Clinical Innovation Poster Abstracts

The In-Hospital Chronic Pain Consult Service (CPCS) was established by the Calgary Chronic Pain Center (CPC) in 2007 to provide treatment recommendations and education to healthcare staff caring for adult patients experiencing chronic pain in the acute care environment. Since then, our service has evolved to become a fully autonomous Nurse Practitioner (NP) service. The CPCS offers a unique model of care delivery that utilizes NPs to their full scope of practice, including prescribing of controlled drugs and substances, and delivery of expert care within an evolving chronic pain landscape amidst the opioid crisis. The CPCS launched with Specialist LINK© in July 2017, an innovative service that connects community providers and specialists in the Calgary area. Specialist LINK© includes real-time, tele-advice line for physicians and NP’s, clinical care pathways, and other resources that help to improve communication and collaboration between community providers and specialty care. We will present evaluation data indicating improved access to chronic pain specialists and provider satisfaction with the advice received. The CPCS has evolved into a distinctive model of care within chronic pain management in Calgary. The utilization of the NP role to provide tele-advice for chronic pain management is a unique model of care delivery that can serve as a foundation for improving care for individuals and their families experiencing chronic pain.

The In-Hospital Chronic Pain Consult Service (CPCS) was established by the Calgary Chronic Pain Center (CPC) in 2007 to provide treatment recommendations and education to healthcare staff caring for adult patients experiencing chronic pain in the acute care environment. Since then, our service has evolved to become a fully autonomous Nurse Practitioner (NP) service.
The CPCS offers a unique model of care delivery that utilizes NPs to their full scope of practice, including prescribing of controlled drugs and substances, and delivery of expert care within an evolving chronic pain landscape amidst the opioid crisis.
The CPCS launched with Specialist LINK© in July 2017, an innovative service that connects community providers and specialists in the Calgary area. Specialist LINK© includes real-time, tele-advice line for physicians and NP's, clinical care pathways, and other resources that help to improve communication and collaboration between community providers and specialty care. We will present evaluation data indicating improved access to chronic pain specialists and provider satisfaction with the advice received.
The CPCS has evolved into a distinctive model of care within chronic pain management in Calgary. The utilization of the NP role to provide tele-advice for chronic pain management is a unique model of care delivery that can serve as a foundation for improving care for individuals and their families experiencing chronic pain.
Initially established by the Calgary Chronic Pain Center (CPC) in 2007, the In-Hospital Chronic Pain Consult Service (CPCS) was developed to provide treatment recommendations and education to healthcare staff caring for adult patients experiencing chronic pain in the acute care environment. Since then, our service has evolved to become a fully autonomous Nurse Practitioner (NP) service.
Various developments have contributed to the CPCS becoming a unique model of care delivery in the acute care setting. These include utilization of NPs to their full scope of practice, including prescribing of controlled drugs and substances; the need for expert knowledge and experience in the evolving chronic pain landscape amidst the opioid crisis; and the support of physicians at the CPC.
The CPCS has progressed to providing treatment recommendations in the four acute care sites, extending into the community through discharge recommendations and via a tele-advice line. We also offer educational opportunities for healthcare professionals, provide mentorship and a supportive learning environment for Clinical Clerks and Residents, and work as part of an interdisciplinary team in the NP clinic at the CPC.
The CPCS has evolved into a distinctive model of care within chronic pain management in Calgary. This model of care can serve as a foundation for expert-care delivery in the complex area of chronic pain management across Canada. not been widely examined within patients with chronic pain, despite the importance of this diagnosis within chronic pain populations. Given the importance of diagnosis to tailor treatment, there is a need to examine the prevalence and validity of SSD.
Methods: Adult patients attending the Michael G. DeGroote Pain Clinic referred for psychological services were assessed for SSD using a structured clinical interview, the Diagnostic Assessment Research Tool (DART). Patients also completed psychometric measures assessing several pain related constructs, including pain intensity, catastrophizing, disability, kinesiophobia, depression, anxiety, and somatic symptoms.
Results & Discussion: Two hundred and fifty-four patients with chronic pain were included in the study. Findings suggest that the majority of patients presenting for psychological services within a chronic pain clinic met criteria for SSD. Patients who were diag-nosed with SSD had significantly higher scores on painrelated measures such as pain catastrophizing, kinesiophobia, and disability, and symptoms of anxiety, but not on pain intensity, somatic symptoms, and symptoms of depression. Risk factors such as being female and reporting a history of physical or sexual abuse were significant in the sample, where demographic factors such as unemployment, education, and age were not.
Conclusion: Findings suggest that DSM-5 SSD is highly prevalent in patients with chronic pain presenting for psychological services. Preliminary support for the validity of the SSD diagnosis was also provided, related to associations with kinesiophobia, catastrophizing, anxiety, and disability.
CONTACT Gregory Tippin tipping@hhsc.ca Background: The UK military has 155,000 personnel widely based in the UK and the world. A pain clinic at the national rehabilitation center (DMRC) was until 2016 not staffed bar 1 full time nurse with a weekly visiting consultant. DMRC is not a hospital and all services provided on site need to be risk assessed. Method: Pain interactions were recorded for 2 years following the introduction of an onsite civilian pain consultant. Data includes treatments performed locally and requested beyond, waiting times and patient satisfaction.
Results: During this period the UK military was not involved in conflict. Despite this 20% of the UK was not judged fit to fight. 50% of cases were training injury, 30% sport, 15% mental health issues. 3083 patients attend DMRC in years 2016/7.74% reported pain (average BPI impact 6.25, severity 7), 90% had an anxiety or depression issue. The pain team assessed 768 and arranged intervention for 325 patients. New on-site services included epidurals, radiofrequency to facet or nerves and local neuromodulation reducing waiting times from 6 months (via the NHS) to 2 weeks and psychological assessment. Waiting times for assessment fell from 16 to 1 week. All patients assessed were satisfied or highly satisfied with their service and judged it useful. No significant complications were recorded.
Conclusion: The expansion of the on-site pain service improved speed of assessment and treatment. In future work we will see this improves the outcome of on-site rehabilitation as we increasingly involved earlier in the rehabilitation journey.
Introduction/aims: The Tampa Scale of Kinesiophobia (TSK-11) is a common measure to assess pain-related fear among patients with chronic pain, in line with a biopsychosocial assessment framework. In order to reduce patient burden (time to complete), clinician burden (scoring time), and increase clinical utility, a shorter version of this measure is needed. Thus, we are seeking to develop and validate a short-form TSK with good psychometric properties with the end goal of encouraging uptake of this tool as a gold-standard across chronic pain centers and researchers.
Methods: The Kingston Health Sciences Center (KHSC) Chronic Pain Clinic (Kingston, ON) assesses biopsychosocial characteristics (including TSK-11) for all patients enrolled. Patient-reported baseline data from this registry was extracted from November 2017 to October 2019 (N = 933, M age = 53.5 ± 15.7; 63% female). Data analyses included: 1) factor analyses and subsequent item reduction of the TSK-11, 2) Cronbach's alpha's to evaluate the scale's internal consistency, and 3) correlations between the new short-form TSK and measures reflecting constructs of the fear-avoidance model (e.g. pain catastrophizing, pain severity, depression) to evaluate the concurrent validity of the new measure.
Results: A 2-factor structure was confirmed from the TSK-11 and the final model after item reduction resulted in a 7-item TSK (TSK-7) with 61.2% explained variance and Cronbach's alphas of 0.76 and 0.70 for each factor. High correlations were found between the TSK-7 and TSK-11 (r = 0.96), along with similar correlation between the TSK7 and TSK11 with pain severity (r = 0.33 vs. 0.34), pain catastrophizing (r = 0.58 vs. 0.57) and depression (r = 0.46 vs. 0.45).
Discussion: The TSK-7, a shorter form of the TSK-11, was shown to have good psychometric properties and concurrent validity. This shorter form could help to standardize and simplify questionnaires across chronic pain centers in order to facilitate patient care as well as cross-site research collaboration.
Objective: In recent years, increasing efforts have been made to improve accessibility to evidence-based psychological treatments for chronic pain, notably with "self-help" interventions. This study aimed to evaluate the effectiveness of guided self-help interventions (web-based and bibliotherapy) based on Acceptance and Commitment Therapy (ACT) in comparison to an education intervention among adults living with chronic pain.
Methods: Participants (N = 297) were randomly assigned to a web-based ACT intervention group, an ACT-based bibliotherapy group, or an active control group receiving education on pain through online brochures. Participants completed self-reported online questionnaires at baseline, after the 9-week intervention, and at three-and six-month follow-ups. The primary outcome was pain disability and secondary outcomes were depression, anxiety, and quality of life.
Results: Results of mixed linear models showed statistically significant interaction effects between time and groups for pain disability (F = 2.91, p =.009) and anxiety (F = 2.26, p =.037) in favor of the bibliotherapy group. Results also showed significant main effects for time in terms of depression (F = 13.18, p =.0001) and quality of life (F = 23.96, p =.0001) for all three interventions.
Discussion/Conclusions: Findings suggest all three self-help intervention formats can lead to reductions in pain disability, depression, anxiety, and improvements in quality of life but a guided self-help intervention administered through ACT bibliotherapy may lead to greater reductions in pain disability and anxiety compared to web-based ACT interventions or an education intervention on pain.
Objective: The purpose of this study was to compare the effectiveness of hands-on vs video-based training of a comprehensive assessment of the pelvic floor musculature on a pelvic model.
Methods: A randomized single-blinded trial was conducted between January 16 and November 19, 2018. 46 participants were enrolled and randomized to video (n = 23) and hands-on (n = 23) groups. Both groups underwent pre-training assessment that consisted of a written examination and an Objective Structured Clinical Examination (OSCE). Both groups had a didactic session. The video group then viewed instructional video and the hands-on group underwent hands-on training session with a pelvic floor physiotherapist. Both groups then underwent a posttraining assessment. Primary outcome measure was the change in assessment scores from pre-to posttraining. Secondary outcome measure was usefulness of the training program for clinical practice.
Results: The mean written assessment and OSCE scores improved significantly pre-and post-training in both hands-on and video-based training groups (p < .001). There was no statistically significant difference in the degree of improvement of the mean written assessment scores (p = .19), OSCE scores (p = .10), and comfort level (p = .19) between groups. The training program was useful for clinical practice.
Conclusions: Both video and hands-on are effective training methods. There is no difference in degree of improvement of assessment scores between both methods. This study presents a new effective multidisciplinary training program for teaching the assessment of the pelvic floor musculature to identify a possible muscular cause or contribution to chronic pelvic pain and provide early referral for appropriate treatment.
CONTACT Introduction: Chronic orchialgia (testicular pain), defined as constant testicular pain for ≥3 months that significantly interferes with daily activities, is common, occurring in approximately 2.5% of all urology office visits. Treatment can often be difficult, owing to a lack of standard treatment protocols. Methods: We present the case of a 38-year-old man with chronic left orchialgia following a ruptured varicocele for 2 years rated between 6/10 and 8/10 on a visual pain scale. Ultrasound-guided ilioinguinal block was trialed, which provided excellent relief for 2 months. This was followed by ilioinguinal nerve pulsed radiofrequency which provided longer-term but incomplete pain relief.
Results: Left L1 dorsal root ganglion (DRG) pulsed radiofrequency treatment resulted in 95% pain relief. The patient was contacted 11 months after the procedure and remained pain-free.
Discussion/Conclusion: We conclude that L1 DRG pulsed radiofrequency treatment is a therapeutic option for chronic orchialgia.
A multi-stakeholder group of over 360 individuals, led by Alberta Health Service's Strategic Clinical Networks™ and the Pain Society of Alberta, have come together to create The Alberta Pain Strategy and outline a coordinated approach to managing pain across the lifespan and across the province. The Strategy pays special attention to acute pain, transitional pain, chronic pain, cancer-related pain, and pain related to a palliative illness, condition, or disease. It is built on the principles of Quadruple Aim to improve patients' and families' experiences; patient and population health outcomes; the experience and safety of our people; and financial health and value for money. The Strategy's six guiding principles are as follows: a culture of quality, the patient and family experience, prevention, health care equity, engagement and collaboration, and evidence-informed practice. Three focus areas of acute pain, chronic pain and opioid use in pain management were selected, with pain research and education being priorities that span all domains. Within each focus area, working groups identified priorities that would advance The Strategy's overarching principles and objectives. The Alberta Pain Strategy was released in October 2019 and is available at painab.ca. Introduction/Aim: In a recent Canada wide poll, one in three Canadians (34%) reported experiencing pain that has lasted longer than three months. Thecomplexities of pain impact many aspects of a person's life including employment, personal relationships, sleep, mood, physical, and behavioural health. For many facing such challenges, access to social services and support whether in urban or rural regions, are often difficult and impacts recovery. Methods: In this study, we examine longitudinal data collected from Pain BC's Pain Support Line to identify the social determinants of health needs of people living with pain in British Columbia (BC), Canada. This free telephone-and-email based pain support service is unique in Canada offering a safe space for people to talk about pain and its impact on their life. A quantitative analysis was conducted based on caller data collected from 1,652 clients who used Pain BC's free volunteer-run phone and email Pain Support Line service over a span of four years. The service also provides information on self-management tools, connections to community resources, help navigating the health system, and information about Pain BC's other services and resources.

ORCID
Discussion/Conclusions: The Pain Support Line also aims to attend to each caller using empowering language applying compassionate, trauma-informed, strength-based, and person-centred approach. The data from the support line provides a snapshot of the specific determinants. In addition, the study illustrates the need for individualized support for people in pain by creating a low barrier service that provides social support, concrete resources, and connects people with appropriate local community-based health services.
Background: Participants in a Mindfulness course (for Stress and Pain Management) are asked to create an Art project that expresses their pain, their experiences and/or journey through the Mindfulness program, or any other insights that they have discovered along the way. They are given one week to complete the assignment and then asked to present it to the class.
Aim: The primary objective of this study is to describe the thematic nature of Artwork produced by chronic pain participants, as expression of their feelings and experiences.
Methods: All Artwork was viewed independently by 3 reviewers, each of whom marked the work on the basis of research questions. A qualitative approach using thematic analysis was undertaken. Disagreements between the reviewers were solved by collaborative discussion reaching consensus.
Results: Participants included 13 females, one male; mean age 43.6 years; age range 26-64 years; 9 were employed (6 full time, 3 part time), 3 were on disability and one retired. In regard to the Artwork, 5 major themes emerged as follows: 10/14 depicted a journey/transition; 13/14 showed expression of emotions (9/14 positive and negative emotions; 4/14 only positive emotions); 8/14 included nature themes; 6/14 used words to express their messages (3/14 combined nature and words while 3/14 used words only); and 5/14 had abstract themes. Examples of Art work and themes will be shown.
Conclusions: Artwork by chronic pan patients is a powerful tool for expressing their experiences and emotions even in the eyes of independent observers. has been limited, rendering them unable to obtain adequate relief. Traditionally, the role of patients in research was merely as subjects. However, recent years have seen an increase in emphasis on the value of input from those with lived experiencefrom helping to direct research to shaping policy.
With more than 20 research projects nearing completion, the Chronic Pain Network's fifth year of funding through the Strategy for Patient Oriented Research has seen increased opportunities for those living with pain to engage with researchers, fostering dialogue and collaboration.
Network product PainPLUS CPN incorporates those with lived experience in selecting and rating articles, and producing lay summaries. The Clinical Research Network connects pain clinics across the country to run trials in a clinical setting, with a minimal dataset for a pain registry now being piloted. The Network's Patient Engagement committee has created a document to guide researchers in the acknowledgment of contributions from those with lived experience when writing research papers, and a Patient Advisory Group allows researchers to seek feedback from those with lived experience. The Indigenous Research Advisory committee has compiled a compendium of resources for approaching Indigenous communities and is hosting workshops based on results from a recent survey. New ideas continue to take shape, growing as the Network matures.
CONTACT Norm Buckley buckleyn@mcmaster.ca Background: While pain is often the most common complaint when patients visit their clinicians, most clinicians are uncomfortable with addressing the issue of pain, and it has become increasingly recognized that current pain education for healthcare providers is inadequate. This is evidenced by current public health crises such as, the epidemic for chronic pain and the 'opioid crisis.' Pain education for health care professionals has traditionally been suboptimal. Through the Master of Physical Therapy program at Western University, an elective course, Understanding Pain in Rehabilitation (PT9551b) has been available for physical therapy trainees. The primary outcome for the course was a reflective journal. The true goal of the course; however, is that some students undergo a truly transformative change in the ways they see themselves as 'providers of pain management' or 'providers of physical therapy for people in pain', but it was not previously rigorously explored.
Aim: The primary outcome of this study was to explore physical therapy students lived experiences of the course and determining if the course shaped their professional identities as 'pain management providers.' Methods: Semi-structured interviews took place and the study followed an interpretive phenomenological approach. In following a phenomenological methodology, a small sample size of 8 participants were included.
Results: In conducting this project, it contributed to a larger project of developing a master's level interprofessional pain management program for practicing clinicians that launched September 2019. is used in our clinic as part of a new initiative to improve access to care. The lack of mental health providers embedded in pediatric pain clinics can limit access to care for those most in need. The PPST can identify patients needing more intensive follow up care (i.e., psychotherapy), but the measure has not previously been used to triage patients prior to their initial evaluation. Our clinic triaged 1196 patients over 22 months. The need to manage this extraordinary clinic volume with limited resources (one full-time psychologist and two part-time psychologists) required a novel approach to prospectively triage initial evaluations. We use the PPST to stratify patients into: multidisciplinary or medical-provider-only evaluations. Headache patients scoring <3 on the PPST see only a medical provider. Headache patients scoring ≥3 are evaluated by a medical provider-psychologist team, based on previously established clinical cutoffs. All chronic pain patients are evaluated by a multidisciplinary team, which is consistent with their higher PPST scores when compared to headache patients (p <.001). From our experience: 1) the PPST appropriately triaged patients 86% of the time; 2) 28% of patients only needed education, advice, or medications, which can be provided by medical providers; 3) 72% of patients needed more intensive evaluation by psychologists. Further, we identified that some medical providers needed additional support and training for evaluation of psychosocial issues, which can be provided by interdisciplinary case conferences. Background: Physical activity and exercise can decrease pain severity and improve physical function among adults with chronic pain. Despite the benefits, engaging in physical activity and exercise is a challenge for adults with chronic pain. Previous research has shown that adults with chronic pain want support, tailored advice, and improved access to physical activity and exercise programming. Purpose: To improve access to physical activity programming in the Chronic Pain Clinic at Kingston Health Sciences Center (KHSC), a group-based physical activity goal setting work-shop was developed.
Description of Program: The Chronic Pain Clinic at KHSC is an academic, tertiary care clinic that includes an interdisciplinary team of health care providers with experience and expertise in chronic pain management. The group-based physical activity goal setting workshop is theoretically rooted in social cognitive theory, whereby behavior change is conceptualized as a reciprocal interaction between a person (e.g. adult with chronic pain), environment (e.g. group-based physical activity goal setting workshop), and behavior (e.g. engaging in physical activity). Workshop development took an evidence-based approach and was developed based on a review of the literature, clinician expertise, and patient values. The physical activity workshop is two-hours in length, facilitated by a physiotherapist and/or occupational therapist, and designed for ten patients. It includes a workbook with content on pain science, the role of physical activity for chronic pain management, reflective exercises, and goal setting.
Next Steps: The workshop is currently being piloted, whereby feedback will be sought from multiple stake-holders, including referring clinicians, clinicians who deliver the workshop, as well as patients.
Background: The #PartneringForPain team engaged hundreds of individuals with pediatric chronic pain, family members, and healthcare providers in a JLA Priority Setting Partnership to identify the Top 10 priorities for pediatric chronic pain. There is now an urgent need to ensure these priorities are acted on by relevant stakeholders.
Initiative/Methods: An hour-long interactive round table discussion of the Top 10 priorities took place with 14 multidisciplinary pediatric chronic pain clinicians, 4 hospital administrators, and 2 people with lived experience through the Ontario Chronic Pain Network in April 2019. The session was co-facilitated by a patient partner and researcher/clinician project lead.
Evaluation/Results: Participants largely agreed that the top priorities reflected their own priorities for pediatric chronic pain research and/or care in Ontario (89% agree or strongly agree), were interested to act on at least one of the priorities (83% agree or strongly agree), felt able and empowered to act on at least one of the priorities (79% agree or strongly agree), and thought the session would make a difference to the Ontario Chronic Pain Network (90% agree or strongly agree). All agreed or strongly agreed it is important to partner/engage with patients and families to address these priorities and felt better informed about what priorities Canadians with chronic pain, their families, and clinicians have about treating pediatric chronic pain. Participants also described how they would change their clinical practice, research, or professional activities because of the session.
Conclusions: Our activities showcase knowledge translation and action around patient-and familyidentified priorities.
Background: Each year, over 10,000 osteoarthritis (OA) patients referred to Albertan Hip and Knee Central Intake clinics are determined to be conservative management candidates and there are limited instructions for next steps to support the patient's OA pain management and functional abilities. Conservative care includes all treatment strategies for OA outside of surgery. These treatments and self-management strategies may be offered by multiple health care disciplines and are patient centred, using a shared decision-making approach to determine the most appropriate options for each individual.
Purpose: To determine the impact of conservative care education and tools designed to promote selfmanagement strategies in patients living with OA in their hip or knee joints.
Methods: Three touch points were designed to integrate into existing clinic workflows along with an OA Self-Management Toolkit for patients. The touch points include: (1) An introductory OA education class delivered to all patients whose referral was accepted to a clinic, while they wait for their medical consult. (2) A second, individually tailored class after the medical consult, for those patients who were designated as conservative management candidates. (3) One year of telephone support from a Patient Navigator for conservative management candidates. This is an OA expert who can provide counsel, advise on evidence-informed treatment options or lifestyle changes, and direction to other disciplines when appropriate. Outcome measures and patient satisfaction surveys are delivered on a set schedule to patients by email. Outcome measures included self-rating surveys of OA status and readiness to change, Western Ontario McMaster University Osteoarthritis Index (WOMAC), EQ-5D-5L, and Patient Specific Functional Scale (PSFS).
The OA Self-Management Toolkit include three tools: (1) Report Card: A patient reflection tool to document their experience with conservative treatments to date and identify goals and barriers to determine a treatment plan. The delivery of the program is being tested at the Chinook Bone and Joint Clinic in Lethbridge, Alberta.
Results: Interim results have been completed for the evaluation. Approximately 79% of patients (N=33) were diagnosed with OA in knee joints, and half the patients (N=10) described symptoms of early disease. The majority of patients, 86%, indicated a readiness to change current self-management practices. At the 6-month mark, the WOMAC and EQ-5D-5L scores have shown minimal change. The PSFS findings show a slight improvement of 0.30 in the patients' functional ability, with half of patients indicating stair climbing and walking as priority goals. Patient feedback on the education classes acknowledged the following areas as beneficial to patients: learning about OA and how it affects the joints; learning about available treatment options to suit every lifestyle; debunking misconceptions about exercise as a treatment for OA; and group sessions promote inclusion and a community. Areas for improvement to education content and delivery include: the role of supplements and cannabis; earlier access to information prior to the class; and patient testimonials as positive examples. The majority, 97.0%, of patients who attended the first education class found it valuable and would recommend it to others (N=52). Similarly, 79.2% of patients felt better equipped to manage their OA (N=43) and 69.8% found some information to be repetitive (N=38). Although 92% of patients found the second education class valuable (N=12), patient recruitment has been low and recruitment strategies have been modified at 6-months into the evaluation to encourage participation.
Conclusion: The group education classes improve patients' knowledge about their condition, self-management activities and access to available tools. The interim results revealed minimal changes in WOMAC and EQ-5D-5L scores, highlighting a need for more sensitive surveys to capture functional and quality of life changes for conservative patients. The PSFS survey encouraged goal setting and results showed improvements in the patients' functional ability. An analysis of the Patient Navigator touchpoints, outcome tools collected, and focus group interviews with clinic staff and surgeons will be conducted once the evaluation period is complete in order to determine the full impact on patient care and understanding of conservative management of OA.
This poster describes changes in the practice and regulatory environment concerning pain care in Canada from 2007 to the present. To support the development of the 2010 Canadian Opioid Guideline by the Federation of Medical Regulatory Authorities of Canada, Rhoda Reardon, a researcher with the College of Physicians and Surgeons of Ontario, carried out an environmental scan. It identified 10 items which family practitioners and patients thought would help to address the challenges of pain management. These challenges were believed to underlie prescribing practices around opioid use. Some of these have been realized at either a local, provincial or national levelamongst these are the creation of national guidelines for opioid prescribing, and ongoing updating of these guidelines; creation of a recognized medical specialty in pain management; access to mentors with expertise in pain and addiction for primary care practitioners; improvement of undergraduate curricula for medical trainees; access to prescription monitoring systems; continuing education programs for pain, addiction and prescribing; patient support groups. Some have not-fee codes recognizing the complexity of pain care; access to networks of clinics for interdisciplinary care, practical guidance for emergency departments and walk in clinics on how to manage chronic pain. The poster reviews the environmental scan, and presents a summary of items which have and have not been achieved. With a national pain task force underway and provincial pain strategies being developed, the examination of this environmental scan allows recognition of significant progress for pain care over the past 12 years. Introduction: Chronic pain in children is a significant cause of distress and reduced quality of life. 1,2 A large proportion of children have unrecognized myofascial components to their chronic pain presentation. myoActivation® is a novel, structured assessment and non-pharmacological therapeutic approach to both diagnosis and treatment of chronic myofascial pain. 3 Methods: A detailed history of the timeline of lifetime trauma combined with a quick, structured and reproducible set of posture and movement tests help to easily identify myofascial components of chronic pain. The therapeutic component is delivered utilizing a needling technique, or myofascial release, focused to active myofascial trigger points, fascia in tension and tethered scars. 4 Repeat, or catenated, cycles of intervention followed by repeated movement tests help unravel multiple sources of myofascial chronic pain. myoActivation is a low cost, simple interventional technique that can be included in the biopsychosocial approach to chronic pain management, which is effective in adults as well as children and adolescents. 5 Results: myoActivation has been a treatment option as a component of multidisciplinary treatment in the BC Children's Hospital Complex Pain Service for the last 3 years. The myoActivation process and has been used to assess and manage chronic myofascial pain in children ranging from 4 to 18 years, including non-verbal patients. We will present a review of the last 100 discharged pediatric cases to illustrate key features of this treatment program, outline discharge outcomes and make provisional recommendations for its wider implementation in this population.
Conclusion: The information from this retrospective project will be used to power a future prospective long- Results:Cronbach's alpha for the three scales of the EPB was 0.82. The physical domain of the EBP was significantly predicted (F = 22.78, p < .01) by the PDI (β = −0.26, p < .01), but not the TSK or PCS. The mental domain was significantly predicted (F = 19.87, p < .01) by the PDI (β = −0.23, p < .01) and the PCS (β = −0.18), p < .01), but not the TSK. Lastly, the social domain was significantly predicted (F = 5.40, p < .01) by the PDI (β = −0.13, p = .02), but not the TSK or PCS.
Discussion: The EBP demonstrates excellent internal consistency and criterion validity with the PDI being the most consistent predictor. Even though data are sourced from two distinct program groups with differing strength of change from admission to discharge, the measure continues to be highly internally consistent and valid and can be used to assess chronic pain program benefit overall.

Practical Acute Pain Management for Patients Stabilized on Buprenorphine in Tertiary Care
Introduction: Buprenorphine is a partial μ agonist gaining popularity in Canada for the treatment of opioid use disorder and chronic pain. Its long half-life and high affinity to the μ receptor may theoretically prevent traditional opioids from working as intended during an acute pain episode. Scarce evidence about patients stabilized on buprenorphine in acute pain consists of case reports where opposing views on whether or not this therapy should be continued are presented. Practice guidelines for managing patients stabilized on buprenorphine experiencing acute pain can help practitioners make informed care decisions. Methods: A cross-departmental multidisciplinary working group of experts analyzed available evidence and created tertiary care guidelines and treatment algorithm.
Results: A collaborative multidisciplinary and interdepartmental approach should be taken for an individualized approach to care. The most responsible outpatient prescriber should be contacted to coordinate care with the inpatient team. Usual pain management strategies need to be considered, including: multimodal analgesia, adjuvant therapy, regional anesthetic techniques, neuraxial techniques, ketamine infusions, lidocaine infusions, and non-pharmacological strategies. Buprenorphine may be continued, increased, decreased or paused. Considerations include: whether or not the painful admission is planned and unplanned, a patient's addiction history, the patient's pain history, the patient's daily buprenorphine dose and reason for use, and the severity of expected acute pain.
Conclusions: Being aware of potential drug interactions between buprenorphine and traditional opioids and exploring recommended treatment options during painful admissions may lead to improved safety, better patient outcomes and provide basis for further study. status, the physical environment and social support networks. Addressing these factors, may be more important than modifying existing health services in mitigating inequities in the management of chronic pain.
The World Health Organization (WHO) Commission on the Social Determinants of Health stated unequivocally that governments need to refocus their public health policies to ensure action by all sectors of government to address "the causes of the causes" in order to improve population health. This principle particularly applies when factors that cause and maintain chronic pain are outside the control of the health system.
Working across government sectors can be difficult, with "ownership", funding, reporting arrangements, departmental or agency culture, and language presenting challenges.
The WHO Health in All Policies approach may facilitate intersectoral engagement and co-operation in the development of policy aimed at addressing the epidemic of chronic pain. Background: While outcomes for interdisciplinary pain programs funded by third parties are reporting success rate of 14-60% long term, there is a dearth of outcome data from publicly funded IDPs. Aim: To describe demographic characteristics and evaluate the changes in outcomes of patients' self reported pain, and emotional/functional status, following treatment in a Canadian community-based publicly funded IDP employing a customized, patient centered and shared decision making model.
Methods: This retrospective study was conducted on 218 well selected chronic pain patients, with 158 completing a 3-4-month IDP during 2016-19. Data collected upon exit (N = 158), at 6 months (N = 66) and 12 months (N = 46) after program completion, was as follows: demographic information, pain characteristics, emotional/functional status obtained by validated instruments and Global Impression of Change (GIC). Means of pre-and post-program variables were compared to assess changes of each patient's "journey".
Conclusion: A publicly funded IDP using a customized patient-centered approach proved to be highly effective for chronic pain both in the short (3--4 months) and long term (6 and 12 months), with improvement ranging between 29-77% in different measures. Introduction: Consistent with best practice guidelines, the Michael G. DeGroote (MGD) Pain Clinic offers an interdisciplinary and biopsychosocial program to manage chronic pain, with an emphasis on selfmanagement. However, there are patients who drop out of the program, or attend the program with little reported improvement. Improved outcomes may be associated with matching the type of treatment provided to a patient's readiness to engage in a selfmanagement approach to chronic pain, as theorized by the transtheoretical model of behavior change. Specifically, patients in the pre-contemplative stage, where little action for self-management is being considered, may not be ready for an 8-day selfmanagement program, thus resulting in lower completion rates and poorer clinical outcomes. The aim of this