Research Poster Abstracts

Introduction/Aim: Prescription opioid misuse is observed in up to 20–30% of chronic non-cancer pain (CNCP) patients on long-term opioid therapy. In previous research, factors such as negative affect and opioid craving have emerged as strong determinants of opioid misuse. The contribution of opioid withdrawal symptoms to opioid misuse, however, has remained largely unexplored. The first objective of this study was to examine the association between opioid withdrawal symptoms and opioid misuse among CNCP patients prescribed opioid therapy. We also examined the factors associated with opioid withdrawal symptoms. Methods: In this longitudinal diary study, patients (n = 103) provided reports of pain intensity, negative affect, catastrophizing, opioid withdrawal symptoms, and opioid craving for 14 consecutive days. Prescription opioid misuse was also assessed. Results: A marginally significant association was found between opioid withdrawal symptoms and opioid misuse (r =.19, p = .05). Multilevel analyses revealed that higher daily levels of pain, negative affect, and catastrophizing were associated with heightened opioid withdrawal symptoms (all p’s <.05). Opioid withdrawal symptoms were also associated with opioid craving (p <.05), and a follow-up analysis indicated that craving mediated the association between opioid withdrawal symptoms and opioid misuse (p <.01). Discussion/Conclusions: This study provides new insights into the association between opioid withdrawal symptoms and opioid misuse. Our findings suggest that opioid withdrawal symptoms might lead to opioid misuse indirectly through elevations in opioid craving. Our findings have implications for interventions designed to prevent and/or reduce opioid misuse in patients with pain.

Methods: Emerging adults (N = 85, M age = 18.9, 51.2% female) rated pain intensity (0 = no pain, 10 = worst pain imaginable) and unpleasantness (0 to 10) using a computerized visual analogue scale (VAS) during a thermal psychophysical task. A TSA-II stimulator was used to deliver heat stimuli (less than or equal to 49°C). Participants also completed chronic pain history and catastrophizing questionnaires.
Results: Men without chronic pain had significantly higher intensity ratings than women without chronic pain, t(51) = 2.13, p = .038; however, men with chronic pain had lower intensity ratings than women with chronic pain. Among those reporting low pain catastrophizing, men with chronic pain had significantly lower intensity ratings than men without chronic pain; women with chronic pain had higher unpleasantness ratings than women without chronic pain.
Overall, women without chronic pain had the lowest intensity and unpleasantness ratings; men without chronic pain had the highest intensity and unpleasantness ratings.
Discussion/Conclusions: Results suggest complex interactions among sex, chronic pain status, and pain catastrophizing in relation to experimental pain responses. Furthermore, pain intensity and unpleasantness appear to capture unique aspects of the pain experience.
CONTACT Elana R. Abelson abelsoea@mail.uc.edu Introduction/Aim: Understanding patients' experiences in the environment they are treated is vital in order to improve care and management. The objective of this project is to describe chronic pain patients' perceived impact of participation in a community interdisciplinary pain program (IDP). By sharing the experiences of these patients, we will inform ongoing quality improvement efforts and apprise others who are engaged in similar chronic pain programs. Methods: Retrospective data were collected from 25 patients treated in the PWC IDP who provided written testimonials and/or google reviews between October 2016 and August 2019. Analysis was performed in a) descriptive demographic and pain data; and b) qualitative data extracted from patients' written testimonials. The thematic analysis approach was used for the interpretation of qualitative data.
Results: Male/female ratio was 1:2.5 (p < .001) with mean age 48 ± 18 yrs. Regarding the participants 55% (p < .05) were married and 40% had completed college, university or post-graduate studies. The average duration of pain at time of IDP admission was 5 ± 5 years; 75% had two or more sites of pain. Coding of testimonials revealed a number of themes that were usefully organized in domains and (themes): a) patients' experiences (pain management tools, interdisciplinary pain approach, patient center-care, expectations) and b) previous treatment vs interdisciplinary program care (physician-patient interaction, use of health resources, accurate diagnosis). Detailed results will be presented.
Discussion/Conclusions: Patient opinions are core for improving care. The results of the study will educate pain management teams in their pursue of patientcentered management strategies.
CONTACT S.Fatima Lakha sfatima.lakha@utoronto.ca Introduction/Aim: Previous studies have shown strong relationships between infant pain-related distress and parents' use of insensitive behaviors post-vaccination. 1,2 The present study explored predictors of parents' insensitive behavior in response to infant pain-related distress, focusing on parent psychopathology, parenting stress, pre-needle worry, and pre-needle physiological arousal, as well as infant pre-needle distress.
Methods: The study included parent-infant dyads (n = 56) from the 12-month wave of an ongoing longitudinal study (OUCH Cardio Cohort). Dyads were videotaped and connected to equipment that recorded their heart rate during infants' routine vaccinations. Parent insensitive behaviors were coded for three minutes post-needle2018. 2 Parents rated pre-needle worry on a Likert scale immediately before the needle. Parent psychopathology (PSI) 3 and parenting stress (BSI) 4 were self-reported. Parent heart rate was averaged over the 30second epoch pre-needle using MindWare software (HRV Analysis 3.1.3.). Infant pre-needle pain-related distress was coded for 15 seconds pre-needle using FLACC. 5 A forced-entry regression model was used.
Introduction/Aim: The speed at which pain resolves after surgery is an important consideration in postoperative pain management. The current study examined the influence of psychosocial variables on day-today changes in pain intensity during hospitalization after major cardiothoracic surgery.
Methods: A prospective cohort of patients undergoing major cardiothoracic surgery (N = 949, 34.6% female) completed the Sensitivity to Pain Traumatization Scale (SPTS) and Mindful Attention and Awareness Scale (MAAS) prior to surgery. Maximum pain ratings (11-point NRS) for each day were recorded while the patient was in the hospital after surgery. Growth curve modeling was used to examine the pattern of changes in pain ratings over time and predictors of these changes. Age, sex, and ongoing preoperative chronic pain were included as time-invariant covariates. Daily opioid use (in mg morphine equivalent, MME/day) was included as a time varying covariate.
Results: Unconditional growth curve analyses identified a logarithmic growth curve as better fitting than linear, quadratic, or cubic curves, ΔAIC/BIC > 10. On average, pain intensity decreased over time, b = −2.69, p < .001. Conditional analyses supported inclusion of psychosocial predictors in the model. Controlling for age, sex, and in-hospital morphine use, higher preoperative SPTS scores were associated with slower reduction in pain over time, b = 0.04, p = .007. Preoperative MAAS was unrelated to postoperative pain, p > .05.
Discussion/Conclusions: The results highlight psychosocial risk factors related to the dynamic experience of in-hospital postoperative pain. Targeted perioperative psychosocial interventions may speed up acute postoperative pain resolution.
Introduction/Aim: Primary care providers (PCPs), who provide the bulk of care for patients with chronic pain, often report knowledge gaps, limited resources, and difficult patient encounters while managing chronic pain. This scoping review seeks to evaluate the extent of PCPs' identified knowledge/skill gaps in chronic pain management.
Methods: A broad literature search was conducted on PubMed and the gray literature for relevant articles in the area of knowledge and skill gaps of PCP for managing chronic pain, with multiple search term derivatives of both concepts. The initial search yielded 175 articles which were then screened for relevance, yielding 16 studies for inclusion.
Results: The 16 articles included in this review reflected a variety of study designs, settings, and methods (Table 1). Consistent themes emerged with respect to knowledge gaps in assessment, diagnosis, treatment, and allied health roles in chronic pain. A general lack of confidence in approaching discontinuation of high dose or ineffective opioid regimes, professional isolation and managing complex pain patients with limited access to pain specialists were also reported.
Discussion/Conclusions: Studies summarized in this review demonstrate commonalities that will be useful in creating a targeted, useful and concise curriculum for primary care providers. Findings from these studies will be used to generate a survey to elucidate priority topics for PCPs caring for chronic pain patients. The current scoping review synthesizes information from clinical studies that can inform us in creating a Pain Day for PCPs that will maximize learning and ultimately benefit chronic pain patients. Table 1. A summary of types of study methodologies that assessed primary care providers' deficits in knowledge and skills for chronic pain management.
control ratio). Descriptive and comparative statistics were completed for several biopsychosocial measures (e.g. pain severity, pain catastrophizing, fear of movement, suicidal ideation, depression, quality of life) and healthcare utilization.
Results: Veterans (n = 47) were 79% male with a mean age of 57 ± 14. Compared to age/sex matched civilians (n = 94), more veterans reported having suicidal ideation (23% vs 8.6%). The biopsychosocial measures examined were not clinically different between groups. Veterans utilized more community allied health care such as chiropractor, massage therapist, physiotherapist and psychologist compared to civilians (mean of 25.0 ± 38.0 vs 4.74 ± 8.18 visits in the previous year).
Discussion/Conclusions: Despite heavier utilization of community allied health care by veterans, our results show that this population present similar biopsychosocial characteristics but higher suicidal ideation than the civilian population at enrollment into an interprofessional chronic pain clinic. Findings may reflect that siloed multidisciplinary care for pain management in veterans has no additional benefits. More research is warranted to examine how veterans may benefit from an interprofessional chronic pain program that is evidenced based.
Introduction/Aim: There is a high co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain, yet the mechanisms behind this relationship are poorly understood. This has led to poor treatment outcomes for patients. Beyond occurring together, it is possible that PTSD and chronic pain might interact and aggravate each other through a common traumatic symptom: "pain flashbacks," a phenomenon in which individuals report reexperiencing the physical pain they felt during a traumatic injury.
Methods: This review summarizes the empirical literature on pain flashbacks, including their prevalence and a theoretical analysis of their mechanistic role in exacerbating and maintaining chronic pain and PTSD. Neurobiological and psychological hypotheses are presented to explain the etiology and maintenance of pain flashbacks. A discussion of the meaning of pain flashbacks is presented, emphasizing how individuals attribute their current pain to the pain experienced during the traumatic exposure.
Discussion/Conclusions: Important candidates for the etiology of pain flashbacks include anxiety sensitivity, fear and avoidance behaviors, and the encoding of pain memories at the somatosensory level. Pain flashback prevalence rates documented in the recent literature (49%) are likely an overestimate due to the inclusion of clinical samples and use of a screening tool to determine symptom presence. Future studies will require semi-structured interviews sampled from more diverse populations to determine prevalence. We conclude with recommendations for future research, and discuss treatment implications for individuals who experience pain flashbacks as part of their chronic pain and PTSD symptom profile. This may include psychotherapy, such as interoceptive exposure, targeting fear and avoidance symptoms.
C 021. Calcium imaging of dissociated sensory neurons from naïve and postoperative mice showed that CCL22, but not CCL17, was able to directly activate neurons; electrophysiological recordings demonstrated that sensory neurons are sensitized to CCL22 after injury. These responses were blocked using C 021. Finally, our data show that acute post-surgical pain is reduced in mice lacking CCR4, wildtype animals treated with CCR4 antagonist, as well as transgenic mice depleted of dendritic cells.
Discussion/Conclusions: These results suggest a role for the CCL22:CCR4 axis in the genesis of inflammatory pain via direct communication between dendritic cells and sensory neurons, opening new therapeutic avenues for its control.
CONTACT Jaqueline Raymondi Silva jrs5@queensu.ca Introduction/Aim: Pain is a subjective experience, and as such, it is important to determine the factors that influence how pain is interpreted by others, as these pain inferences can impact how and when a patient receives treatment. Numeric anchoring is a cognitive bias whereby exposure to a numeric quantity influences subsequent judgments involving other quantities. Anchoring effects have previously been shown to influence how a patient's pain intensity is perceived. This study aims to better understand the variables involved in pain inferences by using pain-relevant and painirrelevant images in conjunction with numeric anchors to induce the anchoring effect. Methods: 590 participants read a vignette describing a patient with chronic pain before being randomized to one of six groups (2 × 3 design). Participants viewed a pain-relevant (car crash) or pain-irrelevant (house) image which displayed a scrolling header containing either a high number (NEWS 98), a low number (NEWS 2) or no number (NEWS). Participants were then asked to estimate the patient's pain intensity on a 0-100 numeric rating scale.
Discussion/Conclusions: Pain ratings were not influenced by prior exposure to a numerical anchor (high, low, none) or the relevance of an image to pain (relevant, irrelevant). Future studies are needed to better understand the anchoring effect and the factors that influence pain inferences.
Introduction/Aim: Research has established that children's catastrophizing about their own pain is associated with poorer child pain outcomes. For children of parents with chronic pain, catastrophizing about parental pain might uniquely predict child pain due to increased exposure to parents' chronic pain and disability. This study examined dyadic associations between child and parent catastrophizing about one another's pain and child pain during the cold pressor task (CPT).
Methods: As part of a larger project, 72 parents with chronic pain and one of their children (ages 8-15) completed questionnaires measuring trait catastrophizing about their own and each other's pain. Children completed the CPT and parents and children rated the child's worst pain intensity during the task. Analyses were guided by the Actor-Partner Interdependence Model.
Discussion/Conclusions: Child catastrophizing about parental chronic pain may be a vulnerability factor associated with poorer child pain outcomes and should be considered in future studies and clinical practice.

CONTACT Kristen S. Higgins
Kristen.higgins@dal.ca Introduction/Aim: Emerging adults (EA) with chronic pain (CP) struggle to achieve age-specific expectations due to physical limitations resulting from their pain. Those accessing CP services are frequently viewed as synonymous with the general adult population (ages 18-64), despite significant variation in the relationship they have with their pain condition and societal pressures to achieve stable employment, financial independence and establish social relationships. This study investigated characteristics of EA accessing a specialized CP clinic and describes interventions offered and utilized by this group. Methods: A retrospective chart review was conducted between 2017-18, 41 EA's (aged 18-29) and 41 middle aged adults (MA's) (aged 30-64) receiving care from a CP clinic in Southeastern Ontario were examined over six months. Groups were matched on sex and number of pain sites. Demographic and pain characteristics, interventions, referrals, and clinic utilization were examined using bivariate and multivariate analysis.
Discussion/Conclusions: Findings of this study inform our understanding of characteristics of EA's who utilize CP services and which services are offered and utilized by them. Further research is needed to better understand the efficacy of treatments offered and satisfaction with pain management approaches.
Introduction/Aim: Pain catastrophizing has been broadly defined as an excessive negative cognitive orientation toward painful stimuli. Implicit in this definition is that negative outcome expectancies might be the vehicle through which catastrophizing might contribute to chronic pain. Considerable research has shown that "less positive" outcome expectancies are prospectively related to problematic recovery. However, the prognostic value of negative outcome expectancies has yet to be investigated. This study examined the role of negative and positive outcome expectancies as mediators of the relationship between catastrophizing and pain experience.
Methods: 159 individuals with work-related musculoskeletal injuries were recruited from one of 6 primary care physiotherapy clinics in the greater Montreal region.
Results: Our study replicated previous research findings that pain catastrophizing predicts long-term pain severity. Our findings revealed that lower positive expectancies, but not higher negative expectancies, partially mediated the relationship between pain catastrophizing and long-term pain.
Discussion/Conclusions: Conceptual frameworks have emphasized negative outcome expectancies as a central feature of pain catastrophizing. Although the results of the present study revealed a significant correlation between pain catastrophizing and negative outcome expectancies, negative outcome expectancies did not mediate the relation between pain catastrophizing and long-term pain. The findings suggest that positive outcome expectancies might serve a preventive function in relation to long-term pain. Efforts to reduce the incidence of chronic pain might benefit more from techniques aimed at increasing positive outcome expectancies than techniques aimed at decreasing negative outcome expectancies. Introduction/Aim: Chronic pain is the leading cause of disability worldwide and costs our healthcare systems more than any other practice area. This study observes the relationship between an infused dose of lidocaine and ketamine, and the extent of immediate pain relief in patients with neuropathic pain (including diabetic neuropathy), fibromyalgia, and headache. This is a retrospective cohort review, conducted in a single outpatient center.
This project has been conditionally approved by Veritas IRB Inc.
Methods: 670 subjects (508 females, 162 males) were treated at Allevio Pain Management by Dr. Safakish from March 2013 to May 2017, were included. In total, we analyzed 670 patients and 3,741 infusions.
The median number of infusions was 3. 38% of patients received more than five infusions for their condition. Univariable analysis showed that only lidocaine and ketamine dosages had a statistically significant impact on pain improvement. : We have shown that in outpatients with chronic neuropathic pain, the immediate analgesic effects of intravenous lidocaine and ketamine are impressive. The impact of lidocaine dosage (mg/kg) on pain relief showed borderline significance, while an increase in ketamine dosage (mg) was still associated with clinically meaningful pain relief.
Introduction/Aim: Measurement of infant pain using neurophysiological imaging methods is an emergent area of research, yet, no studies have examined parent perceptions of the use of this technology. This paper reports on parent perceptions of 1) the use of neonatal electroencephalogram (EEG) for pain measurement, and 2) the use of breastfeeding and 24% oral sucrose for neonatal pain management during heel lance.
Methods: A sample of mothers (n = 36) who consented to their newborns taking part in a randomized controlled trial examining the influence of breastfeeding and 24% oral sucrose on pain-related EEG activity completed a study-specific questionnaire.
Results: Mothers reported positive perceptions of the use of EEG for pain measurement, with the majority reporting they felt good or very good (n = 33, 91.7%) about their baby wearing the EEG net. Six mothers (16.7%) indicated that they had concerns about their newborn's comfort and safety prior to EEG application. All (n = 36) mothers perceived that breastfeeding and 24% oral sucrose provided adequate pain relief.
Discussion/Conclusions: In this sample of mothers who agreed to enroll their infant in an EEG study, there were positive perceptions regarding the use of EEG and the pain-reducing efficacy of the interventions. Studies using EEG for pain measurement must prioritize This project has been conditionally approved by Veritas IRB Inc.
Results: A total of 246 patients (186 females, 60 males) that underwent 2-7 prolotherapy sessions were recruited for this study. The mean age was 54.2 years. According to our data, at the time of prolotherapy, 156 (65.5%) of patients were in working age From those 156 patients, 99 (63.4%) returned to work after intervention. 68 patients reported usage of narcotics before treatment (dosage 0.18-27 mg) a significant reduction in narcotic use after intervention was observed (p-value<0.001).
With respect to non-narcotic pain drugs, 84 (34.1%) patients reported a decrease in use, 49.2% reported no change A total of 178 patients (72.3%) had a reduction of 50% or more in at least one BPI item, and 100 patients (40.6%) had a reduction of 50% or more in all BPI items, which was statistically significant.
Using chiropractor or osteopath services which is common in SI joint dysfunction did not show any significant improvement.
Discussion/Conclusions: This study had shown a statistically and clinically significant improvement in BPI, reduction in narcotic consumption, and return to work after treatment.
CONTACT Imrat Sohanpal Imrat.Sohanpal@AllevioClinic.com Introduction/Aim:FAM150b was recently identified as an endogenous ligand of the orphan anaplastic lymphoma kinase receptor (ALK). The expression of ALK is confined to the developing nervous system as well as in innate immune cells where it is involved in proinflammatory responses to infections. Moreover, ALK mutations have been identified in cancers including neuroblastomas, which account for 10% of pediatric cancers. We found that expression of FAM150b was increased in TRPV1 + nociceptors during CFA inflammation, suggesting a role of neuronal FAM150b-ALK signaling in the control of inflammatory pain.
Methods: Transgenic mice that express a GFP conjugated to the TRPV1 channel were used to isolate TRPV1 + neurons following CFA induced inflammation by FACS followed by GeneChip microarray analysis. Inhibition of ALK using crizotinib (i.t.) or lorlatinib (i.t. and i.g.) was tested in the CFA and the formalin models of inflammatory pain. Thermal hyperalgesia post CFA injection was measured using the Hargreaves test. Nociceptive behaviors (paw licking and flinching) were scored in response to formalin.
Results: Fam150b is upregulated in nociceptors during inflammation. Acute ALK inhibition by crizotinib or lorlatinib reduced CFA-induced thermal hyperalgesia as well as formalin-induced inflammatory pain.
Discussion/Conclusions: FAM150b released from TRPV1+ nociceptors promote thermal hyperalgesia during CFA inflammation. Blocking the ALK receptor caused anti-nociceptive effects. Future experiments will deter-mine where FAM150b is acting in the pain pathway and whether it modulates neurons or glial cells in the spinal cord. Identifying the cellular targets of FAM150b could lead to further insights into the role played by nociceptors in pain, inflammation and cancer.
Introduction/Aim: To examine the relationships between caregiver psychological distress and the physiological pain-related distress response of their toddlers during 12-, and 18-month vaccinations. Methods: Caregiver-toddler dyads were followed as part of an ongoing longitudinal study at 12-, 18-, and 24month vaccinations. Only data from 12-(n = 112) and 18months (n = 81) will be reported in the current investigation. Toddler heart rate (HR) and heart rate variability (HRV) 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). Caregiver psychological distress was measured according to different subscales (Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic, Paranoid and Psychoticism) on the Brief Symptoms Inventory (BSI; Derogatis, 2000).
Results: There were no significant correlations between toddler cardiac indicators and BSI subscale scores at 12-months of age. At 18-months, negative correlations emerged between caregiver hostility and toddler heart rate across baseline and post-needle epochs (r = −.26 to −.32, p <.05). Significant positive correlations were also found between caregiver hostility and toddler HRV across post-needle time points at 18months (r =.26 -.29, p <.05).
Discussion: Our findings suggest that caregivers who report more hostility have children who display a pattern of hyporesponsive (lower heart rate and higher heart rate variability) in the vaccination context. Null findings at the 12-month vaccination suggest that impact of parent psychological distress on toddler physiological reactivity and regulation in the vaccination context may not manifest until after 12 months of age.
CONTACT Miranda G. DiLorenzo mgdilo@yorku.ca Introduction/Aim: To examine changes in kinesiophobia in relation to activity limitation after a multidisciplinary rehabilitation program in patients with heterogeneous chronic pain.
Methods: This is a prospective cohort study of 100 patients who completed an interdisciplinary chronic pain management program. Data from baseline (T 0 ), after four weeks of rehabilitation (T 1 ), and at 6-months follow-up (T 2 ) will be analyzed. Outcome measures are the Tampa Scale for kinesiophobia (TSK-11) (Hapidou, O'Brien, Pierrynowski, de las Heras, Patel & Patla, 2012), and the Patient Disability Index (PDI) (Pollard, 1984). The relationship between kinesiophobia and activity limitation will be explored with regards to subgroups with high, medium and low baseline TSK scores, and for those patients who did or did not reach the smallest detectable change (SDC) in TSK. This is a partial replication of a study by Bergsten, Lundberg, Lindberg and Elfving (2012).
Results: Based on common findings in our Program, we expect kinesiophobia to decrease from baseline to after rehabilitation, and to stay relatively stable at the 6-months follow-up point. The PDI is also expected to follow a similar pattern.
Discussion/Conclusions: If the predictions are true, individuals with chronic pain can consider multidisciplinary rehabilitation programs to decrease kinesiophobia and activity limitations and for these changes to persist after the end of the Program. These results can also be useful to therapists in clinical settings who provide rehabilitation and pain management therapies.
CONTACT Eleni G. Hapidou hapidou@hhsc.ca Music has been shown to reduce pain in a variety of contexts, including chronic pain, surgical operations, and experimental research. However, music is incredibly diverse, and we do not yet know which types or styles contribute more than others to the reduction of pain. Previous research has failed to differentiate music into different categories, in part because an appropriate musical typology has not been available. To answer this question, we adopted the "Arousal, Valence, Depth" model of music attributes, which locates songs along three psychological dimensions. We presented a set of musical excerpts to 60 healthy participants concurrently with painful thermal stimulations and showed that low arousal and low valence significantly reduced pain. High depth also reduced pain in subjects with a "systematizing" cognitive style. This research is a first step in uncovering the mechanisms of music-induced analgesia and may inform clinics and therapists as to the best music to use for alleviating pain. Introduction/Aim: To test the effectiveness of music in reducing pain based on three dimensions: Arousal (stimulating-calming), valence (positive-negative emotion), and depth (complex-simple).
Methods: 60 healthy participants participated in the study. First, 28 thermal stimulations were delivered via a TSA-II Medoc thermode to determine their thermal pain response curve. This was used to compute a temperature corresponding to a subjective pain rating of 50/100, which was used throughout the rest of the experiment. Subjects were then presented with 45 clips of 40 seconds in length concurrently with 8-second thermal stimulations, which coterminated with the clips. 27 clips were songs varying along the arousal, valence, and depth dimensions, 9 clips were controls consisting of scrambled music, and 9 were silent controls. For each trial, patients rated the amount of pain they experienced in response to the stimulation.
Discussion/Conclusions: The results indicate that music may reduce pain via multiple pathways. Low arousal in music might result in a state of mental or physiological relaxation, which could help reduce the sensation of pain. The effect of low valence (i.e. sad or melancholic) music is more difficult to explain, but it may be due to a moodcongruence effect or the emotionally soothing property that is anecdotally characteristic of sad music. High depth may reduce pain through cognitive engagement or distraction, which may be particularly salient for people with a systematizing cognitive style who are more prone to attend to the mechanics and structural relationships of stimuli.
Introduction/Aim: Sensory nociceptors that express TRPV1 channel respond to noxious heat/chemical stimuli to produce pain sensation. Recent findings reported that TRPV1+ neurons respond to bacterial infection in the skin, gut or lungs, and modulate host immune response. STING is an innate immune signaling platform that responds to viral/bacterial infections. Using a model of paw infection, we found an upregulation of STING in TRPV1+ neurons.
Methods: TRPV1-GFP C57BL/6 mice were used to conduct FACS-sorting of TRPV1+ neurons followed by GeneChip analysis after CFA paw injection. Measure of type I INF was conducted on cultured DRG neurons by ELISA assay, and on DRG by qPCR. Immunostaining of STING was conducted in DRG tissue sections after CFA injections. Measure of STING protein expression was done by WB analysis from DRGs.
Results: We found that STING is co-expressed with TRPV1 in DRG neurons, and its expression increases upon CFA infection. We observed that type I INF RNA was increased in DRGs post CFA injection. Moreover, we found that cultured DRG neurons release INFβ in response to STING activation by synthetic agonists (DMXAA and ADUS-100).
Discussion/Conclusions: This work uncovers the functional regulation of STING in sensory DRG neurons. Our future experiments will focus on deciphering the role of neuronal STING in TRPV1+ neuronal activity and increased pain sensitivity associated with bacterial infection. We will asses inflammatory response and pain using full and conditional (TRPV1+ neurons) STING KO, as well as TRPV1+ neuron-depleted mice. Our work will highlight a novel role of STING in inflammatory pain induced by bacterial infection.
Methods: As part of an online pilot randomized controlled trial (RCT) in which parent-targeted pain management information was shared with parents of infants prior to their scheduled vaccination, an online survey (15 Likert scale and open-ended questions) was sent to 151 participants to investigate facilitators and barriers to use of pain management strategies subsequent to the vaccination. All data were collected electronically using REDCap. SPSS version 23.0 and thematic analysis was used to perform all descriptive and inferential analyses.
Results: 89 participants (59%) completed the survey. Most parents reported having enough information about pain management (80, 90%), and felt confident to use (78, 89%) and comfortable to communicate their choice to clinicians (75, 84%). However, the following barriers were identified: lack of support from clinicians, individual discomfort, infant's discomfort, and uncomfortable clinical setting, where breastfeeding, upright holding or sucrose was not supported. Facilitators identified were access to a comfortable environment, supportive clinicians, education, sufficient time, available sucrose, and partner support. Solutions included: being confident and advocating for their infant, having a clinical setting which facilitated parents to comfort their infants, empowering parents, and having clinicians' support.
Discussion/Conclusions: This study contributes to implementation science by determining facilitators and barriers of using effective pain management strategies during vaccination of infants.

CONTACT Shokoufeh Modanloo
Smoda044@uottawa.ca Introduction/Aim: Optimal perioperative pain management is an important public health goal with 10% to 50% of patients reporting chronic postsurgical pain (CPSP). With few head-to-head trials of CPSP preventive strategies, ranking is difficult. Through a systematic review, pairwise and network meta-analyses (NMA) we aimed to rank interventions for efficacy and adverse effects. Our goals are to inform the selection of preventative measures in perioperative practice and guide future investigations. Methods: We searched Cochrane Central Registry of Controlled Trials, MEDLINE, Embase, ClinicalTrials.gov, and WHO ICTRP for double-blind, randomized controlled trials of CPSP prevention in adults. We assessed risk of bias and confidence level in the evidence. Using meta-regression, we evaluated potential effect modifiers. Primary outcomes were treatment effect and potential harm. We used group-level data and estimated risk ratio with random effects.
Discussion/Conclusions: Interventions with "acute post-operative pain benefits" had the greatest effect in reducing CPSP risk. Our ranking suggests that "deafferentation" with neural block may be important. Introduction/Aim: Altered interoception becomes particularly interesting due to its links to chronic pain (Di Lernia et al., 2016), but little is known on how altered interoception might develop, and how it contributes to chronic pain development. Stress-induced dysregulation of the HPA axis functioning is currently discussed as a potential candidate. However, developmental research into the effects of stress on interoception and their role for chronic pain is lacking.
Discussion/Conclusions: The present pilot study constitutes a first step to address the salient research question how the reactivity of the physiological stress axes affects IA in healthy preschool children. Reduced IA after stress induction might be due to difficulties in shifting attention between the adjustments of internal sensations (i.e. heart rate) and external cues (i.e. rating scale with different sized circles as a proxy for heart rate). A next step will be the comparison of interoceptive processes between healthy and preschool children with early life pain.
CONTACT Kim Opdensteinen opdensteinen@uni-trier.de Introduction/Aim: The aim of the study was to characterize the treatments that women entering an interdisciplinary chronic pelvic pain program think will be beneficial for their care.
Methods: This is a cohort study of women who were engaged in a one year interdisciplinary chronic pelvic pain program in Calgary in April 2019. Women are required to have seen a general gynecologist prior to referral. All women are asked what treatments they believe will be beneficial as part of their intake questionnaire. Up to three treatments can be reported per patient Results: 98 women were enrolled. The average age was 39.4, range (21-80) with 9.7 years, range (1-49) of pain. The EQ5D health scale was 48.6 range (10 − 90) (n = 87) and PDI, 38 range (0-64) (n = 97). Most women had at least one surgery: 1.8 range (0-9) (n = 93). Parity ranged from 0-4: average 1(n = 89).
Overall 2 women did not answer the question and 32 women (33%) did not know which treatment(s) would be beneficial while 5 women felt they needed investigations to find a cause. A total of 118 treatment choices were listed in the remaining women A rehabilitation approach was identified in 30 women (31%); 15% believed surgery was required and 13% identified a psychological intervention as beneficial. Medical management (surgery, medication, intervention etc.) was 40% of all treatments required.
Discussion/Conclusions: Most women entering an interdisciplinary chronic pelvic pain do not know what treatments they would benefit from. Identified treatments in descending order included: medical/interventional, rehabilitation and psychological interventions. Introduction/Aim: To compare the change in stability during standing with application of the sacroiliac belt in women with pelvic girdle pain (PGP) and those without.
To evaluate the kinematic changes during standing and the stance phase of walking with application of the sacroiliac belt in women with PGP and those without.
Methods: Five women with PGP were matched to women without pain. Stability was measured with 95% confidence ellipse of center of pressure during standing with the belt off and on. Kinematic studies were performed during standing and the stance phase of walking with and without the belt. Descriptive statistics were used. Wilcoxon signed rank test was used to compare belt conditions and groups.
Results:The CoP data showed improved stability in all women with application of the belt (p = .005). No differences between belt conditions were seen during the stance phase of walking. 8 of 10 women showed internal rotation of the femur with standing following application of the belt (p = .040). During the stance phase of walking, all women showed internal rotation (p = .005) and abduction (p = .005) of the femur with belt use.
Discussion/Conclusions: Similar stability and kinematic changes were seen in women with and without PGP making it impossible to distinguish between the two groups when looking at these parameters.
Introduction/Aim: The aim of the study is to characterize the beliefs of causes of pain in women entering an interdisciplinary chronic pelvic pain program.
Methods: This is a cohort study of women who were engaged in a one-year interdisciplinary chronic pelvic pain program in Calgary in April 2019. Women are required to have seen a general gynecologist prior to referral. All women are asked: "What do you believe is the cause of the pain?" as part of their intake questionnaire.
A total of 137 possible causes were listed in the 98 women. 98 women answered at least one cause, 51 at least two causes, 22 three causes, 3 four causes.
The most common reason women gave for their pain was endometriosis (17% of answers or 23% of women); followed by muscular problems (13% of answers or 18% of women) and neurological (12% of answers and 13% of women). Thirteen women (13% of population) did not know the cause of their pain.
Gynecological reasons were listed as 53/137 of possible etiologies (39%). Over 25 different causes of pelvic pain were identified.
Discussion/Conclusions: Women present with diverse beliefs of their cause of pelvic pain. Only 39% are considered of gynecological origin.

CONTACT Magali Robert
Magali.robert@AHS.ca Introduction/Aim: Complex regional pain syndrome (CRPS) is a severely painful condition that presents with a constellation of symptoms. Our understanding of the pathophysiology of CRPS has evolved over time, as has the diagnostic criteria. Our primary objective was to identify screening and diagnostic tools for CRPS and summarize the feasibility, measurement properties and study quality. A secondary objective was to identify screening and diagnostic tools used for CRPS in pediatric populations (0-21 years of age).
Methods: A systematic review of English articles in electronic databases (PsycINFO, MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science was conducted with the aid of a librarian on November 21, 2018. Studies were included if the tool was a screening or diagnostic tool, the tool included self-report or physical examination, and the primary objective of the study was to evaluate the measurement properties or feasibility. For each study, data was extracted for quality indicators using a QUADAS-2 tool. Results: No screening tools were identified. Four diagnostic tools were identified and met Cohen's criteria for well establishment (Veldman's Criteria, IASP Criteria, Budapest Criteria and the Budapest Research Criteria). There are no well-established diagnostic tools for CRPS in youth.
Discussion/Conclusions: As there are no extant screening tools for CRPS, all people with suspected disease should undergo rapid diagnostic assessment by a clinician. For adults, the Budapest Criteria are the preferred diagnostic tool. Future research is recommended to develop a diagnostic tool for pediatric populations and screening tools for both pediatric and adults.
CONTACT Giulia Mesaroli giulia.mesaroli@sickkids.ca Introduction/Aim: Neuropathic pain (NP) is a chronic health disorder caused by damage to the nervous system. NP is characterized by persistent pain that is often treated with opioids, which produce tolerance and dependence. There is thus a need to find alternative drugs for patients who have NP and are tolerant to morphine. We explored the hypothesis that the cannabinoids Delta-9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD) might be used as analgesics following opioid tolerance. Methods: Wistar rats underwent spared nerve injury and were treated with morphine (5 mg/kg s.c. twice daily) or vehicle for 7 days. They were assessed for tolerance to morphine using von-Frey filaments and tolerant rats were then treated with THC (2.5 mg/kg i.p.) or CBD (20 mg/kg i.p.). In-vivo electrophysiological recording of ON cells in the rostral ventral medulla were recorded after injection of THC (10ug) or CBD (1ug) into the periaqueductal gray in tolerant rats to determine the responses of these cells.
Results: A significant progressive reduction in the anti-allodynic effect of morphine was observed over the 7 days of treatment. THC maintained its anti-allodynic effect in morphine-tolerant (AUC = 19.48 ± 0.71) compared with non-tolerant rats (AUC = 20.82 ± 0.34, p=n. s.). Furthermore, THC produced a modest reduction in the firing rate of ON cells in morphine-tolerant (33.7%), compared to non-tolerant rats (45.7%). Instead, preliminary results showed that the antiallodynic effects of CBD were attenuated in morphine-tolerant animals.
Discussion/Conclusions: Overall, these data suggest that THC, but not CBD, may be an effective analgesic to manage neuropathic pain in morphine-tolerant subjects.
Discussion/Conclusions: Compared to TAP, neuropathy-related-DR/ED was associated with a greater increase in CIPN and neuropathic pain, lower cold PT, and longer TUG, suggesting balance/mobility impairment. Further research characterizing CIPNrelated-DR/ED could improve decision-making and QOL. This prospective observational study was primarily designed to understand nurses' knowledge of the medical use of cannabis in the acute post-operative setting, as well as their beliefs regarding cannabis for medical use. The secondary aim was to understand what influenced these knowledge levels and beliefs. 230 registered nurses aged 20-70 years working in a quaternary care academic health science center participated. Desired knowledge levels across all topics pertaining to medical cannabis use, such as therapeutic indications, potential risks, mechanism of action, routes of administration, and dosing strategies were higher than current knowledge (paired t-test, p < .001). Nurses' current levels of knowledge were rated lowest in the areas pertaining to Health Canada's Marijuana for Medical Access Regulations as well as dosing and creating effective treatment plans for patients using medical cannabis. On average, nurses provided neutral responses to questions pertaining to whether (1) they would be comfortable discussing cannabis for medical use (2) protection from legal liability would improve this level of comfort, (3) they believed patients could die from cannabis overuse, 4) cannabis is a strong analgesic that can be used to treat acute pain, and (5) additional education would improve their confidence to have discussions with or treat patients already using medical cannabis. Clear gaps were identified by RNs describing current versus desired knowledge levels related to the use of medical cannabis, as well as beliefs about the effects of cannabis. Ward-based educational updates, workshops and small group learning opportunities were the most favored educational interventions.
Introduction/Aim: This study was primarily designed to understand nurses' knowledge levels of the medical use of cannabis in the acute post-operative setting, as well as their personal beliefs regarding cannabis for medical use. The secondary aim was to understand factors that influenced these knowledge levels and beliefs. This poster will illustrate knowledge gaps that were identified and provide recommendations for future educational interventions.
Methods: A prospective observational study of surgical nurses (N = 230; aged 20-70 years) in a multicenter quaternary care academic health science center was conducted. The main outcome measures were composite knowledge and belief scores, and predictors that influenced these measures.
Results: Desired knowledge across all topics pertaining to medical cannabis use, such as therapeutic indications, potential risks, mechanism of action, routes of administration, and dosing strategies were found to be significantly higher than current knowledge; all paired t-test p-values < 0.001. Nurses' current levels of knowledge were rated lowest in the areas pertaining to Health Canada's Marijuana for Medical Access Regulations as well as dosing and creating effective treatment plans for patients using medical cannabis. On average, nurses provided neutral responses to five attitude questions pertaining to whether (1) they would be comfortable discussing cannabis for medical use with their patients, (2) protection from legal liability would improve this level of comfort, (3) they believed patients could die from cannabis overuse, 4) cannabis is a strong analgesic that can be used to treat acute pain, and (5) additional education would improve their confidence to have discussions with patients or treat patients already using medical cannabis Discussion/Conclusions: Clear gaps were identified by RNs describing their current versus desired knowledge levels related to the use of medical cannabis, as well as beliefs about the effects of cannabis. Future educational interventions should address these gaps to enable RNs to improve their professional capacity to better address patient and family questions. Ward-based educational updates, workshops and small group learning opportunities were the most favored educational interventions.
Introduction/Aim: Pediatric chronic pain is often categorized into three primary sites: abdominal, headache, and musculoskeletal. Studies have demonstrated increased lifetime risk for depressive and anxiety disorders in children and adolescents with chronic pain. These studies have focused primarily on singular pain sites. The Vi Riddell Pain Program was developed to assess chronic pain of various types in youth for up to 3 years. Our goal was to examine the impact of coexisting multiple primary pain sites on the quality of life and mental health of children enrolled in this program.
Methods: A retrospective analysis of 38 8-to 17-year -olds (73.7% female) attending an outpatient multidisciplinary chronic pain program was performed. Patients completed self-report scales for anxiety, depression (PROMIS), and quality of life (PedsQL). Bivariate correlations were done between average pain scores and mental health, and QoL subscales.
Results: Children with abdominal pain had chronic pain in other sites, most commonly headache (50%). In our cohort, 44.7% of children reported pain that was "always present" and 42% indicated an intensity ≥8/10 in the last week. This group's average pain rating correlated with higher rates of depressive symptoms (r = 0.340, p < .05), anxiety (r = 0.358, p < .05), and decreased QoL (r = −0.445, p < .01).
Discussion/Conclusions: Our findings suggest the symptoms experienced by children with abdominal pain and another chronic pain site are associated with a current reduction in quality of life and increased rates of internalizing mental health disorders. Longitudinal studies to investigate the association between specific pain sites and pain amplification in childhood may be warranted.
Introduction/Aim: Craniofacial disorders involving trigeminal sensory neurons disproportionately affect women. A subset of these neurons expresses transient receptor potential vanilloid 1 ion channels (TRPV1). TRPV1 is activated by capsaicin, and can be sensitized by proinflammatory mediators, including serotonin (5HT), causing an enhanced Ca +2 influx and calcitoningene related-peptide (CGRP) release. Studies in males report that trigeminal neurons co-express 5HT 2A receptors and TRPV1, providing an anatomical substrate for sensitization. Interestingly, we found that peripheral 5HT evokes greater orofacial pain behaviors in proestrus and estrus females. Here, we hypothesized that estrogen fluctuations exacerbate serotonergic sensitization of capsaicin-evoked pain via 5HT 2A receptor.
Results: Capsaicin-evoked nocifensive behaviors were significantly exacerbated by 3 µg 5HT in estrus females and males, whereas by 1.5 µg 5HT in proestrus females. Our preliminary data indicates that blocking peripheral 5HT 2A receptors reduces 5HT effects on nocifensive behaviors in both males and females, and also reduces in vitro capsaicin-evoked CGRP release.
Introduction/Aim: Catastrophizing and disability are primary targets of cognitive-behavioral treatment for chronic pain. According to acceptance and commitment therapy, increased pain acceptance protects against the deleterious effects of pain catastrophizing and pain-related disability. The aim of this study was to further support this rationale by examining whether pain acceptance predicts lower pain catastrophizing and disability 12 months after cardiothoracic surgery in patients who develop persistent post-surgical pain (PPSP).
Methods: PPSP was reported by n = 111 (8.2%) of patients 12 months after surgery (mean age = 56.1 years; 48.6% female; mean NRS pain = 3.36, SD = 2.57). Pain acceptance at 3 months was measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Pain disability and catastrophizing at 12-months were measured using the Pain Disability Index (PDI) and Pain Catastrophizing Scale (PCS), respectively. Correlational and multiple regression analyses were conducted to examine relationships between CPAQ, PCS, and PDI scores.
Discussion/Conclusions: For patients who develop PPSP, treatments emphasizing pain acceptance may reduce catastrophizing and disability in the long-term by fostering greater re-engagement with valued life activities.
Introduction/Aim: Chronic pain in youth is a growing epidemic that adversely affects psychosocial and functional domains. The Intensive Pain Rehabilitation Program (IPRP) at the Alberta Children's Hospital attempts to alter these adverse effects via multidisciplinary rehabilitation through a 3-to-6-week, daytreatment model. This program focuses on improving pain self-management skills utilizing interventions from psychologists, family and art therapists, nurses, anesthesiologists, and physical and occupational therapists. Research into the role of physical activity in chronic pain rehabilitation has been limited and largely conducted in adult populations. However, favorable results have been found related to pain severity and physical functioning, which is closely linked to painrelated fear. The present study examined change in selfreported pain interference, fear of pain, and functional disability along with preliminary physical therapy data following youth participation in IPRP.
Methods: Thirty-eight adolescents completed measures of pain interference, fear of pain, and functional disability at baseline (pre-IPRP) and discharge (post-IPRP). Preliminary physical therapy data (n = 11) examined included the Six Minute Walk Test (6MWT), an objective assessment of functional exercise capacity. Paired sample T-tests were used to examine change between baseline and discharge of the IPRP program.
Results: Between baseline and discharge youth reported less pain interference (p = .002), fear of pain (p = .001), and disability (p = .003). The preliminary physical therapy data illustrated an improvement in the 6MWT (p = .046) following physical therapy within IPRP.
Discussion/Conclusions: Findings show that youth attending IPRP report less pain interference, fear of pain, and disability. In addition, youth are experiencing objective improvements in their functional exercise capacity. Introduction/Aim: Multimodal treatment (MMT) and day-hospital intensive interdisciplinary pain treatment (IIPT) are common interventions prescribed to youth with pain-related disability. Rarely have these two models been compared. Our study aimed to evaluate and compare the outcomes and perceived impacts of IIPT and MMT provided at the same facility.

ORCID
Methods: A mixed method convergent design was used. Forty-four IIPT and 138 MMT youth completed the PROMIS Pain Interference for Youth and Children and the PedsQL 4.0 Generic Core Scale at admission, 3 and 12-months post-program. Sixteen IIPT and eight MMT youth and parents then agreed to be interviewed. Questionnaire data was analyzed using longitudinal mixed modeling, while themes were generated from interview transcripts and compared.
Results: The IIPT group demonstrated significant improvement at 3-months and 12-months on the PROMIS Pain Interference. Significant improvements in the PedsQL were noted in both groups across timepoints, with a trend toward more improvement in the MMT group. Themes demonstrated that IIPT youth and parents were confident and empowerment in managing the pain, as compared to those in the MMT. However, IIPT youth described more academic and social repercussions upon their return from the program, than those enrolled in MMT, where academic and social supports were perceived to be intact.
Discussion/Conclusions: Comparing IIPT and MMT specialized pain treatments underscores the positive outcomes experienced by youth in both groups, and highlighted youth most likely to benefit from each program.
Introduction/Aim: Chronic pain affects 1 in 5 youth, and often requires complex multimodal management strategies. Resources on pharmacological management of chronic pain are lacking for youth. Improved health literacy, developed through patient education has been linked to positive patient outcomes. To increase pediatric chronic pain medication literacy, we propose the development of a pain medication resource for youth living with chronic pain, informed by youth with chronic pain.
Methods: The survey was distributed via Canadian community pediatricians, pain clinic distribution lists and social media. Youth, their caregivers, and healthcare providers were surveyed about information youth need to inform their decisions about chronic pain medication. Youth were surveyed about where they currently acquire information. Data was coded and analyzed.
Results: Sixty-eight participants completed the survey, 36 healthcare providers, 22 youth, and 10 caregivers. Information on drug side effects, medication alternatives, dosing, effects of long-term drug use and the role of medication in managing chronic pain were top areas of interest among participants. Primary sources of health information for youth are their doctor, the internet, and pharmacists. Youth indicated they would utilize an interactive resource such as a website or app to access information about chronic pain, medications, and to connect with other youth living with chronic pain.
Discussion/Conclusions: Medication side effects are of top concern when choosing a medication. A resource for youth containing reliable health and medication information would help empower youth to advocate for themselves and make educated health decisions, resulting in improved disease management and health outcomes.
CONTACT Sehjal Bhargava srb158@mail.usask.ca Introduction/Aim: Psychophysical characteristics of patients with chronic back pain have been shown to be heterogeneous. Identifying subgroups with different clinical profiles may inform tailored management and improve outcomes. The objective of this study was to identify clinical profiles of children and adolescents that have similar psychophysical characteristics of chronic back pain. Methods: One hundred and ninety-eight patients with chronic back pain were recruited for the study. Pain assessment was mainly conducted in the form of an interview and with the use of validated pain-related questionnaires assessing their psychosocial factors and quality of life. All patients underwent mechanical and thermal quantitative sensory tests assessing detection and pain thresholds, and conditioned pain modulation efficacy.
Results: Hierarchal clustering partitioned our patients into three clusters. Cluster 1 represented 45.5% of the patients and was characterized by a higher pain threshold and lower psychosocial factors. Cluster 2, representing 35.4% of the cohort was considered to have low psychosocial factors and low pain thresholds. And finally, Cluster 3, 19.2% of patients had increased psychosocial factors and low pain thresholds.
Discussion/Conclusions: This study identified clinical profiles of children and adolescents experiencing chronic back pain based on specific physical and psychosocial characteristics highlighting that chronic pain treatment should address underlying nociceptive and non-nociceptive mechanisms.
CONTACT Don Daniel Ocay don.ocay@mail.mcgill.ca Introduction/Aim: Pathological pain is one of the most common causes of debilitation worldwide and is induced by perturbations within the nociceptive signaling pathway. The spinal cord superficial dorsal horn (SDH) is a crucial component along this pathway and exhibits increased excitability during pathological pain. One process thought to govern this increased excitability is synaptic plasticity, in the form of long-term potentiation (LTP) of SDH neurons. However, the SDH is comprised of a poorly characterized, heterogeneous neuronal population. Therefore, we combined patch-clamp electrophysiology with optogenetics in single SDH neurons to determine which neuronal populations are capable of undergoing LTP. Methods: We obtained acute L4-L6 parasagittal slices from adult TRPV1-ChR2 transgenic mice and recorded from individual SDH neurons using patchclamp electrophysiology. We then excited SDH neurons using selective optogenetic stimulation of TRPV1+central terminals via patterned light stimulation with a 488 nm LED, and measured resultant optogenetic excitatory postsynaptic potentials (oEPSPs).
Results: Selective optogenetic stimulation of TRPV1 +central terminals produced oEPSPs in 12/12 (100%) SDH neurons. For each neuron, LED intensity was optimized to produce oEPSPs resembling spontaneous EPSPs. An optical stimulation paradigm (2 Hz for 2 minutes) was then used to induce SDH neuron synaptic plasticity and produced LTP in 4/8 (50%) neurons. We then grouped SDH neurons by firing type and morphology to determine potential cell-type differences in their capacity to undergo LTP.
Discussion/Conclusions: Our findings demonstrate the capability of individual SDH neurons to undergo long-term potentiation, concomitantly defining the neuronal populations contributing to increased excitability observed in pathological pain conditions. Introduction/Aim: Executive functioning deficits (e.g., difficulties in working memory) are often reported by chronic pain patients and relate to functional disability. Among youth, chronic pain is associated with notable impairment in school-related functioning, particularly in the realm of academic performance (i.e. declining grades). Despite the link between working memory and school functioning, this specific relationship has not been investigated in pediatric chronic pain. Therefore, the aim of this study was to investigate the extent to which working memory interferes with academic functioning among adolescents with chronic musculoskeletal (MSK) pain.
Results: To test the hypothesis that working memory accounts for variance in academic performance above and beyond pain intensity, a hierarchical regression analysis was conducted. Academic performance was regressed onto pain intensity in the first step and academic performance was regressed onto working memory in the second step. Results indicated that working memory accounted for an additional 22% of the variance in academic performance above and beyond that of pain intensity [Δr2 =.22, b =.48, t(26) = 2.79, p =.01].
Discussion/Conclusions: Results suggest that working memory is associated with academic performance above and beyond pain intensity among adolescents with chronic pain. Understanding how specific domains of EF relate to academic performance could inform school-based EF interventions for youth with chronic pain. Introduction/Aim: For many individuals, adverse effects are as important as symptom reduction when deciding whether to use a treatment. In the context where chronic pain (CP) treatment is characterized by off-label prescribing, polypharmacy and multimorbidity, results of premarketing studies should always be complemented by real-world evidence. This study aimed to document the most frequent side effects associated with CP treatment in the context of realworld practice. Methods: Between June and October 2019, a web-based cross-sectional study was conducted in a community sample of adults suffering from CP (Quebec, Canada). Participants completed a standardized checklist about presence and severity (mild, moderate, severe) of 19 side effects that could be associated with their pain medication.
Discussion/Conclusion: Our results could help establish priorities in terms of support that could be offered to CP sufferers. Using multivariate analysis, next steps will include the identification of socioeconomic (e.g., sex, gender) and clinical factors (e.g., pain characteristics, use of nonpharmacological treatments, access to care) associated with such side effects. Introduction/Aim: Chronic pain (CP) patients often report cognitive concerns, such as perceived deficits in working memory (WM). WM involves the cognitive maintenance and manipulation of information for short periods of time and is essential for daily functioning. WM has typically been assessed using self-report questionnaires in clinical CP samples or with experimental pain and WM tasks in healthy samples. A key gap in knowledge exists regarding whether individuals with CP show WM deficits on performance-based neuropsychological measures. Therefore, the aim of this study was to determine if CP status predicts performance in an experimental performance-based WM task. Methods: Emerging adults (N = 81, M age = 18.9, 51.2% female, 78.6% Caucasian, 58.9% with CP) completed a computerized version of an auditory digit span task (WM capacity) and a pain history questionnaire as part of a larger study investigating relationships among cognition, emotion, and pain perception.
Results: A linear regression analysis revealed that approximately 11% of the variance in WM capacity was accounted for by CP status (F(1, 79) = 5.78, p =.02). There was a moderate, negative relationship between CP and WM capacity such that CP (current and/or past) was associated with lower WM capacity (b =.26, t(79) = 2.41, p =.02).
Discussion/Conclusions: Results suggest that CP may be associated with WM deficits in terms of both perceived deficits in daily functioning as well as performance on objective WM measures. The immediate and long-term influence of WM on treatment outcomes and functional disability in CP necessitate further investigation. . The aim of this study is to assess the efficacy of non-pharmacological interventions for preterm procedural pain, excluding kangaroo care, music and breastfeeding. Methods: We searched multiple databases for relevant articles published before April 2019. Participants included preterm infants that were less than one month old. Only randomized controlled trials (RCTs) or RCT cross-over designs that had a no-treatment comparison group were eligible for inclusion in the analyses. Studies examining additive effects of an intervention were also included. Analyses were run separately for thirteen different intervention categories and two pain response types (pain reactivity and immediate pain regulation). Each intervention category was comprised of at least two studies.
Discussion/Conclusions: Non-pharmacological interventions can be effective for reducing pain reactivity and immediate pain regulation for hospitalized preterm infants, and should continue to be evaluated. Introduction/Aim: Sensitivity to pain traumatization (SPT) is a recently-developed construct measuring the propensity to develop responses to pain that resemble a traumatic stress reaction. SPT may be a risk factor for the co-occurrence of chronic pain and PTSD. Parents of youth with chronic pain report significant PTSD symptoms, with a proportion reporting their child's chronic pain as their most traumatic event. The Sensitivity to Pain Traumatization Scale (SPTS-12) was recently developed for use in adults. This study aimed to develop and validate the parent version of the Sensitivity to Pain Traumatization Scale (SPTS-P) and examine its relation to future parenting behaviors and child pain-related outcomes. Methods: 141 youth (72.3% girls) aged 10-18 years (M = 14.28) referred for tertiary-level treatment of A52 RESEARCH POSTER ABSTRACTS chronic pain and one of their parents (92.2% mothers) completed online surveys at baseline and 3 months later. Parents completed the SPTS-P and measures of PTSD, depression, and parenting behaviors. Youth completed measures of pain and psychosocial functioning.

ORCID
Results: Exploratory factor analysis revealed a onefactor structure for the SPTS-P, consistent with the original SPTS-12, that accounted for 37.2% of the variance. One item had poor fit. The SPTS-P demonstrated good reliability and validity. Parent SPT at baseline was positively related to maladaptive parenting behaviors (protectiveness and monitoring) at follow-up (r s =.36-.48, all p <.001) and was unrelated to child outcomes at follow-up.
Discussion/Conclusions: The SPTS-P is a psychometrically-sound measure. Importantly, parents with higher SPT were more likely to engage in parenting behaviors that are associated with greater disability in youth with chronic pain. Introduction: Juvenile Fibromyalgia (JFM) is a chronic widespread pain condition affecting primarily adolescent girls. Although hypersensitivity to pressure pain has been observed in patients with JFM, its underlying brain mechanisms remain unknown. Methods: We characterized brain responses to pressure pain in 18 adolescents with JFM and 24 healthy adolescents (female, ages 13-17) using fMRI. Participants received 12 noxious pressure stimuli (2.5 or 4 kg/cm2, each lasting 10 s, applied to the left thumbnail) and rated pain intensity and unpleasantness on a 0-100 visual analogue scale.
Conclusions: We found a paradoxical attenuation of thalamic responses to pressure pain in hyperalgesic adolescents with JFM, potentially compatible with reductions in peripheral nociceptive input. This finding was paradoxically accompanied by near-normal responses in a brain marker of nociceptive pain and a trend toward over-expression of a brain marker of fibromyalgia pain, suggesting potentially amplified responses in other pronociceptive neural circuits.  [2009][2010][2011][2012] and provincial administrative databases. Among participants reporting suffering from CP in the survey, the annual number of healthcare contacts was computed during the 5 years preceding the questionnaire completion. Group-Based Trajectory Modeling (GBTM) was used to identify subgroups of individuals following similar patterns of healthcare utilization over time.
Discussion/Conclusions: GBTM is an innovative approach to better define healthcare utilization profiles. Next steps will be to examine sociodemographic determinants of healthcare trajectories and their impact on clinical outcomes. Introduction/Aim: Pain of invasive procedures (~10per day) in the neonatal intensive care unit is associated with altered stress hormone (cortisol) regulation, which may contribute to high internalizing (anxiety/depressive) symptoms in children born very preterm. It is unknown whether parenting behaviors ameliorate A54 RESEARCH POSTER ABSTRACTS effects of neonatal pain on cortisol levels across childhood and later internalizing behaviors in these children. We aimed to examine how early pain is associated with patterns of cortisol expression across early childhood and subsequent internalizing problems at 4.5 years, and the role of mother interactive behaviors, to uncover pathways of resilience in this vulnerable population.
Methods: Longitudinal prospective cohort study of infants born very preterm (24-32 weeks gestation) seen at 1.5, 3, 4.5 years. Salivary cortisol was measured three times at each age, and mother-child behaviors filmed (1.5 and 3 years). Internalizing behavior at age 4 was assessed by mother-completed Child Behavior Checklist (CBCL 1. .
Results: Girls of less intrusive mothers were more likely to display stable low cortisol levels across development. Moreover, girls with persistent low cortisol across early childhood were reported by parents to show fewer anxiety and withdrawal behaviors, com-pared to children with high cortisol across childhood. In boys only, neonatal factors were more related to a pattern of high stable cortisol expression.
Discussion/Conclusions: Our findings inform understanding of the role of parenting behaviors in optimizing child stress regulation and internalizing behaviors in children born very preterm. This work advances knowledge of mechanisms of recovery following early life pain in very preterm children. Introduction/Aim: Pain is a primary reason individuals attend an Emergency Department (ED). Long wait times negatively impact patients' experience of pain. Change in symptoms and physiologic variables were measured at 3 time points pre/post a 10 minute therapy dog visit in ED patients who experienced pain. Methods: Using a randomized controlled design, pain, anxiety, depression and well-being were measured with an 11-point rating scale before, immediately after, and 20 minutes post-visit. Blood pressure and heart rate were recorded at the time points. Control data was gathered twice (30 minutes apart). A two-way ANOVA was conducted to compare effects of dog therapy condition on the dependent variables.

ORCID
Results: Participants (n = 198) were 41% female, with a mean age of 58 years. Pain was shown to decrease significantly (mean change = 0.9, SD = 2.05) or almost one value lower on a 0 to 10 scale, in the intervention group compared to no change in control [F(1,193) = 8.54, p = .004, η p 2 = .04]. Anxiety also lowered one numerical value with the intervention compared to control (mean change = 1.13, SD = 2.80) [F(1,193) = 7.95, p = .005, η p 2 = .04]. Depression (mean change = 0.72, SD = 1.71) and well-being ratings (mean change = 0.87, SD = 1.84) similarly decreased for the intervention group. Blood pressure and heart rate had no significant differences in both groups.
Discussion/Conclusions: Clinically significant changes in pain were observed in the therapy dog intervention compared to control. The findings of this novel study contribute important knowledge toward the potential value of ED therapy dogs to affect patients' experience of pain, and related measures of anxiety, depression and well-being. Methods: Male and female C57Bl/6J mice were induced with experimental autoimmune encephalomyelitis (EAE), which models the inflammation, autoimmunity, and demyelination that occurs in human MS. The analgesic efficacy of the KOR agonist U50,488H (1.6-30 mg/kg, i.p.) was measured using von Frey filaments. At first signs of clinical symptoms, brains and spinal cords were isolated and fluorescent in situ hybridization (FISH) used to quantify KOR and dynorphin mRNA levels. Western blots were used to measure changes in KOR protein expression.

ORCID
Results: Mice with EAE showed significantly less U50,488H analgesia compared to control mice. This correlated with a reduction in KOR mRNA and total protein levels in the spinal cord. Dynorphin mRNA levels were not significantly changed.
Discussion/Conclusions: These data indicate that KOR agonists are less effective in EAE. This loss of analgesic activity correlated with a reduction in protein and mRNA expression in the spinal cord. These results are in contrast to what have been described in other models of neuropathic pain, and suggest unique disease mechanisms in this animal model of MS. Results: A repeated measures t-test demonstrated a significant decrease in pain duration from before implant (M = 63.26 hours, SD = 83.78 hours) to longterm follow-up (M = 8.49 hours, SD = 29.10 hours; t (15) = 2.74 p = .015). There was also a significant decrease in spasticity burden from before implant (M = 57.13, SD = 4.06) to long-term follow-up (M = 43.73, SD = 3.91; t(14) = 4.02, p = .001). Pain interference and pain intensity displayed no significant change at long-term follow-up. In this pilot use of the MSSS-88 in CP, the scale demonstrated preliminary validity as scores correlated with pain interference (r = 0.48, p = .006) and intensity (r = 0.47, p = .007).

ORCID
Discussion/Conclusions: These initial analyses suggest that the immediate reduction in pain duration and spasticity burden previously reported are still present nearly four years after ITB implant. Introduction/Aims: Studies have revealed alarmingly high rates of opioid misuse among patients with chronic pain. To date, the contribution of sleep problems to opioid misuse in these patients has yet to be systematically investigated. The main objective of this study was to examine the associations between sleep quality and different types of opioid misuse behaviors among patients with chronic pain prescribed opioids. We also examined the factors that could mediate associations between sleep quality and opioid misuse behaviors.
Methods: In this longitudinal diary study, 103 patients with chronic pain prescribed opioids were recruited. Patients completed measures of sleep quality, pain intensity, negative affect, and opioid craving for 14 consecutive days. Saliva samples were also collected to assess cortisol (i.e., HPA axis) activity, and opioid misuse behaviors (i.e., opioid overuse, using opioids for other reasons than pain, borrowing opioids) were assessed using a validated self-report instrument.
Results: Poorer sleep quality was associated with opioid overuse (−.29, p < .01), but not with any other types of opioid misuse behaviors (both p's > .05).
Poorer sleep quality was associated with heightened pain intensity (p < .001), negative affect (p < .001), and opioid craving (p < .001), but the association between sleep quality and opioid overuse was neither mediated by these variables nor by HPA axis activity (all p's > .05).
Conclusions: Our findings suggest that sleep problems might lead to the overuse of opioids. Interventions designed to improve sleep quality might contribute to reducing opioid misuse among patients with pain.

ORCID
Alberto Herrero Babiloni http://orcid.org/0000-0001-5588-5916 Introduction/Aim: A preoperative pain biomarker would provide an objective measure of pain intensity to help identify patients at risk of poor pain management and provide better targeting pharmacological treatments before surgery. Interleukin-8 (IL-8) is studied as a pro-inflammatory biomarker of pain and is shown to be upregulated in the cerebrospinal fluid (CSF) in acute and chronic pain states. The aim of this study is to evaluate IL-8 as a proxy of pain between patients with and without pain prior to a major orthopedic surgery.
Methods: Seventy patients with adolescent idiopathic scoliosis scheduled to undergo corrective surgery were recruited in this study. CSF samples were collected before opioid injection on the day of surgery, processed and stored pending analysis. Patients self-reported their pain scores on the morning of surgery, 24 hours, 48 hours and 6 weeks after surgery using a numerical rating scale. Chi-squared tests were utilized to identify differences in patients reporting pain and no pain between low/high IL-8 concentration groups.
Discussion/Conclusions: These findings suggest that CSF IL-8 is not a reliable proxy of preoperative pain in pediatric patients undergoing orthopedic surgery. This may be due to the synergistic effect of multiple combinations of anesthetics given to subjects prior to CSF collection which can alter IL-8 transcription. Introduction/Aim: The complex, high-stress neonatal intensive care unit (NICU) environment poses challenges for optimal pain management for healthcare providers (HCPs) including the demanding workload, unpredictable patient conditions, and frequent distractions and interruptions. The NICU environment manifests organizational contextual factors (e.g., organizational culture, resources, leadership) that can influence or modify the successful implementation and delivery of neonatal pain practices. We explored stakeholder perspectives (HCPs, unit managers, senior leaders) about how organizational contextual factors influenced the implementation of the Infant Pain Practice Change (ImPaC) Resource, a multifaceted web-based strategy targeted to change pain practices, in the NICU. The aim was to collect data from the first of four data collection sites to inform future data collection processes.
Methods: One-hour individual, semi-structured interviews were held with five stakeholders (2 HCPs, 1 NICU manager, 2 senior leaders) at a single Canadian, academically affiliated pediatric hospital. The interviews were guided by the Consolidated Framework for Implementation Research, and data were analyzed using an interpretive descriptive approach to qualitative analysis.
Results: Factors associated with effective implementation of the ImPaC Resource included the development of an interdisciplinary pain committee, a culture open to change and excellence in service delivery, available resources (dedicated time, funding, personnel), advocacy from senior leaders, buy-in from unit managers, and prioritization of pain prevention and treatment.
Discussion/Conclusions: Findings highlight key factors considered by HCPs, senior leaders and middle managers as associated with effective implementation of the ImPaC Resource in the NICU.
CONTACT Shelly-Anne Li shellyanne.li@mail.utoronto.ca Introduction/Aim: Painful events provide powerful social learning opportunities for children. For younger children, parents are the primary socialization agents of painful events. Previous research has shown that parents reminisce less adaptively about past painful versus sad events, raising questions about the socio-cultural attitudes about, and avoidance of, pain. Further, parent-child reminiscing about past pain has been linked to children's behavioral expression of empathy for others' pain. However, little is known about why parents avoid discussing pain with their children. The present study examined parental meta-beliefs about discussing pain and their links to parent-child reminiscing and socio-emotional skills.
Methods: Parental meta-beliefs were elicited through interviews with 113 parents of 4-year old children, analyzed using thematic analysis and coded for overall avoidance of discussing pain. Parents also reported on their children's socio-emotional functioning and reminisced about a past painful event with their child. Relations between reminiscing elements and socioemotional functioning were analyzed.
Results: Thematic analysis revealed common parental beliefs about risks and benefits of discussing pain (e.g., normalizing painful experiences, teaching empathy, or instilling fear). Parents who believed in the benefits of discussing pain used elements of adaptive reminiscing with their children. Further, their children had better developed theory of mind, and prosocial and emotion-regulation skills (rs ranged |.21-.26|, ps <.05).
Discussion/Conclusions: Parents hold diverse metabeliefs about discussing pain, which are associated with their reminiscing styles and children's socio-emotional functioning. Better understanding of parental metabeliefs may elucidate the process of pain socialization in children and its role in children's pain trajectories. Introduction/Aim: Chronic pain is associated with suicidality (ideation, plans, attempts), a relationship not fully explained by psychiatric comorbidity. This study described characteristics of chronic pain (presence of usual pain/discomfort) and the prevalence of suicidality across pain conditions (arthritis, migraine, back pain). Associations between usual pain/discomfort and suicidality across pain conditions were also examined.
Methods: We analyzed data from the 2012 Canadian Community Health Survey-Mental Health supplement (N = 25,113). Weighted cross-tabulations described pain characteristics and the prevalence of suicidality according to pain condition. Multiple logistic regressions examined associations between the presence of usual pain/discomfort (reference = absence of usual pain/discomfort) and suicidality among each pain condition.
Results: Across pain conditions, the prevalence of usual pain/discomfort ranged from 40-55%. The prevalence of suicide ideation, plans and attempts was 15-24%, 6-10%, and 5-9%, respectively, among individuals with pain conditions. After adjusting for sociodemographics and psychiatric conditions, usual pain was associated with significantly increased odds of suicide ideation (AOR = Discussion/Conclusions: By elucidating the complex nature of suicidality among those with chronic pain, our findings may facilitate a more targeted approach to screening in this population.
CONTACT Bronwen Grocott grocottb@myumanitoba.ca Introduction/Aim: It is important that pain providers speak with patients/parents about the link between obesity and chronic pain in youth. The specific weight term used when speaking with adults impacts treatment initiation. The aim of this study was to investigate parental response to pain physician's use of weight terminology and education when conveying painrelated information.
Methods: Participants (N = 268 parents) read a vignette about a parent bringing his/her adolescent daughter to a pediatric pain provider, and completed a 14item questionnaire about pain treatment. Vignettes varied according to a 2 × 3 design (pain/obesity education: presence/absence; weight term: obesity, excess body weight, BMI). An exploratory factor analysis (EFA) of questionnaire items was conducted to increase the reliability of the dependent variables. A two-group between-subjects multivariate analysis of variance (MANOVA) was conducted.
Results: EFA yielded a two-factor solution: acceptability of information and personal responsibility toward treatment plan. There was a significant main effect of weight term (p < .05) with term specifically affecting Acceptability (p < .05), but not Personal Responsibility (p > .05). Parents found the physician's message more acceptable when the term "BMI" was used, compared to when "obesity" was used. Whether or not the physician provided education regarding the relationship between pediatric chronic pain and obesity did not impact parental perceptions.
Discussion/Conclusions: Results suggest that weight terminology significantly influences parents' perception of the acceptability of the physician's message. Use of a more clinical/stigmatizing term (i.e., obesity) results in reduced acceptability of the message, which may negatively impact adherence to pain treatment plans and continuity of care. Respite workers are common secondary caregivers of children with I/DD. Using vignette methodology, we sought to examine whether receiving a~4-hour pain or control training impacted respite workers' determination of the presence/absence of pain and the factors considered. Methods: As part of a larger randomized controlled trial (#NCT03421795), 158 respite workers were randomly assigned to receive a pain specific (58 female, 8 male; M age : 29.78) or general care control training ("F-words in childhood disability"; 81 female, 10 male; M age : 31.30). Prior to the training and at follow up (4-6 weeks later), participants read a vignette involving a nonverbal child and indicated whether they believed the child was in pain (yes/no/maybe) and what factors influenced their decision. Frequency and Chi-square analyses were used to examine responses and compare them across groups, respectively.
Results: No significant differences existed between groups in decisions about the presence of pain at pre-training (X 2 = 0.37, p =.83) or follow up (X 2 = 0.65, p =.721). At follow up, both pain training (30.8%) and control groups (32.3%) most commonly reported considering knowledge of the child (i.e. likes/dislikes/temperament) whereas participants who received the pain training were more likely to report considering environmental/situational factors (X 2 = 5.26, p <.05).
Discussion/Conclusions: Pain training led to increased consideration of environmental factors suggesting it may promote awareness of the role of social/ contextual factors in pain.
Introduction/Aim: Parents' use of evidence-based strategies for managing children's vaccination pain can be influenced through knowledge translation (KT) interventions. This study assessed factors related to parents' planned, actual, and future use of pain management strategies at a vaccination appointment following exposure to a vaccination pain management KT intervention.
Methods: Parents of children aged 0-17 reviewed an evidence-based information sheet on vaccination pain management strategies disseminated through an online survey. They reported their impression of the information sheet and plans to use the pain management strategies at an upcoming vaccination via an online survey based on the Information Assessment Method for Parents. Following their child's vaccination, parents completed another survey and reported their actual strategy use, confidence, and plans for future use.
Results: 128 parents completed both surveys. Most parents who planned to use a pain management strategy reported actual use during their child's vaccination (90%, n = 115). Parents who found the information relevant were 9.76 times more likely to use at least one recommendation. Parents who felt confident in their use of strategies during vaccination were 4.23 times more likely to plan to continue using strategies at future vaccinations.
Discussion/Conclusions: This study supports the effectiveness of parent-directed knowledge translation interventions to promote uptake of evidence-based pain management strategies, while also supporting parents' confidence and plans to continue using strategies. These findings highlight the importance of creating KT interventions which are relevant to parents and easily accessible in order to promote uptake of evidence-based vaccination pain management strategies for children.
symptoms, may also modulate the degree of impact sensory disturbances have.
Methods: Patients undergoing lumpectomy or mastectomy with or without axillary surgery (sentinel node or axillary dissection) completed electronic questionnaires preoperatively and at postoperatively at 2-weeks, 3-months, 6and 12-months. The Breast Cancer Pain Questionnaire (BCPQ) longitudinally assessed pain severity, frequency, and degree of sensory disturbance (questions similar to S-LANSS and DN4). The Brief Symptom Index 18 was used to assess somatization.
Discussion/Conclusions: The degree of sensory disturbance experienced by patients was predicted by younger age, axillary surgery, preoperative pain, somatization, and temporal summation on QST. Future perioperative interventions to reduce nerve injury and treat neuropathic symptoms may well be targeted to these higher risk individuals to minimize or prevent chronic post-mastectomy sensory disturbance and pain.
Introduction/Aim: Pain catastrophizing has been associated with greater pain severity, longevity, and impact in various types of persistent pain, including postsurgical pain. We investigated the trajectory of pain catastrophizing (rumination, magnification, and helplessness) regarding pain, and its relation to general somatization and pain severity in the first year after breast surgery.
Methods: Women (n = 259) undergoing lumpectomy, simple mastectomy, and mastectomy with reconstruction were recruited preoperatively to complete validated questionnaires capturing demographics, psychosocial characteristics, including catastrophizing (Pain Catastrophizing Scale), somatization (Brief Symptoms Inventory-18), and affect (Positive and Negative Affect Schedule). Additionally, a brief bedside sensory test of temporal summation of mechanical pinprick pain was conducted. Pain and psychosocial variables were assessed postoperatively out to 1 year after surgery.
Discussion/Conclusions: These findings illustrate that pain catastrophizing varies substantially amongst individuals having surgery for breast cancer, however plays a more prominent role amongst women having reconstructive surgery. Higher preoperative pain catastrophizing scores in the preoperative period suggests that preoperative interventions directed toward A64 RESEARCH POSTER ABSTRACTS Introduction/Aim: Sleep disturbance is often associated with pain persistence and is an important negative sequela that may occur post-surgically. In this prospective longitudinal study of women undergoing breast cancer surgery, we investigated sleep disturbance preoperatively and periodically up to one year. We assessed the relationship of demographic, medical, and psychological factors with sleep disturbance, and its association with acute and persistent postsurgical pain.
Methods: Women ages 18-80 (n = 259) underwent breast-conserving surgery, mastectomy, or mastectomy with reconstruction. PROMIS Sleep Disturbance short form captured extent of sleep disturbance preoperatively and at 2 weeks, 6 and 12 months after surgery. Pain severity, frequency, and physical, cognitive and emotional impact of pain, as well as psychosocial traits, and sensitivity to pain using a brief bedside quantitative sensory test were also longitudinally assessed.
Results: Sleep disturbance was variable amongst individual patients but stable over the course of the study, and moderately correlated with pain at all timepoints (Rho = 0.14-0.51,p's<0.001). Greater sleep dis-turbance was also associated with younger age ( Discussion/Conclusions: Sleep disturbance varies amongst individuals in the first year after surgery, and is associated with postsurgical pain, younger age, general pain sensitivity on QST, and psychosocial functioning. Introduction/Aim: Nociceptive flexion reflex (NFR) is utilized as a biomarker of spinal nociceptive processes. A contact heat evoked potential stimulator (CHEPS) was used to elicit spinal reflex responses from A-delta afferents. While underpowered, this exploratory work aimed to 1) establish the feasibility of testing the NFR using a CHEPS in cerebral palsy (CP), and 2) examine any differences between CP and controls to generate future hypotheses.
Methods: A CHEPS was used to apply 60 stimulus trials to the forearm and lower leg in high functioning women with CP (n = 10; M age = 20.66 years, SD = 2.36) compared to typically developing women (TD; n = 10; M age = 20.51 years, SD = 2.22). Monopolar surface electromyography (EMG) electrodes were placed on the biceps femoris and biceps brachii muscles. The rectified mean and peak EMG were obtained from 90-150 ms after stimulation to quantify the NFR. Z-scores were calculated relative to the 5-65 ms pre-stimulus data. Data were averaged across trials. Participants reported pain intensity using the numeric pain rating scale post-stimulus.
Results: There was no significant difference in mean (t(18) = 1.02, p = .32) or peak (t(18) = 1.68, p = .11) EMG Z-scores between groups. However there was a medium effect size for mean EMG (d = 0.45) and large effect size for peak EMG (d = 0.75) indicating reduced physiologic response in CP. There was no significant difference in pain ratings between groups (t(12.51) = 0.20, p = .84; d = 0.09).
Discussion/Conclusions: Initial findings suggest that subjective pain experiences from CHEPS are similar between women with CP and controls while physiologic responses may be attenuated in CP.
CONTACT Cole Hagen colehagen@gillettechildrens.com Introduction/Aim: Abdominal pain is one of the main symptoms of Inflammatory Bowel Diseases (IBD) and often persists beyond clinical remission. Although we have a good understanding of the mechanisms of peripheral sensitization during colitis, little is known about the central sensitization. Recent work from our lab showed that G-CSF released from activated microglia was able to sensitize gut-innervating TRPV1+ colonic nociceptors that converge in the spinal cord and cause visceral sensitization. Here, we investigated the role of TRPV1+ visceral afferents in central sensitization during colitis. Methods: To assess the role of TRPV1+ colonic afferents in central sensitization, we used a chemogenetic approach to inhibit the activity of TRPV1+ sensory neurons selectively. Six-week-old mice expressing the Gicoupled DREADD (Designer Receptors Exclusively Activated by Designer Drugs) in TRPV1+ neurons were subjected to DSS treatment (2.5%, 7 days). One group was injected twice daily with the DREADD ligand Clozapine N-oxide (CNO) and visceromotor responses were evaluated by colorectal distension.

Results:
The vast majority of TRPV1-and CGRPlabeled neurons expressed the HA-tagged Gi-DREADD in dorsal root ganglia (DRG) demonstrating efficient cre-recombinase activity in small peptidergic neurons. In vitro experiment in cultured DRG neurons from Gi-DREADD mice revealed that CNO exposure induced a significant decrease in capsaicin-evoked currents. CNO exposure, in vivo, produced a decrease in DSSinduced visceral hypersensitivity compared with vehicle-injected mice.
Discussion/Conclusions: Overall, these data provided novel insights in our understanding of the mechanisms of chronic abdominal pain conditions and could be harnessed for developing effective therapeutic approaches to relieve pain in IBD.
Introduction/Aim: A projected increase in osteoarthritis prevalence will result in a correlated increase in total joint arthroplasties (TJA). In many settings, fast-track surgery and ERAS-style perioperative protocols contribute to shorter hospital stays. Early discharge after TJA tasks patients with self-managing postoperative pain that may be severe. Prescribed opioids are necessary to help patients stay on post-TJA physiotherapy pathways, increasing the likelihood of regaining quality of life previously lost to osteoarthritis. The clinical audit reported here begins to explore opioid oversupply and retention following discharge after TJA.
Methods: A cross-sectional survey was developed based on available evidence and clinical experience of the authors. Eight questions concerning post-discharge opioid prescriptions were administered by telephone to 20 participants four weeks after hip or knee TJA at a major hospital in western Canada.
Results: All participants (n = 20) filled an opioid prescription after discharge. Four weeks postoperatively, 15 (75%) were no longer taking daily opioids. Four patients took all of their prescribed opioid; 4 intended to bring unused opioid to a pharmacy for disposal; and 12 intended to keep unused opioids for future needs. Seventeen (85%) were satisfied with the number of pills they received.
Discussion/Conclusions: Prescribed opioids contribute to the risk of overdose and diversion in the community. In the absence of consensus guidelines for acute pain opioid prescribing, clinicians must be vigilant in educating patients about safe use, storage, and disposal of unused opioids. Multidisciplinary exploration and surveillance of post-discharge opioid management may identify systemic gaps and deficiencies in patient and provider education.
Introduction/Aim: The risk constructs based on psychological risk factor (e.g. pain catastrophizing, PC) and sensitization risk factor (e.g. pressure pain threshold, PPT) are important in research and clinical practice. While most research looks at individual constructs, but doesn't consider how different constructs might interact within the same individual. A cumulative impact evaluation of psychological and sensitization risk factors on pain-related outcomes may help guide us in the risk assessment of patients with pain conditions. The aim of this study is to evaluate the cumulative impact of these psychological PC and sensitization PPT risk factors on pain-related outcomes (activity avoidance, pain severity and disability) considering covariates.
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.
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. low catastrophizing and low sensitivity (N = 26), 2. high catastrophizing and low sensitivity (N = 27), 3. low catastrophizing and high sensitivity (N = 25) and 4. high catastrophizing and high sensitivity (N = 31).
Results: One-way ANOVA revealed significant group differences (p < .05, η2 = .08 to.14) on all outcomes of this study (except functional avoidance) and post hoc analysis indicated the significance differences are between group 1 and 4 (p < .05). A cumulative impact is reflected by large effect sizes between group 1 and 4 (d = .8 to 1).
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: To predict 3-months rehabilitation outcomes of positive and negative psychological factors after controlling for significant covariates.
Methods: We included 81 adult participants with subacute nonspecific back pain for data analysis who completed all measures for (1) 3-months follow-up outcomes (i.e. pain severity, affective interference, physical interference and disability); (2) baseline positive (i.e. optimism, resilience and self-compassion) and negative (i.e. pain catastrophizing and pain-related fear) psychological factors. Four multiple regression analyses (dependent variables: pain severity, affective interference, physical interference and disability) were used to determine the predictive capability of positive and negative psychological factors while controlling for significant individual characteristics' covariates.
Other psychological factors are non-significant for predicting any of the 4 outcomes. Baseline pain intensity is a significant predictor for 3 outcomes (except affective interference), whereas baseline pain medication has failed to predict any outcome. Gender shows a significant predictor for physical interference outcome only (β = .199, t = 2.027, p < .05).
Discussion/Conclusions: Among negative psychological factors, only pain catastrophizing predicting 2 outcomes out of 4. None of the positive psychological factors can predict any outcome in his study. Baseline pain catastrophizing and pain intensity assessment may have a clinical benefit for better back pain rehabilitation outcomes considering gender. Insecure attachment has been associated with negative pain outcomes. One contributing factor may be that insecure attachment styles influence pain perceptions, which is an important precursor for adequate support provision. To examine this, 109 romantic couples underwent a cold pressor task. Targets undergoing the task provided pain ratings while perceivers estimated partners' pain. The perception of partners' pain was conceptualized as distinctive accuracy, which assesses one's ability to recognize targets' unique pain experience. Overall, perceivers demonstrated distinctive accuracy. Further, perceivers' and targets' attachment interacted to predict distinctive accuracy. More secure targets, presumably displaying more expressive and relevant pain cues, were judged with greater distinctive accuracy but only by less secure perceivers. This may be because less secure perceivers are highly motivated to attend to their partner. Altogether, this study highlights one important individual difference factor that may help explain why attachment styles influence pain experiences.
Introduction/Aim: In comparison to a secure attachment style (perceptions that care is available and one is worthy of that care), an insecure attachment style (negative perceptions of the self as being worthy of care and/or perceptions of others as being unavailable to provide care) has been consistently linked with pain variables indicative of pain-related distress. Yet, little is known as to why this is. In general, receiving support from close others helps people better cope with pain and is an important precursor for adequate support provision is to perceive one's pain experience accurately. If one does not understand the extent to which their partner is in pain, they may not be able to help them cope with that pain. The present study examines whether attachment styles influence pain perceptions, measured here as distinctive accuracybeing able to recognize targets' unique pain experience. This may further our understanding of the negative pain outcomes associated with insecure attachment. Understanding the influence of attachment on one's ability to cope and manage pain may aid in informing preventions, early interventions, and treatment efforts Methods: Since romantic partners have a significant impact on one's pain experience, this research focused on romantic couples. One hundred and nine romantic couples participated in this study and each member of the couple was randomly assigned to be either the target, the individual undergoing a 60-second cold pressor task, or the perceiver, the individual observing the target undergo the cold pressor task. Following the assignment of roles, participants completed demographic questionnaires assessing personal and relationship well-being as well as attachment style. During the cold pressure task, both the target and the perceiver were simultaneously prompted to provide ratings of the target's pain using an 11-point scale at every 15second interval. The average pain intensity ratings across the 4 time points were recorded.
Results: Results from the current study replicated previous work demonstrating that perceivers underestimate their partner's pain and that insecure attachment is associated with more negative pain outcomes. Despite underestimating partner's pain, perceivers viewed their partners, on average, with considerable distinctive accuracy. Moreover, the association between the target's attachment style and distinctive accuracy was dependent on the perceiver's level of security (b = − 0.25, z = − 2.04, p = .04). More secure target's pain was perceived with greater distinctive accuracy by less secure perceivers (b = 0.29, z = 2.10, p = .04) but not by more secure perceivers (b = − 0.11, z = 0.78, p = .44). Less secure targets were perceived with similar levels of distinctive accuracy by all perceivers (b = 0.08, z = 0.68, p = .50). Overall, the accuracy of pain perceptions depends on both the target's and the perceiver's attachment style.
Discussion/Conclusions: Our findings propose an explanation as to why less securely attached people may experience worse pain outcomes. By examining the differential effects of attachment for targets and perceivers, this research provides evidence to help understand the importance of attachment on pain outcomes.

The Relationship between Perceived Phantom Limb Shortening (Telescoping) and Post-amputation Pain
Andrea Aternali a , Sander L. Hitzig b , Amanda Mayo b , and Joel Katz a a Clinical Psychology, York University, Toronto, Ontario, Canada; b Department of Psychology, York University, Toronto, Ontario, Canada Introduction/Aim: Approximately 80% of individuals who have undergone limb amputation report postamputation pain. Despite ongoing efforts, there are few effective treatments for phantom and/or residual limb pain. The development of interventions for reducing post-amputation pain requires more knowledge about the relationship of phantom limb sensations on recovery. One phenomenon that occurs after amputation is phantom limb "telescoping". Telescoping is defined as the experience of one's phantom hand or foot gradually approaching the residual limb over time and is suggested to impact the experience of phantom pain. The current study explores the relationship between telescoping and post-amputation pain.
Methods: Fourteen adults living with an amputation for at least three months completed questionnaires requesting demographic information, average phantom and residual limb pain (0-10 numeric scale), and telescoping (yes/no) using an online application (https:// phantomlimbs.ca/demo.html). Bivariate point biserial correlation coefficients evaluated the relationship between telescoping and demographic/pain-related information.
Results: A preliminary analysis of 14 limb loss respondents, 2 of whom reported telescoping, showed that telescoping was not correlated with age, sex, eth-nicity, or time since amputation, but it was significantly correlated with level of education, r(12) = 0.849, p < .000. Telescoping was not significantly correlated with average phantom limb pain intensity, r (12) = − 0.204, p = .485, or residual limb pain intensity, r(12) = − 0.037, p = .899. Of the 3 participants who were pain-free, one reported telescoping.
Discussion/Conclusions: The results suggest that post-amputation pain intensity is not related to telescoping. A larger sample is needed for more definitive results. Discussion/Conclusions: This review seeks to inform the implementation of evidence-based interventions for managing acute pain in neonates and older infants.
CONTACT Oana Bucsea obucsea@yorku.ca Introduction/Aim: One in five Canadians are affected by chronic non-cancer pain, with Canada having the highest rate of opioid prescribing in the world. Recent Canadian prescribing guidelines suggest nonpharmacological pain management approaches, like those provided by physiotherapists and occupational therapists, should be used in opioid tapering. We conducted a scoping review to locate and summarize the current evidence regarding the roles of physiotherapy and occupational therapy in opioid tapering for individuals with chronic non-cancer pain.
Methods: A systematic search of Medline, EMBASE, PubMed, and CINAHL databases was conducted. Articles were included if physiotherapy or occupational therapy were described or were part of an interdisciplinary team and if opioid tapering or reduction were mentioned or measured as an outcome.
Results: 22 articles were includedone systematic review, four narrative reviews, two case-reports, six retrospective studies, one cross-sectional study, one randomized controlled trial, one prospective longitudinal cohort, one evidence-based perspective, one pro-gram description, and four conference abstracts. Papers were categorized into 5 themes: multidisciplinary team care, exercise focused, single modalities, patient preferences, and patient experiences.
Discussion/Conclusions: The findings suggest there is currently limited evidence to guide PTs and OTs in their role in opioid tapering for patients with chronic non-cancer pain. It appears the general use of physiotherapy and occupational therapy interventions are helpful in supporting the opioid tapering process, however, further research is needed to establish effectiveness. Introduction/Aim: Sickle cell disease (SCD) is a chronic disease affecting over 5000 individuals in Canada. Acute and chronic pain is commonly experienced and may require hospitalization, medication, and blood transfusions. Hematopoietic stem cell transplant (HSCT) is the only established cure for SCD however, up to 40% of adult HSCT recipients continue to experience pain. Pain in adolescents and young adults (AYAs) following HSCT in childhood has not been investigated. This study aims to explore the pain experience of AYAs who received HSCT to cure SCD.
Methods: Four AYA recipients of HSCT (mean age = 19.75 years [SD = 3.30], 25% male) and their parents (25% fathers) completed separate, semistructured interviews. Participants were asked to describe their SCD experience at multiple time points (i.e., prior to HSCT, during HSCT, following HSCT). Interviews were audio-recorded, transcribed verbatim, and coded by two independent coders using an inductive approach.
Results: Recruitment for the study is ongoing. Parents and AYAs described significant interference in their lives due to SCD and its treatment (e.g., missing school, work or social activities). Families describe HSCT as a life changing event that completely resolved SCD pain. Cultural stigma toward SCD influenced access to social support in all parent narratives.
Discussion/Conclusions: SCD is a painful chronic disease that severely impacts the lives of patients and their families. Enduring stigma surrounding the diagnosis impacts families' ability to access social support. HSCT allowed adolescents to live without pain and pursue social and educational goals. Future research is required to address stigma and bolster social support among families living with SCD.
Introduction/Aim: The experience of pediatric chronic pain is fraught with uncertainty. Individuals who are high in intolerance of uncertainty (IU), which is conceived as a transdiagnostic risk factor for fear and anxiety-related psychopathology, tend to interpret ambiguous situations as more threatening than those who are low in IU. The pediatric fearavoidance model illustrates the bidirectional relationships between parent and youth psychological responses (e.g., catastrophizing) influencing youth fear of pain and pain disability. This study investigated the role of parent and youth IU as predisposing risk factors in the pediatric fear-avoidance model of chronic pain.
Methods: Participants included 138 youth with chronic pain (M age = 14.29 years; 74% female) and their parents (93% female). At baseline, parents and youth reported on their IU and catastrophic thinking about youth pain; youth reported on their fear of pain and pain interference. Three months later, youth and

A72
RESEARCH POSTER ABSTRACTS parents reported on their IU; youth reported on their pain interference. Results: Structural equation modeling supported the prediction that higher baseline youth IU directly exacerbates youth fear of pain, which in turn predicts worse pain interference at follow-up. IU indirectly predicted worse youth fear of pain through its influence on youth pain catastrophizing. Further, baseline youth IU predicted increased IU at follow-up. Parent IU predicted increased parent pain catastrophizing and youth IU.
Discussion/Conclusions: These findings suggest that parent and youth IU play important roles as predisposing risk factors in the pediatric fear-avoidance model of chronic pain. Future research is needed to determine how to target these psychological factors in treatment.

Melanie Noel
http://orcid.org/0000-0003-3752-8055 CONTACT Alexandra Neville alexandra.neville@ucalgary.ca; @neville_alex Introduction/Aim: Chronic pain represents a considerable burden to the individual and society, and often disrupts meaningful aspects of life, however, clinicians use the term "meaningful" in various ways. This inconsistency may contribute to a lack of consensus on how to make rehabilitation personally meaningful for people with chronic pain. The aim of this study was to identify the structure, and function, of the concept "meaningfulness" as it is currently used in peer-reviewed, chronic pain rehabilitation literature; and to develop an operational definition of the concept "meaningfulness" for use in a larger, mixed methods study into meaningfulness in rehabilitation for people with chronic pain.
Methods: This research applied Walker and Avant's Concept Analysis method. A systematic search of chronic pain rehabilitation literature was conducted through databases CINAHL, MEDLINE and PsycINFO, along with citation searching and hand searching. All uses of the concept "meaningful", "meaningfulness" and "personally meaningful" were identified.
Results: After exclusion criteria were applied, 113 articles remained, however, only ten of these used "meaningful" as perceived by the person with chronic pain. From the findings, an operational definition of patient-defined meaningfulness was developed.
Discussion/Conclusions: The concept "meaningfulness" was used inconsistently, which suggests that rehabilitation clinicians and patients may not identify the same things to be meaningful. The definition derived from the concept analysis is: Patient-identified meaningfulness describes that which patients themselves select as being of value, and relates to their personal sense of identity. With this definition, further rigorous research will be conducted into the benefits of personally meaningful chronic pain rehabilitation. Introduction/Aim: Chronic headaches are highly prevalent in youth, and often persist into adulthood. The present study explored the extent that alterations to brain structures involved in emotional processing (i.e. amygdala and associated connections [i.e. the uncinate fasciculus, which connects parts of the limbic system e.g. the amygdala with the frontal lobe]), as well as behavioral changes (i.e. posttraumatic stress symptoms [PTSS] and poor sleep quality) resulting from early life trauma were associated with persistent headaches in youth.
Methods: Thirty youth aged 10-18 years with chronic headaches underwent a 3T MRI scan. Left and right amygdala volumes were acquired and summed. Mean fractional anisotropy (FA) values of the left and right uncinate fasciculus were acquired and averaged. Youth tracked their daily headaches for one-month, and selfreported on their pubertal status, sleep quality and PTSS using validated measures. Linear regression was used to explore the relationships between average number of headaches, brain and behavior measures.
Discussion/Conclusions: Alterations to regions of the brain involved in emotional processing and PTSS appears to underlie the chronification of headaches in youth. By addressing PTSS, clinicians may be able to reduce the frequency of headaches in patients, leading to associated brain changes and thereby preventing the persistence of pain into adulthood. for MS. T1-and T2-weighted MR images were examined to determine lesion characteristics. Clinical followup data were examined to assess treatment response. Results: All 4 patients fulfilled criteria for the diagnosis of TN. While MRI findings were highly suggestive of MS, patients did not meet diagnostic criteria for MS, and were identified as having RIS. TN pain was not sufficiently controlled with medical treatment and all patients elected to undergo surgery.

ORCID
Discussion/Conclusions: This report is the first description of TN associated with RIS. These patients present with TN and white matter lesions suggestive of MS, with an otherwise normal neurological examination. These findings point to the role of central demyelination as a potential pathogenesis of TN pain.
Introduction/Aim: Fear of movement associated with chronic pain often leads to deconditioning, postural compromises and subsequent risk of falls. Compared to the general population, individuals with chronic pain are at greater risk of falling. This study evaluated several measures used to assess falls risk in the elderly. These included Selfselected Walking speed (SSWS), Timed Up and Go (TUG), Sit-to-Stand (STS), and the Ability-Specific Balance Confidence Questionnaire (ABC). Measures were obtained at the start of a pain management group. Individuals with chronic pain were compared to existing norms, and relationships between measures were assessed.
Methods: Prior to treatment, 216 individuals with ongoing pain completed measures of pain intensity, the ABC, Self-selected Walking Speed, Timed Up and Go, and the Sit to Stand. Norms were determined based on sex and age. Correlations were calculated to examine the relationships among these measures.
Results: Overall, the performance of individuals with ongoing pain on the physical measures was similar to the elderly. Physical performance did not differ for men and women, was unrelated to age, and was negatively related to pain intensity. Scores on the ABC did not differ by sex, were unrelated to age, and negatively related to pain intensity. Poorer physical performance significantly correlated with decreased confidence with respect to balance.
Discussion/Conclusions: Ongoing pain is associated with increased risk of falling. This risk does not differ for men and women and is independent of age. Greater pain intensity is related to poorer physical performance and decreased confidence for balance. Risk of falling should be assessed for all individuals with ongoing pain regardless of age.
Introduction/Aim: Virtual Patient (VP) technology has been used to elucidate disparities in adult pain care. A strength of VP technology is the ability to standardize/manipulate aspects of the clinical encountersuch as patient demographics (eg, race, gender), behaviors (eg, guarding, bracing), and expressions (ie, facial displays, vocalizations)to test hypotheses about providers' pain care decisions. Although disparities in pain care for youth have garnered recent attention, our understanding is limited by the lack of experimental investigations on this topic. VP technology is well-suited to fill this gap.
Methods: Virtual pediatric patients (VPPs) were developed using Autodesk Character Generator and Adobe Fuse. Initial VPPs were modeled on functional abdominal pain such that all VPPs demonstrate condition-specific, dynamic pain expressions (ie, grimacing, holding stomach). Several iterations were developed with a focus on patient (eg, race, gender, age) and caregiver factors (eg, behavior toward child), allowing systematic investigation of their impact on providers' pain care decisions. In our initial study, VPPs varied on gender and race (ie, Black/White), with other characteristics standardized across VPPs.
Results: Providers (N = 129 [sample 1], 43 [sample 2]) made pain care decisions for 4 VPPs (one of each race/gender). Systematic differences across patient race/gender were identified. Moreover, results suggest that providers engaged with VPPs similarly to real patients, and responses were not substantially biased by social desirability.
Discussion/Conclusions: Identifying the individual and contextual factors that affect provider decisionmaking is an essential first step to reducing disparities in pediatric pain care. VP technology offers unique advantages to achieving this goal.
Introduction/Aim: Although many studies identified sex as a predictor of pain treatments utilization (women being more likely), the association between the use of nonpharmacological modalities and gender is less clear. This study aimed to explore the association between sex, gender and the use of nonpharmacological treatments for chronic pain (CP).
Methods: In 2019, a province-wide web-based crosssectional study was conducted among adults suffering from CP (Quebec, Canada). Sex was measured as a dichotomous variable and gender roles (behavioral norms applied to men/women) were measured using the Bem Sex-Role Inventory (BSRI). The median split method was applied to masculine/feminine BSRI scores to form subgroups. Multivariate logistic regression allowed the identification of variables associated to nonpharmacological treatments use. Discussion/Conclusions: Gender roles differences were found regarding the use of nonpharmacological A76 RESEARCH POSTER ABSTRACTS treatments and may suggest a need for more personalized promotion of such treatment modalities. Further studies should explore if gender roles affect treatment preferences or are associated with barriers to treatment.

Results
Introduction/Aim: How children remember pain sets the stage for future pain experiences. Parents with higher trait anxiety prior to their child's surgery have children who develop a negatively-biased recall of their post-surgical pain. Further, parental catastrophizing about child pain prior to surgery predicts greater pain memory biases, which is linked to future pain problems and fear-avoidance. Little is known about why parents demonstrate these behaviors. The present study examined the impact of parental surgical history on their catastrophic thinking about child pain, as well as children's post-surgical pain and fear. Methods: The sample included 85 children (aged 4-7) scheduled to undergo a tonsillectomy and one of their parents. Prior to surgery, parents reported on their past surgical experiences and completed a measure of catastrophic thinking about child pain. Children's postoperative pain intensity and pain-related fear were reported on days 1-3 following surgery.
Results: Parents who reported being more afraid of their own post-surgical pain catastrophized more about their child's pain (p =.03). Parental catastrophic thinking about child pain was also related to worse child pain intensity and fear post-surgery (ps <.05).
Discussion/Conclusions: These findings extend existing research by identifying potential factors that impact parental pre-operative anxiety and pain catastrophizing. Parents who recall being afraid of their own post-surgical pain also catastrophize about their children's pain, putting their children at risk for worse pain outcomes after surgery. These findings underscore the importance of parental factors in the surgical experience of children and provide a target for pain management interventions.
Introduction/Aim: Chronic pain (pain lasting > 3 months) afflicts 15-40% of youth. Youth with chronic pain experience greater peer victimization and report having less friends. Furthermore, among youth in this population, it is estimated that approximately 50% have a parent with chronic pain. Little research to date has examined the relationships between pain and social functioning in parents and youth. The present study examined the relationships between these variables.
Methods: 95 youth aged 8-18 and one of their parents were recruited from a tertiary-level pediatric chronic pain program at a children's hospital in Western Canada. The dyad completed a questionnaire at intake and again 3 months later. Parent and youth rated their pain intensity on an 11 point NRS. Parents completed the PROMIS Ability to Participate in Social Roles subscale. Youth completed the PROMIS Peer Relationships Subscale.
Results: Parent and child pain had no significant affect on parent social functioning at 3 months. Parent and child pain were significantly associated with youth social functioning at 3 months. This relationship differed by gender. The influence of parent pain on youth social functioning was significant for girls (ΔR 2 = .03, ΔF = 4.22, p <.05) but not boys, whereas the impact of youth pain on youth social functioning was significant for boys (ΔR 2 = .12, ΔF = 5.49, p < .05) but not girls.
Discussion/Conclusions: This study adds to a growing body of literature surrounding the importance of parental experience of pain on youth functioning. The results suggest that girls may be especially impacted by their parents' experience of pain.
Introduction/Aim: North America is experiencing an interrelated public health crisis, involving the management of chronic pain and the risks associated with opioid misuse. A fundamental challenge is to achieve a balance between decreasing the misuse of opioids and associated harms while optimizing pain care.
Methods: Chronic pain patients at risk for opioid misuse (n = 30) were randomly assigned to Integrated Psychosocial Group Treatment (IPGT) or treatment as usual (TAU). IPGT consists of 6 group sessions involving psychoeducation, motivational interviewing, cognitive behavioral therapy, mindfulness, and peer support. Participants were assessed at baseline, 6 weeks, and 9 weeks. Outcomes were assessed using self-reported measures and included: (1) feasibility; (2) acceptability; and (3) pain severity, pain interference, pain catastrophizing, and opioid misuse. Data were analyzed using descriptive and multivariate analyzes.
Results: All intervention components were delivered to 87% (n = 13) of IPGT recipients who reported a high level of satisfaction. Findings suggested that the IPGT group experienced nonsignificant improvements in pain severity compared to the TAU control group (β = 0.22, p = .35). However, we observed significant treatment by time interactions on the outcome of pain interference (β = 3.32, p = .05) and pain catastrophizing (β = 2.74, p = .02). We detected no significant differences in opioid misuse (AOR = 069, p = .16).
Discussion/Conclusions: This study provides support for IPGT being acceptable and feasible for delivery in chronic pain patients at risk for opioid misuse in which efficacy was demonstrated in pain interference Introduction/Aim: Optimal perioperative pain management is an important public health goal with 10% to 50% of patients reporting chronic postsurgical pain (CPSP). With few head-to-head trials of CPSP preventive strategies, ranking is difficult. Through a systematic review, pairwise and network meta-analyses (NMA) we aimed to rank interventions for efficacy and adverse effects. Our goals are to inform the selection of preventative measures in perioperative practice and guide future investigations.
Methods: We searched Cochrane Central Registry of Controlled Trials, MEDLINE, Embase, ClinicalTrials. gov, and WHO ICTRP for double-blind, randomized controlled trials of CPSP prevention in adults. We assessed risk of bias and confidence level in the evidence. Using meta-regression, we evaluated potential effect modifiers. Primary outcomes were treatment effect and potential harm. We used group-level data and estimated risk ratio with random effects.
Results: We included 102 studies with 13,416 participants. CPSP incidence in placebo patients varied according to IASP coding. In high-risk patients (IASP Discussion/Conclusions: Interventions with "acute post-operative pain benefits" had the greatest effect in reducing CPSP risk. Our ranking suggests that "deafferentation" with neural block may be important. A preplanned living NMA comparing top-ranking interventions may address under-powered studies with low precision in the estimates. Introduction/Aim: The goal of this study was to evaluate the moderators of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) to improve the treatment of provoked vestibulodynia (PVD), a chronic genital pain disorder. 1 These treatments are shown to reduce self-reported pain and pain catastrophizing in PVD. 2,3 Methods: One hundred and thirty women with PVD were assigned to a CBT or MBCT group. The following potential moderators were examined at pre-treatment : 1) age 2) pain duration 3) pain intensity 4) PVD subtype (acquired or life-long) 5) treatment credibility 6) the Five Facet Mindfulness Questionnaire (FFMQ) 7) the Big 5 personality domains. 4 The outcome measures of sexual dysfunction, the numerical rating of pain, and pain catastrophizing were evaluated at pre-and post-treatment, and at 6-and 12-months follow-up.
Moderation was tested using multilevel models, nesting four time points within a participant. The interaction of the moderator, time effect, and treatment assignment was evaluated for significance and a simple slope analysis of significant interactions was performed.
Results: Treatment credibility moderated the pain intensity of women (B = 0.305, p < .01), where those with higher treatment credibility ratings improved more when they were in the MBCT group than the CBT group. Moreover, PVD subtype moderated pain catastrophizing (B = 3.150, p < .05). Those with lifelong PVD improved more in the CBT condition, while women with acquired PVD improved more in the MBCT condition. No other tested variables moderated outcomes.
Discussion/Conclusions: These findings may assist clinicians in individualizing psychological treatment recommendations for women seeking pain relief from their PVD.

Sophie Bergeron
http://orcid.org/0000-0001-8601-761X Introduction/Aim: Pregnancy-related back pain symptoms persist for some women. The aim of this study was to determine the prevalence and associated biopsychosocial predictors of perinatal back pain persisting up to 5 to 14 months postpartum among Canadian mothers.

Methods:
We analyzed data from the 2006 Maternity Experiences Survey (MES). Weighted prevalence of persistent perinatal back pain was estimated for the full sample of women (n = 5,798), and a subsample who reported problematic back pain during the first 3 months postpartum (n = 2,251). Multiple logistic A80 RESEARCH POSTER ABSTRACTS regression models were employed to identify factors associated with persistent perinatal back pain (yes/no) pain in each group. Results: Overall, 16.3% of Canadian mothers reported persistent back pain at 5 to 14 months postdelivery. Among women who reported problematic back pain during the first 3 months postpartum, 45.6% continued to have un-resolved symptoms lasting 5-14 months after childbirth. The biopsychosocial predictors of persistent back pain in the full sample were: maternal age <20 years; immigrant status; obesity; poorer perceived health; high perceived stress; higher stressful life events; inadequate social support postdelivery; history of violent abuse; residence in Quebec and Ontario; and lower household income. Significant predictors among those whose back problems persisted from 3 months to 5-14 months were: immigrant status; poorer perceived health; higher stressful life events; inadequate social support post-delivery; history of violent abuse; and rural dwelling.
Discussion/Conclusions: Maternal care services and policies should consider biopsychosocial factors that may influence delayed recovery of back pain in the postpartum period when designing and implementing interventions.
CONTACT Oluwakemi Awe oluwakemi.awe@usask.ca Introduction/Aim: The Sensitivity to Pain Traumatization Scale (SPTS-12) was created to assess the propensity to develop a traumatic stress response to pain. Despite preliminary support, the SPTS-12 has yet to be examined over time and its predictive validity has not been evaluated. The aim of the present study is to investigate how SPTS-12 scores change over time in a clinical sample of patients receiving care after surgery from the Toronto General Hospital Transitional Pain Service.
Methods: A sample of 361 adults (55% male; M age = 50.6 years, SD age = 14.3) completed questionnaires assessing symptoms of pain, anxiety, depression, and trauma at multiple visits to the Transitional Pain Service after surgery. Latent-class mixed-model analysis was used to estimate latent trajectories of SPTS-12 scores across days after surgery. One-way ANOVAs were then used to determine how trajectory classes differed over time on measures of morphine use, average pain intensity, pain interference, and depressive symptoms.
Results: The final model consisted of five SPTS-12 trajectory groups, three of which were characterized by significantly decreasing scores over time. Analysis of pain-related outcomes predicted by SPTS-12 trajectories provided evidence of criterion validity of the SPTS-12. SPTS-12 trajectories did not significantly differ on morphine use at any time point. SPTS-12 trajectories for average pain, pain interference, and depression scores differed at two or more postsurgical visits (all p < .001).
Discussion/Conclusions: The present results support the long-term stability of SPTS-12 scores, as well as the ability of the SPTS-12 to predict important painrelated outcomes over time. Introduction/Aim: Digital psychological interventions have shown efficacy for improving disability in adolescents with chronic pain. However, little is known about the psychological characteristics that contribute to positive changes during treatment. The aim of this study is to examine baseline psychological characteristics (diagnosis uncertainty, readiness to change [RtC]) as predictors of treatment perceptions (expectancies, helpfulness) and treatment outcomes. Methods: Youth with chronic pain were recruited from a tertiary care pediatric pain clinic. Youth completed measures of: sociodemographics, diagnostic uncertainty, sleep, pain, interference, executive function, RtC, and treatment perceptions at baseline (T1), mid-treatment (T2), post-treatment (T3) and 3-month follow-up (T4). All youth received access to WebMAP: an 8-module online Cognitive Behavioral Treatment that teaches pain coping skills.
Discussion/Conclusions: These preliminary results show that diagnosis uncertainty is associated with pretreatment RtC, which may impact perceptions and expectancies about treatment. Further research exploring these associations is warranted. Methods: This data is from an ongoing longitudinal study (OUCH Cardio Cohort) that follows parent-child dyads during vaccination at 12 months (n = 121), 18 months (n = 67), and 24 months (n = 39). Children's pain was measured using the FLACC scale (Merkel et al., 1997) immediately, and at one-and two minutes postneedle. Parents rated their worry pre-and post-needle, as well as their child's pain post-needle using Likert scales. Parent stress (PSI; Abidin, 2012) and psychological A82 RESEARCH POSTER ABSTRACTS distress (BSI; Derogatis, 2001) were also measured. A hierarchical regression analysis was run at all three ages with parent pain ratings as the outcome variable. Child sex was entered in the model first, then children's pain behaviors, then parent variables. Results: At 12 months, parent worry pre-needle (ß = .21, p = .03) and parenting stress (ß = .21, p = .04) predicted parent pain beyond children's pain behaviors (1 min post-needle ß = .23, p = .02). At 18 months, parent worry post-needle significantly predicted parent pain ratings (standardized ß = .32, p = .02), controlling for all other variables. The model at 24 months was not significant.
Discussion/Conclusions: Parent worry and stress are important factors contributing to parent pain ratings. Given the importance of accurate pain assessment for the proper management of children's pain, efforts to address parent worry and stress should be considered during vaccination appointments. Introduction/Aim: The aim of this review was to identify empirically supported barriers and facilitators for prescribing opioids for Chronic Non-Cancer Pain (CNCP) through a systematic review of qualitative literature.
Methods: Six databases were searched from inception to June 3, 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias rated, and confidence in evidence graded using Cochrane Confidence in the Evidence from Reviews of Qualitative research (CERQual). Constructs identified were coded using the Theoretical Domains Framework Results: Twenty-six studies reporting on 599 healthcare providers were included. Themes were extracted from data and fourteen constructs were identified that contributed as barriers or facilitators to prescribing opioids for CNCP. Barriers to prescribing opioids included perceived inadequate education (moderate confidence), self-efficacy to prescribe opioids for complex cases (low confidence), regulatory scrutiny (moderate confidence), opioid diversion (moderate confidence), patient-related (e.g., overdose) salient events (high confidence), provider-related (e.g., threat) salient events (high confidence), insufficient time (high confidence), and concerns related to patient misuse (high confidence). Facilitators included a positive patient-provider relationship (moderate confidence), patient-provider communication (low confidence), education on opioid prescribing tools (low confidence), lack of available non-opioid alternatives (moderate confidence), setting goals with patients (moderate confidence), and institutional pressure (low confidence).
Discussion/Conclusions: Understanding the barriers and facilitators that influence opioid-prescribing offers important insight into modifiable targets for interventions. Such interventions can support providers in delivering care consistent with guidelines to manage CNCP, while minimizing risks.
Introduction/Aim: Sensory neurons in the dorsal root ganglion (DRG) have been shown to become hyperexcitable/sensitized in response to chronic inflammatory stimuli as often occurs in autoimmune disorders like rheumatoid arthritis or Multiple Sclerosis (MS). This sensitization in response to inflammation has been postulated to be an underlying cause of the chronic pain associated with these disorders. The molecular pathways mediating sensitization, however, remain to be fully elucidated. We hypothesize that morphological and functional changes in the mitochondria of nociceptors (pain sensing sensory neurons) are involved in this process. Given the well-established sex bias of painful autoimmune disorders, we also predict that these changes are more prominent in female nociceptors.
Methods: We have begun to test our hypotheses by stimulating male and female DRG sensory neurons in vitro with physiologically relevant doses of the inflammatory cytokine TNFα and examining changes in mitochondrial morphology.
Results: We find that both 24 and 48 hours of TNFα stimulation lead to significant changes in mitochondrial morphology. Interestingly, these changes were only evident in female sensory neurons.
Discussion/Conclusions: Ongoing studies are evaluating functional readouts of male and female sensory neurons such as cellular respiration and reactive oxygen species production in response to TNFα stimulation. These pathways may represent novel targets to treat pain associated with chronic, neuroinflammatory disorders and also shed light on why pain in these conditions is biased toward females.
CONTACT Aislinn Maguire maguire@ualberta.ca how these subgroups differed on demographic and patient-reported outcomes.
Methods: A total of 187 children and adolescents (8 to 17) with cancer in China were prospectively recruited and asked to complete the following measures: pain intensity, pain duration, pain interference and pain control using the Chinese translation of validated questions from the Pain Squad Cancer App, as well as 7 short forms of symptoms and function using Pediatric PROMIS. LPA was used to identify latent subgroups of pain patterns.
Results: Three latent classes were identified: Low (68.3%), Continuous/Chronic (19.9%), and High/Acute (55.3%) class. Children in High/Acute class were more likely to be cared by unemployed guardians. Inpatient children were more likely to be in the Continuous/ Chronic class. With the exception of Peer Relationships, the other patient-reported outcomes (depressive symptoms (p = .001), anger (p < .001), anxiety (p = .040), and fatigue (p = .039), mobility (p = .010)), were significantly higher in High/Acute than in Low class. There was no significant difference for upper extremity function in pairwise comparison, but significant as a whole (p = .038).
Discussion/Conclusions: Three distinct pain subgroups demonstrate the heterogeneity in pain patterns among Chinese children and adolescents with cancer. These subgroupings can assist clinicians to better identify and target treatments for patients at higher risk of pain.
CONTACT Wen Zhang zhangwenivy@aliyun.com Introduction/Aim: Individuals referred to chronic pain clinics often experience difficulties with emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness as a result of their pain. Thus, the University of Alberta Multidisciplinary Pain Clinic began offering Pain 401, a Dialectical Behavior Therapy (DBT) skills training group, to chronic pain patients with the goal of improving psychosocial functioning and quality of life. The aim of the current study was to assess patients' satisfaction with this novel chronic pain treatment. Methods: Pain 401 consists of twelve 90-minute sessions that cover four skill areas. At post-treatment, patients were asked to complete a treatment satisfaction questionnaire that included Likert-style rating items and open-ended questions. Quantitative feedback was analyzed using descriptive statistics and qualitative feedback was analyzed using content analysis.
Results: Fifteen patients returned their treatment satisfaction questionnaire. Overall, patients were extremely satisfied with Pain 401 (M = 4.73/5; SD =.46). Every patient said the group was worth their time and they would recommend it to others with chronic pain. Patients rated all the skills as helpful, but rated distress tolerance and emotion regulation most highly. Emotion regulation was rated the most difficult skill. Patients' open-ended responses illustrated the most valued aspects of the treatment and included suggestions for group improvement.
Discussion/Conclusions: Patients with chronic pain reported high satisfaction with a 12-session DBT skills training group. Qualitative feedback provided by patients will be used to improve future offerings of Pain 401. Treatment satisfaction will be considered in combination with treatment effectiveness when evaluating group outcomes. Methods: We systematically searched MEDLINE, EMBASE, CINAHL and Guidelines International Network databases. We also searched the National Center for Complementary and Integrative Health website. Eligible articles were CPGs for the treatment or management of rheumatoid arthritis and osteoarthritis. Two independent reviewers evaluated the quality of reporting for each guideline that provided CAM recommendations, and the specific section providing CAM recommendations, using the AGREE II instrument.
Discussion/Conclusion: Approximately half of arthritis CPGs finclude CAM recommendations. In those that do, a gap exists in that the quality of CAM recommendations are of significantly lower quality than overall recommendations across the stakeholder involvement, rigor of development, and applicability domains.
Introduction/Aim: Posterior spinal fusion surgery for adolescent idiopathic scoliosis (AIS) is associated with significant postoperative pain. Remifentanil, an opioid analgesic commonly infused during spinal fusion surgery, has been associated with increased postoperative opioid consumption. The primary objective of this study is to correlate intraoperative remifentanil dose with postoperative opioid consumption in a cohort of AIS patients.
Methods: Our study, conducted with SickKids REB approval, is a retrospective chart review of patients aged 12-18 who have undergone posterior spinal fusion for AIS repair by one surgeon at SickKids from 2011-2017. We collected data on baseline characteristics, surgical A86 RESEARCH POSTER ABSTRACTS complexity, perioperative analgesic agents and postoperative pain. Results: Data for 85 patients has been extracted. The sample population is 83.5% female with a mean (SD) age of 14.8 (1.51) years and weight of 56.8 (14.33) kg. The perioperative course of our study population is characterized by a mean (SD) OR duration of 427 (65.25) minutes, 12.1 (1.39) vertebrae instrumented, 1.07 (0.31) days to ambulation and 4.8 (0.89) days to discharge. An interim analysis of the correlation between total weight-adjusted remifentanil dose and total postoperative weight-adjusted opioid dose at 96 hours produced an R 2 value of 0.0004.
Discussion/Conclusions: The majority of LBP guidelines provide CAM recommendations; however, the quality of CAM recommendations are significantly lower than overall recommendations across a number of domains. Introduction/Aim: Dysmenorrhea is the most prevalent gynecological concern among adolescents. Although previous research has suggested that adolescents with dysmenorrhea are at risk for poor psychological and social functioning, the impact of dysmenorrhea on psychological and social functioning in North American adolescents has been neglected. We examined pain-related menstrual characteristics along with the relationship between dysmenorrhea and psychological and social functioning, among North American adolescents. We hypothesized that more severe dysmenorrhea symptoms would be associated with more symptoms of depression and anxiety, and that adolescents would report that menstrual pain negatively impacts their social functioning.

Psychological and Social Consequences of Dysmenorrhea in Adolescents
Methods: This study is a preliminary investigation using data being collected as part of a larger investigation on menstrual pain and adolescent health. We recruited adolescents aged 14 to 18 living in North America to complete an online survey. Following receipt of parental consent and adolescent assent, adolescents completed measures of menstrual characteristics, social functioning, anxiety and depression.
Results: Thirty-eight adolescents girls completed the survey (Mage = 15.92). The majority of participants (74%) reported physical pain with menstruation. There was a significant positive relationship between menstrual symptom severity and symptoms of anxiety, r =.63, p <.001 and symptoms of depression, r =.61, p <.001. Further, 43% of teens indicated that their social activities were limited by menstrual pain.
Discussion/Conclusions: Consistent with research in other regions, North American adolescents are reporting that dysmenorrhea negatively impacts their psychological and social functioning. Implications are discussed.
CONTACT Kayla M. Wall kayla.wall@usask.ca Introduction/Aim: An inherent appeal of network meta-analysis (NMA) is the ability to rank competing treatments using the surface under the cumulative ranking curve (SUCRA) approach; however, the validity of these rankings is uncertain. We evaluated the concordance between the SUCRA approach and a minimally-contextualized GRADE assessment. Methods: We searched MEDLINE/PubMed, EMBASE, CINAHL, PsycInfo, and CENTRAL, up to March 2019 for randomized trials exploring opioids vs. another opioid or placebo for chronic noncancer pain. We constructed a frequentist NMA that explored the relative effect of each opioid on pain relief. We then estimated the SUCRA for each opioid from 0% (worst) to 100% (best). Concurrently, we assessed the certainty of evidence using the GRADE approach (dichotomized as "moderate-to-high" or "low-to-very-low" certainty of evidence) and categorized opioids first based on their effectiveness vs. placebo and then vs. other competing opioids, and finally according to GRADE ratings.
Results: We included 76 studies with 21,752 patients that evaluated 15 individual opioids. The SUCRA method suggested codeine-extended release (94%) and oxymorphone-ER (88%) as the best opioids for pain relief. The certainty of evidence for both these drugs relative to placebo was, however, low. All comparisons supported by moderate-to-high certainty-evidence demonstrated that opioids were more effective than placebo, but that none were superior to others.
Discussion/Conclusion: Our findings suggest that apparent differences in effectiveness between opioids, when ranked according to SUCRA, result from the failure to consider the certainty of evidence.

Inhibition of the Pain-related Pupil Dilation Response during Pain Inhibition by Distraction
Alice Wagenaar-Tison a , Antoine Bergeron b , Zoha Deldar a , Stéphane Northon a , Nabi Rustamov a , Sylvain Sirois b , and Mathieu Piché a a Department of Anatomy, Université Du Québec À Trois-Rivières, Trois-Rivières, Québec, Canada; b Department of Psychology, Université Du Québec À Trois-Rivières, Trois-Rivières, Québec, Canada Introduction/Aim: It has been reported that pain inhibition is associated with facilitation of the nociceptive flexion reflex (NFR) during a mental arithmetic task (distraction). This sensorimotor dissociation may reflect the regulation of stimulus saliency to facilitate protective motor behaviors. Besides, pain evokes a pupil dilation response (PRD), which reflects stimulus saliency. The aim of this study was to clarify whether NFR facilitation during pain inhibition by distraction reflects changes in saliency, as indexed by the PDR.
Methods: Twenty healthy volunteers were recruited in the study. All participants received a series of 90 painful stimuli at the right ankle, distributed equally in three conditions: control, anticipation and distraction. Anticipation was produced by a visual cue presented 1 s before painful stimuli. Distraction was produced by a mental arithmetic task performed during painful stimulation. Pain was measured using a visual analogue scale. NFR and PDR were measured using electromyographic and pupillometric methods.
Results: Pain ratings were significantly decreased by distraction (p < .001), but not by anticipation (p = .7). NFR amplitude tended to increase during distraction, but was not significantly different between conditions (p = .3). Pupil diameter increased between 500 and 1000 ms post-stimulus in the control condition, but this response was abolished by distraction (p < .05). Moreover, anticipation decreased pupil diameter compared with control, between −500 and −200 ms prestimulus (p < .05).
Discussion/Conclusions: These results indicate that the saliency of pain stimuli is decreased during pain inhibition by distraction. The dissociation between pain and NFR amplitude is suggestive of a motor facilitation independent of saliency.
CONTACT Mathieu Piché mathieu.piche@uqtr.ca Introduction/Aim: When a child or adolescent lives beyond cancer, they face a lifetime of uncertainty about new or changing physical symptoms. Symptoms such as pain could indicate a normal health event (e.g. muscle ache), a consequence of toxic treatment, or cancer recurrence. The challenge for every survivor is knowing how to monitor, attend to, and interpret everyday experiences of pain. Yet, very little is known about how cancer survivors experience and respond to pain in their everyday lives. Methods: We conducted semi-structured interviews with 25 Adolescent and Young Adult (AYA) cancer survivors (15-25 years old; 45% female, 45% male, 10% non-binary) on their lived experience of perceiving, interpreting, and responding to pain during survivorship. A reflexive thematic analysis was performed.
Results: Two overarching themes were generated. The first theme highlighted how pain experiences related to young survivors' varying sense of connection with their body. Some survivors reported feeling in tune with their bodies, while others described a deep sense of disconnection or that their body felt like an adversary. The second theme represented how young survivors interpreted pain and other signals from their body, particularly the need to play detective with every new feeling of pain and how this contributed to an overall sense of embodied risk.
Discussion/Conclusions: Pain is a complex and often threatening experience after cancer. Assessment and intervention for post-cancer pain must be considered within a biopsychosocial framework, including fears and anxieties that patients hold about postcancer pain as a signal of bodily threat. Yet, this research relies on written vignettes, which may not accurately reflect observers' responses when seeing children experience pain. We examined whether observers' ratings of children's pain were influenced by the child's age and gender when shown videorecordings of children in pain.
Methods: Adult participants (N = 101, M age = 22.69) watched videorecordings of children completing the cold pressor task. Sixteen stimulus videos were shown and represented children across four age and gender groups: girls aged 6-8 and 9-12, boys aged 6-8 and 9-12. Participants rated their perception of the child's pain severity using a 10-point rating scale. A twofactor, repeated measures ANOVA was conducted to examine the effects of child's age and gender on observer ratings of pain severity.
Results: There was a significant interaction between child's age and gender (F(1, 100) = 179.20, p <.000) on perception of pain severity. Pain severity was rated higher for older boys compared to younger boys, but no difference in ratings was observed between older and younger girls. The main effect of child's age on perception of pain severity was significant (F(1, 100) = 309.31, p <.000). The main effect for gender was not significant.
Discussion/Conclusions: Findings of contextual influences on observer ratings of children's pain shown through videorecordings are inconsistent with previous research relying on written vignettes. Implications for pain assessment and healthcare are discussed.
CONTACT Randa Elgendy randa.elgendy@usask.ca Introduction/Aim: Diabetic neuropathy is a major clinical manifestation of diabetes that damages the nerves and affects the peripheral nervous system. The ability to be aware of a patient's quality of pain and characteristic is instrumental to good diagnosis leading to proper management. However, in most poor environments, patient's knowledge of neuropathic pain characteristic and experiences are usually silent during diagnosis and management The study assessed the subjective pain experiences and impact of diabetic neuropathy in an environment where patients lack adequate information on PDN.
Method: A qualitative methodological framework focusing on participant's pain experiences and personal beliefs concerning PDN was used to purposely recruit 30 diabetic patients diagnosed to have neuropathic pain. After ascertaining neuropathy a semi-structured interview guide was used to elicit each response regarding PDN experiences. The data was transcribed and analyzed using a thematic approach to qualitative analysis.
Results: The main complaint was sensitivity to touch and intense pain in the foot or fingers. The patients A92 RESEARCH POSTER ABSTRACTS experienced numerous pain characteristics such as burning numbness, tingling, and stabbing in various parts of the body. Other daily symptoms included frequent urination, tummy aches, kneel pain, lower back pain, and chest pain. Patients claimed that these pain characteristics had resulted in a poor quality of health and financial burden. Discussion/Conclusions: The voice of patients in poor environments regarding diabetic neuropathic pain is usually silent during diagnoses but forms the baseline for management. Patient's claimed that clinicians don't allow them to discuss pain characteristics and subjective experiences during diagnosis.
Introduction/Aim: The Workers' Compensation Board of Alberta (WCB-Alberta) offers rehabilitation for claimants with Traumatic Psychological Injuries (TPI) aimed at facilitating return-to-work. This study examines the effects of having comorbid painful physical injuries on return-to-work of claimants undergoing TPI rehabilitation.
Methods: We conducted a secondary analysis of administrative data collected on injured claimants with TPI admitted to WCB-Alberta's TPI programs between the years 2014-2016. Claimants were categorized into two sub-groups. Group 1 (n = 313) included claimants with TPI only, and Group 2 (n = 180) included claimants diagnosed with comorbid painful physical injuries. Variables included age, sex, occupation, duration of injury, and return-to-work status at discharge. Chi-squared tests examined differences in return-to-work outcomes.
Results: Claimants were primarily male (44%) with a mean age of 41 (± 11) years in Group 1 and primarily male (52%) with a mean age of 40 (± 12) years in Group 2. Group 1 were primarily public safety personnel (32%) exposed to a psychologically traumatic event in the workplace, while Group 2 were primarily workers in the trades (51%) involved in transport accidents. Mean duration of injury in Groups 1 and 2 were 198 (± 558) and 149 (± 299) days, respectively. Successful return-to-work across Groups 1 and 2 was achieved for 52% and 25% of claimants, respectively (p < .001).
Discussion/Conclusions: Findings demonstrate that return-to-work is significantly lower for workers with TPI and comorbid painful physical injuries. Identifying comorbidities and best practices in rehabilitation for claimants undergoing TPI rehabilitation is needed to optimize return-to-work.
Introduction/Aim: The use of interventional pain management (IPM) modalities to alleviate chronic pain is increasing despite the lack of high-quality evidence. We undertook a survey to explore practice patterns, training, and attributes of IPM practice in Canada.
Methods: We administered a 32-item survey via seven Canadian physician member organizations, whose members were engaged in the management of chronic pain.
Results Discussion/Conclusions: Our survey indicates that IPM practice and training was not uniform, and that interventional therapies for chronic pain may not be performed in accordance with the best available evidence. Our survey highlights a lack of IPM training opportunities, which may result in substandard training. Concerted efforts involving physician organizations and regulators are needed to standardize IPM training and develop clinical guidelines to optimize evidence-based practice.
Introduction/Aim: Persistent neuropathic pain is a common complication after breast cancer surgery, ranging from 10% to 70%. We conducted a systematic review to address this uncertainty.
Methods: We searched MEDLINE, EMBASE, CINAHL and PsycINFO from inception to November 2018, to identify observational studies that reported persistent neuropathic pain after breast cancer surgery. We performed random effects meta-analysis with Freeman-Tukey transformation for prevalence, and pooled pain intensity after converting all pain scales to a 10 cm visual analogue scale (VAS). The GRADE approach was used to rate the quality of evidence.
Ten studies (901 patients) reported persistent neuropathic pain intensity among patients with the pooled score of 3.8 cm (95%CI 3.1 to 4.5 cm on a 10 cm VAS), indicating 49% of these patients suffering moderate-tosevere pain (≥4 cm on a 10 cm VAS). We did not find significant subgroup effects between validated instruments (3.4 cm, 95%CI 1.8 to 4.9 cm) vs. clinical assessment (4.0 cm, 95%CI 3.2 to 4.9 cm, test of interaction p = .38) Discussion/Conclusions: Persistent neuropathic after breast surgery is common, affecting approximately 1 in 3 women undergoing this procedure, and half who develop persistent complaints experience moderate to severe pain.
Prevalence of persistent neuropathic pain after breast cancer surgery Intensity of persistent neuropathic pain after breast cancer surgery Introduction/Aim: Pain is a common experience and primary concern for individuals with Inflammatory Bowel Disease (IBD). Abdominal pain and extraintestinal symptoms contribute to the overall pain experience of individuals with IBD and negatively affect quality of life. Our aim was to outline pain characteristics and the impact of pain on quality of life in a worldwide sample of individuals with IBD. Methods: 375 adults (74% female, M age = 40 years) with IBD completed a series of validated questionnaires online to assess pain course (painDETECT), pain localization and severity (pain body diagram), IBD activity (IBD Symptom Inventory Short Form), shame (Chronic Illness-Related Shame Scale), and depressive symptoms (Patient Health Questionnaire Nine).
Results: A majority of the sample reported experiencing some pain over the course of one month: 15.7% of participants reported pain attacks with pain inbetween, 25.1% reported pain attacks without pain inbetween, 21.8% reported persistent pain with pain attacks, and 26% reported persistent pain with slight fluctuations. 11.5% of participants reported no pain. Abdominal (52%) and back (32%) pain were the main pain localizations. Pain was significantly associated with greater disease activity, b = 4.8403, SE = .4989, p < .001, shame, b = 1.0438, SE = .2477, p < .001, and depressive symptoms, b = 1.1852, SE = .1847, p < .001.
Discussion/Conclusions: Pain is highly prevalent in IBD and has a substantial impact on quality of life. Results from this study underscore the importance of pain management in IBD. Parents completed the PRISM which yields low (scores 0--5) and moderate/high (scores 6--12) risk groups. Parents also reported on protective behaviors, distress tolerance, and catastrophizing about their child's pain. Youth reported on pain intensity, frequency and activity limitations. T-tests and chi-squares tested differences between PRISM risk groups.

ORCID
Results: PRISM scores classified 9.1% of parents (n = 6) as moderate/high-risk and 90.9% low-risk (n = 60). PRISM risk group did not differ by youth or parent demographic factors. The moderate/high-risk group reported higher protectiveness (t = −4.39,

A98
RESEARCH POSTER ABSTRACTS p < .001), less tolerance of and higher catastrophizing about child pain (t = 2.43, p = .02; t = −5.23, p < .001). Youth activity limitations and pain were not different by risk group. Discussion/Conclusions: The PRISM can rapidly screen parents of youth with acute MSK pain to identify those who may need additional supports. Scores may inform interventions targeting parent behaviors and distress. Longitudinal data will examine if youth of parents identified as high risk have poorer outcomes including development of chronic pain.
Introduction/Aim: Metacognitions have been associated with chronic pain, including pain intensity and pain-related disability, and with pain catastrophizing. Researchers have hypothesized that metacognitions may moderate the relationship between pain catastrophizing and pain-related outcomes, however, this has not yet been tested. The current study aimed to examine whether metacognitions about health moderate the relationship between pain catastrophizing and painrelated disability, controlling for pain severity.
Methods: University students with self-reported chronic pain (N = 280) completed the Brief Pain Inventory -Short Form, measuring pain severity and pain interference, the Pain Catastrophizing Scale (PCS), and the Metacognitions about Health Questionnaire (MCQ-HA), containing three subscales: 1) Metacognitive Beliefs about Biased Thinking (MCQ-HAB), 2) That Thoughts can Cause Illness, and 3) That Thoughts are Uncontrollable. Preliminary regression analyses were conducted to determine the appropriateness of variables for inclusion in the moderation model. Moderation analysis was then conducted using the PROCESS macro for SPSS.
Results: Preliminary regression analyses indicated that, while controlling for pain severity, PCS scores predicted pain interference, and that MCQ-HAB was the only MCQ-HA subscale to predict pain interference. Moderation analysis was then conducted with pain interference as the dependent variable, PCS as the independent variable, and MCQ-HAB as the moderator, controlling for pain severity. Results indicated significant effects of both PCS (β=.08, p =.003) and MCQ-HAB (β=.31, p =.012) on pain interference, as well as a significant interaction effect of PCS and MCQ-HAB (β= −.01, p =.048), where higher PCS scores were associated with greater pain interference at low, but not high, levels of MCQ-HAB.
Discussion/Conclusions: Findings suggest that metacognitive beliefs about biased thinking may moderate the relationship between pain catastrophizing and pain-related disability. A critical appraisal using the AGREE II was conducted to determine whether criteria were sufficient to establish best practice guidelines. Methods: The AGREE II includes 23 questions scored on a 7-point scale and divided into the following six domains: purpose, stakeholders, rigor, clarity, applicability, and editorial independence. Three independent reviewers appraised criteria, and individual scores were averaged across each domain.
Results: Overall, criteria achieved a score of 43.5%, which is insufficient to establish guidelines. Criteria had three main limitations: first, recommendations were not based on a systematic review of the literature, and methods of expert consensus were not described. Second, the Panel did not address the main reasons why existing criteria require clarification, which are largely to do with the lack of consensus surrounding the utility of dynamic imaging, choice in craniometrics and pathological thresholds, and the role of neurophysiological testing in evaluating clinical manifestations. Third, the risks/benefits of the procedure were not discussed, and the final recommendation included vague qualifiers such as "possible brainstem compression" and "significant instability … or deficits to warrant a fusion." Discussion/Conclusion: Objective indications for the management of complications involving the hypermobile spine remain to be determined. Progress hinges on a more rigorous approach to synthesizing the literature, and future criteria must include explicit detail about the radiological and clinical modalities/metrics used in the diagnostic workup.
Introduction/Aim: Nurses learn to assess and manage pain during their undergraduate education and they refine their pain management skills after graduation. However, little is known about nurse's experience in managing pain as they transition to practice. The aim of this study was to explore the experiences of new graduate registered nurses (NG-RNs) managing pain as they transition to practice from the educational setting to the workplace.
Methods: A qualitative descriptive design was used to gain an understanding of the NG-RNs experience. NG-RNs (n = 15) completed a telephone interview up to 12 weeks after graduation. They were asked the following questions: What aspects of managing pain do undergraduate nursing students find stressful?; How confident do you feel managing patients' pain now? A100 RESEARCH POSTER ABSTRACTS Results: Participants reported three salient issues that made managing pain as a nursing student stressful: dependence on other healthcare providers, lack of experience, and fear of harm. The experiences described reflected a sense of helplessness when trying to manage pain as a student. To reduce this stress, they identified consulting with clinical faculty, using their theoretical knowledge, and non-pharmacological methods to manage pain. Eleven participants reported a moderate level of confidence in managing pain post-graduation. They identified needing more clinical experience, and not being confident in managing chronic pain, or acute on chronic pain.
Discussion/Conclusions: The findings of this study provide some insight into the experience of NG-RNs managing pain. Providing nursing students with clinical and theoretical experiences to improve their confidence in managing pain may ease the transition to independent nursing practice.
Introduction/Aim: Low back pain etiology is complex and has many contributing variables. The purpose of this systematic review was to report evidence of chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain in young people.
Methods: This systematic review and meta-analysis included cohort and inception cohort studies that investigated potential risk factors for back pain in children, adolescents, and young adults. Potential risk factors of interest were chronic physical illnesses, mental health disorders, or other psychological features. Searches were conducted in MEDLINE, Embase, CINAHL, and Scopus from inception to June 2018.
Results: Nineteen of 2653 screened articles were included in the qualitative synthesis, and data from 12 articles were included in the meta-analysis. Evidence from inception cohort studies demonstrated the most likely risk factors for back pain are psychological distress, as well as psychological features including emotional coping problems and somatosensory amplification. Evidence from noninception cohort studies cannot distinguish between potential risk factors or triggers for back pain. However, we identified several additional factors that are associated with back pain. Specifically, asthma, headaches, abdominal pain, depression, anxiety, conduct problems, somatization, and "feeling tense" are potential risk factors/triggers for back pain.
Discussion/Conclusions: The most likely risk factors for back pain are psychological features. Due to the limitations of the literature we still cannot be certain if physical illnesses, mental health disorders, and psychological features are comorbidities, triggers, or risk factors for back pain. More high-quality research is needed to better elucidate these relationships. Background: The purpose of this study was to assess time trends in the amount and total cost of opiate prescribing in Canada prior to and following the legalization of cannabis.
Methods: Canada wide monthly claims data for public and private payers were obtained from IQVIA PharmaStat for January 2016 -June 2019. The drug products evaluated consisted of morphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, oxycodone and tramadol. All opiate volumes were converted to a mean morphine equivalent dose (MED) per claim. Time series regression modeling was undertaken with dependent variables being mean MED per claim and total monthly spending. The slopes of the time series curves were compared post vs. pre cannabis legalization.
Results: Over the 42-month time horizon, there was a steady and statistically significant decline in the mean MED per claim within public drug plans. However, when comparing post vs. pre legalization, the decline in MED was 5.4 times greater in the former time period (22.3 vs. 4.1 mg per claim every month). In addition, total monthly opiate spending reductions averaged $95,000 per month before October 2018 compared to $267,000 per month following the legalization of cannabis. Similar findings were also observed within private payer plans.
Conclusions: It appears that the legalization of cannabis coincided with a marked drop in opiate usage in Canada. Consistent with reports from other studies, our findings support the hypothesis that easier access to cannabis for pain may reduce opiate usage and save drug costs for both public and private drug plans.
CONTACT George Dranitsaris george@augmentium.com Introduction/Aim: Up to 80% of adults will experience spine related complaints, which may result in diagnostic imaging, including plain x-rays, computed tomography, and magnetic resonance imaging. We performed a systematic review to explore the rates of A102 RESEARCH POSTER ABSTRACTS inappropriate spine imaging, as well as the effectiveness of interventions to decrease inappropriate imaging. Methods: We searched MEDLINE, HealthStar, EMBASE, CINAHL, Index to Chiropractic Literature, and The International Guideline Library from inception until July 8, 2018. Eligible studies reported on the proportion of inappropriate spine-related imaging or tested a strategy to improve the appropriateness of spine-related imaging. Articles underwent title, abstract, and full-text screening, followed by data extraction in duplicate.
Results: Of 17,527 unique citations, we reviewed 483 full text studies. We identified 62 eligible studies: 35 studies explored rates of inappropriate spine-related imaging, while 27 studies explored interventions to reduce inappropriate imaging of axial complaints. Inappropriate rates of cervical spine imaging ranged from 3%-54%, most frequently based on the National Emergency XRadiography Utilization Study and American College of Radiology criteria. Inappropriate rates of lumbar spine imaging ranged from 13%-80%, most frequently based on the U.S. Agency for Health Care Policy and Research guidelines. Interventions to improve appropriate imaging included guideline dissemination, educational interventions, and decision support systems, reducing imaging rates between 0%-80%, with active strategies implemented at the point-of-care showing larger effects.
Discussion/Conclusions: Inappropriate spine imaging is an ongoing issue. Active decision aids reduced inappropriate imaging rates more than passive dissemination of educational material.
Introduction/Aim: Clinically elevated levels of posttraumatic stress disorder (PTSD) symptoms have been documented in parents of youth with chronic pain and are related to worse child pain intensity. Child factors including catastrophic thinking about pain have been shown to mediate this relationship. However, less is known about the role of PTSD-related parent factors, such as a poor sleep quality, in this pathway. The current study is the first to examine parent sleep quality as a potential mediator in the parent PTSD-child pain relationship among youth with chronic pain.
Methods: Fifty-one youth with chronic pain and one of their parents (M = 45 years; 91% mothers) were recruited from a tertiary-level pain management program. Parents completed questionnaires assessing sleep quality and PTSD symptoms and youth reported on their pain intensity at baseline. Correlation and mediation analyses were conducted to examine the relationship between parent variables and youth pain outcomes.
Results: Poor parent sleep quality was associated with higher levels of PTSD symptoms (r =.43, p <.01) and higher child pain intensity (r =.54, p <.001). Higher PTSD was correlated with higher child pain intensity (r =.37, p <.001). Parent sleep quality mediated the relationship between parent PTSD and child pain intensity (n = 51, ab = 0.05, CI BCa = 0.0047 to 0.13).
Discussion/Conclusions: Findings suggest that parent reported sleep quality may explain how parent PTSD symptoms influence child pain outcomes. Prospective research using objective measures to measure parent sleep quality is needed. Chronic pain is defined as pain without apparent biological value that has persisted beyond the normal tissue healing time (IASP, 2012). One of four Canadians or 25% of the population in Canada are suffering from chronic pain. Approaching these patients has always been a major challenge and of course individualized, particularly if they have sustained an injury like a car accident, work-related injury, etc. Many experts believe that chronic pain is sometimes a physical manifestation of psychological issues. Could experiencing injustice be one of them? Among the different questionnaires available for assessing chronic pain patients, including the Brief Pain Inventory (BPI), Pain stages of change (PSCQ), McGill pain, Pain Catastrophe Scale, etc, Injustice Questionnaire questionnaire (IEQ) could also be very useful. Particularly if injury has occurred as a result of another's error or negligence. Therefore, pain patients might experience post-injury life with a sense of injustice as well as chronic pain disease. A study of 300 patients referred to Chronic Pain Management Program (CPMP) by community physicians in 2018 and 2019 showed that 160 of the patients sustained an injury as their inciting event, and 79% of them had IEQ scores of 30 or higher, indicating high level of perceived injustice. Furthermore, 92% had multiple investigations, and specialists' visits, and polypharmacy without any clear diagnosis. Only 19% of them were suffering from severe and 38% from moderately depression but 36% of them had severe and 29% moderate anxiety.
Introduction/Aim: Although injustice has a long history in philosophy and psychosocial, only recently the topic of perceived injustice has been used among pain specialist. In many chronic pain patients, life following injury is associated with persistent psychosocioemotional issues. Current research suggest that perceived injustice consequent to injury might represent one of the strongest predictors of problematic outcomes. Injured individuals who report high levels of perceived injustice also experience more intense pain, more severe depression and are less likely to return to work. Individuals with high levels of perceived injustice display more pain behavior, seek more medical attention, and rate themselves as more severely disabled. Perceptions of injustice are also associated with the persistence of post-traumatic stress symptoms consequent to injury.
Methods: After having read extensive literature review about bioethics, injustice experience, and chronic pain disease; A retrospective cross-sectional study of 300 consecutive patients referred to CPMP, Thunder Bay, ON, in 2018 and 2019 was carried out. In this study, 160 patients were found to have an injury as their inciting event. They all were provided with Injustice Experience Questionnaire (IEQ) which is a 12-item scale that asks respondents to indicate the frequency with which they experience different thoughts concerning the sense of unfairness in relation to their injury. 153 of them completed and scored the IEQ. Those with the IEQ score of 30 or higher, representing clinically relevant level of perceived injustice, were included and their demographics data and result of other questionnaires (BPI, GAD-7, PHQ-9 and McGill Pain questionnaire) were collected and analyzed.
Discussion/Conclusions: Very high percentage of chronic pain patients in Northern Ontario are perceiving high levels of injustice, based on their IEQ scores. It is certainly a yellow flag in their pain management. Failure to pay attention to it may result in unsuccessful Introduction/Aim: Pain is a basic and necessary experience that alerts us to physical harm or infection. Yet pain is notoriously difficult to describe and harder still for one person to "stand in the shoes" or understand what another person's pain is like. Empathy from other people is essential for treating or communicating with these patients, despite the barriers to feel patients' pain. Therefore, we designed a VR game in which participants inhabit an avatara character who suffers from chronic pain.
Methods: To understand user experiences of our AS IF VR game, we designed a usability test. The study was a posttest, pretest study, proposed to assess participants' empathy levels toward CP patients before and after playing AS-IF. Additionally, we analyzed the sense of embodiment (SoE) levels of our participants.
Results: Overall, after playing the VR game, participants scored significantly higher on the Willingness to Help Scale and the Kindness subscalean adaptation of the Empathy questionnaire. Further, from the semistructured interviews, we were able to gather essential feedback about the strengths and limitations of the current VR design, such as the effectiveness of pain representations.
Discussion/Conclusions: The visual-motor synchronicity of a player's full-body movements mirrored by the avatar appears to elicit identification with the avatar. Results revealed that the game was effective in improving implicit and explicit empathy. Furthermore, findings showed that the game raised the emotional and perspective-taking aspects of players' empathy. Introduction: Ongoing pain and post-traumatic stress symptoms (PTSS) are late effects among survivors of childhood cancer (SCCs). Previous research in noncancer pediatric chronic pain populations has established robust relationships between parent and child PTSS and pain outcomes. Parent and child pain catastrophizing has been shown to mediate this relationship. These relationships have not been explored in SCCs. We investigated the role of parent and child PTSS and pain catastrophizing on pain outcomes in SCCs.
Results: Higher survivor pain catastrophizing was associated with higher pain severity (r =.49, p < .001) and interference (r =.43, p < .001). Higher parent pain catastrophizing was associated with higher survivor pain severity (r =.50, p = .004) but not interference (r =.14, p > .05). Neither parent nor child PTSS was associated with survivor pain outcomes (p's >.05). Controlling for age and gender, linear regressions revealed parent and survivor pain catastrophizing each predicted survivor pain severity, and cumulatively accounted for 54% of the variance in pain severity scores.
Conclusions: Contrary to previous findings in the chronic pain literature, PTSS was unrelated to pain outcomes in SCCs. However, similar to chronic pain populations, parent and child pain catastrophizing impacted child pain interference and severity. Familybased interventions targeting pain catastrophizing should be evaluated for this population.
Introduction/Aim: Arthritis is projected to exacerbate with the increase of the aged population in Canada [1] . Live With Arthritis Plus (LWAP) is an app designed by eTreatMD to diagnose joint arthritis symptoms and measure their impact factors and treatment effectiveness. Under industrial guidelines from the Food and Drug Administration (FDA), the researchers conducted a Human Factor Usability (HFU) study on LWAP, evaluating its intended Use of Device (UoD), Instructions for Use (IFU), and the Ability to Support Safe and Effective Use (ASSEU).
Methods: Aging adults (45+) diagnosed with Osteoarthritis (OA) or Rheumatoid Arthritis (RA) ("patients") were recruited through a Snowball sampling for this study.
There were two main stages: a Training Stage (TrS) watching LWAP's video tutorials, and a Testing Stage (TeS) of actually interacting with the app under-designed scenarios. The patients were then asked to fill out HFU questionnaires, followed by semistructured interviews with the researchers.
Results: In-experiment observations and interviews showed that the patients were unable to use LWAP's hand-image functionality due to their constant tremors of hands. Additionally, while a majority (64%) of the patients reported positive experiences with LWAP's User Interface, those preferring outward methods (distraction) to confront pain denied future use of this app since daily pain tracking prevents distraction.
Discussion/Conclusions: Patients recording their pain symptoms and treatments in the past expressed satisfaction with LWAP. However, patients' physical and age conditions should be expressly considered while polishing features including: • Image-taking • Icon size and consistency Introduction/Aim: Phantom Limb Pain (PLP) is a type of neuropathic pain perceived in a part of the body after a limb is "missing" through amputation or is nonfunctioning as a result of a severe injury such as a Brachial Plexus Avulsion (BPA). Examples of nonpharmacological interventions include mirror therapy (MT), motor imagery, the use of immersive virtual reality (VR) and augmented reality (AR) technologies. Among these interventions, VR and AR technology have been shown to reduce PLP during and temporarily after the intervention; in some cases, the pain alleviation lasted for extended periods of time, up to six months. Methods: In March 2019, a search was conducted in the databases of Cochrane, PubMed, IEEE, ACM, and Google Scholar. Using the primary keywords "Phantom Limb Pain," "Virtual Reality," and "Augmented Reality," twenty research studies in total were selected. All these studied were reviewed and their reported analgesic effects analyzed.
Results: Researchers using VR/AR interventions reported approximately 34-55% decreases in perceived pain as indicated by the McGill Pain Questionnaire with varying intervention durations and frequencies.
Notably, prior research showed majority PLP patients reported a decreased awareness of their phantom limb's kinesthesia. Some researchers used VR/AR interventions to restore the patients' sense or control of phantom limb movement, which in turn leads to pain reduction.
Discussion/Conclusions: The findings and implications of this review may shed light on the analgesic effects of VR/AR interventions, on future designs of VR/AR environments and tasks that are critical for the effectiveness of alleviating PLP.
Introduction/Aim: This study aims to limit surgically instigated chronic pain risk by adapting the Ontario Pediatric Chronic Pain Network (OPCN) registry to create a patient-driven perioperative pain assessment questionnaire for the pediatric Transitional Pain Service (pTPS). 1,2 Methods: Patients and parents seen in the pTPS from July-December 2019 are entered in this Quality Improvement project. We followed the Plan-Do-Study-Act Cycle. 3 Plan: Investigators identified relevant Patient-Reported Outcomes Measurement Information System (PROMIS®) pain-related scores 4 and developed qualitative questions on patients' pain goals. Lastly, investigators added a satisfaction survey to inform questionnaire improvements.
Do: Questionnaires are e-sent to participants the week before their pTPS appointment in Research Electronic Data Capture (REDCap TM ).
Study: Investigators review questionnaire completion, satisfaction and recommendations.
Act: Recommendations applicable to all participants are implemented during the study to observe satisfaction changes over time. A pTPS' staff focus group will finalize the questionnaire by assessing recommendations' feasibility.
Results: 56 questionnaires were sent to 23 patientparent dyads. Participants completed the questionnaire in 3-20 minutes. 53.57% questionnaires were completed which is consistent with other pediatric psychological surveys. 5 14.29% patients "strongly agreed" and 64.29% "agreed" the questionnaire captured important information about their pain. 13.33% parents "strongly agreed" and 53.33% "agreed" with this. 7.14% "strongly disagreed" with this statement. 13.33% "disagreed," but changed their responses to "agree" or "strongly agreed" after the questionnaire's revisions. 92.86% patients and 93.34% parents felt the language in questionnaire was clear.
Discussion/Conclusions: Results from the satisfaction survey support a qualitative and quantitative mixed-methods approach since it allows patient goals to drive their perioperative care.
Introduction: Chronic pain is prevalent in many industrialized nations. Pain takes a significant toll on personal physical and mental wellbeing, and exerts very high costs to families, employers and society. Encouragingly, research shows that pain and sleep have a reciprocal nature, thus suggesting that interventions to improve sleep may decrease pain symptoms. To-date, we know little about how companion dog ownership may influence the pain/sleep relationship. Typical advice to remove pets from the bedroom negates the possible positive benefit of human-animal co-sleeping; a more nuanced examination is warranted. The objective of this study was to investigate pain patients' perception about the impact of their pet dog on sleep.
Methodology: A content analysis of interview data exploring patients' perception about the impact of the pet dog on sleep. The qualitative dataset was extracted from a subgroup of participants in a larger study focused on the pain patient/pet dog relationship. The subgroup was asked, "Does your dog have a positive or negative impact on your sleep?" Using an iterative approach, the data were thematically coded.
Main Findings: Theme codes included: companionship; physical presence/'cuddles'; routine/schedule; distraction from anxiety/worry at night; reassuring/ protective presence; active intervention to keep partici-pant safe; daytime activity to promote sleeping at night; and reciprocal concern for the sleep of the pet dog.
Principle Conclusions and Implications: Companion dogs may play important roles in helping some chronic pain patients achieve better quality sleep. Routine advice to remove the dog to improved sleep could be counter-productive and more nuanced and contextualized recommendations should be developed. 1

Disclosure Statement
No potential conflict of interest was reported by the authors. Introduction/Aim: Among veterans in Canada, twice as many (41%) experience chronic pain compared to the general population (20%). The aim of this study was to compare chronic pain management outcomes in 68 veterans and 68 non-veterans attending an intensive, four-week chronic pain management program at the Michael G. DeGroote Pain Clinic. The two groups were matched for age and gender.

A112 RESEARCH POSTER ABSTRACTS
Methods: Data were obtained from psychometric measures completed by patients at admission and discharge to examine program effectiveness and differences in pain experience. These included bothersome symptoms, pain intensity, pain-related disability, depression, anxiety, catastrophizing, kinesiophobia, sensitivity to pain traumatization, stages of change, acceptance of pain, and satisfaction measures.
Results: MANOVA was used to examine session (admissiondischarge) by group (veterannonveteran) differences on psychometric measures using SPSS. Data analysis yielded significant differences from admission to discharge and between veterans and nonveterans on catastrophizing, kinesiophobia, sensitivity to pain traumatization, pain acceptance, stages of change, and pain coping, all favoring veterans.
Discussion/Conclusions: Evidence supports the effectiveness of the interdisciplinary pain management program in addressing chronic pain and comorbidity in veterans and non-veterans and provides insight into how pain is experienced differently by veterans. Further research on veteran chronic pain would provide more insight into the unique pain experience within this group.
CONTACT Eleni G. Hapidou hapidou@hhsc.ca Introduction/Aim: The recent strides in optogenetics has spurred research into the neural basis of pain in vivo and in freely moving animals. We have developed and characterized a method for the delivery of light to the spinal dorsal horn that is suitable for optogenetic studies in freely behaving mice. Using this approach, we activated TRPV1 + nociceptors expressing channelrhodopsin (ChR2) to investigate how the activation of these sensory fibers can both acutely modulate behavior and induce hyperalgesia. Methods: A ceramic ferrule was surgically implanted in the lumbar vertebrae of wildtype (WT) mice and mice expressing ChR2 in TRPV1 + afferents (TrpV1-ChR2). A fiber optic patch cable connected the implanted lens to a blue LED light source for stimulation of the central terminals of the TRPV1 + primary afferents. Possible adverse effects of this surgery were studied using immunohistochemical assessment of spinal cord glial activation, open field and rotarod behavioral assays. Mechanical sensitivity was assessed using von Frey filaments and thermal sensitivity using a thermal gradient assay to measure thermal preference.
Results: We observed that the surgical technique did not result in any changes in evoked motor function, spontaneous locomotion or mechanosensitivity. In addition, there was no evidence of astrocyte or microglia activation in the spinal cord after surgery. Delivery of blue light through the implant was found to result in robust nocifensive behaviors in the TRPV1-ChR2 mouse line. After suprathreshold stimulation of TRPV1-ChR2 at 2-Hz for 10 minutes, mice exhibited robust mechanical hypersensitivity which lasted approximately 2 weeks. Similar stimulation in implanted WT mice did not result in mechanical hypersensitivity. Notably, thermal preferences of the mice were not affected by either suprathreshold 2-Hz stimulation or acutely delivered subthreshold stimulation. Finally, delivery of light at a subthreshold intensity that did not acutely produce nocifensive behaviors produced progressively more pronounced nocifensive behaviors after prolonged stimulation.
Discussion/Conclusions: Optogenetic activation of TRPV1 + afferents produced a surprisingly long-lasting mechanical hypersensitivity. This suggests that optogenetically-induced hyperalgesia may mechanistically differ from the shorter duration hypersensitivity induced by capsaicin activation of peripheral TRPV1 +afferents. In addition, persistent subthreshold stimulation eventually resulted in an emergence of nocifensive behaviors over the time course of the stimulation, alluding to potential wind-up. Further work will investigate the mechanisms of these behavioral changes.
Introduction/Aim: A multitude of contextual factors contribute to individual differences in pain response. Existing research has begun to characterize individual variability in pain response in full term infants. We aimed to classify individual pain response trajectories during 2, 6, 12, and 18-month immunizations appointments in infants born preterm.
Methods: A cohort of preterm infants was followed during routine immunizations. Video was recorded during appointments to capture pain response with the Modified Behavioral Pain Scale (MBPS) assessed at baseline, injection, and recovery (2-minute post needle period). Latent class analysis was used to group infants in classes of pain response trajectories.
Results: A total of sixty-four infants (average gestational age 32.5 weeks) participated. Stable classes were identified at each age. At the 2-month immunization, infants demonstrated an increased response to pain, with 17% showing no regulation. From ages 6 to 18months, fewer infants displayed a pain response. Those who responded were able to regulate pain during the recovery period, with varying time to regulation driving different classes. At every age, during injection, average pain response in at least one class was meaningfully different (>1-point on MBPS) to the sample average. Discussion/Conclusions: There is substantial variation in preterm infants' pain response trajectories. Infants at older ages demonstrated improved ability to regulate pain. In full term infants mean pain scores within classes differed from the sample mean during recovery, compared to during injection as found in this preterm sample. Further research in larger samples is needed to identify factors associated with pain trajectory class.
Early Identification of Opioid-Induced Sedation: Taking a Step beyond Looking at Arousability

Danielle Dunwoody
School of Nursing, York University, Toronto, Ontario, Canada Introduction/Aim: Managing acute pain within the acute care setting is challenging for all levels of practitioners. Clinical decision making regarding opioids has the limited supports of linear pain and sedation scales, which can conflict at times with clinical judgment. This study examined the common meanings of opioidinduced sedation and shared practices in the context of post-operative pain management in expert Post-Anesthesia Care Unit (PACU) nurses.
Methods: An interpretive phenomenology approach was utilized for this study. Twenty expert PACU nurses participated in qualitative interviews regarding their lived experiences. An interpretive team was utilized for the analysis of data, as well as validating themes and the pattern with a subset of participants.
Results: Four themes identified through the participants stories were recognizing that every patient is different, engaging in iterative knowing, walking a fine line, and looking beyond and anticipating. Participants were able to identify the picture of sedation within their clinical practice experiences which supported further dimension to the concept of opioidinduced sedation to include: arousability, hemodynamic and respiratory stability, mobility/motor function, cognition/consciousness, and safety.
Discussion/Conclusions: The results of this study suggest further investigation into the role cognition and consciousness play in relationship to the assessment opioid-induced sedation in the context of pain management with opioids specifically, in the acute pain phase. Further exploration into the roles of consciousness and cognition in relationship to opioid-induced sedation is warranted. Balancing pain control with sedation is an iterative, patient specific, and dynamic process that involves complex assessment components of nursing care.
Introduction/Aim: Physician adherence to guideline recommendations for use of opioids to manage chronic pain is often limited Methods: In February 2018, we administered a 28item, online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain, and if physicians had altered practices in response to recommendations.
Results: We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective non-opioid treatment, as barriers. Thirty-seven percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering.
Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts.
Discussion/Conclusions: There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.
Introduction/Aim: We systematically reviewed observational studies to establish the prevalence of opioid use disorder (OUD) among patients prescribed this class of medication for CNCP, and to explore factors associated with the development of OUD.
Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, and PsycINFO from inception to December 2018. Two specialists in addiction medicine reviewed each potentially eligible study, blinded to results, to ensure their outcome met current criteria for OUD. We pooled estimates of OUD across eligible studies using random-effects models. When possible, we pooled estimates of association with OUD for all independent variables reported by more than one study.
Results: Twenty-two studies were eligible for our review. Rates of OUD across studies ranged considerably, and the pooled prevalence of OUD was 20% (95% CI: 15% to 24%). We found moderate certainty evidence for a significant association between OUD and age (odds ratio [OR] for every 10year increment, 0.63; 95% CI: 0.43 to 0.90) and current smokers (OR 1.63; 95% CI: 1.25 to 2.12); high certainty evidence for a significant association between OUD and male sex (OR 1.50; 95% CI: 1.05 to 2.14); and low certainty evidence for a significant association between OUD and a history of mental health disorders (OR 1.49; 95% CI: 1.17 to 1.89). Low certainty evidence showed no significant association between OUD and history of alcohol abuse/ dependence or history of drug abuse.
Discussion/Conclusions: Limited evidence suggests that one in five CNCP patients prescribed opioids will develop OUD.