Saifee Rashiq

Challenges in accessing multidisciplinary pain treatment facilities in Canada.

Purpose: The objective of this survey was to examine the services offered by multidisciplinary pain treatment facilities (MPTFs) across Canada and to compare access to care at these MPTFs.Methods: A MPTF was defined as a clinic that advertised specialized multidisciplinary services for the diagnosis and management of patients with chronic pain, having a minimum of three different health care disciplines (including at least one medical speciality) available and integrated within the facility. The search method included approaching all hospital and rehabilitation centre administrators in Canada, the Insurance Bureau of Canada, the Workplace Safety and Insurance Board or similar body in each province. Designated investigators were responsible for confirming and supplementing MPTFs from the preliminary list for each province. Administrative leads at each eligible MPTF were asked to complete a detailed questionnaire regarding their MPTF infrastructure, clinical, research, teaching and administrative activities.Results: Completed survey forms were received from 102 MPTFs (response rate 85%) with 80% concentrated in major cities, and none in Prince Edward Island and the Territories. The MPTFs offer a wide variety of treatments including non-pharmacological modalities such as interventional, physical and psychological therapy. The median wait time for a first appointment in public MPTFs is six months, which is approximately 12 times longer than non-public MPTFs. Eighteen pain fellowship programs exist in Canadian MPTFs and 64% engage in some form of research activitiesConclusion: Canadian MPTFs are unable to meet clinical demands of patients suffering from chronic pain, both in terms of regional accessibility and reasonable wait time for patients’ first appointment.RésuméObjectif: L’objectif de ce sondage était d’examiner les services offerts par les établissements pluridisciplinaires de traitement de la douleur (MPTF — multidisciplinary pain treatment facility) au Canada et de comparer l’accès aux soins dans ces MPTF.Méthode: Un MPTF a été défini comme une clinique affichant des services pluridisciplinaires spécialisés pour le diagnostic et la prise en charge des patients souffrant de douleurs chroniques, et possédant au moins trois disciplines différentes de soins de santé (y compris au moins une spécialité médicale) à disposition et intégrées dans l’établissement. La méthode de recherche comprenait la prise de contact avec tous les administrateurs d’hôpitaux et de centres de réhabilitation canadiens, le Bureau d’assurance du Canada, la Commission de la sécurité professionnelle et de l’assurance contre les accidents du travail ou avec d’autres organismes similaires dans chaque province. Des chercheurs désignés étaient responsables pour la confirmation et l’ajout de MPTF à la liste préliminaire dans chaque province. On a demandé à la direction administrative de chaque MPTF éligible de remplir un questionnaire détaillé concernant l’infrastructure de son MPTF ainsi que ses activités de soins, de recherche, d’enseignement et de gestion.Résultats: Des formulaires de sondage complétés ont été reçus de 102 MPTF (taux de réponse de 85 %), dont 80 % sont situés dans des grandes villes, et aucun sur l’Ile du Prince Edouard et les Territoires. Les MPTF offrent une grande diversité de traitements, y compris des modalités non pharmacologiques, comme par exemple les traitements interventionnels, physiques et psychologiques. Le temps d’attente médian pour un premier rendez-vous dans un MPTF public est de six mois, ce qui est environ 12 fois plus long que dans un MPTF non public. Dix-huit programmes de fellowship en douleur existent dans les MPTF canadiens, et 64 % de ces établissements ont des activités de recherche.Conclusion: Les établissements pluridisciplinaires de traitement de la douleur canadiens ne peuvent répondre aux demandes cliniques de patients souffrant de douleurs chroniques, que ce soit en termes d’accessibilité régionale ou de temps d’attente raisonnable pour le premier rendez-vous d’un patient.

Dedicated multidisciplinary pain management centres for children in Canada: the current status.

Purpose: The objective of this study was to examine the services currently offered by multidisciplinary pain treatment facilities (MPTFs) dedicated for pediatric chronic pain management across Canada.Methods: A MPTF was defined as a clinic that advertised specialized multidisciplinary services for the diagnosis and management of chronic pain and had a minimum of three different health care disciplines (including at least one medical speciality) available and integrated within the facility. The search method was previously described in an accompanying article. Designated investigators were responsible for confirming and supplementing MPTFs from the preliminary list in their respective provinces. Administrative leads at each eligible MPTF were asked to complete a detailed questionnaire on their infrastructure, clinical, research, teaching and administrative activities. Only MPTFs dedicated to pediatric populations were included.Results: Only five centres surveyed had dedicated pediatric MPTFs, all located in major cities in five different provinces. While the median wait time was four weeks, it could be as long as nine months in one MPTF. Headache and neuropathic pain were the most commonly treated pain syndromes. All MPTFs included physicians, nurses and psychologists, and used a rehabilitation model that incorporated a wide variety of pharmacological, psychological and physical therapies. All centres provided training for medical and other healthcare professionals, and three of the five centres conducted research. Government funding was the major source of funding for patient services and overhead costs.Conclusions: There are very few pediatric MPTFs in Canada. These facilities exist in five of ten provinces, each within large urban centres. Limited accessibility leads to variable and prolonged wait times for pediatric patients suffering from chronic pain.RésuméObjectif: L’objectif de cette étude était d’examiner les services actuellement offerts par les établissements pluridisciplinaires de traitement de la douleur (MPTF — multidisciplinary pain treatment facility) spécialisés dans la prise en charge des douleurs chroniques chez les enfants au Canada.Méthode: Un MPTF a été défini comme une clinique affichant des services pluridisciplinaires spécialisés pour le diagnostic et la prise en charge des patients souffrant de douleurs chroniques, et possédant au moins trois disciplines différentes de soins de santé (y compris au moins une spécialité médicale) à disposition et intégrées dans l’établissement. La méthode de recherche a été précédemment décrite dans un article concomitant. Des chercheurs désignés étaient responsables de la confirmation et de l’ajout de MPTF à la liste préliminaire dans leur province respective. On a demandé à la direction administrative de chaque MPTF éligible de remplir un questionnaire détaillé concernant l’infrastructure de son MPTF ainsi que ses activités de soins, de recherche, d’enseignement et de gestion. Seuls les MPTF se consacrant aux enfants ont été inclus.Résultats: Seulement cinq des centres contactés offraient des MPTF pédiatriques spécialisés, tous situés dans des grandes villes de cinq provinces différentes. Bien que le temps d’attente médian soit de quatre semaines, il pouvait aller jusqu’à neuf mois dans un des établissements. Les maux de tête et les douleurs neuropathiques constituaient les syndromes de la douleur les plus fréquemment soignés. Tous les MPTF comptaient des médecins, des infirmiers, infirmières et psychologues, et utilisaient un modèle de réhabilitation qui comprenait une grande diversité de traitements pharmacologiques, psychologiques et physiques. Tous ces centres fournissent une formation pour les professionnels médicaux et de la santé, et il existait de la recherche dans trois des cinq établissements. Le financement public constituait la source la plus importante de financement pour les services aux patients et pour les frais généraux.Conclusion: Il n’existe que très peu d’établissements pluridisciplinaires de traitement de la douleur spécialisés en pédiatrie au Canada. Ces centres existent dans cinq des dix provinces, et tous se trouvent dans des centres urbains d’envergure. Un accès limité engendre des temps d’attente variables et prolongés pour les enfants souffrant de douleurs chroniques.

Role of Health Care Professionals in Multidisciplinary Pain Treatment Facilities in Canada

PURPOSEnTo examine the role of health care professionals in multidisciplinary pain treatment facilities (MPTF) for the treatment of chronic pain across Canada.nnnMETHODSnMPTF were defined as clinics that advertised specialized multidisciplinary services for the diagnosis and management of chronic pain, and had staff from a minimum of three different health care disciplines (including at least one medical specialty) available and integrated within the facility. Administrative leaders at eligible MPTF were asked to complete a detailed questionnaire on their infrastructure as well as clinical, research, teaching and administrative activities.nnnRESULTSnA total of 102 MPTF returned the questionnaires. General practitioners, anesthesiologists and physiatrists were the most common types of physicians integrated in the MPTF (56%, 51% and 32%, respectively). Physiotherapists, psychologists and nurses were the most common nonphysician professionals working within these MPTF (75%, 68% and 57%, respectively), but 33% to 56% of them were part-time staff. Only 77% of the MPTF held regular interdisciplinary meetings to discuss patient management, and 32% were staffed with either a psychologist or psychiatrist. The three most frequent services provided by physiotherapists were patient assessment, individual physiotherapy or exercise, and transcutaneous electrical nerve stimulation. The three most common services provided by psychologists were individual counselling, cognitive behavioural therapy and psychodynamic therapy. The major roles of nurses were patient assessment, assisting in interventional procedures and patient education.nnnCONCLUSIONnDifferent health care professionals play a variety of important roles in MPTF in Canada. However, few of them are involved on a full-time basis and the extent to which pain is assessed and treated in a truly multidisciplinary manner is questionable.

Opioid analgesics suppress male gonadal function, but opioid use in men and women does not correlate with symptoms of sexual dysfunction

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