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Purpose/objective Chronic pain has a significant negative impact on the quality of life, including sleep disruption. There is compelling evidence that cognitive-behavioral therapy can be effective in treating sleep disorders. To our knowledge, no research has been carried out on brief cognitive-behavioral educational interventions in individuals with chronic pain. This study was conducted to determine whether a brief education session that incorporates sleep hygiene and cognitive-behavioral strategies would help improve the sleep of individuals with chronic pain. Research method/design Eighty-five patients from a tertiary care Multidisciplinary Pain Centre completed all aspects of the study. This sample was randomized into 2 groups: a treatment group who received a brief cognitive-behavioral educational session, and a control group who did not. All participants completed a daily sleep diary for 28 days. Measures on sleep quality, beliefs and attitudes about sleep, pain, disability, and mood were recorded at baseline. Results No significant differences were found between groups on demographic, pain, disability, mood measures, or sleep quality at baseline. Overall, 42% of the individuals who completed this study had depression scores above the clinical cutoff. This sample reported a high level of pain-related disability. Individuals in the treatment group had significantly reduced sleep onset latency compared to controls. No significant differences between groups on the number of times waking or hours slept. Conclusions/implications Our findings suggest that there is potential for a brief educational intervention to have a positive impact on some aspects of sleep in the chronic pain population.

Chronic pain is a significant problem in children and teens, and adolescents with chronic pain often struggle to attend school on a regular basis. We present in this article a novel program we developed that integrates attendance at a group cognitive-behavioural chronic pain self-management program with earning high school credits. We collaborated with Alberta Education in the development of this course, Chronic Pain 35. Adolescents who choose to enroll are invited to demonstrate their scientific knowledge related to pain, understanding of and engagement with treatment homework, and demonstrate their creativity by completing a project, which demonstrates at least one concept. Integrating Chronic Pain 35 into an adolescent’s academic achievements is a creative strategy that facilitates the engagement of adolescents in learning and adopting pain coping techniques. It also helps teens to advocate for themselves in the school environment and improve their parents’ and teachers’ understanding of adolescent chronic pain. This is one of the first successful collaborations between a pediatric health program and provincial education leaders, aimed at integrating learning and obtaining school credit for learning about and engaging in health self-management for teens. The authors hope this paper serves as an effective reference model for any future collaborating programs aimed at supporting teens with chronic pain to obtain high school credits.

BackgroundChronic pain is a common problem in adolescents that can negatively impact all aspects of their health-related quality of life. The developmental period of adolescence represents a critical window of opportunity to optimize and solidify positive health behaviors and minimize future pain-related disability and impaired work productivity. This research focuses on the development and evaluation of a smartphone-based pain self-management app for adolescents with chronic pain. ObjectiveThe objectives of this study were to characterize (1) the feasibility of deploying a mobile health (mHealth) app (iCanCope) to the personal smartphones of adolescent research participants; (2) adherence to daily symptom tracking over 55 consecutive days; (3) participant interaction with their symptom history; and (4) daily pain-related experiences of adolescents with chronic pain. MethodsWe recruited adolescents aged 15-18 years from 3 Canadian pediatric tertiary care chronic pain clinics. Participants received standardized instructions to download the iCanCope app and use it once a day for 55 days. Detailed app analytics were captured at the user level. Adherence was operationally defined as per the relative proportion of completed symptom reports. Linear mixed models were used to examine the trajectories of daily symptom reporting. ResultsWe recruited 60 participants between March 2017 and April 2018. The mean age of the participants was 16.4 (SD 0.9) years, and 88% (53/60) of them were female. The app was deployed to 98% (59/60) devices. Among the 59 participants, adherence was as follows: low (4, 7%), low-moderate (14, 24%), high-moderate (16, 27%), and high (25, 42%). Most (49/59, 83%) participants chose to view their historical symptom trends. Participants reported pain intensity and pain-related symptoms of moderate severity, and these ratings tended to be stable over time. ConclusionsThis study indicates that (1) the iCanCope app can be deployed to adolescents’ personal smartphones with high feasibility; (2) adolescents demonstrated moderate-to-high adherence over 55 days; (3) most participants chose to view their symptom history; and (4) adolescents with chronic pain experience stable symptomology of moderate severity. Trial RegistrationClinicalTrials.gov NCT02601755; https://clinicaltrials.gov/ct2/show/NCT02601755 (Archived by WebCite at http://www.webcitation.org/74F4SLnmc)

BACKGROUND:The efficacy of some common, questionable chronic pain interventions has been debated and it is unclear why sufferers of chronic noncancer pain agree to receive them. This study attempts to determine if chronic pain sufferers characteristically more readily accept treatment with questionable benefit.OBJECTIVES:This study aims to compare the strength of acceptance or rejection of a hypothetical, mock chronic pain treatment of debatable value by two groups of patients: those reporting chronic noncancer pain and those who are 'pain free'.METHODS:A questionnaire proposing a hypothetical treatment for chronic pain was distributed to two groups: Group 1 (n=160), patients attending a chronic pain centre, and Group 2 (n=240), patients attending a family practice centre. Patients were asked to score their 'treatment acceptance' using a modified Likert scale. The treatment was based on the risks and benefits of epidural steroids.RESULTS:Ninety-three patients in Group 1 were eligible for inclusion in the 'chronic pain' group and 92 patients from Group 2, for the 'pain free' group. The median scores were identical at +3; nonparametric testing revealed no significant difference between the groups in their acceptance of the treatment.CONCLUSIONS:An analogue study such as this removes the potential bias of clinical interaction with a physician, but lacks some reality. Nonetheless, the results from this study did not support the hypothesis that patients with chronic noncancer pain accept treatment of questionable benefit more readily than those who are 'pain-free'.

Objective. In this study, we were interested in determining whether we could alter a pain response in a chronic pain patient population by exposing participants to different videos prior to inducing acute pain. Design. This observational case series study required participants to report their pain level during the cold pressor task after viewing an instruction video. Setting. Recruitment and testing took place in a tertiary care multidisciplinary pain center. Subjects. Forty adults with chronic pain participated in the study and completed the cold pressor test. Methods. Prior to testing, questionnaires measuring pain, empathy, and catastrophic thinking were completed and participants were randomized to view an instructional video where an actress either demonstrated pain behavior or a stoic response during the cold pressor test. Results. Participants with higher levels of catastrophizing reported higher pain levels during the cold pressor test. Personal Distress Empathy measures of participants who viewed the pain catastrophizing video were significantly correlated with their final pain reports. Following the cold pressor task, participants’ pain reports for their primary chronic pain sites were significantly reduced. Conclusions. These results support previous findings that people with chronic pain show the tendency toward increased acute pain experience if levels of catastrophizing and Personal Distress Empathy measures are higher. Participants reported attenuated chronic pain following induced pain, also in line with previous research suggesting a central endogenous inhibitory effect. Our findings shed light on the role of emotional and social components affecting the experience of pain in individuals with chronic pain.

BACKGROUND: Opioid analgesia impairs gonadal function in men and women, but the correlation with symptoms and hormonal measurements of hypogonadism is not well established.OBJECTIVE: To determine the frequency of impaired gonadal function in men and women using opioids for chronic pain, and to determine the correlation of symptoms with hormonal measurements of gonadal function.METHODS: A prospective study of patients attending a multidisciplinary pain clinic was conducted. A total of 65 women (47 opioid users and 18 nonopioid analgesic controls) and 32 men (26 opioid users and six controls) were enrolled. Histories of sexual dysfunction and hormonal testing (men: total testosterone [TT], free testosterone [FT], prolactin and luteinizing hormone; women: FT, TT, prolactin, dehydroepiandrosterone sulphate, sex hormone-binding globulin, progesterone, luteinizing hormone and follicle-stimulating hormone, and estradiol) were obtained.RESULTS: In men, a low FT level was more common in opioid users (20/26; P=0.04). In men with abnormal hormone levels, there was no difference in the frequency of sexual dysfunction compared with men with normal hormone levels, and no difference in the frequency of opioid versus nonopioid use. In women, opioid users had lower FT levels (P=0.02). Low dehydroepiandrosterone sulphate was more frequent in women on opioids (P=0.03) in the menopausal group only (P=0.046). Premenopausal women taking opioids more frequently had a low TT level (P=0.03). The frequency of female sexual dysfunction was the same in opioid users (32/47) and controls (13/18; P=0.75), and also did not relate to any hormone abnormality.DISCUSSION: Men taking opioids had lower FT and higher prolactin levels, and women taking opioids had lower FT levels. Frequency of sexual dysfunction did not correlate with hormone levels in either men or women taking opioids.CONCLUSION: Opioids frequently cause low FT levels in men, but there is no relationship between abnormal hormone levels and symptoms of sexual dysfunction. Therefore, all men should be screened for low FT levels. Women on opioids had lower FT levels, but this did not correlate with sexual dysfunction symptoms. Therefore, measurements of FT or other hormones were not considered to be useful in women.

Individuals far from treatment centres are at increased risk of unmet needs. Given the high prevalence of headache, this is a great concern. With increased communication technology advancements including telehealth comes the opportunity to treat remote patients with limited or no access.

Headache pain has been found to be a common pain complaint across cultures. Much remains to be learned regarding the etiology and biological treatments of complex headaches. Much is unknown regarding etiology and biological treatments of headache