Chronic Pain Network

Leader(s): Joy MacDermid, Dave Walton
Institution(s): University of Western Ontario, Hand and Upper Limb Centre
Other Members: HULC Surgeon Investigators: Ruby Grewal, Ken Faber, George Athwal

Why was the study done?
The rates of musculoskeletal (MSK) pain from diseases like arthritis or injuries are quite different for men and women. While this varies for different conditions, overall, women have much higher rates of chronic MSK pain. We wanted to understand whether differences were related to how pain was measured, different risks, or differences in treatment outcomes that affect recovery following an injury or joint replacement surgery. We focused on men and women who broke their wrist or had an arm joint replacement as these are common sources of acute pain that sometimes becomes chronic pain.

How was the study done?
We did a series of studies to look at different potential reasons for pain outcomes.
MEASUREMENT studies were performed on different tools used to assess pain in men and women to explore whether biases might explain the higher pain scores typically recorded for women.
COHORT studies were used to determine what factors might explain sex or gender differences in outcome following a wrist fracture or joint replacement surgery. We measured biological and social factors at baseline, recovery at multiple timepoints, and used statistical models to identify factors that affected recovery.
QUALITATIVE studies (interviews with surgeons, therapists, patients) were used to determine how experience, beliefs, and decision-making affected pain outcomes.

What were the study results?
MEASUREMENT study findings indicate that many of the tools used to assess MSK pain outcomes did not provide appropriate scaling of pain, and a minority measured differently for men and women.
Our ongoing COHORT study will identify factors that we can use to predict who is at risk of chronic pain following a wrist fracture or arm joint replacement. We will use these factors to triage patients into alternative treatment pathways.
QUALITATIVE study findings indicate that clinicians are reluctant to discuss sex and gender, but latent presumptions do exist. Some patients feel that their sex or gender does affect how their pain was managed or experienced. We will use this information to provide more sex and gender sensitive treatment programs.

• Shafiee E, Farzad M, MacDermid J, Beygi AS, Vafaei A, Farhoud A. Cross-cultural adaptation and measurement properties of the Patient-Rated Tennis Elbow Evaluation for the Persian language. Doi: 10.1177/1758998320910177. Hand Therapy. In press, March 2020.
• Nazari G, MacDermid JC, Bobos P, Furtado R. Psychometric Properties of the Single Assessment Numeric Evaluation (SANE) in Patients with Shoulder Conditions. A Systematic Review. Doi: 10.1016/j.physio.2020.02.008 Physiotherapy. In press, March 2020.
• Bobos P, Ziebart C, Furtado R, Lu Z, MacDermid JC. Psychometric properties of the global rating of change scales in patients with low back pain, upper and lower extremity disorders. A systematic review with meta-analysis. doi: 10.1016/j.jor.2020.01.047 J Ortho. 21:40-48, 2020 Sept-Oct.
• Jumbo S, MacDermid JC, Kalu M, Packham T, Athwal G, Faber K. Measurement properties of the Brief Pain Inventory-Short Form (BPI-SF) and the revised Short-Form McGill Pain Questionnaire-Version-2 (SF-MPQ-2) in pain-related musculoskeletal conditions: A systematic review. Arch Bone Joint Surg. Doi: 10.22038/abjs.2020.36779.1973. Arch Bone Jt Surg. 8(2): 131-141, 2020.
• Nazari G, Lu S, MacDermid JC, MPT Student Group. Psychometric Properties of Performance-based Functional Tests in Patients with Shoulder pathologies. A Systematic Review and Meta-Analysis. doi: 10.1016/j.apmr.2019.11.011. [Epub ahead of print]. Arch Phys Med Rehabil. 2019 Dec 28. pii: S0003-9993(19)31465-0.
• Furtado R, MacDermid JC, Bryant DM, Faber KJ, Athwal GS. Evaluating the reproducibility of the short version of the Western Ontario Rotator Cuff Index (Short-WORC) prospectively. JSES Open Access, in press 2019 Dec.
• Packham TL, Spicher CJ, MacDermid JC, Quintal I, Buckley N. Evaluating a sensitive issue: reliability of a clinical evaluation for allodynia severity. doi: 10.1080/08990220.2019.1704242. 2019 Dec 20:1-6. [Epub ahead of print] Somatosens Mot Res.
• Bobos P, MacDermid J, Nazari G, Furtado R; CATWAD. Psychometric properties of the global rating of change scales in patients with neck disorders: a systematic review with meta- analysis and meta-regression. doi: 10.1136/bmjopen-2019-033909. BMJ Open. 29(11):e033909. 2019 Nov 25
• Jumbo S, MacDermid JC, Packham T. Athwal G, Faber K. Reproducibility: reliability and agreement parameters of the Revised Short McGill Pain Questionnaire Version-2 for use in patients with musculoskeletal shoulder pain. Can J Pain, accepted Dec 2019.
• Furtado R, Nazari G, MacDermid JC. A systematic review of the cross-cultural adaptations and measurement properties of the Shoulder Pain and Disability Index. Doi: 10.1177/1758998319876953 Hand Therapy, 24(4):107-115, 2019 Oct.
• Nazari G, Bobos P, Lu Z, MacDermid JC. Psychometric Properties of the Single Assessment Numeric Evaluation in Patients with Lower Extremity Pathologies. A Systematic Review. doi: 10.1080/09638288.2019.1693641 Disability and Rehablitation. 2019 Nov 28:1-8
• Bobos P, Nazari G, Lu Z, MacDermid JC. Measurement Properties of the Hand Grip Strength Assessment. A Systematic Review with Meta-analysis doi: 10.1016/j.apmr.2019.10.183. [Epub ahead of print] Review. Arch Phys Med Rehabil. pii: S0003-9993(19)31366-8, 2019 Nov
• Modarresi S, Aref-Eshghi E, Walton DM, MacDermid JC. Does a Familial Subtype of Complex Regional Pain Syndrome Exist? Results of a Systematic Review. Canadian Journal of Pain. 3(1):157-166, 2019 June.