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Canadian MPTFs are unable to meet clinical demands of patients suffering from chronic pain, both in terms of regional accessibility and reasonable wait time for patients' first appointment.

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There are very few pediatric MPTFs in Canada. These facilities exist in five of ten provinces, each within large urban centres. Limited accessibility leads to variable and prolonged wait times for pediatric patients suffering from chronic pain.

There is now considerable evidence that regular exercise is (a) a viable, cost-effective, but underused treatment for mild to moderate depression that compares favorably to individual psychotherapy, group psychotherapy, and cognitive therapy, and (b) a necessary ingredient in effective behavioral treatments that reduce self-reported pain in individuals with chronic pain. Preliminary evidence also suggests that regular exercise deserves further attention as (a) a singular treatment for some anxiety disorders, for individuals suffering from body image disturbance, and for the reduction of problem behavior of developmentally disabled persons, and (b) an adjunct in treatment programs for schizophrenia, conversion disorder, and alcohol dependence. Critical Review of Empirical Research Using Clinical PopulationsWe reviewed studies since 1981 in which exercise was used as a primary or adjunctive intervention in treating individuals with the following clinically diagnosed psychiatric disorders: depression, anxiety, developmental disabilities, schizophrenia, somatoform, and substance abuse. Because of their seminal contribution, two important studies from the 1970s are also mentioned. 275This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Objectives-This study examined factors associated with impaired quality of life and functioning in a sample of treatment-seeking adolescent migraineurs.Subjects-The 37 participants were 51.4% female, and averaged 14.3 years of age and 4.1 migraines per month for the previous 36 months.Procedure-The Migraine-Specific Quality of Life Questionnaire, questionnaire items inquiring about missed activities, and headache diary recordings of missed and impaired activity time served as dependent measures. Variables studied were age; gender; migraine frequency, duration, and severity; presence of nausea, photophobia, or phonophobia; and number of visits to an emergency department in the previous year.Results-Three hierarchical forward regressions and one logistic regression, controlling for age and gender, revealed that the presence of nausea and at least one emergency department visit predicted poorer quality of life and a greater number of missed activities in these adolescent migraineurs. The presence of migraine-related missed activity hours from headache diaries was predicted by being male, having higher combined photophobia and phonophobia sensitivity scores, as well as more frequent and severe migraines. Greater impairment was predicted by having longer average duration attacks.Conclusions-These preliminary findings suggest that the continued development of effective treatment approaches to alleviate pain, suffering, and disability in adolescent migraineurs is required. In particular, evidence for the impact of nausea and sensitivities suggests that they may be important targets for treatment. As well, adolescent migraineurs with a history of a visit to an emergency department in the previous year likely experience greater individual and family distress, more disability, and poorer quality of life that require thoughtful, comprehensive treatment to prevent the development of more severe headache difficulties. Keywordsadolescent migraine; quality of life; disability In the United States, approximately 7% of female and 5% of male adolescents (aged 12 to 17 years) experience migraine. 1 It has been established that, in adults, migraine impairs

Different health care professionals play a variety of important roles in MPTF in Canada. However, few of them are involved on a full-time basis and the extent to which pain is assessed and treated in a truly multidisciplinary manner is questionable.

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