No abstract

life including daily routine, footwear choice, family life, work and accessing health care (44%). Percentage coverage of items directly reflects the dominant concerns of people with PsA-related foot problems and clinicians. Whilst priorities for clinicians included the diverse expression of disease and determining the nature of foot symptoms as mechanical or inflammatory, a key theme from patients was the psychological impact of foot involvement on daily life coupled with self-management strategies (coping skills, self-care activities and availability of social support), which was poorly recognised by clinicians. Consequently, nearly a quarter of survey content was dedicated to these areas of impact highlight by patients (23%). Engaging patients and clinicians in the survey development methods ensured that face and content validity were confirmed and cognitive and usability standards were achieved. Conclusion: By incorporating the views of those with the disease and of clinicians into the survey development process, good conceptual coverage of items important to both patients and clinicians was achieved whilst minimising responder burden. This is the first study to develop a survey on foot involvement in PsA based on best practice methods in qualitative survey design, which may have utility in the future development of assessment or screening tools.

Introduction/Background Chronic Pain is a complex condition. Our approach is to enable young people to function despite their pain. All patients are offered our Pain Education Workshop (PEW) based on pain education, self-management, and cognitive behavioural therapy. Pre-pandemic this was delivered face to face, and with social distancing guidelines in place we adapted virtually in response to patient need. We were interested to see if the children and young people were finding the intervention useful in their journey towards managing their pain. We hoped this would prove to a positive experience for our patients in a time of great uncertainty. Description/Method Data was collected from patients who attended a weekday virtual PEW (a 3-hour multidisciplinary biopsychosocial intervention) at Evelina London Children’s Hospital between November 2020 and May 2022. All patient had an initial appointment in our multidisciplinary Paediatric and Adolescent Chronic Pain Clinic. Overall, the aims of the workshop are for patients to learn and recognize the link between psychosocial factors and the impact of boom and bust on pain intensity, whilst supporting patients’ ability to self-manage. Attendees completed a series of pre and post workshop self-report questionnaires. The questionnaires requested patients to rate their confidence in their understanding of pain and in using self-management strategies, using a 5 point Likert scale (1=Not at All to 5=Extremely Confident). Patients were then asked an open question to establish what they would like to gain from the workshop. Immediately post workshop patients were asked to re-rate their confidence in their understanding of pain and in using self-management strategies. They were also asked to report what they will do differently as a result of attending the workshop. A statistical comparison of the patients’ confidence in understanding chronic pain before and after PEW; and in self-management strategies were assessed with paired t-tests. Our null hypothesis being that no difference pre and post workshop would be found. A qualitative content analysis of the patient’s reported hopes for (pre-workshop) and what they took away (post workshop) was undertaken and key themes were identified. Discussion/Results Since November 2020, a total of 140 patient were offered PEW, 107 of which undertook this intervention. Group sizes varied from 4-14 young-person and parent diads, over 17 sessions. Full data sets for pre- and post-intervention feedback were analysed on 56/107 patients. These patients’ average age was 14 (range 9-18); 47 female, 9 male. The mean patient self-reported understanding of chronic pain pre-workshop was 2.8/5 (range 1-5). Post-workshop scores increased to 4.0/5 (range 3-5). Patient’s confidence in managing their pain increased from 3.2/5 (range 2-5) to 3.9/5 (range 2-5). Paired T-tests on these scores showed a statistically significant difference in understanding chronic pain post PEW (P < 0.001), and in confidence in self-management post PEW (P < 0.001). Themes identified pre-intervention by the young people included: • Increasing understanding and knowledge of chronic pain • learning how to cope with pain • Improving access to treatment Take home message themes: • relaxation techniques • pacing • goal setting. Analysis of the themes in combination with the patient reported scores demonstrated that outcomes as set by the young person were met by the intervention. The results from this study provide evidence for the effectiveness of PEW, in terms of delivering predefined workshop outcomes. It showed significant improvements in patients understanding of chronic pain, and patient’s confidence in using self-management strategies. Similarly, when asked what they took away from the intervention, patients reported wanting to practice using self-management strategies-reinforcing the assumption that PEW was effective in increasing patients confidence to self-manage. As a result, the findings are supportive of assumptions that CBT interventions combined with pain education can have a positive impact, increasing patient’s self-efficacy and increasing their confidence to self-manage. Key learning points/Conclusion In conclusion, this study provides evidence for the effectiveness of a brief multidisciplinary biopsychosocial intervention for chronic pain. Previous research into the field has mainly focused on face-to-face interventions run over numerous weekly sessions. We have demonstrated similar effectiveness whilst using an online, one-off intervention. This demonstrates services can access patients and offer effective treatment whilst reducing the impact on resources. Moreover, we provided much needed virtual support for young people during and post pandemic. Limitations: • Small sample size. Larger sample is needed to fully assess the effectiveness of virtual PEW and to generalise to a wider population. • High attrition rate (33/140). Paediatric patients with chronic conditions are more likely to show persistent/chronic absences (school attendance <90%). Research has shown that psychoeducational interventions have been most effective when they are run on weekends to minimise the loss of school. Access to technology to participate in a virtual group may also be a factor. It is likely that further longitudinal studies are needed to assess the long-term effectiveness of PEW. We are unable to predict whether patients remained confident in using self-management strategies after the workshop or for how long. Since chronic pain is recurrent pain lasting longer than 3 months it is important to capture how effective PEW is in increasing patient’s confidence in managing their condition in the long-term. It is also necessary to assess the long-term effectiveness of PEW in increasing and improving patients understanding of pain. Studies have shown recall can improve 9-24 hours after new information is learnt. However, past 24 hours, recall of learnt information starts to decline if the information is not relearned continuously. Not being able to recall pain messages can affect patients’ abilities to utilise this knowledge to inform coping strategies and manage symptoms long term.

No abstract

Background We present a case that was referred and seen in our chronic pain clinic, and highlight the importance of keeping an open mind about alternative diagnoses when reviewing these patients. Methods Please refer to the results section. Results A 12 year-old girl was referred with right sided neck and shoulder pain associated with occasional pins and needles. The patient was a competitive swimmer, training and competing five times a week at her peak. She did not have a history of mottling or colour change, and clinically she had full range of motion of her joints and no neurological deficit. On repeated assessments, she had reproducible pain on horizontal flexion and reduced muscle bulk of the right shoulder, although power was preserved. Functionally the patient had to reduce her participation in swimming due to pain, and found it difficult to carry or lift things, brush or wash her hair, or write for extended periods of time. Imaging with shoulder X-ray and shoulder and cervical spine MRI did not reveal a cause, and she did not have an anatomical variation such as a thoracic rib. Due to the reproducibility on swimming, an ultrasound looking at the insertion of the biceps insertion during dynamic movements was arranged and was also normal with no subluxation noted. As she failed to improve with chronic pain education, chronic pain approach to physiotherapy sessions and graded reintroduction of swimming, ultrasound angiology was arranged. This showed minor disease in the right subclavian, axillary, brachial, radial and ulnar arteries, with significant reduction in right brachial arterial flow with the patient supine, right arm in horizontal flexion and contralateral head turn. This suggested arterial thoracic outlet syndrome (TOS). All other positions resulted in no significant difference in arterial flow. TOS is traditionally broken into two categories – neurogenic and vascular, the latter can be broken down further into arterial or venous. While in adults, the vast majority (90-95%) present as neurogenic, in the paediatric population there is a higher proportion of vascular cases. This has implications, as vascular TOS can be complicated by vessel disease and thrombus formation. There are a number of case reports in which management is reported as decompression of the thoracic outlet with partial first rib resection, with or without scalene muscle resection. Consideration of hypercoagulable states is also warranted. We have referred our patient to the vascular team for an urgent review and await their assessment and feedback about management. Conclusion A proportion of patients managed with chronic pain syndrome will have an alternative explanation for their pain. In particular, if a patient has focal pain or pain that is reproducible on a particular movement or activity, consider alternate diagnoses. Conflicts of Interest The authors declare no conflicts of interest.