What is the one thing that Jen Stinson wants people challenged by pain to know about? Explore the current state of pain science research and clinical practice in this concise interview with Jen Stinson.
About Prof Jen Stinson
Dr. Jennifer Stinson is a Nurse Clinician-Scientist in Child Health Evaluative Sciences and an Advanced Practice Nurse in the Chronic Pain Program at the Hospital for Sick Children in Toronto. For more info, see her research profile.
Jen encouraged viewers of this video to look into the following resources: https://covid19mentalhealthresearch.ca/wp-content/uploads/2020/09/BIRNIE-CMH-KS-1-pager-ENG-2020-08-24.pdf
The ‘Pain Management Apps & Online Resources’ Page found here: https://www.kidsinpain.ca/ https://doi.org/10.1080/24740527.2020.1771688
Transcript
What’s the one thing that you want people challenged by pain to know?
Well first Josh, thanks for inviting me to be part of this series. I think the one thing that I want people to know about pain is that researchers in Canada, but elsewhere, are really trying right now to partner with clinicians, patients who live with chronic pain, and their families, to rapidly develop virtual care solutions for these young people, not only during the pandemic but beyond that. We know that the pandemic has had a big toll on people with chronic pain across the lifespan, but especially for young people. I’m sure you’re aware there’s been reports across all countries saying how young people are experiencing new onsets of pain, like headaches, stomach aches, limb pain, which you and I both know if we don’t treat it can lead to chronic pain, right? So, we know that early and widely accessible virtual care treatments can help prevent a lifelong course of chronic pain and mental health problems in young people with chronic pain.
I think obviously during the pandemic it’s revealed that we have huge cracks in our health care system; not just in Canada but this is around the world, right? We really don’t have a lot of virtual care solutions. Virtual care is really any interaction that you have between patients or members of their healthcare team that occurs remotely. It occurs using technology; so, it can be apps, it can be websites, it can be therapy that’s guided by a healthcare professional over teleconferencing, like you and I are doing right now. My lab which is called iOUCH, which is improving outcomes in child health, is all about focusing on harnessing the power of these digital health technologies to promote pain self-management in young people with painful chronic conditions, including chronic pain.
One example from my lab, which you know a little bit about, is the ‘I Can Cope With Pain’ app. Following along with what Katie Birnie was talking about the importance of co-designing these technologies with young people, we really designed this app for young people with young people to provide personalized self-management. It includes symptom-tracking, goal setting, pain coping strategies, peer-support, and just basic pain neuroscience education. We’ve created this platform now for people with chronic pain, arthritis, sickle cell, and we’ve got some new versions coming out for post-op pain (because we know that people that have post-op pain if it’s not well treated that can lead to chronic pain), I think harnessing these sort of technologies, came to light during the pandemic because all the virtual care was sort of halted. For example, you couldn’t even see a physical therapist if you needed to. So, a lot of these young people were left without any treatments for their chronic pain. A bunch of us in Canada, with Melanie Noel and myself as the PI, we’re leading a study to develop stepped care solutions to reduce the impact of COVID-19 on pain, physical symptoms, mental health, and substance use (which we know has increased during the pandemic). I think you did talk with Katie Birnie and she mentioned that one of the top 10 research priorities for young people with chronic pain in Canada was improved access to care, and specifically mental health care, so I think this aligns with what patients and families and clinicians are wanting during this pandemic and beyond.
I’m just imagining if one of those families is watching this: What should they do?
Good question. What happened with us is that, basically: So SickKids leads one of the largest chronic pain programs in Canada, and when the pandemic hit like sort of March 13th or whatever, where it said you know “we’re halting all in-person visits”, we were able to successfully pivot our program at SickKids to virtual care where within a two-week period we were able to move 70 in-person visits to virtual visits. We’ve talked to patients and families and they’ve said the majority of them want to continue with virtual care. But one of the things that we had to do was rapidly source what freely available resources are for families. Again, Katie and I work a lot together, so we partnered with SKiP, which is ‘Solutions for Kids in Pain’, and within a week we sourced all the virtual free care solutions like Tonya Palermo’s web map, so that we could push that to patients and families, so they could access these types of care while PT was halted, while a lot of the mental health services were halted.
One of the things in this project that we are doing is we’re interviewing patients and families to look at the impact of COVID-19 on them, and the resources that they have and barriers to accessing care. We’ve interviewed health care providers as well, and really a lot of the healthcare providers (65% of them) had rapidly moved to doing virtual care, but the majority of them reported barriers – technical issues, patients and families not having a camera, not being able to do a detailed physical assessment, some of those things that are getting in the way. And then Katie, also together with myself, did a rapid knowledge synthesis to actually look what’s out there related to best-care practices for virtual care and also, to determine what kind of solutions are readily available. She basically did that evidence summary to identify that there are lots of opportunities to leverage virtual care. There are some effective virtual care solutions that have been implemented, and it did identify that there’s gaps where we do need much more evidence specifically related to chronic pain in young people and their families, and that patients, families, and health care providers are really interested in engaging in virtual care solutions.
We’ve done a survey of our patients and families, and a lot of them really want to stay with that, or a hybrid model where they do most of it virtually and if they really need to come in because of a physical assessment or a more complex patient, that we bring them in for those types of things. Katie right now is leading an environmental scan; it’s mainly in Canada but we are looking at other places as well, for solutions that are readily available right now, that we can build into this kids pain portal that we’re trying to develop in Canada.
It sounds like a lot of the potential tech developments have to be accelerated at the moment. Do you have a vision of where things are heading in the next decade or so? Will care be a hybrid approach? What will health care for people in pain look like?
I think I’ve heard so many people say, “there’s no going back!”, so virtual care is here to stay. And I do agree; it will be a hybrid model. But I think we’ll have much better technology, for example, technology to do remote physical assessments and things like that in the future. I’ve heard of some of that coming down the pipeline; apps with more sensors you can track in real time physical activity. We know from our study of healthcare providers that during the pandemic there’s sort of two groups of kids with chronic pain; one group that kind of regressed back and stopped doing physical activity, stopped doing sports, stopped interacting at all with friends, and leading to higher anxiety and depression; and then we had a group that still managed to continue with coping, seeing their friends remotely, still trying to be engaged in school. I think if we can help tailor the solutions to those two groups of people and ways that they’re coping with pain I think will be helpful, as well some more personalized virtual care, I think would be important.
A lot of people talk about a stepped care approach; there’s not one solution for all patients. That’s what we’re trying to build in that kids pain portal; is that the care will be based on that individual child. So, there will be some assessments that are done, and then based on how they’re doing in terms of physical and mental health, different strategies will be pushed to them. It’s based on a resiliency-based model, where you sort of give the least intense intervention to that person, and then if they do it and they still aren’t improving, then you step it up, right? Where they may actually come to some therapy-guided session with a therapist, but a lot of it can be done self-guided on their own, if the young people are motivated and don’t have serious mental health issues that are getting in the way. But you have to be able to step up and step down the care based on the individual patients needs. So, I think tailoring and personalized health is definitely another avenue that we need to be exploring.
Thank you so much for your time Jen I really appreciate it.
That’s great, well thanks for including me.