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.
Can J Anaesth. 2022 Jul;69(7):849-858. doi: 10.1007/s12630-022-02241-0. Epub 2022 Mar 18.
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.
建议对患有复杂慢性疼痛（CP）的患者采用多学科方法。许多多学科疼痛治疗机构（MTPF）使用患者排除标准，但对其特征知之甚少。本研究的目的是描述加拿大公共 MTPF 中排除标准的频率和特征。
我们进行了一项横断面研究，将 MTPF 定义为有三个以上学科（至少有一个医学专业）的专业人员组成的诊所，其服务在该机构内整合。我们于 2017-2018 年向全国各地 MTPF 的行政负责人分发了一份基于网络的问卷。他们被邀请完成一份关于其设施特点的问卷。使用描述性统计和相关措施进行数据分析。
共有 87 个 MTPF 纳入分析。其中一半（52%）报告使用了三个或更多的排除标准。排除标准的数量与首次预约的等待时间或过去一年的新咨询次数之间没有显著关联。纤维肌痛和偏头痛是最常被排除的疼痛综合征（分别占 MTPF 的 10%和 7%）。超过四分之一的 MTPF 排除了患有心理健康障碍（30%）和/或物质使用障碍（29%）的患者，包括有专家在其工作人员中的 MTPF。
多学科疼痛治疗机构的排除标准很可能影响患有复杂疼痛问题和心理社会脆弱性的 CP 患者。需要做出政策努力，以支持加拿大 MTPF 为公平获得疼痛管理做出贡献。
