Chronic Pain Network

Leader(s): Margot Latimer (Co-PI), Sharon Rudderham (Co-PI)
National Community Engagement & Research Coordinator: John R. Sylliboy
Institution(s): IWK Health Centre, Centre for Pediatric Pain Research, Eskasoni Health Centre, Dalhousie University
Other Members: Finley, A.; Harman, K.; Mushquash, C.; Paul, K.; Chorney, J.; Hutt-MacLeod, D.; Perley-Dutcher, L.

Why was the study done? 
A child’s expression of their pain experience is complex and related to historical, social and cultural factors. Our research shows that the way Indigenous children/youth express their pain may not be consistent with the way health providers are trained to assess it. This can lead to under-treated pain that has a range of negative effects including impaired development, medical fears, anxiety, chronic pain, poor school outcomes and lack of trust in the healthcare system. Because of this long and short-term impact, it is critical that we work towards an improved understanding of the pain care experience for Indigenous children as well as an overall commitment to improving the health and wellbeing of Indigenous people of Canada.

How was the study done? 
Since 2017 we have been reaching out to Indigenous communities/health centres across Wabanaki (Canada/parts of US) to expand our previous research. To date we have partnered with project leads from Hamilton, ON, Halifax, NS and Winnipeg, MB. Data collection/analysis is complete in ON and on-going at our other sites. Methods include gathering stories and art and reviewing pain-related health data. Through study involvement youth experience culturally teachings including Elder smudge teachings and Mi’kmaw artist teachings. Our hope is to collect and share knowledge in a respectful and mutually benefiting way for all involved. Knowledge gained highlights how Indigenous history needs to be considered centrally by care and service providers.

What were the study results?
Results from one site have been gathered, others are ongoing. Using the Medicine Wheel to guide analysis we found pain and management of it to be based in balancing mental, emotional, spiritual and physical health. Artwork and stories identified emotional, mental and spiritual pain while health data showed youth received mainly physical pain diagnoses (90%) and minimal mental health diagnoses (21%); a mismatch in what youth shared and what they seek care for. Conversation themes found predictors/indicators of imbalance and ways to re-establish this balance. Development and testing of the Kids Hurt App has also taken place as well as development of online training on Indigenous history, cultural teachings and culturally safe health strategies.
The ACHH ‘Kids Hurt’ app is also currently being updated to improve functionality, include 3D imagery and Mi’kmaw language option.

• Aboriginal Children’s Hurt & Healing (ACHH) Initiative. First Nation community health video [Video file]. (2018). The First Peoples Child & Family Review: Special Audiovisual Edition. 13(2). Retrieved from https://youtu.be/HzK5za-rrCc
• Latimer, M., Rudderham, S., Lethbridge, L., MacLeod, E., Harman, K., Sylliboy, J. R., Filiaggi, C. & Finley, G. A. (2018). Occurrence of and referral to specialists for pain-related diagnoses in First Nations and non–First Nations children and youth. CMAJ, 190(49): E1434-E1440. DOI: https://doi.org/10.1503/cmaj.180198
• Latimer, M., Sylliboy, J. R., MacLeod, E., Rudderham, S., Francis, J., Hutt-Macleod, D., . . . Finley, G. A. (2018). Creating a safe space for First Nations youth to share their pain. PAIN Reports, 3(Suppl. 1): E682. DOI: 10.1097/pr9.0000000000000682
• Harman, K. (2015). Interpretation of the experience of pain: Using a two-eyed approach to address a clinically relevant health issue.  Physiotherapy Practice 15(2). 25-27.
• Latimer, M., Finley, G.A., Rudderham, S., Inglis, S., Francis, J., Young, S., & Hutt-MacLeod, D. (2014). Expression of pain in Mi’kmaq children from one Atlantic Canadian community: A qualitative study. Canadian Medical Association Journal Open, 2(3): E133-E138.
• Latimer, M., Simandl, D., Finley, A., Rudderham, S., Harman, K., Young, S., MacLeod, E., Hutt-MacLeod, D., & Francis, J. (2014). Understanding the impact of the pain experience on Aboriginal children’s wellbeing: Viewing through a Two-Eyed Seeing lens. First Peoples Child and Family Review, 9(1): 22-37.
• Latimer, M., Young, S., Dell, C., & Finley, G. A. (2012). Aboriginal children and physical pain: What do we know?. Journal of Aboriginal Health, 9(1): 7-14.