Background Pain is a significant issue affecting adolescents. However, adolescents often receive outdated, non-evidence-based management for pain. School-based pain education has been identified as a priority for pain management in Australia, yet none is endorsed in schools. This paper describes the process of developing and evaluating the Pain Smart education module for students aged 12–16 at Australian secondary schools.Methods The process included five phases: (1) listening to adolescent voices; (2) developing the Pain Smart lessons and resources; (3) piloting the Pain Smart education module; (4) refining the Pain Smart education module; and (5) evaluating the Pain Smart education module. Each phase is mapped to an implementation framework: Phase 1 is aligned with the Consolidated Framework for Implementation Research, Phase 2 and 4 with the Knowledge-to-Action Framework, and Phase 3 and 5 with the Conceptual Framework for Implementation Outcomes.Results Phase 1 identified gaps in students’ knowledge and preferences for learning about pain at school. Phase 2 used these findings and evidence-based concepts to develop three curriculum-aligned, ready-to-teach lessons. Phase 3 piloted the module in two secondary schools, demonstrating acceptability, appropriateness and feasibility while identifying issues with study processes. Phase 4 refined the lessons and study processes based on these findings. Phase 5 describes a cluster randomized controlled trial to evaluate the module.Conclusions The Pain Smart education module was developed using a comprehensive and collaborative learning approach. Using established implementation frameworks ensured the module addresses real-world barriers and perspectives of relevant parties. Ongoing evaluation will determine its effectiveness and inform its future scalability.
Background Many Canadians experience prolonged pain, uncertainty, and stigma before receiving an endometriosis diagnosis, with delays averaging 11 years from symptom onset. Endometriosis, defined by the presence of endometrial-like tissue outside the uterine cavity, impacts 10% of Canadian women and approximately 9% of transgender men. Existing screening measures are limited because they often focus on advanced disease and were developed outside Canada.Aims The aim of this study is to revise the ENDOPAIN-4D screening measure to match a Canadian young adult (age 18–25) population.Methods Using a participatory approach, the study involved four phases: an initial Delphi consensus survey with Canadian endometriosis experts; a virtual working meeting with a purposively selected subgroup; a second Delphi survey with working group members to refine proposed changes and reach consensus; and a third Delphi to collect final feedback. Participants included people with lived and living experience of endometriosis, gynecologists, pain medicine specialists focused on chronic pelvic pain, primary care providers, and other healthcare professionals involved in endometriosis care.Results Sixty-five experts participated in the first Delphi round. Five major themes were identified: conceptual appropriateness of domains, question clarity, response option clarity, item redundancy, and simplification for a Canadian young adult audience. Fifteen experts participated in the working meeting and second Delphi round, where they refined item wording, clarified core concepts, and finalized items for the revised screening measure.Conclusions This study adapted the ENDOPAIN-4D for Canadian young adults, resulting in a 22-item, five-domain screening measure called Screening for Early Endometriosis Detection (SEED).
iCanCope™ (ICC) is a digital self-management program for 15–25 year olds with chronic pain. This study evaluated program satisfaction and efficacy through a two arm randomized controlled trial in Canadian tertiary care pain clinics. Participants were randomized to receive either ICC (app and website with symptom tracking and trending, pain education, goal setting, library, community forum) or an identically branded active control program with limited features. Outcomes were assessed at baseline, postprogram (2 months; T2), and follow-up (6 months; T3). Satisfaction was assessed using the Acceptability eScale and qualitatively with a subset of intervention participants. Linear mixed effects models characterized treatment effects on primary (pain interference) and secondary outcomes. Of 302 enrolled participants, 297 were analyzed (mean age = 17.1 ± 2.4, 83% female). Outcome completion rates were 89% at T2 and 71% at T3. Program acceptability was high in both the intervention (33.9 ± 7.0) and control group (32.7 ± 6.8). Most participants exhibited moderate to high engagement with daily checkins (intervention: 79%, active control: 80%). No significant treatment effects were found. However, improvements across time in pain interference at T2 (β = −0.58, p < .001) and T3 (β = −0.64, p = .0016) and improvements in knowledge about managing pain at T2 (β = −0.54, p < .0001) and T3 (β = −1.04, p < .0001) were found for both groups. Most (15/16) interviewees reported that ICC enhanced their confidence and/or ability to engage in pain self-management. Digitally mediated symptom tracking and trending and pain education is engaging and beneficial for 15–25 year olds with chronic pain. Use of an active-control may have diminished the ability to detect treatment-group effects. ICC has been translated to French-Canadian and publicly released as a free self-management tool. Trial Registration: ClinicalTrials.gov, NCT02601755
Background Due to structural inequities, many migrant workers face adverse health outcomes potentially exposing them to long-term pain issues. However, the extent of current knowledge on chronic pain (>3 months) in this population is unclear. As labor migration policies evolve toward less protective measures, it is essential to gain insights into the experiences and drivers of chronic pain among migrant workers.Aims Drawing on the theoretical framework of intersectionality, this scoping review aimed to synthesize existing knowledge on chronic pain among migrant workers in Canada and the United States. More precisely, we examined evidence related to epidemiology, treatments, lived experiences, and the role of social and structural determinants.Methods This review followed the Joanna Briggs Institute methodology for scoping reviews. A search of four databases was followed by a screening and extraction procedure involving four researchers. Relevant findings were reported through quantified and narrative syntheses.Results This scoping review highlights a major gap in understanding pain chronicity among migrant workers. Nine studies met the eligibility criteria. Most studies have focused on occupational health outcomes. Definitions of chronic pain are inconsistent. Only one qualitative study examined migrant workers’ pain trajectories beyond workplace settings. Social and structural determinants were underscored in all studies, including poor working conditions, socioeconomic precarity, unfavorable labor market structure, restrictive immigration policies, racism and discrimination, and gendered inequities.Conclusions This review invites researchers and policymakers to move beyond occupational health approaches to fully appraise and tackle the intersecting structural and political drivers exposing migrant workers to lifelong experiences of chronic pain.
