Study design: Clinical practice guidelines. Objectives: To develop the first Canadian clinical practice guidelines for treatment of neuropathic pain in people with spinal cord injury (SCI). Setting: The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. Methods: The CanPainSCI Working Group reviewed the evidence for different treatment options and achieved consensus. The Working Group then developed clinical considerations for each recommendation. Recommendations for research are also included. Results: Twelve recommendations were developed for the management of neuropathic pain after SCI. The recommendations address both pharmacologic and nonpharmacologic treatment modalities. Conclusions: An expert Working Group developed recommendations for the treatment of neuropathic pain after SCI that should be used to inform practice.

BackgroundMultidisciplinary pain treatment facilities (MPTFs) are considered the optimal settings for the management of chronic pain (CP). This study aimed (1) to determine the distribution of MPTFs across Canada, (2) to document time to access and types of services, and (3) to compare the results to those obtained in 2005–2006.MethodsThis cross-sectional study used the same MPTF definition as in 2005–2006—that is, a clinic staffed with professionals from a minimum of three different disciplines (including at least one medical specialty) and whose services were integrated within the facility. A comprehensive search strategy was used to identify existing MPTFs across Canada. Administrative leads at each MPTF were invited to complete an online questionnaire regarding their facilities.ResultsQuestionnaires were completed by 104 MPTFs (response rate 79.4%). Few changes were observed in the distribution of MPTFs across Canada compared with 12 years ago. Most (91.3%) are concentrated in large urban cities. Prince Edward Island and the Territories still lack MPTFs. The number of pediatric-only MPTFs has nearly doubled but remains small (n=9). The median wait time for a first appointment in publicly funded MPTFs is about the same as 12 years ago (5.5 vs 6 months). Small but positive changes were also observed.ConclusionAccessibility to public MPTFs continues to be limited in Canada, resulting in lengthy wait times for a first appointment. Community-based MPTFs and virtual care initiatives to distribute pain services into regional and remote communities are needed to provide patients with CP with optimal care.

Background: Community-based care fills an important service gap for patients living with chronic pain. Better understanding of unmet patient needs in the community may inform improved policy and resource allocation. Aims: The aim of this study was to describe patients presenting to a community-based, multidisciplinary chronic pain clinic in Vancouver, British Columbia. Methods: This is a retrospective cross-sectional study of 935 unique consecutive patients who completed an intake questionnaire between January 2016 and March 2017. All data were patient reported. Results: Nine hundred thirty-five patient records were analyzed for descriptive characteristics. The mean age of the population was 49.5 (SD = 14.9) years; 70% were female. Approximately 50% of patients lived below the poverty line in Vancouver; 30% were not working due to disability, 51% had pain for more than 5 years, and 63% reported severe functional impairment. Conclusions: Substantial unmet need is demonstrated in this patient population accessing a community-based chronic pain clinic. The population described is mainly of working age with significant functional impairment, reflecting a high level of need due to severity and duration of symptoms, poverty, and other characteristics described. RÉSUMÉ Contexte: Les soins communautaires comblent une lacune importante pour les patients qui souffrent de douleur chronique. Une meilleure compréhension des besoins des patients qui ne sont pas comblés au sein de la communauté pourrait permettre d'améliorer les politiques et l'allocation des ressources. But: Décrire les patients qui se présentent dans une clinique communautaire multidisciplinaire de douleur chronique à Vancouver, Colombie-Britannique (C.-B.). Méthodes: Étude transversale rétrospective de 935 patients uniques consécutifs qui ont répondu à un questionnaire d'admission entre janvier 2016 et mars 2017. Toutes les données étaient déclarées par les patients. Résultats: Les dossiers de 935 patients ont été analysés afin d'en tirer les caractéristiques descriptives. L'âge moyen de la population était de 49,5 ans (É.-C. 14,9) et 70 % étaient des femmes. Approximativement 50 % des patients vivaient sous le seuil de pauvreté à Vancouver, C.-B.; 30 % ne travaillaient pas en raison d'une incapacité, 51 % avaient de la douleur depuis plus de cinq ans et 63 % ont fait état d'une déficience fonctionnelle grave. Conclusions: Des besoins considérables demeurent non comblés au sein de cette population de patients ayant recours à une Clinique communautaire de douleur chronique. La population décrite est principalement en âge de travailler, ce qui démontre un niveau élevé de besoins en raison de la gravité et de la durée des symptômes, de la pauvreté et d'autres caractéristiques décrites.

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Study design: Clinical practice guidelines. Objectives: To develop the first Canadian clinical practice guidelines for screening and diagnosis of neuropathic pain in people with spinal cord injury (SCI). Setting: The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. Methods: The CanPainSCI Working Group reviewed evidence to address clinical questions regarding screening and diagnosis of neuropathic pain after SCI. A consensus process was followed to achieve agreement on recommendations and clinical considerations. Results: Twelve recommendations, based on expert consensus, were developed for the screening and diagnosis of neuropathic pain after SCI. The recommendations address methods for assessment, documentation tools, team member accountability, frequency of screening and considerations for diagnostic investigation. Important clinical considerations accompany each recommendation. Conclusions: The expert Working Group developed recommendations for the screening and diagnosis of neuropathic pain after SCI that should be used to inform practice.