On February 19, 2025, the Registered Nurses Association of Ontario officially unveiled its new edition of best practice guidelines (BPG) on how to prevent, assess and manage pain across the lifespan – guidelines that were prepared by an expert panel co-chaired by Ingram School of Nursing Professor Céline Gélinas. "All individuals living with acute or chronic pain deserve access to person-centered, evidenced-based pain management,” she insists.
Titled Pain: Prevention, assessment and management (Fourth edition), this evidence-based resource is designed to enhance decision-making for nurses, interprofessional teams, educators, health-service organizations, academic institutions, persons living with pain and their families. Co-chaired with Lindsay Jibb, Assistant Professor at the University of Toronto's Lawrence Bloomberg Faculty of Nursing and Scientist at the Hospital for Sick Children, the panel included several expert members from various health disciplines and care sectors as well as persons with lived experiences. The guidelines cover four main categories: screening and assessment of pain; management of pain; interprofessional practice in pain management; and pain education for students entering health professions as well as healthcare providers.
Internationally recognized for her expertise in pain research, Prof. Gélinas is best known for having developed the Critical-Care Pain Observation Tool (CPOT), considered one of the reference alternative measures for critically ill patients unable to self-report their pain. Available in more than 20 languages, the CPOT has been implemented in several hundred intensive care units worldwide.
On the education front, Prof. Gélinas teaches pain assessment in the critically ill adult in the nursing curriculum at the ISoN and supervises graduate and postgraduate students/fellows. She also serves as a lecturer for the Graduate Chronic Pain Management Certificate (online) offered by the School of Physical and Occupational Therapy at McGill.
While the nursing perspective is foundational to her research, Prof. Gélinas emphasizes that assessing pain and establishing the best pain management plan involves a collaborative effort. “Every member of the interprofessional team has a role to play, including patients and their family members,” she explains. Additionally, she notes that effective acute pain management may help prevent the development of chronic pain, resulting in better clinical outcomes and cost savings to our embattled health care system.
Prof. Gélinas just received a new three-year (beginning April 1, 2025) Canadian Institutes of Health Research (CIHR) Project Grant in the amount of $386,326 for a study titled “Prevalence, factors and trajectories of chronic pain following a stay in the Intensive Care Unit (ICU): From discharge to 12 months”. As she explains, patients admitted to the ICU suffer from a critical care condition which requires intensive monitoring and treatment. More than half of them will experience moderate to severe pain during their ICU stay, and more than 25% of ICU survivors live with chronic pain months to years after their discharge – many of whom require long-term use of opioids to control their pain. “Our goal is to contribute to a better understanding of opioid use in ICU survivors in Quebec, and to improvements in pain management in the recovery process for better prevention of chronic pain and opioid use/misuse.” In addition to Prof. Gélinas, who will serve as Principal Investigator on this study, the project team includes researchers from various disciplines such as nursing, medicine, pharmacy, and psychology, as well as people with lived experience of pain.
Prof. Gélinas also leads CIHR-funded research on the implementation of a collaborative approach to pain management in Quebec ICU settings and the validation of a multiparameter technology called Nociception Level index (NOL) for ICU pain assessment. The NOL captures various physiologic parameters (e.g., heart rate, pulse wave, skin temperature) simultaneously through a finger probe which, through an algorithm, generates an index value from 0 to 100. Values above 20-25 have been shown to be indicative of the perception and sensation of pain. Given that there is no valid alternative valid measure for ICU patients who are unable to self-report their pain or exhibit behaviors indicative of pain, further research in this area is needed.
“Research is a powerful tool to guide the development of best practice guidelines and policies that improve the lives of populations and advance the nursing discipline,” she concludes.