Trauma- and violence-informed assessment and management of pain: A scoping review protocol

Trauma has been defined as “a lasting emotional response that often results from living through a distressing event” (CAMH, 2022). The experience of a traumatic even can adversely impact an individual’s sense of safety, sense of self, their ability to regulate their emotions, and navigate relationships. Exposure to trauma is widespread; a survey of 24 countries which included 68,894 respondents found that over 70% reported at least one traumatic event and 30.5% were exposed to four or more traumatic events (Benjet et al., 2016). In Canada the rate of exposure to traumatic events is 75.9% (Van Ameringen et al., 2008). It is increasingly recognized that trauma may set the stage for persistent psychological and physical distress (D’Andrea et al., 2011). Pain and trauma are highly comorbid and is associated with increased experiences of pain, functional impairments, and healthcare utilization (McKernan et al., 2019; Nicol et al., 2016; Sachs-Ericsson et al., 2017). Individuals with a history of traumatic life events may be at risk of re-traumatization as a result of their health care experiences (Coles & Jones, 2009). In recognition of this, Health Canada established the Canadian Pain Task Force (CPTF) to provide advice on best practices for the prevention and management of chronic pain. Their final report, an Action Plan for Pain in Canada (2021), recommended that an equity-oriented and trauma- and violence-informed (T&VI) approach is essential to understand, prevent, and treat pain in populations disproportionately impacted by pain. Trauma- and violence-informed care recognizes the universal impact of trauma, how trauma may present in individuals, and responses in a way that avoids re-traumatization (SAMHSA, 2014). Despite the increased recognition of the need for trauma-informed care, limited research has assessed the principles and practices of trauma- and violence-informed pain assessment and pain management. As such, in order to map the research literature in this area, a scoping review using Arksey and O’Malley’s framework methodology (2005) will be conducted with support from a professional librarian for trauma- and violence-informed approaches to pain assessment and pain management.

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