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Message from the editors
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Dr. Cathy Jeffery, Dr. Susan Tupper
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As we ease into the end of winter, 2021, we take time to reflect on all that has happened during the last (very interesting!) year. Despite the context of a global pandemic, visitation restrictions in healthcare, and changes in how we interact with others and do our everyday activities, we recognize that SaskPain and our collaborators have a lot to celebrate. Here are some highlights since our last newsletter:
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- Our website redesign is complete, along with a new logo. Check out www.saskpain.ca for all the latest news on pain management resources, education, and research in Saskatchewan.
- SaskPain is partnering on a research project called "Improving Pain in Saskatchewan" that aims to co-design new services for pain in 3 communities.
- Read the exciting update about #SeePainMoreClearly the international social media campaign that was launched on October 1, 2020.
- Leland Sommer, RN(NP) provides resources for pain assessment in Continuing Care.
- The Canadian Pain Task Force continues their important work.
- The Chiropractors' Association of Saskatchewan is presenting an important learning opportunity.
- SaskPain Board member changes:
- We are very sad to announce that Glen-mary Christopher, board co-chair, has stepped down to focus on other activities. Glen-mary has given so much of her heart, time, and energy over the past 10 years. Her work towards the development of what is now SaskPain began with the SRNA Professional Practice Group in Pain Management. She helped facilitate stakeholder meetings, co-wrote foundational reports, presented to healthcare decision makers, worked on applications for incorporation and grant funding, and led the work to develop board policies. Glen-mary, we will miss your encouraging perspective, thoughtful reflections, guidance, and tireless contributions on the board.
- We are excited to welcome three new Board members Dr. Anita Chakravarti, Kelly Kizlyk, and Alexandria Pavelich! All three of these amazing women bring extensive experience, unique perspectives, and new ideas to SaskPain.
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Improving Pain in SK Research Project:
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The Improving Pain in SK research team is wrapping up Phase 1 of the project, which was a pain management needs assessment in three communities: Saskatoon's downtown and core neighborhoods, Yorkton, and Regina's pediatric services. During this phase the team conducted interviews with approximately 64 people who live with chronic pain, 60 healthcare providers, 4 healthcare decision makers, and 3 representatives of community-based organizations (total of 131 interviews). From these interviews the team has collated a list of recommendations for changes that will improve pain management and the lives of those living with pain in Saskatchewan. Recommendations range from online support and education for people living with pain to rapid access pain clinics for people who present to the emergency department. Work has already begun for an online workshop series. The Yorkton team members and collaborators have planned an exciting 3 workshop series of interactive sessions for people living with pain on March 10th, 17th, and 24th called "Partners in Pain".
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Contact selene.daniel-whyte@usask.ca for more information on how to attend or register for the series at www.tinyurl.com/Yorkton. The Saskatoon-based research assistant, Jessica Jack, will present Phase 1 findings at the Canadian Pain Society scientific meeting at the end of April. As the team moves into Phase 2, local working groups will be supported to select and design a change strategy for their community. Want to keep posted on our research? Email selene.daniel-whyte@usask.ca to join the newsletter mailing list or follow on Facebook: Improving Pain in SK, and Instagram: @improvingpainsk. Find links to favorite websites at: linktr.ee/improvingpainsk. Improving Pain in SK is funded by the Saskatchewan Health Research Foundation and Saskatchewan Centre for Patient Oriented Research.
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#SeePainMoreClearly
After a successful initial launch a year ago and with additional funding by the Saskatchewan Health Research Foundation and the Saskatchewan Centre of Patient-Oriented Research and in partnership with national and provincial organizations (e.g., AGE-WELL Network of Centres of Excellence, Canadian Association of Gerontology, Alzheimer Society of Saskatchewan), health care personnel, patients and family, researchers and health care administrators; we have launched an international social media campaign #SeePainMoreClearly on October 1st, 2020, the International Day for Older Persons, to increase awareness of the under-assessment and under-management of pain in people living with dementia by disseminating evidence-based findings and practices.
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We worked with a digital media partner to revamp our seepainmoreclearly.org website. Our website now includes additional information and resources tailored to the needs of healthcare personnel, patients and families, researchers, and policy makers. In addition, our team is working with a digital media partner to scale the production of evidence-based videos, blog posts, and images discussing the problem of pain in dementia and the available solutions to this problem. We are regularly sharing content and information on our social media pages: Facebook (@seepainmc), Instagram (@SeePainMoreClearly), LinkedIn (See Pain More Clearly), Twitter (@seepainmc), and YouTube (See Pain More Clearly). Our team is systematically evaluating the success of the #SeePainMoreClearly initiative through various social media metrics (e.g., video views, hashtag mentions, engagement), questionnaires (Questionnaires Here), and interviews.
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-Louise Castillo, B.Sc., Graduate Student in Clinical Psychology
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-Thomas Hadjistavropoulos, Ph.D., Research Chair in Aging and Health and Professor.
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Pain Assessment in Continuing Care
Leland Sommer, MN, Lead Nurse Practitioner, Eden Care Communities
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Pain is not a normal part of aging nor something that should be experienced in silence. High prevalence of cognitive impairment in continuing care (3) can make pain assessment challenging but the appropriate resources make it possible.
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The presence of pain can be quickly identified by any member of the elder’s care partner team through utilization of The One Minute Pain Assessment. One Minute Pain Assessment
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Times to assess for pain:
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- On move-in or presentation to a healthcare provider
- Transitions in care between healthcare settings
- When there is a change in function
- When the care team reports a change or concern
- When the family reports a change or concern
Once pain is identified, a standardized assessment tool provides baseline evaluation of the impact of pain on related aspects of functioning of the elder. Eden Care Communities has adapted a tool from Alberta Health Services and GeriatricPain.org tools. Eden Care Pain Assessment Tool
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Self-reported pain scores, such as numeric or verbal rating scale, should always be attempted regardless of cognitive ability.
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- People who score 18 or higher on the Mini Mental State Examination (MMSE) are typically capable of providing valid self-report (8)
- People who score 13 or lower on the MMSE are least likely to provide valid self-reports (4)
When self report is not possible or reliable, consider utilization of a nonverbal pain behaviour tool to assess pain in the moment. Two examples are the:
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- PACSLAC-II (1)
- PainAD (7)
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Pain scores, with application of the same scoring tool, can be utilized to assess and reassess effectiveness of interventions an to inform if adjustments or changes are needed.
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With appropriate identification and assessment, interventions to best manage and decrease the impact of pain can be planned and trialed.
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- Chan, S., Hadjistavropoulos, T., Williams, J., Lints-Martindales, A., (2014). Evidence-based development and initial validation of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II). The Clinical Journal of Pain, Vol.30(9), p.816-824
- Chibnall, J. T., & Tait, R. C. (2001). Pain assessment in cognitively impaired and unimpaired older adults: a comparison of four scales. Pain, 92(1-2), 173–186. https://doi.org/10.1016/s0304-3959(00)00485-1
- CIHI (2018). Dementia in long-term care. Retrieved October 25, 2020 from https://www.cihi.ca/en/dementia-in-canada/dementia-care-across-the-health-system/dementia-in-long-term-care
- Hadjistavropoulos T. (2005). Assessing pain in older persons with severe limitations in ability to communicate. In: Gibson SJ, Weiner D, editors. Pain in the elderly. Seattle: IASP Press; pp. 135–51. doi: 10.1097/AJP.0b013e31802be869.
- Kelly, A.M. (2009). Gerontology Pain Management. In B. St. Marie (Ed.), Core Curriculum for Pain Management Nursing. (2nd ed), Kendal Hunt Publishing, Dubuque, IA.
- Pasero, C. & McCaffery, M. (2011). Pain Assessment and Pharmacologic Management. St.Louis: Elsevier Mosby.
- Warden, V, Hurley AC, Volicer, V. (2003). Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. J Am Med Dir Assoc, 4:9-15. Developed at the New England Geriatric Research Education & Clinical Center, Bedford VAMC, MA.
- Weiner, D. K., Peterson, B. L., Logue, P., & Keefe, F. J. (1998). Predictors of pain self-report in nursing home residents. Aging (Milan, Italy), 10(5), 411–420. https://doi.org/10.1007/bf03339888Chibnall JT, Tait RC. Pain. 2001 May; 92(1-2):173-86.
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Canadian Pain Task Force (CPTF)
The Task Force has a three-year mandate to:
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- Assess how chronic pain is currently addressed in Canada;
- Conduct national consultations and review available evidence to identify best and leading practices, potential areas for improvement, and elements of an improved approach to the prevention and management of chronic pain in Canada;
- (Updated January 2021) Provide recommendations on priority actions to ensure people with pain are recognized and supported and that pain is understood, prevented, and effectively treated across Canada
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The Task Force will deliver three reports to Health Canada, one for each of the three elements of their mandate. The first report was submitted in June 2019. Members will work with an External Advisory Panel that will provide advice and information related to certain elements of the Task Force's mandate.
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The Task Force reports to the Associate Assistant Deputy Minister of the Controlled Substances and Cannabis Branch of Health Canada.
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Latest report October 2020:
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Learning Opportunity - Chiropractic Rounds
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The Chiropractors' Association of Saskatchewan is presenting a Webinar on March 23, 2021 from 6:30 p.m. - 7:30 p.m. on the topic of Examining the Burden of Back Pain on the Health Care System. Jessica J. Wong, DC is presenting. Click on the link to the poster below to get details about how to register to attend this important session.
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