The findings of the present concept analysis will help to standardize the use and definition of the term pacing across disciplines for the purposes of both pain management and research.

Purpose To evaluate the effect of a preoperative protocol that triages patients awaiting total joint arthroplasty to one of four strategies designed to mitigate the risk of allogeneic blood transfusion (ABT) based on a priori transfusion risk on perioperative exposure to allogeneic blood. Methods We compared the transfusion experiences of a historical control series of 160 subjects with a study group of 160 subjects treated by protocol. Protocol subjects with hemoglobin (Hb) 100-129 gÁL -1 were given erythropoietin, dosed by weight. Subjects with Hb 130-139 gÁL -1 underwent preoperative autologous blood harvest and perioperative re-infusion as deemed clinically necessary. Subjects with Hb [139 gÁL -1 received no special intervention, unless they were aged[70 yr and weighed\70 kg, in which case they received oral iron and folate supplementation. Results The relative risk of ABT in the Study group was 0.68 (95% confidence interval 0.54-0.85). The Control group received 104 units of allogeneic blood and the Study group received 35 units (P = 0.0007). These differences cannot be explained by differences in transfusion risk or autologous units transfused. There was no worsening of anemia or its consequences in the Study group. Conclusion A simple protocol based on easily obtained preoperative clinical indices effectively targets interventions that mitigate the risk of ABT. RésuméObjectif Nous avons voulu e´valuer l'effet d'un protocole pre´ope´ratoire re´partissant les patients devant subir une arthroplastie totale afin qu'ils suivent l'une de quatre strate´gies dans le but de diminuer le risque de transfusion de sang alloge`ne (TSA) selon leur risque a priori de transfusion sur l'exposition pe´riope´ratoire a`du sang alloge`ne. Méthode Nous avons compare´les expe´riences de transfusion d'une se´rie historique de cas te´moins compose´e de 160 patients a`un groupe d'e´tude de 160 patients traite´s sur la base de notre protocole. Les patients de notre protocole pre´sentant un taux d'he´moglobine (Hb) de 100-129 gÁL -1 ont reçu de l'e´rythropoı¨e´tine, dose´e en fonction de leur poids. Les patients ayant une Hb de 130-139 gÁL -1 ont subi une re´colte pre´ope´ratoire et une re-perfusion pe´riope´ratoire de sang autologue lorsque cela a éte´juge´ne´cessaire d'un point de vue clinique. Les patients ayant une Hb [139 gÁL -1 n'ont pas fait l'objet d'une intervention spe´ciale, sauf s'ils e´taient aˆge´s de[ 70 ans et pesaient \ 70 kg; dans ce cas, ils ont reçu des supple´ments de fer et d'acide folique par voie orale. Résultats Le risque relatif de TSA dans le groupe a`l'e´tude e´tait de 0,68 (intervalle de confiance 95 %, 0,54-0,85). Le groupe te´moin a reçu 104 unite´s de sang alloge`ne, contre 35 dans le groupe a`l'e´tude (P = 0,0007). Ces diffe´rences ne peuvent s'expliquer par des diffe´rences au niveau du risque

At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend the group outpatient Cognitive Behavioural Therapy (CBT) program, called Pain 101, or to individual outpatient CBT. It was hypothesized that a brief physician-delivered CBT (brief-CBT) intervention at first point of contact improves subsequent pain acceptance. Using a randomized double blinded methodology, 26 participants received a standard intake assessment and 26 the standard assessment plus the brief-CBT intervention. Measures were taken at three points: pre and post-intake assessment and after Pain 101 or individual CBT (or day 30 post-assessment for those attending neither). The primary outcome measure was the Chronic Pain Acceptance Questionnaire—Adolescent version (CPAQ-A). Comparing pre and post-intake measures, there was a significant (p = 0.002) increase in the CPAQ-A scores—four-fold more in the brief-CBT intervention group (p = 0.045). Anxiety (RCADS-T Score) was significantly reduced post-intake and significantly more reduced in the intervention group compared to the control group (p = 0.024). CPAQ-A scores were significantly increased (p < 0.001) (N = 28) and anxiety (RCADs-T) was significantly reduced by the end of Pain 101 (p < 0.003) (N = 29) as was fear of pain as measured by the Tampa Scale for Kinesiophobia (p = 0.021). A physician-delivered brief-CBT intervention significantly and meaningfully increased CPAQ-A scores and reduced anxiety in youth with chronic pain. Furthermore, CBT through Pain 101 is effective at increasing acceptance, as well as reducing anxiety and fear of movement.