle frontal gyrus.
Discussion/Conclusions: For the first time, we demonstrated that radiosurgery for TN leads to longitudinal and transient cortical thickness changes within default mode, executive control, limbic, somatomotor, and visual brain networks. Further studies are needed to ascertain the functional role these structural changes may play in GKRS' therapeutic effect.
Introduction/Aim: Chronic pain affects 1 in 5 Canadians and costs over $43B annually, yet effective and safe treatment options remain elusive. Recent discoveries have brought to the forefront sex differences in mechanisms of pain as a potential explanation why novel pre-clinical therapeutics have not translated into successfully in clinical trials.
Methods: To begin understanding how males and females differ in pain processing, we analyzed gene expression, using RNA sequencing, and DNA methylation, using reduced representation bisulfite sequencing (RRBS), in rodent models of neuropathic pain.
Results: Across both sexes, our data reveals peripheral nerve injury (PNI) caused upregulation of 61 genes involved in innate immune responses in spinal cord. In females specifically, we observed PNI-induced downregulation of 5 genes involved in neuronal function and upregulation of two classes of Cathepsins. (C and E). On the other hand, in males, we observed upregulation