Frequency and characteristics of patient exclusion criteria in Canadian multidisciplinary pain treatment facilities: a cross-sectional study.

Mar 21, 2022

Contributor: Lise Dassieu,Manon Choinière,Laurence Saint-Jean,Fiona Webster,Philip Peng,Norm Buckley,Ian Gilron,Owen Williamson,G Allen Finley,Krista Baerg,Audrée Janelle-Montcalm,Maria Hudspith,Aline Boulanger,Tania Di Renna,Howard Intrater,Brenda Lau,John Pereira

Frequency and characteristics of patient exclusion criteria in Canadian multidisciplinary pain treatment facilities: a cross-sectional study.

A multidisciplinary approach is recommended for patients with complex chronic pain (CP). Many multidisciplinary pain treatment facilities (MTPFs) use patient exclusion criteria but little is known about their characteristics. The objective of this study was to describe the frequency and characteristics of exclusion criteria in public Canadian MTPFs.
We conducted a cross-sectional study in which we defined an MPTF as a clinic staffed with professionals from three disciplines or more (including at least one medical specialty) and whose services were integrated within the facility. We disseminated a web-based questionnaire in 2017-2018 to the administrative leads of MPTFs across the country. They were invited to complete the questionnaire about the characteristics of their facilities. Data were analyzed using descriptive statistics and correlation measures.
A total of 87 MTPFs were included in the analyses. Half of them (52%) reported using three exclusion criteria or more. There was no significant association between the number of exclusion criteria and wait time for a first appointment or number of new consultations in the past year. Fibromyalgia and migraine were the most frequently excluded pain syndromes (10% and 7% of MPTFs, respectively). More than one MPTF out of four excluded patients with mental health disorders (30%) and/or substance use disorders (29%), including MPTFs with specialists in their staff.
Multidisciplinary pain treatment facility exclusion criteria are most likely to affect CP patients living with complex pain issues and psychosocial vulnerabilities. Policy efforts are needed to support Canadian MPTFs in contributing to equitable access to pain management.

© 2022. Canadian Anesthesiologists’ Society.

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About The Expert

Lise Dassieu

Research Center of the Centre Hospitalier de l’Université de Montréal, Saint Antoine Building, 850 Saint Denis Street, Montreal, QC, H2X 0A9, Canada. lise.dassieu@umontreal.ca.

Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. lise.dassieu@umontreal.ca.

Manon Choinière

Research Center of the Centre Hospitalier de l’Université de Montréal, Saint Antoine Building, 850 Saint Denis Street, Montreal, QC, H2X 0A9, Canada.

Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.

Laurence Saint-Jean

Research Center of the Centre Hospitalier de l’Université de Montréal, Saint Antoine Building, 850 Saint Denis Street, Montreal, QC, H2X 0A9, Canada.

Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.

Fiona Webster

Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.

Philip Peng

Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Department of Anesthesiology, University Health Network-Western Hospital, Toronto, ON, Canada.

Norm Buckley

Department of Anesthesia, Michael G DeGroote School of Medicine, Hamilton, ON, Canada.

Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.

Ian Gilron

Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, ON, Canada.

Department of Anesthesiology, Kingston General Hospital, Kingston, ON, Canada.

Owen Williamson

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

JPOCSC Pain Management Clinic, Fraser Health Authority, Surrey, BC, Canada.

G Allen Finley

Department of Anesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.

Center for Pediatric Pain Research, IWK Health, Halifax, NS, Canada.

Krista Baerg

Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada.

Department of Pediatrics, Saskatchewan Health Authority, Saskatoon, SK, Canada.

Audrée Janelle-Montcalm

Research Center of the Centre Hospitalier de l’Université de Montréal, Saint Antoine Building, 850 Saint Denis Street, Montreal, QC, H2X 0A9, Canada.

Maria Hudspith

Pain BC Society, Vancouver, BC, Canada.

Aline Boulanger

Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.

Pain Clinic, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada.

Tania Di Renna

Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Department of Anesthesiology, Women’s College Hospital, Toronto, ON, Canada.

Howard Intrater

Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

Pain Clinic, Health Sciences Centre, Winnipeg, MB, Canada.

Brenda Lau

Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.

CHANGE Pain Clinic, Vancouver, BC, Canada.

John Pereira

Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Calgary Chronic Pain Center, Alberta Health Services, Edmonton, AB, Canada.

References

PubMed