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K - Ameliorate Neuropathic Pain

6. Evidence-based tools to evaluate treatment efficacy and patient adherence (e.g., Canadian guidelines for opiate use in treatment of non-cancer pain). 7. Funding available to rehab team members to support CPD activities related to pain management (e.g., to attend key conferences, share new knowledge through grand rounds or journal club, or for visiting content experts). Clinical Care Priorities 1. Further research in neuropathic pain prevention. 2. Enhanced pain management in SCI by ensuring national standards for adequate access to evidence-based therapies (e.g., funding across Canada for approved therapies for neuropathic pain in spinal cord injury, like Pregabalin). 3. Better education for healthcare professionals on the importance of managing neuropathic pain in SCI. 4. Timely access to experts in pain management, including SCI. 5. Better education for patients (e.g., Spinal Cord Injury University, SCI-U). Research Priorities 1. Clinical trials for evidence-based pharmacological and nonpharmacologic management of neuropathic pain, and preventing NeP in SCI, is essential to strengthen current therapies, to better understand treatments and their timing, and to lead to the greatest success in pain management. Research priorities should include: a. Non-pharmacologic: A single centre or small, multicentre trial to further explore the role of acupuncture in the treatment of NeP in SCI; and a large, group-based protocol for evaluation of the value of CBT programs (e.g., group-based pain management), for individuals with post-SCI pain. b. Pharmacologic: Clinical trials to assess the efficacy and tolerability of cannabinoids (e.g., nabilone and/or sativex), for NeP in SCI; a pilot study to explore the role of topical agents in the management of NeP, in focal distribution; and clinical trials to look at the efficacy of oral opiates in managing NeP, after SCI. 2. Development of a better understanding of the pathophysiology of pain development (e.g., PET or functional MRI studies in SCI individuals, with and without NeP); and animal models of NeP, post-SCI, where novel medications could be tried. Health Policy Priorities 1. Eliminate regional disparities and financial barriers for access to evidence-based treatments. 2. Educate policy makers on the importance of good pain management. The E-Scan data sets show large disparities in access to pain specialist clinicians, for all disciplines, including physicians. Mandated universal application of available evidence-based therapies for NeP, though accreditation, is recommended. Research Priorities 1. Pilot study to explore the role of topical agents in the management of neuropathic pain, in focal distribution. 2. Further research on the prevention of NeP, wherever possible. 3. Better SCI pain management by ensuring national standards for adequate access to evidence-based therapies, education for healthcare professionals on the importance of managing neuropathic pain in SCI, better education for individuals (e.g., SCI-U), and timely access to experts in SCI pain management. Knowledge generation is progressing well, with a growing number of research projects and collaborative research groups. However, funding is lacking, necessitating strong advocacy for a change in policy, to better support research and clinical care for individuals with pain, after SCI. To prepare, work is needed on clinical application (to ensure provision of a national, unified, evidence-based approach to managing NeP after SCI), and the identification of barriers. AMELIORATE NEUROPATHIC PAIN | BODY STRUCTURE AND FNUCTION 113


K - Ameliorate Neuropathic Pain
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