'To see or not to see?' That is the question: teleconsultations in primary care and the impact on 2-week-wait referrals and outcomes

The COVID-19 pandemic has resulted in an unprecedented change to service delivery within the National Health Service (NHS). After the UK government advised general practitioners to conduct consultations remotely where possible, remote consultations rose from < 30% before the pandemic to almost 80% of consultations at the height of the pandemic. After the national lockdown was lifted, remote consultations continued to account for > 70% of consultations. Telemedicine has previously been shown to be an effective model for triaging referrals from primary care to 2-week-wait (2WW) skin cancer clinics. However, to our knowledge, no study has assessed the impact of telemedicine in assessing patients remotely at their initial primary care consultation prior to referral to secondary care. Our study aimed to assess whether the mode of consultation [face to face (F2F) or remote] in primary care affected the outcomes of consultations in 2WW skin cancer clinics. In total, 988 patients were referred to the 2WW clinic in September 2020. Of these, 37 9% (n = 375) were referred after F2F consultations in primary care. Thirty-seven per cent (n = 364) were referred after remote consultations, with the majority being telephone consultations with photographs (76%). The mode of primary care consultation was unclear in 21 1% (n = 209) of patients. A higher proportion of patients who had remote consultations were discharged (43 4%;n = 158/364) from the 2WW clinic than patients who had F2F consultations (36 2%;n = 136/375). There was a significantly higher number of benign lesions referred following a remote consultation in primary care compared with a F2F consultation (70% vs. 59%;P = 0 004). Interestingly, there was a higher proportion of benign lesions referred after telephone consultations with photographs vs. those without. The accelerated use of telemedicine in the COVID-19 era will provide useful information on how telemedicine can be optimized in the future. Lessons learnt during this time will inevitably shape the future digital landscape within the NHS. A key ambition set out in the NHS Long Term Plan published in January 2019 was to increase remote consultations within primary care. While remote consulting certainly has a role in some settings, our study highlights the value of F2F consultations for the initial assessment of patients presenting with lesions in primary care, in order to reduce the number of unnecessary referrals and hospital visits.

Impact of the COVID-19 pandemic on Canadian Armed Forces Veterans who live with chronic pain

Introduction: Chronic pain is more prevalent in military Veterans than in the general population. The extent to which the COVID-19 pandemic has affected Canadian Armed Forces (CAF) Veterans living with chronic pain is unknown. This study compared the impact of the pandemic and public health measures on Canadian Veterans and non-Veterans. Methods: An online cross-sectional study was conducted across Canada. Participants (n = 3,159) were adults with chronic pain recruited from April to May 2020. Seventy-six participants reported having formerly served in the CAF and were pair-matched with non-Veterans. Results: CAF Veteran participants' mean age was 55.1 (standard deviation = 9.6) years;50.0% were female. Over 60% lived with chronic pain for > 10 years. Two thirds of Veterans (67.1%) reported worsened pain since pandemic onset, and 44.7% experienced moderate to severe psychological distress. This was comparable to the non-Veteran group (63.2%, p = 0.61;35.5%, p = 0.25), and no differences were found between female and male Veterans (p = 0.22, p = 0.36). Percentages of participants reporting changes in pharmacological pain treatments because of the pandemic were similar in CAF Veterans (14.9%) and non-Veterans (13.3%) (p = 0.68). Over 50% of Veterans modified their physical/psychological pain treatments due to the pandemic, compared with 45.3% of non-Veterans (p = 0.24). Discussion: Pain deterioration, psychological distress, and pain treatment changes were observed in CAF Veterans living with chronic pain during the COVID-19 pandemic, as was the case in non-Veterans. These results will help develop interventions to adequately face pandemic waves to come and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) Introduction : La prevalence de la douleur chronique est plus elevee chez les veterans que dans la population en general. La mesure dans laquelle la pandemie de COVID-19 a touche les veterans des Forces armees canadiennes (FAC) souffrant de douleur chronique n'est pas connue. La presente etude compare l'impact de la pandemie et des mesures de sante publique chez des veterans et des non-veterans canadiens. Methodologie : Une etude transversale en ligne a ete effectuee partout au Canada. Les participants (n = 3 159) etaient des adultes vivant avec de la douleur chronique, recrutes en avril et en mai 2020. Soizante-seize participants ont indique avoir servi dans les FAC et ont ete apparies avec des non-veterans. Resultats : L'age moyen des participants veterans FAC etait de 55,1 ans (ecart-type = 9,6);50 % etaient des femmes. Plus de 60 % d'entre eux vivaient avec de la douleur chronique depuis plus de 10 ans. Deux tiers des veterans (67,1 %) ont indique que leur douleur s'etait aggravee depuis le debut de la pandemie et 44,7 % ont ressenti de la detresse psychologique moderee a grave. Ces pourcentages sont comparables a ceux observes chez le groupe de non-veterans (63,2 %, p =0,61 ;35,5 %, p = 0,25) et aucune difference n'a ete notee entre les veterans masculins et feminins (p = 0,22, p = 0,36). Les pourcentages de participants rapportant des changements dans leurs traitements pharmacologiques pour la douleur, en raison de la pandemie, etaient semblables chez les veterans des FAC (14,9 %) et les non-veterans (13,3 %) (p = 0,68). Plus de 50 % des veterans ont modifie leurs traitements physiques/psychologiques pour la douleur en raison de la pandemie, comparativement a 45,3 % des non-veterans (p = 0,24). Discussion : Une intensification de la douleur, de la detresse psychologique et des modifications apportees aux traitements de la douleur ont ete observees pendant la pandemie de COVID-19 chez les veterans des FAC qui vivent avec la douleur chronique comme c'etait le cas chez les non-veterans. Ces resultats aideront a mettre au point des interventions qui permettront de faire face de facon adequate aux prochaines vagues de la pandemie et a de futures crises sanitaires. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement Chronic pain is more frequent in military Veterans than in the general population. The objective of this study was to assess whether the COVID-19 pandemic has had a greater impact on Canadian Armed Forces (CAF) Veterans who live with chronic pain compared to non-Veterans. An online survey of Canadian adults with chronic pain was conducted between April and May 2020;76 respondents reported having formerly served in the CAF and were compared with 76 similar non-Veterans. About two thirds of the Veterans had been living with chronic pain for longer than 10 years. Two thirds reported worsened pain since the pandemic began. Nearly half experienced moderate to severe psychological distress. These changes were similar to those in non-Veterans with chronic pain. A significant number of Veterans and non-Veterans changed their pain treatments due to the pandemic. In summary, the COVID-19 pandemic and associated restriction measures did not have a greater impact in CAF Veterans with chronic pain compared with non-Veterans. However, changes in chronic pain supports are needed to be better prepared for COVID-19 waves to come and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

"We survived the pandemic together”: The impact of the COVID-19 pandemic on Canadian families living with chronic pain

Introduction Pediatric chronic pain is a significant problem in Canada, affecting one in five youth. This study describes the impact of the pandemic on the experiences of Canadian families living with chronic pain through interviews with youth living with chronic pain, parents, and siblings. Methods Employing a qualitative descriptive design, in-depth semistructured interviews were completed with Canadian youth living with pain, as well as parents and siblings. Participants were not required to be related. Interviews were analyzed using a reflexive thematic analysis approach. Results Forty-four interviews were completed with 14 parents, 19 youth with chronic pain, and 11 siblings from across the country. Three key themes were developed: (1) absorbing and shifting: the toll of the pandemic on the family system (e.g., loss of coping mechanisms, shifting roles to respond to the pandemic), (2) social ambiguity and abandonment (e.g., social sacrifice and abandonment by the health care system), and (3) building community resilience: familial adaptation to the pandemic (e.g., family cohesion, confidence, and self-management). Discussion/Conclusions Youth, parents, and siblings reported that the pandemic impacted coping strategies across the family system. These results outline the challenges youth experienced managing their pain and overall health throughout the pandemic and the resilience built within families during this time. Going forward, it would be relevant to examine how racialized and structurally marginalized youth with chronic pain and their families experienced the pandemic. Future research should examine how unexpected benefits of the pandemic (e.g., increased confidence and self-management) may be sustained into the future.

"We survived the pandemic together": The impact of the COVID-19 pandemic on Canadian families living with chronic pain.

Introduction: Pediatric chronic pain is a significant problem in Canada, affecting one in five youth. This study describes the impact of the pandemic on the experiences of Canadian families living with chronic pain through interviews with youth living with chronic pain, parents, and siblings. Methods: Employing a qualitative descriptive design, in-depth semistructured interviews were completed with Canadian youth living with pain, as well as parents and siblings. Participants were not required to be related. Interviews were analyzed using a reflexive thematic analysis approach. Results: Forty-four interviews were completed with 14 parents, 19 youth with chronic pain, and 11 siblings from across the country. Three key themes were developed: (1) absorbing and shifting: the toll of the pandemic on the family system (e.g., loss of coping mechanisms, shifting roles to respond to the pandemic), (2) social ambiguity and abandonment (e.g., social sacrifice and abandonment by the health care system), and (3) building community resilience: familial adaptation to the pandemic (e.g., family cohesion, confidence, and self-management). Discussion/Conclusions: Youth, parents, and siblings reported that the pandemic impacted coping strategies across the family system. These results outline the challenges youth experienced managing their pain and overall health throughout the pandemic and the resilience built within families during this time. Going forward, it would be relevant to examine how racialized and structurally marginalized youth with chronic pain and their families experienced the pandemic. Future research should examine how unexpected benefits of the pandemic (e.g., increased confidence and self-management) may be sustained into the future.

Introduction: La douleur chronique pédiatrique est un problème important au Canada, qui touche un jeune sur cinq. Cette étude décrit les répercussions de la pandémie sur les expériences des familles canadiennes vivant avec la douleur chronique par des entrevues avec des jeunes vivant avec une douleur chronique, des parents et des frères et sœurs.Méthodes: À l'aide d'un devis descriptif qualitatif, des entretiens semi-structurés approfondis ont été réalisés auprès de jeunes Canadiens vivant avec la douleur, leurs parents, et leurs frères et sœurs. Il n'était pas nécessaire que les participants aient un lien familial. Les entretiens ont été analysés à l'aide d'une approche d'analyse thématique réflexive.Résultats: Quarante-quatre entretiens ont été réalisés auprès de 14 parents, 19 jeunes souffrant de douleur chronique et 11 frères et sœurs de tout le pays. Trois thèmes clés ont été abordés : (1) l'absorption et le changement : le coût de la pandémie pour le système familial (p. ex., perte de mécanismes d'adaptation, changement de rôles pour réagir à la pandémie), (2) l'ambiguïté sociale et l'abandon (p. ex., le sacrifice social et l'abandon par le système de soins de santé), et (3) le renforcement de la résilience communautaire : adaptation familiale à la pandémie (p. ex., cohésion familiale, confiance et auto-prise en charge).Discussion/Conclusions: Les jeunes, les parents et les frères et sœurs ont signalé que la pandémie avait eu des répercussions sur les stratégies d'adaptation dans l'ensemble du système familial. Ces résultats décrivent les défis rencontrés par les jeunes pour prendre en charge leur douleur et leur santé globale tout au long de la pandémie, ainsi que la résilience démontrée par les familles pendant cette période. À l'avenir, il serait pertinent d'examiner comment les personnes racialisées et les jeunes structurellement marginalisés souffrant de douleur chronique et leurs familles ont vécu la pandémie.Les recherches futures devraient examiner comment les avantages inattendus de la pandémie (par exemple, une confiance accrue et l'auto-prise en charge) peuvent être maintenus à l'avenir.

Stress and Pain Before, During and After the First Wave of the COVID-19 Pandemic: An Exploratory Longitudinal Mixed Methods Study.

Aims: This study explores the association between subjective feeling of stress and pain experience in the context of the COVID-19 pandemic with a focus on characteristics known to trigger a physiological stress response [sense of low control, threat to ego, unpredictability and novelty (STUN)]. Methods: This exploratory longitudinal convergent mixed methods design consisted of online questionnaires over three time points (before, during and after the 1st wave of the COVID-19 pandemic) (N = 49) and qualitative interviews (N = 27) during the 1st wave of the pandemic on distinct samples of individuals living with chronic pain (CP). Both types of data sources were mixed upon integration using joint display. Results: Mean pain intensity scores remained stable across time points, while pain unpleasantness and pain interference scores significantly improved. Global impression of change scores measured during the first wave of the pandemic do not entirely concord with pain scores evolution. Two thirds of participants reported a global deterioration of their pain condition at the beginning of the pandemic. Stress and pain catastrophizing before the pandemic were associated with pain scores throughout the pandemic; while most specific measures of stress due to the novel, uncontrollable, unpredictable and threatening nature of the pandemic were not. Qualitative data demonstrated that the deterioration reported in pain status reflected additional dimensions, including spatial expansion of the painful area, reduced access to treatments and challenges in adapting pain management strategies. Conclusions: Helping individuals to negotiate stressful aspects of the pandemic might help offset the negative impacts of stress on pain status in this context or other important life events.

Experiences of Pediatric Pain Professionals Providing Care during the COVID-19 Pandemic: A Qualitative Study.

Chronic pain affects 1 in 5 youth, many of whom manage their pain using a biopsychosocial approach. The COVID-19 pandemic has impacted the way that healthcare is delivered. As part of a larger program of research, this study aimed to understand the impact of the pandemic on pediatric chronic pain care delivery including impact on patients' outcomes, from the perspective of pediatric healthcare providers. A qualitative descriptive study design was used and 21 healthcare providers from various professional roles, clinical settings, and geographic locations across Canada were interviewed. Using a reflexive thematic analysis approach 3 themes were developed: (1) duality of pandemic impact on youth with chronic pain (i.e., how the pandemic influenced self-management while also exacerbating existing socioeconomic inequalities); (2) changes to the healthcare system and clinical practices (i.e., triaging and access to care); (3) shift to virtual care (i.e., role of institutions and hybrid models of care). These findings outline provider perspectives on the positive and negative impacts of the pandemic on youth with chronic pain and highlight the role of socioeconomic status and access to care in relation to chronic pain management during the pandemic in a high-income country with a publicly funded healthcare system.

Impact of the COVID-19 pandemic on Canadian Armed Forces Veterans who live with chronic pain

LAY SUMMARY Chronic pain is more frequent in military Veterans than in the general population. The objective of this study was to assess whether the COVID-19 pandemic has had a greater impact on Canadian Armed Forces (CAF) Veterans who live with chronic pain compared to non-Veterans. An online survey of Canadian adults with chronic pain was conducted between April and May 2020;76 respondents reported having formerly served in the CAF and were compared with 76 similar non-Veterans. About two thirds of the Veterans had been living with chronic pain for longer than 10 years. Two thirds reported worsened pain since the pandemic began. Nearly half experienced moderate to severe psychological distress. These changes were similar to those in non-Veterans with chronic pain. A significant number of Veterans and non-Veterans changed their pain treatments due to the pandemic. In summary, the COVID-19 pandemic and associated restriction measures did not have a greater impact in CAF Veterans with chronic pain compared with non-Veterans. However, changes in chronic pain supports are needed to be better prepared for COVID-19 waves to come and future health crises. Introduction: Chronic pain is more prevalent in military Veterans than in the general population. The extent to which the COVID-19 pandemic has affected Canadian Armed Forces (CAF) Veterans living with chronic pain is unknown. This study compared the impact of the pandemic and public health measures on Canadian Veterans and non-Veterans. Methods: An online cross-sectional study was conducted across Canada. Participants (n = 3,159) were adults with chronic pain recruited from April to May 2020. Seventy-six participants reported having formerly served in the CAF and were pair-matched with non-Veterans. Results: CAF Veteran participants' mean age was 55.1 (standard deviation = 9.6) years;50.0% were female. Over 60% lived with chronic pain for > 10 years. Two thirds of Veterans (67.1%) reported worsened pain since pandemic onset, and 44.7% experienced moderate to severe psychological distress. This was comparable to the non-Veteran group (63.2%, p = 0.61;35.5%, p = 0.25), and no differences were found between female and male Veterans (p = 0.22, p = 0.36). Percentages of participants reporting changes in pharmacological pain treatments because of the pandemic were similar in CAF Veterans (14.9%) and non-Veterans (13.3%) (p = 0.68). Over 50% of Veterans modified their physical/psychological pain treatments due to the pandemic, compared with 45.3% of non-Veterans (p = 0.24). Discussion: Pain deterioration, psychological distress, and pain treatment changes were observed in CAF Veterans living with chronic pain during the COVID-19 pandemic, as was the case in non-Veterans. These results will help develop interventions to adequately face pandemic waves to come and future health crises.

Impact of the COVID-19 pandemic on the pharmacological, physical, and psychological treatments of pain: findings from the Chronic Pain & COVID-19 Pan-Canadian Study.

INTRODUCTION: Multimodal treatment is recognized as the optimal paradigm for the management of chronic pain (CP). Careful balance between pharmacological and physical/psychological approaches is thus desirable but can be easily disrupted. OBJECTIVES: This study aimed at exploring the impact of the COVID-19 pandemic on pharmacological and physical/psychological treatments of CP. METHODS: A Pan-Canadian cross-sectional web-based study was conducted between April 16th and May 31st 2020 among adults living with CP when the country was in the ascending slope of the first COVID-19 pandemic wave. RESULTS: A total of 2864 participants shared their treatment experience (mean age: 49.7 years and women: 83.5%). Among medication users (n = 2533), 38.3% reported changes in their pharmacological pain treatment. The main reasons were as follows: (1) changes in pain symptoms, (2) lack of access to prescribers/cancellation of medical appointments, and (3) increased medication intake in compensation for stopping physical/psychological treatments because of the pandemic. Among participants who used physical/psychological pain management approaches before the pandemic (n = 2467), 68.3% had to modify their treatments or self-management strategies. Common reasons were lack of access to clinics/exercise facilities and the need to compensate for having to stop another type of physical/psychological treatment because of the pandemic-related public health safety measures. CONCLUSIONS: Our study underlines the negative impact of the COVID-19 pandemic on access to pain relief, which is considered a fundamental human right. Results will help to justify resource allocation and inform the development of interventions to be better prepared for waves to come and future health crises.

Une étude transversale sur l’évolution de la douleur et la détresse psychologique chez les personnes atteintes de douleur chronique : l’étude pancanadienne « Douleur chronique et COVID-19 »

Introduction. La pandémie de COVID-19 a eu un impact disproportionné sur les populations vulnérables, notamment les personnes atteintes de douleur chronique. Nous avons examiné les associations entre les variations géographiques des taux d’infection par le coronavirus, le stress et l’intensité de la douleur et nous avons étudié les facteurs associés à l’évolution de la douleur et à la détresse psychologique chez les personnes atteintes de douleur chronique pendant la pandémie. Méthodologie. Cette analyse s’inscrit dans le cadre d’une initiative plus vaste, l’étude pancanadienne « Douleur chronique et COVID-19 », qui emploie une méthode de recherche transversale observationnelle. Au total, 3 159 personnes atteintes de douleur chronique ont répondu à une enquête quantitative entre le 16 avril et le 31 mai 2020. Résultats. Les deux tiers (68,1 %) des participants avaient entre 40 et 69 ans, et 83,5 % étaient des femmes. Les deux tiers (68,9 %) des répondants ont signalé une aggravation de leur douleur depuis le début de la pandémie. Un niveau élevé de risques perçus liés à la pandémie (rapport de cotes ajusté : 1,27 %;intervalle de confiance [IC] à 95 % : 1,03 à 1,56), un niveau élevé de stress (1,21;IC à 95 % : 1,05 à 1,41), la modification des traitements de la douleur pharmacologiques (3,17;IC à 95 % : 2,49 à 4,05) et physiques/psychologiques (2,04;IC à 95 % : 1,62 à 2,58) et enfin le fait d’occuper un emploi au début de la pandémie (1,42;IC à 95 % : 1,09 à 1,86) étaient associés à une probabilité accrue de déclarer une aggravation de la douleur. La perte d’emploi (34,9 % des personnes travaillaient avant la pandémie) a été associée à une probabilité inférieure (0,67;IC à 95 % : 0,48 à 0,94) de déclarer une aggravation de la douleur. Près de la moitié (43,2 %) des personnes ont indiqué une détresse psychologique d’intensité modérée ou grave. Les émotions négatives à l’égard de la pandémie (2,14;IC à 95 % : 1,78 à 2,57) et le stress global (1,43;IC à 95 % : 1,36 à 1,50) ont été associés à une détresse psychologique modérée ou grave. Conclusion. Les résultats de l’étude ont permis de cerner, outre les facteurs biomédicaux, plusieurs facteurs psychosociaux à prendre en compte pour surveiller l’état des patients atteints de douleur chronique et faciliter leur accès aux traitements pendant une pandémie.

A cross-sectional study of pain status and psychological distress among individuals living with chronic pain: the Chronic Pain & COVID-19 Pan-Canadian Study. / Une étude transversale sur l'évolution de la douleur et la détresse psychologique chez les personnes atteintes de douleur chronique : l'étude pancanadienne « Douleur chronique et COVID-19.

BACKGROUND: The COVID-19 pandemic has had a disproportionate impact on vulnerable populations, including individuals with chronic pain. We examined associations between geographical variations in COVID-19 infection rates, stress and pain severity, and investigated factors associated with changes in pain status and psychological distress among individuals living with chronic pain during the pandemic. METHODS: This investigation is part of a larger initiative, the Chronic Pain & COVID-19 Pan-Canadian Study, which adopted a cross-sectional observational design. A total of 3159 individuals living with chronic pain completed a quantitative survey between 16 April and 31 May 2020. RESULTS: Two-thirds (68.1%) of participants were between 40 and 69 years old, and 83.5% were women. Two-thirds (68.9%) of individuals reported worsened pain since pandemic onset. Higher levels of perceived pandemic-related risks (adjusted odds ratio: 1.27; 95% confidence interval: 1.03-1.56) and stress (1.21; 1.05-1.41), changes in pharmacological (3.17; 2.49-4.05) and physical/psychological (2.04; 1.62-2.58) pain treatments and being employed at the beginning of the pandemic (1.42; 1.09-1.86) were associated with increased likelihood of reporting worsened pain. Job loss (34.9% of individuals were employed pre-pandemic) was associated with lower likelihood (0.67; 0.48-0.94) of reporting worsened pain. Almost half (43.2%) of individuals reported moderate/severe levels of psychological distress. Negative emotions toward the pandemic (2.14; 1.78-2.57) and overall stress (1.43; 1.36-1.50) were associated with moderate/severe psychological distress. CONCLUSIONS: Study results identified psychosocial factors to consider in addition to biomedical factors in monitoring patients' status and facilitating treatment access for chronic pain patients during a pandemic.

Chronic pain experience and health inequities during the COVID-19 pandemic in Canada: qualitative findings from the chronic pain & COVID-19 pan-Canadian study.

BACKGROUND: Chronic pain affects about 20 % of the Canadian population and can lead to physical, psychological and social vulnerabilities. However, this condition remains poorly recognized and undertreated. During 2020, as the COVID-19 pandemic disrupted daily living and health care systems, the situation of people with chronic pain has drawn little public attention. METHODS: This qualitative study was part of a pan-Canadian mixed-methods project and aimed to understand the experiences and challenges of people living with chronic pain during the COVID-19 pandemic in Canada. Between May and August 2020, we conducted in-depth semi-structured interviews with 22 individuals living with chronic pain across the country. We used reflexive thematic analysis to interpret data. RESULTS: Our findings underscored four dimensions of the chronic pain experience during the pandemic: (1) Reinforced vulnerability due to uncertainties regarding pain and its management; (2) Social network as a determinant of pain and psychological condition; (3) Increasing systemic inequities intermingling with the chronic pain experience; (4) More viable living conditions due to confinement measures. Though several participants reported improvements in their quality of life and reduced social pressure in the context of stay-at-home orders, participants from socio-economically deprived groups and minorities reported more challenges in accessing pain relief, health care services, and psychosocial support. CONCLUSIONS: The COVID-19 pandemic has revealed and intensified pre-existing disparities and challenges among people living with chronic pain in terms of material resources, psychosocial condition, social support, and access to care. In post-pandemic times, it will be essential to address flaws in health and welfare policies to foster equity and social inclusiveness of people with chronic pain.

The Experiences of People Living With Chronic Pain During a Pandemic: "Crumbling Dreams With Uncertain Futures".

People living with chronic pain experience multiple challenges in their daily activities. Chronic pain is complex and often provokes life circumstances that create increased social isolation. Living with chronic pain during the pandemic may add additional layers of complexity to their daily lives. The researchers endeavored to explore the experiences of people living with chronic pain during the COVID-19 pandemic. Researchers conducted semi-structured, open-ended interviews about how the pandemic influenced participants' lives. The interviews were recorded and analyzed using an applied philosophical hermeneutics approach. The findings were feeling socially isolated, losing their sense of livinghood, and experiencing augmented stress levels which, in most cases, aggravated their chronic pain. In addition to gaining an in-depth understanding of the needs of people living with chronic pain, these findings may guide policy decisions with the intention of improving health care access and the overall experiences of people living with chronic conditions during a pandemic.

COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals.

Background: The COVID-19 pandemic presents one of the greatest threats to pediatric pain care seen in generations. Due to public health restrictions, many pediatric pain clinics halted in-person appointments, delaying and disrupting access to care. There is no existing research on the impacts of COVID-19 on pediatric chronic pain care in Canada or the challenges experienced by health care professionals and pain clinics. Aims: The aim of this study was to evaluate the impact of COVID-19 on Canadian pediatric chronic pain care by documenting how health care professionals provided care during the first six months of the pandemic. Methods: Two Canadian online cross-sectional surveys were conducted: one among Canadian pediatric pain clinic directors (Study 1) and another among multidisciplinary pediatric pain health care professionals (Study 2). Results: Responses from 13/13 Canadian pediatric pain clinics/rehabilitation programs indicated that all clinics provided virtual care during the pandemic. No significant changes were reported on the frequency of appointment requests. Most clinics reported no perceived change in patient pain levels (n = 9/13, 69%) or occurrence of pain flares (n = 10/13, 77%). Results from 151 individual health care professionals indicated that the majority (90%) of non-emergency department respondents were providing virtual care. The main challenges of virtual care included technological barriers, financial concerns, infrastructure and logistics, privacy, and clinical challenges. Conclusions: This study documented the impact of the COVID-19 pandemic on pediatric chronic pain care in Canada and highlighted the rapid shift to using virtual solutions. Simultaneously, respondents outlined current challenges and potential solutions to consider in the development of virtual care guidelines and policy in Canada.

Contexte: La pandémie de COVID-19 représente l'une des plus grandes menaces pour les soins de la douleur pédiatrique jamais connue depuis des générations. En raison de restrictions de santé publique, de nombreuses cliniques pédiatriques de la douleur ont interrompu les rendez-vous en personne, occasionnant ainsi des retards et des perturbations dans l'accès aux soins. Il n'existe pas de recherche sur les répercussions de la COVID-19 sur les soins pédiatriques de la douleur chronique au Canada ou sur les défis rencontrés par les professionnels des soins de santé et les cliniques de la douleur.Objectifs: L'objectif de cette étude était d'évaluer les répercussions de la COVID-19 sur les soins pédiatriques de la douleur chronique au Canada en documentant la façon dont les professionnels de la santé ont prodigué les soins au cours des six premiers mois de la pandémie.Méthodes: Deux enquêtes transversales canadiennes en ligne ont été menées : l'une auprès des directeurs de cliniques pédiatriques de la douleur canadiennes (Étude 1) et l'autre auprès de professionnels des soins de santé de la douleur pédiatriques multidisciplinaires (étude 2).Résultats: Les réponses obtenues de la part de 13 / 13 cliniques pédiatriques de la douleur / programmes de réadaptation ont indiqué que toutes les cliniques avaient fourni des soins virtuels pendant la pandémie. Aucun changement significatif n'a été rapporté sur la fréquence des demandes de rendez-vous. La plupart des cliniques n'ont signalé aucun changement perçu dans les niveaux de douleur des patients (n = 9/13, 69 %) ou la survenue de poussées douloureuses (n = 10/13, 77 %). Les résultats obtenus de 151 professionnels de la santé ont indiqué que la majorité (90 %) des répondants de département autres que les urgences fournissaient des soins virtuels. Les principaux défis des soins virtuels comprenaient les barrières technologiques, les préoccupations financières, l'infrastructure et la logistique, la confidentialité et les défis cliniques.Conclusions: Cette étude a documenté les répercussions de la pandémie de COVID-19 sur les soins pédiatriques de la douleur chronique au Canada et a mis en lumière le passage rapide à l'utilisation de solutions virtuelles. Simultanément, les répondants ont décrit les défis actuels et les solutions potentielles devant être tenues en compte dans l'élaboration de lignes directrices et de politiques sur les soins virtuels au Canada.