Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  was established by the Calgary Chronic Pain Center (CPC) in 2007 to provide treatment recommendations and education to healthcare staff caring for adult patients experiencing chronic pain in the acute care environment. Since then, our service has evolved to become a fully autonomous Nurse Practitioner (NP) service.The CPCS offers a unique model of care delivery that utilizes NPs to their full scope of practice, including prescribing of controlled drugs and substances, and delivery of expert care within an evolving chronic pain landscape amidst the opioid crisis.The CPCS launched with Specialist LINK© in July 2017, an innovative service that connects community providers and specialists in the Calgary area. Specialist LINK© includes real-time, tele-advice line for physicians and NP’s, clinical care pathways, and other resources that help to improve communication and collaboration between community providers and specialty care. We will present evaluation data indicating improved access to chronic pain specialists and provider satisfaction with the advice received.The CPCS has evolved into a distinctive model of care within chronic pain management in Calgary. The utilization of the NP role to provide tele-advice for chronic pain management is a unique model of care delivery that can serve as a foundation for improving care for individuals and their families experiencing chronic pain.a,*, Krista Aktuga, Kari Blessinga, Lori Montgomery http://orcid.org/0000-0001-6338-6455b,c, Jennifer Kirkera and Maria VinnikaRuth HanisaCalgary Pain Program, Alberta Health Services, Calgary, Alberta, Canada; bDepartment of Family Medicine, University of Calgary, Calgary, Canada; cAnesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, CanadaCONTACT Ruth Hanis ruth.hanis@ahs.ca© 2020 Alberta Health Services. Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  in 2007, the In-Hospital Chronic Pain Consult Service (CPCS) was developed to provide treatment recommendations and education to healthcare staff caring for adult patients experiencing chronic pain in the acute care environment. Since then, our service has evolved to become a fully autonomous Nurse Practitioner (NP) service.Various developments have contributed to the CPCS becoming a unique model of care delivery in the acute care setting. These include utilization of NPs to their full scope of practice, including prescribing of controlled drugs and substances; the need for expert knowledge and experience in the evolving chronic pain landscape amidst the opioid crisis; and the support of physicians at the CPC.The CPCS has progressed to providing treatment recommendations in the four acute care sites, extending into the community through discharge recommendations and via a tele-advice line. We also offer educational opportunities for healthcare professionals, provide mentorship and a supportive learning environment for Clinical Clerks and Residents, and work as part of an interdisciplinary team in the NP clinic at the CPC.The CPCS has evolved into a distinctive model of care within chronic pain management in Calgary. This model of care can serve as a foundation for expert-care delivery in the complex area of chronic pain management across Canada.a,*, Geraldine Cullen-Deanb, Catherine Munnsc and Stephen BrownbGiulia MesaroliaDepartment of Physical Therapy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; bDepartment of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; cDepartment of Anesthesia and Pain Medicine, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, CanadaCONTACT Giulia Mesaroli giulia.mesaroli@sickkids.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  is a painful condition of a limb characterized by a constellation of symptoms that occur most typically after a minor trauma. In pediatrics, the average age of onset is 12 years, is more prevalent in females, and most commonly occurs in the lower limb. Clinical expertise suggests that early access to intervention and treatment may lead to a more favorable prognosis. The International Association for the Study of Pain suggests a 1-week wait-time for acute onset CRPS-1 to receive pain specialist assessment. The Chronic Pain Clinic at The Hospital for Sick Children in Toronto, Canada, implemented a Rapid Access Clinic (RAC) for pediatric CRPS-1 as a quality improvement project. Main outcomes included (1) reduction in wait-times for interprofessional assessment; (2) reduction in wait-times for physical and psychological therapy; (3) feasibility and (4) acceptability.Methods: The RAC was implemented in April 2019. Patients referred to our center with suspected CRPS-1 underwent a rapid triage process, interprofessional assessment , and rapid access to treatments.Results: Between April 2019 - March 2020, 24 patients were referred to the RAC. Wait-times were significantly reduced for triage (mean = 4.3 days), assessment (mean = 12.5 days) and intervention . Data obtained from patient and family satisfaction surveys and staff focus group yielded highly positive results.Discussion: This novel approach to assessing pediatric CRPS-1 is feasible, acceptable and resulted in a significant reduction in wait-times. Further evaluation is needed to understand if early intervention lead to improve outcomes in this population.a,* and Laura KatzaGregory TippinaMichael G. DeGroote Pain Clinic, McMaster University Medical Centre, Hamilton, Ontario, CanadaCONTACT Gregory Tippin tipping@hhsc.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (Introduction: Somatic Symptom Disorder (SSD) was introduced in DSM-5 as a replacement for DSM-IV Pain Disorder, where SSD includes a specifier for patients with predominantly pain. To date, SSD has not been widely examined within patients with chronic pain, despite the importance of this diagnosis within chronic pain populations. Given the importance of diagnosis to tailor treatment, there is a need to examine the prevalence and validity of SSD.Methods: Adult patients attending the Michael G. DeGroote Pain Clinic referred for psychological services were assessed for SSD using a structured clinical interview, the Diagnostic Assessment Research Tool (DART). Patients also completed psychometric measures assessing several pain related constructs, including pain intensity, catastrophizing, disability, kinesiophobia, depression, anxiety, and somatic symptoms.Results & Discussion: Two hundred and fifty-four patients with chronic pain were included in the study. Findings suggest that the majority of patients presenting for psychological services within a chronic pain clinic met criteria for SSD. Patients who were diagnosed with SSD had significantly higher scores on pain-related measures such as pain catastrophizing, kinesiophobia, and disability, and symptoms of anxiety, but not on pain intensity, somatic symptoms, and symptoms of depression. Risk factors such as being female and reporting a history of physical or sexual abuse were significant in the sample, where demographic factors such as unemployment, education, and age were not.Conclusion: Findings suggest that DSM-5 SSD is highly prevalent in patients with chronic pain presenting for psychological services. Preliminary support for the validity of the SSD diagnosis was also provided, related to associations with kinesiophobia, catastrophizing, anxiety, and disability.a,*Jon NormanaMedical Division, Defence Medical Rehabilitation Centre, Stanford-on-Soar, Leicestershire, UKCONTACT Jon Norman jonathan.norman114@mod.gov.uk© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  was until 2016 not staffed bar 1 full time nurse with a weekly visiting consultant. DMRC is not a hospital and all services provided on site need to be risk assessed.Method: Pain interactions were recorded for 2 years following the introduction of an onsite civilian pain consultant. Data includes treatments performed locally and requested beyond, waiting times and patient satisfaction.Results: During this period the UK military was not involved in conflict. Despite this 20% of the UK was not judged fit to fight. 50% of cases were training injury, 30% sport, 15% mental health issues.3083 patients attend DMRC in years 2016/7.74% reported pain , 90% had an anxiety or depression issue. The pain team assessed 768 and arranged intervention for 325 patients. New on-site services included epidurals, radiofrequency to facet or nerves and local neuromodulation reducing waiting times from 6 months (via the NHS) to 2 weeks and psychological assessment. Waiting times for assessment fell from 16 to 1 week. All patients assessed were satisfied or highly satisfied with their service and judged it useful. No significant complications were recorded.Conclusion: The expansion of the on-site pain service improved speed of assessment and treatment. In future work we will see this improves the outcome of on-site rehabilitation as we increasingly involved earlier in the rehabilitation journey.http://orcid.org/0000-0002-0649-3550a,b,c,d,*, Laura Katze, Jennifer Bossioa,f, Tom Doulasa, Mary Anne Gooda, Kyle Vader http://orcid.org/0000-0002-0667-9726a,h, Rosemary Wilson http://orcid.org/0000-0003-3262-243Xb,c, Scott Duggana,c,iEtienne J. Bisson aChronic Pain Clinic, Kingston Health Sciences Centre-Hotel Dieu Hospital Site, Kingston, Ontario, Canada; bSchool of Nursing, Queen’s University, Kingston, Ontario, Canada; cDepartment of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada; dCentre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada; eMichael G. DeGroote Pain Clinic, McMaster University, Hamilton, Ontario, Canada; fSchool of Medicine, Queen’s University, Kingston, Ontario, Canada; gSchool of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada; hDepartment of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, CanadaCONTACT Etienne J. Bisson etienne.bisson@kingstonhsc.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  is a common measure to assess pain-related fear among patients with chronic pain, in line with a biopsychosocial assessment framework. In order to reduce patient burden (time to complete), clinician burden (scoring time), and increase clinical utility, a shorter version of this measure is needed. Thus, we are seeking to develop and validate a short-form TSK with good psychometric properties with the end goal of encouraging uptake of this tool as a gold-standard across chronic pain centers and researchers.Methods: The Kingston Health Sciences Center (KHSC) Chronic Pain Clinic  assesses biopsychosocial characteristics (including TSK-11) for all patients enrolled. Patient-reported baseline data from this registry was extracted from November 2017 to October 2019 . Data analyses included: 1) factor analyses and subsequent item reduction of the TSK-11, 2) Cronbach’s alpha’s to evaluate the scale’s internal consistency, and 3) correlations between the new short-form TSK and measures reflecting constructs of the fear-avoidance model  to evaluate the concurrent validity of the new measure.Results: A 2-factor structure was confirmed from the TSK-11 and the final model after item reduction resulted in a 7-item TSK (TSK-7) with 61.2% explained variance and Cronbach’s alphas of 0.76 and 0.70 for each factor. High correlations were found between the TSK-7 and TSK-11 (r = 0.96), along with similar correlation between the TSK7 and TSK11 with pain severity (r = 0.33 vs. 0.34), pain catastrophizing (r = 0.58 vs. 0.57) and depression (r = 0.46 vs. 0.45).Discussion: The TSK-7, a shorter form of the TSK-11, was shown to have good psychometric properties and concurrent validity. This shorter form could help to standardize and simplify questionnaires across chronic pain centers in order to facilitate patient care as well as cross-site research collaboration.a,*, M. Gabrielle Pagéb and Frédérick DionneaMarie-Eve MartelaDepartment of Psychology, Université Du Québec À Trois-Rivières (UQTR),Trois-Rivières, Québec, Canada; bCentre De Recherche, Centre Hospitalier De l’Université De Montréal, & Department of Anesthesiology and Pain Medicine, Université De Montréal, Montreal, Québec, CanadaCONTACT Marie-Eve Martel Marie-Eve.Martel1@uqtr.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  based on Acceptance and Commitment Therapy (ACT) in comparison to an education intervention among adults living with chronic pain.Methods: Participants (N = 297) were randomly assigned to a web-based ACT intervention group, an ACT-based bibliotherapy group, or an active control group receiving education on pain through online brochures. Participants completed self-reported online questionnaires at baseline, after the 9-week intervention, and at three- and six-month follow-ups. The primary outcome was pain disability and secondary outcomes were depression, anxiety, and quality of life.Results: Results of mixed linear models showed statistically significant interaction effects between time and groups for pain disability  and anxiety  in favor of the bibliotherapy group. Results also showed significant main effects for time in terms of depression  and quality of life  for all three interventions.Discussion/Conclusions: Findings suggest all three self-help intervention formats can lead to reductions in pain disability, depression, anxiety, and improvements in quality of life but a guided self-help intervention administered through ACT bibliotherapy may lead to greater reductions in pain disability and anxiety compared to web-based ACT interventions or an education intervention on pain.http://orcid.org/0000-0002-3401-262Xa,*, Suzanne Funkb, Erwin Karremanc, Huse Kamencica, Rashmi BhargavaaMaria Giroux aObstetrics & Gynecology, University of Saskatchewan, Regina, Saskatchewan, Canada; bPelvic Floor Physiotherapy, Emerald Physiotherapy and Rehabilitation, Regina, Saskatchewan, Canada; cStatistics, Saskatchewan Health Authority, Regina, Saskatchewan, CanadaCONTACT Maria Giroux mag640@mail.usask.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  and hands-on (n = 23) groups. Both groups underwent pre- training assessment that consisted of a written examination and an Objective Structured Clinical Examination (OSCE). Both groups had a didactic session. The video group then viewed instructional video and the hands-on group underwent hands-on training session with a pelvic floor physiotherapist. Both groups then underwent a post-training assessment. Primary outcome measure was the change in assessment scores from pre- to post-training. Secondary outcome measure was usefulness of the training program for clinical practice.Results: The mean written assessment and OSCE scores improved significantly pre- and post-training in both hands- on and video-based training groups (p < .001). There was no statistically significant difference in the degree of improvement of the mean written assessment scores (p = .19), OSCE scores (p = .10), and comfort level (p = .19) between groups. The training program was useful for clinical practice.Conclusions: Both video and hands-on are effective training methods. There is no difference in degree of improvement of assessment scores between both methods. This study presents a new effective multidisciplinary training program for teaching the assessment of the pelvic floor musculature to identify a possible muscular cause or contribution to chronic pelvic pain and provide early referral for appropriate treatment.a,* and Aaron KirschnerbRahul PathakaAllevio Pain Clinic, Wasser Pain Management Centre, University of Toronto, Toronto, Ontario, Canada; bDivision of Neurology, McMaster University, Hamilton, Ontario, CanadaCONTACT Rahul Pathak Rahul.Pathak@allevioclinic.com© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License , defined as constant testicular pain for ≥3 months that significantly interferes with daily activities, is common, occurring in approximately 2.5% of all urology office visits. Treatment can often be difficult, owing to a lack of standard treatment protocols.Methods: We present the case of a 38-year-old man with chronic left orchialgia following a ruptured varicocele for 2 years rated between 6/10 and 8/10 on a visual pain scale. Ultrasound-guided ilioinguinal block was trialed, which provided excellent relief for 2 months. This was followed by ilioinguinal nerve pulsed radiofrequency which provided longer-term but incomplete pain relief.Results: Left L1 dorsal root ganglion (DRG) pulsed radiofrequency treatment resulted in 95% pain relief. The patient was contacted 11 months after the procedure and remained pain-free.Discussion/Conclusion: We conclude that L1 DRG pulsed radiofrequency treatment is a therapeutic option for chronic orchialgia.a,*, Tracy Wasylakb, Susan Sobey-Fawcettc, Lori Montgomery http://orcid.org/0000-0001-6338-6455d, Nivez Rasice and Robert TanguayfJohn X. PereiraaFamily Medicine, University of Calgary, Calgary, Alberta, Canada; bAlberta Health Services, Strategic Clinical Networks, Nursing, University of Calgary, Calgary, Alberta, Canada; cStrategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada; dFamily Medicine & Anesthesiology Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada; eAnesthesia, University of Calgary, Calgary, Alberta, Canada; fPsychiatry & Surgery, University of Calgary, Calgary, Alberta, CanadaCONTACT John X. Pereira john@johncpc.com© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  reported experiencing pain that has lasted longer than three months. Thecomplexities of pain impact many aspects of a person's life including employment, personal relationships, sleep, mood, physical, and behavioural health. For many facing such challenges, access to social services and support whether in urban or rural regions, are often difficult and impacts recovery.Methods: In this study, we examine longitudinal data collected from Pain BC’s Pain Support Line to identify the social determinants of health needs of people living with pain in British Columbia (BC), Canada. This free telephone-and-email based pain support service is unique in Canada offering a safe space for people to talk about pain and its impact on their life. A quantitative analysis was conducted based on caller data collected from 1,652 clients who used Pain BC’s free volunteer-run phone and email Pain Support Line service over a span of four years. The service also provides information on self-management tools, connections to community resources, help navigating the health system, and information about Pain BC’s other services and resources. Discussion/Conclusions: The Pain Support Line also aims to attend to each caller using empowering language applying compassionate, trauma-informed, strength-based, and person-centred approach. The data from the support line provides a snapshot of the specific determinants. In addition, the study illustrates the need for individualized support for people in pain by creating a low barrier service that provides social support, concrete resources, and connects people with appropriate local community-based health services.a,*, Alex Mailisb and Angela Mailis http://orcid.org/0000-0001-5662-8989cLouisa MailisaMindfulness Teacher & Certified Professional Coach, Pain and Wellness Centre, Vaughan, Ontario, Canada; bChiropractor & Professional Coach, Pain and Wellness Centre, Vaughan Ontario, Canada; cPhysical Medicine & Rehabilitation, University of Toronto, Vaughan Ontario, CanadaCONTACT Louisa Mailis louisa@thepwc.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (Background: Participants in a Mindfulness course (for Stress and Pain Management) are asked to create an Art project that expresses their pain, their experiences and/or journey through the Mindfulness program, or any other insights that they have discovered along the way. They are given one week to complete the assignment and then asked to present it to the class.Aim: The primary objective of this study is to describe the thematic nature of Artwork produced by chronic pain participants, as expression of their feelings and experiences.Methods: All Artwork was viewed independently by 3 reviewers, each of whom marked the work on the basis of research questions. A qualitative approach using thematic analysis was undertaken. Disagreements between the reviewers were solved by collaborative discussion reaching consensus.Results: Participants included 13 females, one male; mean age 43.6 years; age range 26–64 years; 9 were employed , 3 were on disability and one retired. In regard to the Artwork, 5 major themes emerged as follows: 10/14 depicted a journey/transition; 13/14 showed expression of emotions ; 8/14 included nature themes; 6/14 used words to express their messages (3/14 combined nature and words while 3/14 used words only); and 5/14 had abstract themes. Examples of Art work and themes will be shown.Conclusions: Artwork by chronic pan patients is a powerful tool for expressing their experiences and emotions even in the eyes of independent observers.a,*, Kim Begleyb and Megan GrovesbNorm BuckleyaAnesthesiology, McMaster University, Hamilton, Ontario, Canada; bChronic Pain Network, Hamilton, Ontario, CanadaCONTACT Norm Buckley buckleyn@mcmaster.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License . Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  has been available for physical therapy trainees. The primary outcome for the course was a reflective journal. The true goal of the course; however, is that some students undergo a truly transformative change in the ways they see themselves as ‘providers of pain management’ or ‘providers of physical therapy for people in pain’, but it was not previously rigorously explored.Aim: The primary outcome of this study was to explore physical therapy students lived experiences of the course and determining if the course shaped their professional identities as ‘pain management providers.’Methods: Semi-structured interviews took place and the study followed an interpretive phenomenological approach. In following a phenomenological methodology, a small sample size of 8 participants were included.Results: In conducting this project, it contributed to a larger project of developing a master’s level interprofessional pain management program for practicing clinicians that launched September 2019.a,*, Nina Linnemanb, Kim Anderson Khanc, Chasity Brimeyerc, Steven J. Weismanc and Keri R. HainsworthcMonica L. GremillionaPsychiatry, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA; bCounseling Psychology, University of Wisconsin—Milwaukee, Milwaukee, Wisconsin, USA; cAnesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USACONTACT Monica L. Gremillion mgremillion@chw.org© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  required a novel approach to prospectively triage initial evaluations. We use the PPST to stratify patients into: multidisciplinary or medical-provider-only evaluations. Headache patients scoring <3 on the PPST see only a medical provider. Headache patients scoring ≥3 are evaluated by a medical provider-psychologist team, based on previously established clinical cutoffs. All chronic pain patients are evaluated by a multidisciplinary team, which is consistent with their higher PPST scores when compared to headache patients (p <.001). From our experience: 1) the PPST appropriately triaged patients 86% of the time; 2) 28% of patients only needed education, advice, or medications, which can be provided by medical providers; 3) 72% of patients needed more intensive evaluation by psychologists. Further, we identified that some medical providers needed additional support and training for evaluation of psychosocial issues, which can be provided by interdisciplinary case conferences.The Pediatric Pain Screening Tool  is used in our clinic as part of a new initiative to improve access to care. The lack of mental health providers embedded in pediatric pain clinics can limit access to care for those most in need. The PPST can identify patients needing more intensive follow up care , but the measure has not previously been used to triage patients a,*, Tom Doulasa, Lori Selkirka, Kerry Oultona and Scott DugganaKyle VaderChronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, CanadaCONTACT Kyle Vader kyle.vader@kingstonhsc.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License , a group-based physical activity goal setting work- shop was developed.Description of Program: The Chronic Pain Clinic at KHSC is an academic, tertiary care clinic that includes an interdisciplinary team of health care providers with experience and expertise in chronic pain management. The group-based physical activity goal setting workshop is theoretically rooted in social cognitive theory, whereby behavior change is conceptualized as a reciprocal interaction between a person (e.g. adult with chronic pain), environment , and behavior . Workshop development took an evidence-based approach and was developed based on a review of the literature, clinician expertise, and patient values. The physical activity workshop is two-hours in length, facilitated by a physiotherapist and/or occupational therapist, and designed for ten patients. It includes a workbook with content on pain science, the role of physical activity for chronic pain management, reflective exercises, and goal setting.Next Steps: The workshop is currently being piloted, whereby feedback will be sought from multiple stake-holders, including referring clinicians, clinicians who deliver the workshop, as well as patients.a,*, Carley Ouelletteb, Esther Fleurimondc, Kimberly Nelsond, Julie Drurye, Garry Salisburyf, Christine Lamontagneh, Paula Forgeron http://orcid.org/0000-0002-4686-9698i, Fiona Campbellj, Jennifer Stinsonk and Kathryn A. BirnielJustina MarianayagamaFaculty of Medicine, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; bSchool of Nursing, McMaster University, Hamilton, Ontario, Canada; cGatineau, Quebec, Canada; dWindsor, Ontario, Canada; eOttawa, Ontario, Canada; fMinistry of Health and Long Term Care, Kingston, Ontario, Canada; gDepartment of Anesthesiology and Pain Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; hSchool of Nursing, University of Ottawa, Ottawa, Ontario, Canada; iDepartment of Anesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; jChild Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; kDepartment of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, CanadaCONTACT Justina Marianayagam jmarianayagam@nosm.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License , were interested to act on at least one of the priorities (83% agree or strongly agree), felt able and empowered to act on at least one of the priorities (79% agree or strongly agree), and thought the session would make a difference to the Ontario Chronic Pain Network (90% agree or strongly agree). All agreed or strongly agreed it is important to partner/engage with patients and families to address these priorities and felt better informed about what priorities Canadians with chronic pain, their families, and clinicians have about treating pediatric chronic pain. Participants also described how they would change their clinical practice, research, or professional activities because of the session.Conclusions: Our activities showcase knowledge translation and action around patient- and family-identified priorities.a, Sofia Azeezb,*, Katelyn Reczekb and Emily BrockmanbKira EllisaAlberta Health Services Bone and Joint Health Strategic Clinical Network, Calgary, Alberta, Canada; bAlberta Bone and Joint Health Institute, Calgary, Alberta, CanadaCONTACT Sofia Azeez sazeez@albertaboneandjoint.com© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  patients referred to Albertan Hip and Knee Central Intake clinics are determined to be conservative management candidates and there are limited instructions for next steps to support the patient’s OA pain management and functional abilities. Conservative care includes all treatment strategies for OA outside of surgery. These treatments and self-management strategies may be offered by multiple health care disciplines and are patient centred, using a shared decision-making approach to determine the most appropriate options for each individual.Purpose: To determine the impact of conservative care education and tools designed to promote self-management strategies in patients living with OA in their hip or knee joints.Methods: Three touch points were designed to integrate into existing clinic workflows along with an OA Self-Management Toolkit for patients. The touch points include:(1)  An introductory OA education class delivered to all patients whose referral was accepted to a clinic, while they wait for their medical consult.(2)  A second, individually tailored class after the medical consult, for those patients who were designated as conservative management candidates.(3)  One year of telephone support from a Patient Navigator for conservative management candidates. This is an OA expert who can provide counsel, advise on evidence-informed treatment options or lifestyle changes, and direction to other disciplines when appropriate. Outcome measures and patient satisfaction surveys are delivered on a set schedule to patients by email. Outcome measures included self-rating surveys of OA status and readiness to change, Western Ontario McMaster University Osteoarthritis Index (WOMAC), EQ-5D-5L, and Patient Specific Functional Scale (PSFS).The OA Self-Management Toolkit include three tools:(1)  Report Card: A patient reflection tool to document their experience with conservative treatments to date and identify goals and barriers to determine a treatment plan.(2)  Treatment Menu: A bingo card of conservative treatment options based on the 2019 Osteoarthritis Research Society International Guidelines for the Non-Surgical Management of Knee, Hip and Polyarticular Osteoarthritis.(3)  Resource Inventory: A list of local community resources for OA conservative care.The delivery of the program is being tested at the Chinook Bone and Joint Clinic in Lethbridge, Alberta.Results: Interim results have been completed for the evaluation. Approximately 79% of patients (N=33) were diagnosed with OA in knee joints, and half the patients (N=10) described symptoms of early disease. The majority of patients, 86%, indicated a readiness to change current self-management practices. At the 6-month mark, the WOMAC and EQ-5D-5L scores have shown minimal change. The PSFS findings show a slight improvement of 0.30 in the patients’ functional ability, with half of patients indicating stair climbing and walking as priority goals. Patient feedback on the education classes acknowledged the following areas as beneficial to patients: learning about OA and how it affects the joints; learning about available treatment options to suit every lifestyle; debunking misconceptions about exercise as a treatment for OA; and group sessions promote inclusion and a community. Areas for improvement to education content and delivery include: the role of supplements and cannabis; earlier access to information prior to the class; and patient testimonials as positive examples. The majority, 97.0%, of patients who attended the first education class found it valuable and would recommend it to others (N=52). Similarly, 79.2% of patients felt better equipped to manage their OA (N=43) and 69.8% found some information to be repetitive (N=38). Although 92% of patients found the second education class valuable (N=12), patient recruitment has been low and recruitment strategies have been modified at 6-months into the evaluation to encourage participation.Conclusion: The group education classes improve patients’ knowledge about their condition, self-management activities and access to available tools. The interim results revealed minimal changes in WOMAC and EQ-5D-5L scores, highlighting a need for more sensitive surveys to capture functional and quality of life changes for conservative patients. The PSFS survey encouraged goal setting and results showed improvements in the patients’ functional ability. An analysis of the Patient Navigator touchpoints, outcome tools collected, and focus group interviews with clinic staff and surgeons will be conducted once the evaluation period is complete in order to determine the full impact on patient care and understanding of conservative management of OA.This work was developed with the guidance of the Hip and Knee Osteoarthritis Conservative Working Group Tri-leads: Kelly Dinsmore, Dr. Ted Findlay and Dr. Geoff Schneider – with special acknowledgement to Sheila Kelly and Shannon Stephenson for their clinical input and support. The vision, implementation and evaluation of the program was achieved in collaboration with the Bone and Joint Health Strategic Clinical Network and the Alberta Bone and Joint Health Institute.http://orcid.org/0000-0002-1031-6813a,*, Angela M. CarolbD Norman Buckley aDepartment of Anesthesia, McMaster University, Hamilton, Ontario, Canada; bCollege of Physicians and Surgeons of Ontario, Assistant Clinical Professor, Department of Family Medicine, McMaster University, Hamilton, Ontario, CanadaCONTACT D Norman Buckley buckleyn@mcmaster.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License . Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License :51–8.108630452.King, et al.Pain. 2011;152(12):2729–38.220780643.Lauder, et al. doi: 10.5772/intechopen.84377.4.Boyles, et al.J Man Manip Ther. 2015;23(5):276–93.269552575.Lauder, et al.Curr Trends Med; 1(1): 1–16.a,* and Laura KatzbEleni G. HapidouaMichael G. DeGroote Pain Clinic, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; bMedical Centre, Michael G. DeGroote Pain Clinic, Hamilton Health Sciences and McMaster University Hamilton, Hamilton, Ontario, CanadaCONTACT Eleni G. Hapidou hapidou@hhsc.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License , Pain Program Satisfaction Questionnaire (PPSQ), Self-Evaluation Scale (SES), Tampa Scale of Kinesiophobia (TSK), Pain Disability Index (PDI), and Pain Catastrophizing Scale (PCS). Internal consistency and predictive validity of the EPB were demonstrated using Cronbach’s alpha and linear regressions.Results:Cronbach’s alpha for the three scales of the EPB was 0.82. The physical domain of the EBP was significantly predicted  by the PDI , but not the TSK or PCS. The mental domain was significantly predicted  by the PDI  and the PCS (β = −0.18), p < .01), but not the TSK. Lastly, the social domain was significantly predicted  by the PDI , but not the TSK or PCS.Discussion: The EBP demonstrates excellent internal consistency and criterion validity with the PDI being the most consistent predictor. Even though data are sourced from two distinct program groups with differing strength of change from admission to discharge, the measure continues to be highly internally consistent and valid and can be used to assess chronic pain program benefit overall.a,* and Laura Katz, PhD., C.PsychaAdria Fransson, BHScPTMichael G. DeGroote Pain Clinic, McMaster University Medical Centre, Hamilton, Ontario, CanadaCONTACT Adria Fransson fransson@hhsc.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  is a physiological response of the central nervous system demonstrated by hypersensitivity to both noxious and non-noxious stimuli. The Central Sensitization Inventory (CSI) identifies key symptoms associated with CS syndromes, however, minimal research has evaluated CS in patients with chronic pelvic pain (CPP). The aim of this study was to evaluate the CSI with psychometric measures completed by female patients enrolled in an 8-session interdisciplinary CPP group program offered at the Michael G. DeGroote Pain Clinic.Methods: Patients completed questionnaires for the CPP program including the CSI and pain-related variables such as pain self-efficacy (PSEQ), fear of movement (TSK), quality of life (PPIQ), pain catastrophizing (PCS) and depression, anxiety and stress (DASS-21). Data were analyzed using descriptive statistics, and a linear regression was utilized to evaluate pain-related predictors of the CSI.Results: Fifty-one females completed the assessment. The regression was significant  with pain catastrophizing , quality of life , depression , and anxiety  as significant predictors of the CSI, while fear of pain/re-injury , pain self-efficacy  and stress  were not.Discussion/Conclusion: Results demonstrate that the CSI was significantly predicted by a number of pain-related measures in women attending an interdisciplinary CPP group program. This suggests that CPP is not just a “tissue issue” but involves the sensitization of the nervous system including cognitions, quality of life, and mental wellbeing. As such, CPP is a complex condition that requires an interdisciplinary approach to treatment.http://orcid.org/0000-0002-2728-1661a, Tricia Metzb, Nathaniel Morin http://orcid.org/0000-0002-9220-1648c, Jennifer Joo http://orcid.org/0000-0002-2552-3268d, Kayla Dennessa, S. Monty Ghoshb, Jeremy Hammingd, Humeira Dhanjia, Roberta DeJonga, and Robert L. TanguayePatrycja Vaid aAcute Pain Service, Alberta Health Services, Calgary, Alberta, Canada; bAlberta Health Services, Opioid Dependency Program, Calgary,Alberta, Canada; cAlberta Health Services, Pharmacy Services, Calgary, Alberta, Canada; dAlberta Health Services, Anesthesia, Calgary, Alberta,Canada; eUniversity of Calgary, Addictions Services, Calgary, Alberta, CanadaCONTACT Patrycja Vaid patrycja.vaid@ahs.ca Acute Pain Service, Alberta Health Services, Calgary, Alberta, Canada© 2020 Alberta Health Services. Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License . Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  Commission on the Social Determinants of Health stated unequivocally that governments need to refocus their public health policies to ensure action by all sectors of government to address “the causes of the causes” in order to improve population health. This principle particularly applies when factors that cause and maintain chronic pain are outside the control of the health system.Working across government sectors can be difficult, with “ownership”, funding, reporting arrangements, departmental or agency culture, and language presenting challenges.The WHO Health in All Policies approach may facilitate intersectoral engagement and co-operation in the development of policy aimed at addressing the epidemic of chronic pain.a,*, Richard Van Wylickb, Nancy Dalgarnoc, Fran Kirbyd, Klodiana Kolomitro http://orcid.org/0000-0003-1250-8146c, Bryan MacLeode and David FluskfLisa GravesaFamily and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA; bPediatrics, Office of Professional Development & Educational Scholarship, Queen’s University, Kingston, Ontario, Canada; cFaculty of Health Sciences, Office of Professional Development & Educational Scholarship, Queen’s University, Kingston, Ontario, Canada; dThe Association of Faculties of Medicine of Canada, Ottawa, Ontario, Canada; eClinical Science Division, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; fDiscipline of Anesthesia, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, CanadaCONTACT Lisa Graves lisa.graves@med.wmich.edu© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  medical students in pain medicine and substance use disorder.Objective: The purpose of this initiative is to close the educational gaps and empower the next generation of physicians with knowledge, skills, and resources needed to diagnose, treat and manage pain and substance use.Methods:(1)  Conducted two environmental scans to rigorously analyze existing curricula and high-impact practices.(2)  Convened educational curriculum leaders to articulate competencies and learning objectives required by physicians.(3)  Planned, using emerging technology and advanced instructional design, a comprehensive curriculum relevant to all Canadian medical schools.Results: A curriculum structure has been informed by the environmental scans and undergraduate curriculum leaders. Competencies and content have been established within pedagogical frameworks mapped to a spiral curricular structure, and aligned with a national framework for medical education. This curriculum, its competencies and objectives will be presented.Conclusions: An innovative national, bilingual, curriculum in pain and substance use disorder is a pivotal component of a national response to the opioid crisis. Our plan is to evaluate and extend the curriculum’s reach beyond undergraduate medical education, to postgraduate and continuing professional development by providing a competency-based, evidence-informed approach that aims to close the knowledge gaps and empower new and practicing physicians.http://orcid.org/0000-0001-5662-8989a,*, Jordan Robinsonb, Shah Fatima LakhabAngela Mailis aPhysical Medicine & Rehabilitation, University of Toronto, Vaughan, Ontario, Canada; bPain & Wellness Centre, Vaughan, Ontario, CanadaCONTACT Angela Mailis angela.mailis@uhn.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License , at 6 months (N = 66) and 12 months (N = 46) after program completion, was as follows: demographic information, pain characteristics, emotional/functional status obtained by validated instruments and Global Impression of Change (GIC). Means of pre-and post-program variables were compared to assess changes of each patient’s “journey”.Results: Male/female ratio was: 1:2.1(p < .5); mean age 45 ± 16 years (18–83 yrs). Outcome data indicated statistically and clinically significant improvement from pre-treatment to post-treatment at 3 months (program exit) and 6 and 12-months post exit respectively, on all emotional/functional batteries. Examples of improvement are: BPI Pain interference score 40%, 47% and 53%; Anxiety 40%, 30% and 50%; Catastrophizing 46%, 46% and 64%; GIC (much/very much improved) 77%, 46% and 76%, respectively.Conclusion: A publicly funded IDP using a customized patient-centered approach proved to be highly effective for chronic pain both in the short (3–4 months) and long term (6 and 12 months), with improvement ranging between 29-77% in different measures.a,*, Greg Tippina and Laura KatzaVeronica WongMichael G. DeGroote Pain Clinic, McMaster University Medical Centre, Hamilton, Ontario, CanadaCONTACT Veronica Wong wongver@hhsc.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  Pain Clinic offers an interdisciplinary and biopsychosocial program to manage chronic pain, with an emphasis on self-management. However, there are patients who drop out of the program, or attend the program with little reported improvement. Improved outcomes may be associated with matching the type of treatment provided to a patient’s readiness to engage in a self-management approach to chronic pain, as theorized by the transtheoretical model of behavior change. Specifically, patients in the pre-contemplative stage, where little action for self-management is being considered, may not be ready for an 8-day self-management program, thus resulting in lower completion rates and poorer clinical outcomes. The aim of this study is to describe the ongoing development and evaluation of a single-session interdisciplinary intervention (“Introduction to Pain Management”) targeting patients in the “pre-contemplative” stage with the goal to improve their readiness for change.Methods: Patients identified as in the pre-contemplative stage based on the Pain Stages of Change Questionnaire were recommended to participate in the Introduction to Pain Management single-session group prior to enrollment in the 8-day interdisciplinary pain management program. The group intervention consists of a 60–90 minute Pain Neuroscience Education class with a physiotherapist followed by a 60–90 minute Motivational Interviewing session with a psychologist.Preliminary Results & Discussion: Preliminary results will be presented, such as changes in readiness for change on the Pain Stages of Change Questionnaire, and insights will be shared on the development of this novel readiness intervention.a,*, Jeremiah Buhlerb, Martine Southallb, Liana Rockb and Catherine Desorcy-NantelbPamela HolensaDepartment of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; bDepartment of Psychology, University of Manitoba, Winnipeg, Manitoba, CanadaCONTACT Pamela Holens pholens@deerlodge.mb.ca Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License . Preliminary evidence for a Mind-Body intervention for chronic pain used with a military and police population revealed significant reductions in both pain intensity and disability . The aim of the present study was to examine the influence of homework completion on treatment outcomes for this intervention.Methods: Seventeen military and police personnel (both active and retired) completed a 10-week Mind-Body intervention for chronic pain. Treatment was offered in groups of 6–8 individuals and utilized materials from the workbook “Unlearn Your Pain” .Results: A series of multiple regression analyses revealed that homework completion did not predict changes in pain disability or pain intensity from pre-to post-treatment. Furthermore, analyses showed that the type of homework completed  was not predictive of treatment outcomes.Discussion: Contrary to other findings regarding the influence of homework completion and treatment outcomes, the findings from this study suggest that positive treatment gains can be made irrespective of homework completion. Though these findings are preliminary in nature given the small sample size, the implications are important as many individuals present with limited motivation to complete out-of-session activities.a,*, Jeremiah Buhlerb, Liana Rockb, Adair Libbrechtb, Michelle Paluszekc, Catherine Desorcy-Nantelb, Brent Joyalb and Martine SouthallbPamela HolensaDepartment of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; bDepartment of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; cDepartment of Psychology, University of Regoma, Regina, Saskatchewan, CanadaCONTACT Pamela Holens pholens@deerlodge.mb.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License .Results: Analyses revealed that participants’ pain ratings were significantly decreased following the 10-week treatment. Pain-related disability was also improved, and kinesiophobia trended in the anticipated direction.Discussion: This mind-body approach to chronic pain treatment shows significant potential for decreasing the experience of chronic pain among military, RCMP, and veterans. Future research using a randomized controlled trial format appears warranted.http://orcid.org/0000-0002-2728-1661a,*, Patty Wilsonb, Gregory Abelsethc, Jacqueline Klemannd, S Monty Ghoshe, Cristina ZaganellifPatrycja Vaid aAcute Pain Service (APS), Alberta Health Services (AHS), Calgary, Alberta, Canada; bInjectable Opioid Agonist Therapy (iOAT), Addiction and Mental Health,Alberta Health Services (AHS), Calgary, Alberta, Canada; cSection of Orthooedics, Department of Surgery, University of Calgary, Calgary, Alberta, Canada; dOrthopedics,Alberta Health Services (AHS), Calgary, Alberta, Canada; eCalgary ODP,Alberta Health Services (AHS), Calgary, Alberta, Canada; fCalgary iOAT Program, Alberta Health Services (AHS), Calgary, Alberta, CanadaCONTACT Patrycja Vaid patrycja.vaid@ahs.ca© 2020 Alberta Health Services. Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License  frequently suffer with chronic pain. Problematic opioid misuse ranges between 19-21% among those with chronic pain, and 8–12% struggle with Opioid Use Disorder (OUD) :569-76). One treatment for OUD is Opioid Replacement Therapy (ORT), which can be accomplished with injectable, or oral Opioid Agonist Treatment . Patients requiring iOAT represent a small fraction of individuals with OUD, and an even smaller fraction of individuals requiring TKR.Case Report: We present a case report of a patient who required a TKR while receiving iOAT & oOAT of 4075 mg of oral daily morphine equivalent dose (MED) for OUD and chronic pain. Patients using medications for OUD present a clinical challenge during the perioperative period :658e; Macintyre PE, Russell RA, Usher K, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care. 2013;41(2):222). Effective acute pain management of patients on ORT is complicated by opioid tolerance, hyperalgesia, dependence and other psychosocial issues :222). Despite this challenge, the patient’s post-surgical pain was well managed using a multimodal and collaborative multidisciplinary approach. The coordinated care between the Acute Pain Service, Addictions Service, Anesthesia, Orthopedic Surgery, Pharmacy, Social Work, and Transition Services all contributed to this patient’s positive experience.Discussion: Marginalized populations such as those using iOAT require the utmost care and compassion to ensure safety and promote positive outcomes post operatively. During the current opioid crisis, it is essential to become familiar with iOAT/oOAT, work collaboratively, draw on expert opinion and be prepared for the complex care required for treating the acute pain of patients on ORT in tertiary care.http://orcid.org/0000-0002-4787-8879a,*, Laura Flynnb, Daniel Z. Buchman http://orcid.org/0000-0001-8944-6647c, John Flanneryd, Andrea D. Furlan http://orcid.org/0000-0001-6138-8510dLaura Murphy aDepartment of Pharmacy, University Health Network, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; bLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; cDalla Lana School of Public Health, Joint Centre for Bioethics, University Health Network, University of Toronto, Toronto, Ontario, Canada; dFaculty of Medicine, University of Toronto, Toronto Rehab,University Health Network, Toronto, Ontario, CanadaCONTACT Laura Murphy laura.murphy@uhn.ca© 2020 The Author(s). Published with license by Taylor & Francis Group, LLC.http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (Pharmacogenomic (PGx) testing has the potential to improve outcomes for patients with pain. PGx is the study of the role the genome plays in drug response, with a focus on genetic variants that affect pharmacokinetics and pharmacodynamics. It is an emerging field of medicine, with tests marketed directly to patients with pain and healthcare professionals. Approximately 60% of variation in individual responses to pain medications relate to genetic polymorphisms. Other medical specialties are more advanced in the implementation of PGx, for example cardiology and mental health. There are known gene-drug interactions with associated evidence-informed prescribing actions. Currently, there is very limited evidence supporting the use of PGx for patients living with pain and these tests are unfamiliar to many clinicians. We present three case studies of patients living with pain who pursued PGx testing to illustrate clinical, practical, and ethical considerations. Their PGx results provided insight into lack of response to therapies, risk of potential adverse effects, and potential future drug interactions. We discuss challenges with PGx report interpretation and usefulness. PGx testing raises ethical issues including those related to consent, privacy, confidentiality, potential secondary uses of genetic data, and return of results. These cases illustrate the need for further research and education to navigate integration of PGx in pain medicine.


Trigeminal neuralgia (TN) causes severe episodic, unilateral facial pain and is initially treated with antiepileptic medications. For patients not responding or intolerant to medications, surgery is an option.In order to expand understanding of the pain-related burden of illness associated with TN, a cross-sectional survey was conducted of patients at a specialist center that utilizes a multidisciplinary care pathway. Participants provided information regarding their pain experience and treatment history, and completed several patient-reported outcome (PRO) measures.n = 62, 48%) and side effects . A total of 52 (40%) patients had undergone surgery, of whom 30 had microvascular decompression (MVD). Although surgery, especially MVD, provided satisfactory pain control in many patients, 29% of post-surgical patients reported complications, 19% had pain worsen or stay the same, 48% were still taking pain medications for TN, and 33% reported new and different facial pain.Of 129 respondents, 69/128  reported no pain in the past 4 weeks. However, 84 (65%) respondents were on medications, including 49 (38%) on monotherapy and 35 (27%) on polytherapy. A proportion of patients had discontinued at least one medication in the past, mostly due to lack of efficacy (In most PRO measures, respondents with current pain interference had poorer scores than those without pain interference. In the Patient Global Impression of Change, 79% expressed improvement since beginning of treatment at this clinic. These results indicate that while the multidisciplinary approach can substantially alleviate the impact of TN, there remains an unmet medical need for additional treatment options. Trigeminal neuralgia (TN) is a rare condition that affects the trigeminal nerve, resulting in extreme, sporadic, sudden, electric shock-like unilateral facial pain . The attRecently, TN was classified into 3 categories: classical (primary), in which vascular compression of the nerve with morphological changes in the trigeminal root is observed; secondary, in which major neurologic disease such as multiple sclerosis or tumor of the cerebellopontine angle has been identified; and idiopathic, in which no cause has been found , 8.Primary treatment for TN has been pharmacological therapy, with the antiepileptic drugs (AEDs) carbamazepine and oxcarbazepine being first-line ; a rangeThere is considerable evidence that TN has a significant impact on QoL , 10, 13.The current study is a cross-sectional component of a longitudinal survey project, and consists of assessments performed at a single timepoint, in a cohort of patients receiving a high level of clinical care at a specialist facility which has been managing TN patients over several years using a multidisciplinary care pathway. The aim of this study was to gain increased insight into the BOI of TN by looking at medication use, surgery, pain experience and quality of life as measured by several PROs, and to determine whether current treatments are meeting patient needs. The well-documented and consistently recorded medical and therapeutic history of these patients allowed a high level of specificity and accuracy in the analysis of the results.Patients were recruited for the study in 2018 from a dedicated multidisciplinary facial pain clinic within a London teaching hospital. At this facility, if patients are taking medication(s), reviews are every 6 months on average; patients may be discharged if they are no longer taking medications following surgery. This single-site patient population has been managed longitudinally since 2007 in a specialized multidisciplinary team model, with access to physicians, dentists, clinical psychologists, a clinical nurse specialist, a neurologist and 3 neurosurgeons. The multidisciplinary team follows the hospital-approved guidelines, which are based on published guidelines for TN .Patients were initially contacted and informed of the study by a member of the multidisciplinary team. Patients who were able to be contacted and were reported to have primary TN were invited to complete the survey. This was the first time they were being asked by the multidisciplinary facial pain clinic to complete a survey electronically.This cross-sectional survey was deployed using a web-based system. If patients were unwilling or unable to complete the online form, they were offered a paper version of the survey. The survey included items about pain interference, history and experience of medication use, history and experience of surgery related to TN, and 5 PRO measures. The 5 PRO measures were: 1) The Penn-Facial Pain Scale-Revised (PENN-FPS-R), an instrument to assess patient-reported impact of facial pain, was used to inform pain status and the interference of facial pain with patients’ activities of daily living (ADLs) during the past week, including general activity, walking, work, mood, enjoyment of life, relations with others, and sleep ; 2) The Descriptive analyses were used to report demographic and health information, patient-reported pain experience, treatment history and PRO instrument scores. Stratifications were made based on pain status, current medication use (monotherapy/polytherapy/no current meds), and surgery. For the surgical stratification, patients were classified as (1) “microvascular decompression (MVD) only” if having one or more MVD procedures but no non-MVD procedures for TN; (2) “Ablative surgery” if having one or more ablative procedures such as gamma knife, radiofrequency thermocoagulation, including stereotactic radiosurgery, but no MVD procedures; (3) “MVD + ablative surgery” if having procedures of both types, or (4) no surgery. Quantitative analyses were performed using SAS software .A cohort of 235 patients were initially screened for the study, of whom 195  were invited to participate. Of them, 21 declined, and 174 patients  initially agreed to participate. Patients could either complete an online survey or, if they requested, were sent a paper survey. Ultimately, a total of 129 patients completed and returned usable patient surveys, which formed the basis of the analyses , White (88%), married 71%), ≥ 65 years (60%) and retired (56%)  reported that they had not experienced pain in the past 4 weeks. However, only 50 patients scored a zero on the Penn-FPS-R measure, indicating no pain interference. Of the 69 who reported not experiencing pain in the past 4 weeks, 37 (54%) patients were currently not on any medication and 38 (55%) had undergone 1 or more surgical procedures . Current mean medication use per patient was 1.1 medications, with some patients currently taking up to 5 medications. At the time of survey completion, 84/129 (65%) patients were on medication, with 49 (38%) on monotherapy and 35 (27%) on polytherapy of 2 or more medications; 45/129 (35%) were using no medications.Over the course of treatment, patients had taken a mean of 3.7 medications with a range of 1–13 Table . CurrentA total of 52/129 (40%) patients had undergone a surgical procedure to manage their TN. The median time since last surgery, based on 21 participants for whom these data were available, was about 3 years. The most common surgery was MVD  with 8 of these patients also having another type of surgery Table . MVD wasOverall patients had a positive post-surgical experience, with 36/52 (69%) of all patients who had surgery reporting much better pain relief including 21/52 (40%) reporting complete pain relief Table . Of thosn = 8). Even with MVD, 5/38 (13%) required repeat MVD surgery, and all 5 of these patients still had some interference in ADLs as assessed by the Penn-FPS-R.Pain medications for TN were being taken by 25/52 (48%) who had undergone surgery Table , and 17/Of 53 respondents who reported pain in the past 6 months, 7 (13%) felt daily pain while 14 (26%) had pain-free periods for months. A total of 39 of these 53 participants had pain in the past 4 weeks  showed numerically lower  quality of life scores than those reporting no pain interference on the EQ-5D-5L index . The EQ-VAS showed similar results: those with current pain interference had lower global health scores  than those who did not . Patients who were not on medication and those who had undergone an MVD had numerically better overall outcomes on the PGIC and BPI measures than those who were on medication and those who did not have MVD. Patients with no current pain interference scores also reported numerically better scores on the BPI-SF pain interference scale . In the PGIC measure, which asked participants if they experienced improvement since starting treatment at this clinic, 79% expressed their condition had very much or much improved with 10 (8%) reporting worsening of their condition. The HADS anxiety and depression scores, on average, were within the normal range (0 to 7) for both those who had experienced pain episodes in the past 4 weeks and those who had not.. A summary of PRO measure results for medication and surgical history is included in Supplement A summary of PRO measure results by TN attack frequency is shown in Table 8This cross-sectional study, conducted at a specialist facial pain treatment facility, consisted of a subpopulation of patients of an earlier study . The stuEven though most patients reported improvement since beginning treatment, the majority were still on medications, with 42% of those individuals on polytherapy. At the time of the survey patients were taking an average of 1.1 medications, however overall treatment history shows patients on average had taken 3.7 drugs for TN, and as many as 13 different drugs. During the course of treatment a substantial percentage of patients had discontinued 1 or more medication(s) for various reasons, frequently due to lack of efficacy or tolerability. While polytherapy can yield clinical benefits, it also carries increased risk of AEs and drug interactions –26. A stIn this study, although surgery, especially MVD, often alleviated pain in many patients, this was not always the case: 10/52 (18%) of respondents reported somewhat worse or same pain post-surgery. Additionally, a proportion of patients required multiple surgeries and several patients experienced complications post-surgery. Further, a sizable percentage of patients continued to use medications after surgery. Also, the long-term outcome of surgery is unknown and can be deduced only from a longitudinal follow-up of this patient population. Published reports have shown that while the short-term success rate of surgery is high, there is a risk of recurrence even when initial outcomes are good, especially over time. In some cases, patients require repeat surgery or return to medications. In a follow-up study of TN patients who had MVD with a median follow-up period of 9.7 years, some patients were found to relapse even though they had immediate post-surgery relief . While rIt should be noted that the favorable results in this study were obtained at a facility able to provide a very high level of care that consists of the concurrent involvement of healthcare practitioners from multiple disciplines, thorough monitoring of patients using established PROs, as well as prompt and thorough pharmacological and surgical interventions; this level of care may not be feasible at all conventional treatment centers . Traditin = 46) and emotional functioning (n = 17) and only 35 studies collected data on patient satisfaction [To the authors’ knowledge, this is the first study to extensively explore the interrelated aspects of pain interference, treatment history, and patient-reported disease impact in patients who were managed following treatment recommendations of the American Academy of Neurology and the European Federation of Neurological Societies . This stsfaction . This stsfaction  MoreoverThis study has some limitations. The chief limitation is that because TN is an episodic disease, the durability of pain relief is difficult to ascertain from a cross-sectional survey and it is likely to underestimate the impact of TN. Further studies with broader cohorts and data collection at multiple time points could expand upon the results presented above to account for the episodic nature of the disease and to understand the impact of TN in different patient populations. Another limitation is that because this study was conducted at a specialist multidisciplinary facility, data obtained in this study are unlikely to be applicable to the general UK TN patient population. This study also did not capture drug dosage information, and so could not assess whether those patients who had undergone surgery and were still taking medications were able to use lower doses post-surgery. Finally, the PGIC asked about change in TN since treatment began at this clinic. Given that participants had been in treatment for an average of more than 6 years, this long recall period may compromise the reliability of their responses. The response rate may have been affected by patients’ unfamiliarity with completing online surveys and the lack of suitable IT skills.These results, in conjunction with previously published results , indicatAdditional file 1. TN PRO Scores Medication and Surgery History


Symptomatic bone marrow lesions on MRI in patients with knee osteoarthritis are strongly associated with progressive deterioration of the joint and an increased risk of progression requiring joint replacement surgery. This study evaluates the efficacy of knee arthroscopy with adjunctive subchondroplasty (i.e. cartilage stabilization) to improve self-rated visual analog scale (VAS) pain scores, rate of conversion to arthroplasty, and patient satisfaction levels.A retrospective chart review and phone survey was performed on 12 patients who had undergone knee arthroscopy with adjunctive subchondroplasty for knee pain associated with chronic subchondral bone marrow lesions on MRI. Follow-up for the 12 patients was 36 months on average (range of 12 to 51 months), self-reported paired preoperative and postoperative VAS scores were analyzed in addition to rate of conversion to arthroplasty and patient satisfaction.The results demonstrated statistically significant reductions in mean preoperative VAS scores versus six-week postoperative VAS scores from 7.58 to 1.83 (p < 0.001) in addition to significant reductions in mean preoperative VAS scores to final postoperative VAS scores from 7.58 to 1.60 (p < 0.001). There was no statistically significant association (p > 0.05) with patients’ demographic and clinical data  and rate of revision to total arthroplasty after receiving the arthroscopic subchondroplasty procedure. Out of the 12 patients, two (16.7%) patients went on to conversion to total knee arthroplasty.In this series, knee arthroscopy with adjunctive subchondroplasty for the treatment of osteoarthritis with symptomatic bone marrow lesions was associated with clinically significant improvements in VAS pain scores. Furthermore, patients who underwent subchondroplasty had a low rate (16.7%) of conversion to total knee arthroplasty at 36-month follow-up. Osteoarthritis, also known as degenerative joint disease, is the most common disease affecting the knee and leads to approximately 700,000 total knee replacements  performed annually in the United States.Atraumatic subchondral bone marrow lesions (BML) of the knee identified on magnetic resonance imaging (MRI) have been shown to be associated with progressive deterioration of articular cartilage and severe arthritic changes to the joint.In 2008, Scher and associates found that in patients who have knee osteoarthritis, there was a nine-fold increase in the rate of progression to total knee arthroplasty within three years when there were symptomatic subchondral BML identified on MRI compared to osteoarthritis patients without an associated BML.It has been concluded that knee arthroscopy alone for the treatment of symptomatic osteoarthritis of the knee is not beneficial.This procedure is known as a subchondroplasty and is commonly performed in conjunction with knee arthroscopy.Purpose of Study The primary purpose of this study was to measure the efficacy of the arthroscopic subchondroplasty procedure on three outcomes: a) changes in postoperative visual analog scale (VAS) pain scores (0-10) , b) rate of conversion to arthroplasty, and c) overall patient satisfaction ratings. The secondary aim of the study was to test for possible differences in outcomes of patients with varied demographic and condition-relevant clinical characteristics , length of symptoms).A chart review and phone survey were performed on all patients who had undergone a subchondroplasty procedure between January 2014, , and December 2017 by one of the three different orthopedic surgeons at a teaching community hospital. This time frame was selected to study patients that have had at least a 12-month follow-up. The surgeons in this study included Dr James Kehoe, who is the senior author in this study, in addition to Dr Shariff Bishai and Dr Jeffrey Carroll.After obtaining Institutional Review Board (IRB) approval, eligible patients were contacted by phone and asked to consent to participate in the study. Of the 31 patients who had received a subchondroplasty during the selected study period, only 12 (38.7%) patients were successfully contacted by telephone to participate in the study. There were 2 additional patients that were able to be contacted, but did not wish to participate in the study.A follow-up phone survey at six weeks after surgery and at the end of the clinical follow-up were conducted to examine patients’: 1) current VAS pain ratings (0-10), 2) history of conversion to total arthroplasty of the affected knee, and 3) to determine overall patient satisfaction with the subchondroplasty procedure. Patient satisfaction was assessed by asking the following two questions: 1) “Were you satisfied with the results of your subchondroplasty procedure?” and 2) “If you could go back in time, would you still choose to have the procedure?” An additional chart review was performed to collect preoperative and postoperative VAS pain scores and data concerning conversion rates to arthroplasty.The inclusion criteria included moderate to severe pain for greater than three months; failure of symptom relief with over the counter non-steroidal anti-inflammation (NSAID) medications, corticosteroid injections, hyaluronic acid injections, or physical therapy; the presence of at least one BML in a weightbearing portion of the knee on MRI; patient reported pain within the knee compartment corresponding to BML location on MRI; with pain in the corresponding compartment of greater than 4 out of 10 based on the VAS score.Patients were excluded from the study if their primary cause of pain was likely due to another pathology as determined by clinical exam or intraoperative findings. Exclusionary criteria included: a) the presence of inflammatory arthritis, b) Kellgren-Lawrence grade four changes consisting of severe joint space narrowing and bone spur formation of the involved compartment, c) gross knee instability, or d) greater than seven degrees of varus  or valgus  alignment. Patients who were found to have significant intra-articular pathology during arthroscopy that could have contributed to their pain were also excluded. No patients that were contacted and wished to participate in this study required exclusion based on the above criteria.The subchondroplasty procedure was performed in a standard arthroscopic fashion by the three surgeons as previously described in similar studies.Patients were permitted to be full weight-bearing immediately after surgery and were provided standard postoperative instructions for knee arthroscopy. All patients were seen postoperatively at the standard follow-up intervals with release to full unrestricted activities at six weeks. The standard postoperative follow-up included evaluations at two weeks, six weeks, three months, and six months. Patients are then seen one-year postoperatively and annually thereafter. None of the sample patients required formal postoperative physical therapy.For all patients, baseline preoperative VAS pain scores were obtained in addition to VAS scores at six weeks follow-up. Dr Krebs and Dr Kehoe recorded documentation for all failed nonoperative treatments in addition to retrospective review of patient anthropometric data, operative reports and imaging. Patients who underwent conversion to total knee arthroplasty did not have their final postoperative VAS scores included in the data analysis. The average final postoperative VAS scores were obtained at 36 months (range 12-51 months).Before proceeding with any statistical analysis, the fourth author CRB assessed data outliers, out of range values, and the need for data cleaning and editing by performing a series of frequencies, proportions, descriptive statistics  and figures . After this process, any needed data editing and cleaning was conducted. Bivariate analyses were performed to determine any associations between the study explanatory variables  and preoperative and postoperative VAS scores.Such analyses included Fisher exact tests and independent as well as paired Student’s t-tests for categorical and continuous variables, respectively. Fourth author CRB conducted all analyses using Stata/MP 15 statistical software package . The usual 0.05 Type I error threshold for statistical significance was used for all analyses.The average age of patients included in this series was 58 years (SD±17.6) years old (range 26 to 85 years old). The 12 patients included in this study consisted of five males and seven females with a total of three right knees and nine left knees. The average height was 67 (SD±4.3) inches (range 59 to 72 inches) and average weight was 177 (SD±25.0) pounds (range 150 to 228 pounds). The average body mass index (BMI) was 30.3 (SD±7.3) (range 22.8 to 39.5). The average length of symptoms (LOS) before surgery was 7.4 months (SD±2.6) (range four to 12 months). A review of patient characteristics is presented in Table 1.Significant reductions in six-week postoperative VAS scores (1.83) were observed when compared to preoperative VAS scores (7.58) (p < 0.001). Similarly, final postoperative VAS scores (1.92) were significantly lower than preoperative scores (7.58) (p < 0.001). There was no statistically significant difference (p > 0.05) in VAS pain scores between 6-week postoperative (1.83) and final postoperative scores (1.60). Please refer to Table 2 for a summary of the results. The improved postoperative VAS scores after the subchondroplasty procedure were consistent with the overall patient reported satisfaction rate of 92% (11 of 12 patients).Of the 12 patients included in this series, two (16.6%) went on to an arthroplasty procedure on the affected knee within the time frame studied. Of these two patients, the average length of time from subchondroplasty to conversion to total knee arthroplasty was 9.5 months (range seven to 12 months). There was no association with patient demographic or clinical characteristics  and rate of conversion to arthroplasty after having the subchondroplasty procedure.The mean postoperative VAS scores at six weeks for patients who underwent conversion to arthroplasty (4.5) was significantly higher than the patients who did not undergo an arthroplasty procedure . There was no statistically significant correlation with preoperative or final VAS pain scores and rate of revision. Fishers exact test was performed and did not identify any significant associations with gender, side of knee, surgeon, or satisfaction score and revision to arthroplasty.The findings from this study demonstrated significant reductions in VAS pain scores at an average of 36-month follow-up in this sample of patients receiving the arthroscopic subchondroplasty procedure. These findings constitute clinically significant changes, as there were over five-point decreases in VAS scores following surgery. Improvements in VAS pain scores have been shown to be clinically significant with changes of at least two points.The current literature has demonstrated favorable results for most patients who receive the subchondroplasty procedure such as improved VAS pain scores and low conversion rate to total arthroplasty within two-year follow-up.Similarly, Bonadio et. al.The 2015 Chatterjee et. al.For the treatment of knee osteoarthritis with associated symptomatic BMLs, knee arthroscopy with adjunctive subchondroplasty appears to be an effective and less invasive treatment option with minimal risk of complications. In the literature review by Astur et. al.The question has arisen regarding possible technical difficulty in performing knee arthroplasty on patients who previously underwent subchondroplasty. A study by Yoo et al.Our work has several limitations that must be considered in the evaluation of this study. First, it is a case series with only 12 patients, which leads to the possibility of selection bias and lack of generalizability. The relatively low number of patients is secondary to the subchondroplasty surgery being a newer type of procedure for treatment of a small subset of patients with BMLs on MRI. Second, there is no control group to compare to the intervention group.Third, there was a lack of standardization in the collection of postoperative data due to patients missing appointments and not filling out VAS pain scores at regular progressive intervals from the time of surgery. Fourth, there was a general lack of postoperative MR imaging to evaluate the status of the BML following subchondroplasty. Despite these limitations, this study offers the longest follow-up data at 36 months on a set of patients undergoing the subchondroplasty procedure.In this series, knee arthroscopy with adjunctive subchondroplasty was associated with clinically significant improvements in VAS pain scores and a low rate of conversion to total knee arthroplasty in a sample of patients with symptomatic knee BMLs at a minimum of 36-month follow-up.Future studies are needed to examine the possible improvement of bone marrow edema or signs of subchondral BML remodeling with clinical outcomes. Larger randomized-controlled trials are also needed to truly define the indications and prognostic indicators when considering the use of subchondroplasty for the treatment of symptomatic BMLs.The authors declare no conflict of interest.


The purpose of the study was to investigate whether dynamic monocyte chemoattractant protein-1 (MCP-1) level might be as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract.Consecutive bilateral cataract patients undergoing bilateral sequential phacoemulsification were retrospectively enrolled. Patients’ preoperative anxiety score and intraoperative pain score were registered. Aqueous humor samples were obtained during surgery. MCP-1 level in the aqueous humor was measured by enzyme linked immunosorbent assay (Elisa). Patients were assigned to seven subgroups based on the interval between first-eye and second-eye cataract surgery. Comparisons were performed for a subjective sensation and MCP-1 levels among different subgroups.pain score during second-eye surgery was significantly higher than during first-eye surgery. Whereas there was no statistical difference in anxiety score between both surgeries. Result from subgroups comparison showed that the visual analog scale (VAS) pain score was statistically greater in 1-group and 6-group during the second eye surgery. Anxiety score did not statistically differ in subgroups. Additionally, the second-eye MCP-1 level was significantly higher at week 1and 6 intervals. Preoperative MCP-1 level was positively correlated with perceiving pain score during both surgeries.MCP-1 level in aqueous humor significantly correlated with perceived pain during cataract surgery. Dynamic MCP-1 level could function as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract, which might support clinicians in treatment optimization and clinical decision-making. Cataract is one of the most common and serious eye diseases leading to blindness and severe visual impairment especially in patients aged 50 years or older worldwide –3. SinceAs an invasive procedure, cataract surgery might cause disruption of the blood-aqueous humor barrier, thereby resulting in production of prostaglandin in aqueous humor. Those might be associated with postoperative complications such as pain of a contralateral eye, anterior segment inflammation and macular edema especially in patients with bilateral cataracts , 11, 12.Inflammation is known to be closely associated with the development of pain , 18. CytThe study recruited consecutive bilateral cataract patients undergoing bilateral sequential phacoemulsification with IOL implantation under topical anesthesia from department of Cataract, Ophthalmic center, the second affiliated hospital of Jilin university between May, 2016 and October, 2016. All patients’ sequential second-eye operation was conducted within 6 weeks after the first-eye surgery. First-eye surgery was carried out with a higher-grade cataract or otherwise poorer vision. The exclusion criteria were as follow: (1) patients with tumors or coronary heart disease who are taking oral nonsteroidal drugs ; (2) patients with a history of ocular trauma or surgery; (3) poor compliance or involuntary movement to cataract surgery under topical anesthesia; (4) patients with baseline eye pain including glaucoma or high intraocular pressure; (5) patients taking pain relief medications or therapy; (6) patients with complicated cataract. Finally, 141 patients remained and were analysed in the present study. Approval of protocol was obtained from the Ethical Committee of the second hospital of Jilin University.Written informed consent was signed from every eligible patient and their relatives. The methods were carried out according to every guideline and regulation. Record related to patient was anonymous and de-identified prior to analysis. The study was conducted in accordance with the Declaration of Helsinki.Routinely topical anesthesia using minims proparacaine hydrochloride was performed at the beginning of the operation. Then an eye speculum was used to keep the eye open and the eye was centered under an operating microscope. The conjunctive sac was washed with povidone-iodine and ample amount of normal saline in turn. After those procedures, about 100-200ul aqueous humor samples from the anterior chamber via the transparent anterior angular membrane above were obtained by 1ml injection syringe during first-eye and second eye surgery, and they were immediately stored at -80. Conventional hydrodissection, chopping, nucleus rotation, and phacoemulsification were conducted. Then an optimal IOL was implanted by a dedicated injector. Finally, the incision was hydrated with balanced salt solution and verified for water tightness after the aspiration of any residual viscoelastic material.Preoperative anxiety was assessed when a patient was in the waiting room before surgery using a validated simplified State-Trait Anxiety Inventory  and a visual analog scale (VAS) for anxiety. VAS anxiety is presented as a numbered line ranging from 0 (no anxiety) to 10 (unbearable anxiety). Perioperative pain was immediately evaluated after surgery via a VAS for pain, which was presented as a numbered line ranging from 0 (no pain) to 10 (unbearable pain). Preoperative anxiety and perioperative pain evaluation were performed by two trained investigators, respectively.Baseline data including age at surgery, gender and interval time between surgeries was obtained from medical records. Preoperative examinations related to eye including vision, intraocular pressure, axial length, and nuclear grading were also recorded. Besides, detail surgical procedures also were retrieved from surgical or nursing records.The level of MCP-1 in aqueous humor sample was measured using a commercial enzyme linked immunosorbent assay (ELISA) kit according to the instructions of the manufacturer .P value < 0.05 was considered to be statistically significant.Quantitative data were presented as the median (range), while categorical data were expressed as the frequency and percentage of the total group. The chi-square test was used to determine any significant difference between categorical variables. Based on their distribution, continuous variables were compared using the Wilcoxon’s rank-sum test or Student’s t-test. Linear regression analysis was used to explore significant correlations in continuous data with linear relationships. Statistical analysis was performed using PASW Statistics 23.0 software . Two-sided Baseline characteristics of 141 consecutive bilateral cataract patients  undergone consecutive cataract surgeries were summarized in Table Poperation room time = 0.769 and Pphacoemulsification time = 0.754).Comparisons between first-surgery and second-surgery were recorded in Table PSTAI = 0.101 and PVAS = 0.114) .Although the median anxiety scores were relatively and slightly lower in patients who underwent second-eye surgery than those in patients who underwent first-eye surgery, there was no significant difference between the two groups . What is more, the median MCP-1 level in aqueous humor during first-eye surgery were significantly greater in group 1  and group 6  . Additionally, MCP-1 level across all the subgroups significantly correlated with the VAS pain score in the second-eye cataract surgery, with a correlation coefficient of r = 0.724, r2 = 0.524, P < 0.001) (Fig. Regarding the correlation of perioperative pain score with MCP-1 levels, results from Fig. Uncomplicated cataract extraction under topical anesthesia is the main surgical approach to treat cataract. However, it is common observation that bilateral cataract patients undergoing sequential phacoemulsification with IOL implantation might experience more painful sensation during second-eye surgery, even though both procedures were performed by a same clinician and under same condition . PeriopeThen, we further investigated patients’ perceived pain at different intervals between first-eye and second eye cataract surgery. All the recruited patients were subdivided into seven subgroups based on the intervals. Results showed that patients’ VAS pain scores were statistically greater when the interval was at week 1and week 6than those when the second-eye operation was conducted at other intervals, while STAI and VAS anxiety score had no significant difference among subgroups. The findings also confirmed that some factors after a first-surgery might affect patients’ perceived pain during second eye operation . Hence, Pain is known to be closely associated with inflammation . Pain-reLinear regression analysis suggested a strong correlation between MCP-1 level and perioperative VAS pain score during both surgeries, suggesting that MCP-1 level could function as a predictor of patients’ perceived pain. The following reasons might explain this finding. Firstly, phacoemulsification surgery impairs the blood-aqueous barrier and mediates infiltration of inflammatory cell, which could change the microenvironment of aqueous chambers , 39. ThoWe also discussed the relationship of the interval between both surgeries of perceived pain and MCP-1 level during the second eye surgery. Results showed when the interval was at week 1and week 6, VAS pain score during the second eye surgery was significantly greater than those when surgery was conducted at other intervals. Similarly, the MCP-1 level was also much higher when surgery was performed at week 1 and week 6 intervals. Linear regression analysis suggested MCP-1level strongly correlated with VAS pain score. Hence, dynamic MCP-1 level might function as a predictor of perceived pain in bilateral cataract patients undergoing sequential phacoemulsification eye surgeries. Following reasons might partly explain the results. Firstly, unilateral eye surgical procedure might lead to acute inflammatory response in both eyes. The acute inflammatory response further regulates the production of inflammatory cytokines including MCP-1 . When thThe findings of the present study should be interpreted in consideration of its possible limitations. First, the study is a retrospective and a single center design with relatively small sized sample, which might have a negative impact on the findings. Besides, relevant mechanism involved in the specific pathway and infiltration of inflammatory cells in the contralateral eye was not investigated in the present study. Therefore, further basic researches need to be performed to identify the detailed mechanism and our findings remain to be confirmed by multicenter prospective clinical studies.In conclusion, MCP-1 level in aqueous humor significantly correlated with perceived pain during cataract surgery. Dynamic MCP-1 level could function as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract, which might support clinicians in treatment optimization and clinical decision-making.