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El-Tallawy SN, Pergolizzi JV, Vasiliu-Feltes I, Ahmed RS, LeQuang JK, Alzahrani T, Varrassi G, Awaleh FI, Alsubaie AT, Nagiub MS. Innovative Applications of Telemedicine and Other Digital Health Solutions in Pain Management: A Literature Review. Pain Ther 2024; 13:791-812. [PMID: 38869690 PMCID: PMC11255158 DOI: 10.1007/s40122-024-00620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
Since the COVID-19 pandemic, healthcare systems are facing extraordinary challenges. Our approaches to medicine have changed and created a whole new generation of people who have chronic pain. Various medical services were postponed. The pandemic significantly impacted the bio-psychosocial model of pain and the management of chronic pain. These new challenges affected millions of patients worldwide, with more burden on patients with chronic pain. Telemedicine and digital health rather than traditional office visits have become essential tools for communications, resulting in an unmatched surge in telehealth adoption. This new approach facilitated the remote treatment and follow-up of patients who have difficulty to access the healthcare services, particularly patients with chronic pain and those who were receiving regular controlled medications. An extensive computer search was conducted, during the period (from January 2014 to March 2024), and included literature from PubMed, Scopus, MEDLINE, and Google scholar. According to preset inclusion and exclusion criteria, a total of 38 articles have been included in this review article. This literature review focuses on the innovation of telemedicine and digital health in pain management, especially in the context of the challenges posed by the COVID-19 pandemic. The manuscript provides a comprehensive overview of telemedicine and digital communications, their evolution, and their significance in healthcare. It also emphasizes the benefits, challenges, limitations, and the ethical concerns of telemedicine in pain management after the COVID-19 pandemic. Furthermore, the document explores the different modes of the telecommunications and discusses the future directions of the digital health technology.
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Affiliation(s)
- Salah N El-Tallawy
- Anesthesia and Pain Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Anesthesia Department, Faculty of Medicine, Minia University & NCI, Cairo University, Cairo, Egypt.
| | | | | | - Rania S Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Tariq Alzahrani
- Anesthesia and Pain Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Fouad I Awaleh
- Anesthesia Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah T Alsubaie
- Anesthesia Department, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abberger B, Grauer T, Kieselbach K. The Use of Telemedicine in an Interdisciplinary Pain Center in the Years 2020 and 2021 in Germany: Effects of the COVID-19 Pandemic. Telemed J E Health 2024. [PMID: 39069915 DOI: 10.1089/tmj.2024.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Introduction: COVID-19 changed the management of patients with chronic pain. The increased utilization of telemedicine was recommended as a solution. Telemedicine provides medical services by overcoming the geographical distance between practitioner and patient and makes it possible to continue treating the patients with a high level of safety for patients and staff. The aim of our study is to investigate the data on the use of telemedicine in an interdisciplinary pain center in the years 2020 and 2021. Methods: Every patient contact in 2020 and 2021 with the interdisciplinary pain center was registered. Dataset consists of 4,156 patient contacts (N = 1,996 in the year 2020; N = 2,160 in the year 2021). For each patient contact, we collected data on age, sex, place of residence, and the reason or type of the contact. In addition, the incidence rates were used as a data source for the COVID-19 development. Results: In 2020, there was a significant decrease in face-to-face contacts (85.0% to 59.4%) and a significant increase in telemedicine use (especially video calls 0.6% to 20.0%). The use of telemedicine had a temporary peak at the beginning of 2021 (first quarter of 2021: 41.2%). The trend generally reversed during 2021: face-to-face contacts increased again (25.5% to 58.9%) and telemedicine decreased (mainly video calls 41.2% to 25.9%). Conclusion: The results show that telemedicine was successfully implemented in an interdisciplinary pain center during 2020 and 2021. In addition to the software requirements and the data protection, the aspect of digital literacy appears to be relevant. There seems to be a need for an implementation plan in pain centers that includes guidelines for the use of telemedicine.
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Affiliation(s)
- Birgit Abberger
- Interdisciplinary Pain Center, University Medical Center Freiburg, Freiburg, Germany
| | - Tom Grauer
- Interdisciplinary Pain Center, University Medical Center Freiburg, Freiburg, Germany
| | - Kristin Kieselbach
- Interdisciplinary Pain Center, University Medical Center Freiburg, Freiburg, Germany
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Capetti B, Conti L, Marzorati C, Grasso R, Ferrucci R, Pravettoni G. The Application of tDCS to Treat Pain and Psychocognitive Symptoms in Cancer Patients: A Scoping Review. Neural Plast 2024; 2024:6344925. [PMID: 38645612 PMCID: PMC11032211 DOI: 10.1155/2024/6344925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Background The use of transcranial direct current stimulation (tDCS) to modulate pain, psychological aspects, and cognitive functions has increased in recent years. The present scoping review aims to investigate the use of tDCS in cancer patients and its significant impact on psychocognitive and pain related symptoms. Methods From the earliest available date to June 2023, a comprehensive search was conducted in three electronic scientific databases-PubMed, Scopus, and Embase-and other supplementary sources. Ten relevant studies were identified and included, comprising single case studies, randomized controlled trials, pilot studies, and one retrospective study. PRISMA guidelines for scoping reviews were followed. Results These studies investigated the use of tDCS to improve pain and psychocognitive aspects in patients with various types of cancer, including breast, oral, bladder, lung, pancreatic, head and neck cancer, hepatocellular carcinoma, and meningioma. Overall, the results suggest that tDCS has shown efficacy in relieving pain, reducing anxiety and depression, and improving cognitive function in cancer patients. Conclusion Due to the limited number and high heterogeneity of the existing literature in this field, more investigation and the establishment of standardized protocols would be required to obtain more conclusive evidence.
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Affiliation(s)
- Benedetta Capetti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberta Ferrucci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- I Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, Milan 20142, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Valenza-Peña G, Calvache-Mateo A, Valenza MC, Granados-Santiago M, Raya-Benítez J, Cabrera-Martos I, Díaz-Mohedo E. Effects of Telerehabilitation on Pain and Disability in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:796. [PMID: 38610217 PMCID: PMC11012007 DOI: 10.3390/healthcare12070796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: This systematic review and meta-analysis explores the effectiveness of telerehabilitation in patients suffering from chronic neck pain, specifically on pain and disability. The research delves into an area of growing significance within the realm of healthcare, aiming to understand the impact of digital interventions on the rehabilitation process for individuals with prolonged neck pain. (2) Methods: The comprehensive review encompasses a wide array of studies evaluating the collective outcomes of numerous trials focused on telerehabilitation strategies. In this systematic review, PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched to identify studies on telerehabilitation's impact on pain. (3) Results: Eight studies met the inclusion criteria. Using the Downs and Black quality assessment, three studies were classified as good and five as fair. The authors identify specific modalities within telerehabilitation, such as remote exercise programs and virtual consultations, that contribute significantly to positive patient outcomes. Meta-analysis indicated a significant overall effect of telerehabilitation on pain reduction (MD = -1.27; 95% CI = -2.06; -0.47; p = 0.002). These findings support telerehabilitation's efficacy in pain management. (4) Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of telerehabilitation as an effective and accessible means of managing chronic neck pain, offering valuable insights for both healthcare practitioners and policymakers in advancing patient-centered care.
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Affiliation(s)
- Geraldine Valenza-Peña
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 60 Av. Ilustración, 18016 Granada, Spain; (G.V.-P.); (A.C.-M.); (I.C.-M.)
| | - Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 60 Av. Ilustración, 18016 Granada, Spain; (G.V.-P.); (A.C.-M.); (I.C.-M.)
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 60 Av. Ilustración, 18016 Granada, Spain; (G.V.-P.); (A.C.-M.); (I.C.-M.)
| | - María Granados-Santiago
- Department of Nursing, Faculty of Health Sciences, University of Granada, 60 Av. Ilustración, 18016 Granada, Spain; (M.G.-S.); (J.R.-B.)
| | - Julia Raya-Benítez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 60 Av. Ilustración, 18016 Granada, Spain; (M.G.-S.); (J.R.-B.)
| | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 60 Av. Ilustración, 18016 Granada, Spain; (G.V.-P.); (A.C.-M.); (I.C.-M.)
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Cerda IH, Therond A, Moreau S, Studer K, Donjow AR, Crowther JE, Mazzolenis ME, Lang M, Tolba R, Gilligan C, Ashina S, Kaye AD, Yong RJ, Schatman ME, Robinson CL. Telehealth and Virtual Reality Technologies in Chronic Pain Management: A Narrative Review. Curr Pain Headache Rep 2024; 28:83-94. [PMID: 38175490 DOI: 10.1007/s11916-023-01205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review provides medical practitioners with an overview of the present and emergent roles of telehealth and associated virtual reality (VR) applications in chronic pain (CP) management, particularly in the post-COVID-19 healthcare landscape. RECENT FINDINGS Accumulated evidence points to the efficacy of now well-established telehealth modalities, such as videoconferencing, short messaging service (SMS), and mobile health (mHealth) applications in complementing remote CP care. More recently, and although still in early phases of clinical implementation, a wide range of VR-based interventions have demonstrated potential for improving the asynchronous remote management of CP. Additionally, VR-associated technologies at the leading edge of science and engineering, such as VR-assisted biofeedback, haptic technology, high-definition three-dimensional (HD3D) conferencing, VR-enabled interactions in a Metaverse, and the use of wearable monitoring devices, herald a new era for remote, synchronous patient-physician interactions. These advancements hold the potential to facilitate remote physical examinations, personalized remote care, and innovative interventions such as ultra-realistic biofeedback. Despite the promise of VR-associated technologies, several limitations remain, including the paucity of robust long-term effectiveness data, heterogeneity of reported pain-related outcomes, challenges with scalability and insurance coverage, and demographic-specific barriers to patient acceptability. Future research efforts should be directed toward mitigating these limitations to facilitate the integration of telehealth-associated VR into the conventional management of CP. Despite ongoing barriers to widespread adoption, recent evidence suggests that VR-based interventions hold an increasing potential to complement and enhance the remote delivery of CP care.
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Affiliation(s)
- Ivo H Cerda
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Alexandra Therond
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Cambridge, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | | | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Maria Emilia Mazzolenis
- Paulson School of Engineering and Applied Sciences, John A, Harvard University, Boston, MA, USA
| | - Min Lang
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Christopher Gilligan
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sait Ashina
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - R Jason Yong
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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van der Meer HA, Doomen A, Visscher CM, Engelbert RHH, Nijhuis-van der Sanden MWG, Speksnijder CM. The additional value of e-Health for patients with a temporomandibular disorder: a mixed methods study on the perspectives of orofacial physical therapists and patients. Disabil Rehabil Assist Technol 2024; 19:433-445. [PMID: 35960692 DOI: 10.1080/17483107.2022.2094000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 06/17/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD). MATERIALS AND METHODS A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding their experience using an e-Health application, Physitrack. The modified telemedicine satisfaction and usefulness questionnaire and pain intensity score before and after treatment were collected from the patients. RESULTS Ten OPTs, of which nine actively used Physitrack, described that the e-Health application can help to provide personalised care to patients with TMD, due to the satisfying content, user-friendliness, accessibility, efficiency, and ability to motivate patients. Ten patients, of which nine ended up using Physitrack, felt that shared decision-making was very important. These patients were positive towards the application as it was clear, convenient, and efficient, it helped with reassurance and adherence to the exercises and overall increased self-efficacy. This was mostly built on their experience with exercise videos, as this feature was most used. None of the OPTs or patients used all features of Physitrack. The overall satisfaction of Physitrack based on the telemedicine satisfaction and usefulness questionnaire (TSUQ) was 20.5 ± 4.0 and all patients (100%) showed a clinically relevant reduction of TMD pain (more than 2 points and minimally 30% difference). CONCLUSION OPTs and patients with TMD shared the idea that exercise videos are of added value on top of usual physical therapy care for TMD complaints, which could be delivered through e-Health.Implications for RehabilitationPhysical therapists and patients with temporomandibular disorders do not use all features of the e-Health application Physitrack in a clinical setting.Exercise videos were the most often used feature and seen as most valuable by physical therapists and patients.Based on a small number of participants, e-Health applications such as Physitrack may be perceived as a valuable addition to the usual care, though this would need verification by a study designed to evaluate the therapeutic effect (e.g., a randomised clinical trial).
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Affiliation(s)
- Hedwig A van der Meer
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
- Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Annet Doomen
- Physiotherapy Private Practice 'De Molen', Houten, The Netherlands
- Institute of Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
| | | | - Caroline M Speksnijder
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
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Coffman CR, Leng JC, Ye Y, Hunter OO, Walters TL, Wang R, Wong JK, Mudumbai SC, Mariano ER. More Than a Perioperative Surgical Home: An Opportunity for Anesthesiologists to Advance Public Health. Semin Cardiothorac Vasc Anesth 2023; 27:273-282. [PMID: 37679298 DOI: 10.1177/10892532231200620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Public health and the medical specialty of anesthesiology have been closely intertwined throughout history, dating back to the 1800s when Dr. John Snow used contact tracing methods to identify the Broad Street Pump as the source of a cholera outbreak in London. During the COVID-19 pandemic, leaders in anesthesiology and anesthesia patient safety came forward to develop swift recommendations in the face of rapidly changing evidence to help protect patients and healthcare workers. While these high-profile examples may seem like uncommon events, there are many common modern-day public health issues that regularly intersect with anesthesiology and surgery. These include, but are not limited to, smoking; chronic opioid use and opioid use disorder; and obstructive sleep apnea. As an evolving medical specialty that encompasses pre- and postoperative care and acute and chronic pain management, anesthesiologists are uniquely positioned to improve patient care and outcomes and promote long-lasting behavioral changes to improve overall health. In this article, we make the case for advancing the role of the anesthesiologist beyond the original perioperative surgical home model into promoting public health initiatives within the perioperative period.
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Affiliation(s)
- Clarity R Coffman
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jody C Leng
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ying Ye
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Oluwatobi O Hunter
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Tessa L Walters
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel Wang
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jimmy K Wong
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Seshadri C Mudumbai
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward R Mariano
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Zaboli R, Bahadori M, Jafari H, Mousavi SM, Bahariniya S, Mehdizadeh P, Delavari A. A study of factors affecting the length of hospital stay (LOS) of COVID-19 patients: A qualitative evidence in Iranian hospital. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:403. [PMID: 38333181 PMCID: PMC10852180 DOI: 10.4103/jehp.jehp_1576_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/25/2022] [Indexed: 02/10/2024]
Abstract
BACKGROUND The present study aimed to identify the administrators' and physicians' experiences and viewpoints about the factors affecting the length of stay (LOS) of COVID-19 patients and provide valid operational evidence. MATERIALS AND METHODS The current study was carried out qualitatively and phenomenologically on experts, officials, and administrators of hospitals in 2021. Purposeful sampling was performed with the maximum diversity. To achieve a comprehensive view, snowball sampling was conducted. Twenty-one experts in the field of healthcare and emerging diseases participated in this study. Semi-structured interviews were used to collect the data. The study sites were universities of medical sciences and hospitals of the Ministry of Health of Iran. The interview questions included questions about the factors affecting the LOS and strategies for controlling the LOS of COVID-19 patients in infectious units. Text analysis was performed through the content analysis method in MAXQDA-10 software. RESULTS Based on the experts' viewpoints, several factors affected the LOS in COVID-19 patients. These factors were divided into five clinical, preclinical, economic, social, and management subcategories. The proposed solutions included policy solutions (supportive policies, development of home care services, training and culture building, and establishment of clinical guidelines) and operational solutions (drug management, promotion of equipment and facilities, telehealth or telemedicine services, and promotion of clinical and support processes). CONCLUSION One of the main tasks of hospital administrators is identifying the factors affecting the reduction of LOS. Among these factors, clinical and management factors in the hospital are more important and need more planning and attention by hospital officials.
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Affiliation(s)
- Rouhollah Zaboli
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Jafari
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Masood Mousavi
- Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sajjad Bahariniya
- Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Parisa Mehdizadeh
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abdoreza Delavari
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
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9
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Conti L, Marzorati C, Grasso R, Ferrucci R, Priori A, Mameli F, Ruggiero F, Pravettoni G. Home-Based Treatment for Chronic Pain Combining Neuromodulation, Computer-Assisted Training, and Telemonitoring in Patients With Breast Cancer: Protocol for a Rehabilitative Study. JMIR Res Protoc 2023; 12:e49508. [PMID: 37971805 PMCID: PMC10690524 DOI: 10.2196/49508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Chronic pain is a disabling symptom frequently reported in patients with breast cancer with a prevalence ranging from 25% to 60%, representing a major health issue. It has negative consequences on health status, causing psychological distress and affecting quality of life. Furthermore, the clinical management of chronic pain is often inadequate, and many patients do not benefit from the administration of pharmacological treatments. Alternative therapeutic options have been implemented to improve the psychophysical well-being of patients, including neuromodulation and complementary interventions. OBJECTIVE We aimed to investigate the effectiveness of a home care strategy combining computerized rehabilitation, transcranial direct current stimulation (tDCS), and remote telemonitoring via a web-based platform in patients with breast cancer suffering for chronic pain. METHODS A web-based structured survey aimed at monitoring chronic pain and its effect on psychological functions will be delivered to patients with breast cancer through social media and email. In total, 42 patients with breast cancer affected by chronic pain will be recruited during the medical screening visit. The patients will be randomly divided into 3 treatment groups that will carry out either tDCS only, exercise therapy only, or a combination of both over a 3-week period. All the treatments will be delivered at the patients' home through the use of a system including a tablet, wearable inertial sensors, and a tDCS programmable medical device. Using web-based questionnaires, the perception of pain (based on the pain self-efficacy questionnaire, visual analogue scale, pain catastrophizing scale, and brief pain inventory) and psychological variables (based on the hospital and anxiety depression scale and 12-item short form survey) will be assessed at the beginning of treatment, 1 week after the start of treatment, at the end of treatment, 1 month after the start of treatment, and 3 months after the start of treatment. The system's usability (based on the mobile app rating scale and system usability scale) and its involvement in the decision-making process (based on the 9-item shared decision-making questionnaire) will be also evaluated. Finally, at the end of the treatment, a digital focus group will be conducted with the 42 patients to explore their unexpressed needs and preferences concerning treatment. RESULTS The study project is scheduled to start in June 2023, and it is expected to be completed by August 2025. CONCLUSIONS We expect that the combination of tDCS and telemedicine programs will reduce pain perceived by patients with breast cancer and improve their mental well-being more effectively than single interventions. Furthermore, we assume that this home-based approach will also improve patients' participation in routine clinical care, reducing disparities in accessing health care processes. This integrated home care strategy could be useful for patients with breast cancer who cannot find relief from chronic pain with pharmacological treatments or for those who have limited access to care due to poor mobility or geographical barriers, thus increasing the patients' empowerment and reducing health care costs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49508.
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Affiliation(s)
- Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberta Ferrucci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- ASST Santi Paolo e Carlo San Paolo University Hospital, Milan, Italy
- Aldo Ravelli' Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Mameli
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Ruggiero
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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10
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Buonanno P, Marra A, Iacovazzo C, Vargas M, Nappi S, Squillacioti F, de Siena AU, Servillo G. The PATIENT Approach: A New Bundle for the Management of Chronic Pain. J Pers Med 2023; 13:1551. [PMID: 38003866 PMCID: PMC10672627 DOI: 10.3390/jpm13111551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/15/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Chronic pain is one of the most challenging diseases for physicians as its etiology and manifestations can be extremely varied. Many guidelines have been published and many therapeutic options are nowadays available for the different types of pain. Given the enormous amount of information that healthcare providers must handle, it is not always simple to keep in mind all the phases and strategies to manage pain. We here present the acronym PATIENT (P: patient's perception; A: assessment; T: tailored approach; I: iterative evaluation; E: education; N: non-pharmacological approach; T: team), a bundle which can help to summarize all the steps to follow in the management of chronic pain. METHODS We performed a PubMed search with a list of terms specific for every issue of the bundle; only English articles were considered. RESULTS We analyzed the literature investigating these topics to provide an overview of the available data on each bundle's issue; their synthesis lead to an algorithm which may allow healthcare providers to undertake every step of a patient's evaluation and management. DISCUSSION Pain management is very complex; our PATIENT bundle could be a guide to clinicians to optimize a patient's evaluation and treatment.
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11
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Bansal V, Pingenot E, Huh B, Javed S. Trends of opioid prescription in cancer patients utilizing telemedicine: a retrospective study. Pain Manag 2023; 13:509-517. [PMID: 37814828 DOI: 10.2217/pmt-2023-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Aim: Prescribing patterns among healthcare practitioners remain a recurring theme of interest in the opioid crisis. This study aims to provide insight on opioid prescribing patterns for cancer pain in telemedicine and in-person encounters during COVID-19. Materials & methods: A retrospective chart review of 1000 encounters (500 telemedicine and 500 in-person) at an academic tertiary care comprehensive cancer center. Results: On average, overall, significantly higher narcotics (in morphine milligram equivalents [MME]) prescribed for patients receiving telemedicine services. In-person encounters had a significantly higher proportion of narcotic (in MME) increases in subsequent visits. Conclusion: Our institution continues to adapt telehealth services as an additional care venue and deeper insight helps mitigate development of maladaptive opioid prescribing patterns.
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Affiliation(s)
- Vishal Bansal
- Department of Physical Medicine & Rehabilitation, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | | | - Billy Huh
- Department of Pain Medicine, Division of Anesthesiology, Critical Care Medicine, & Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saba Javed
- Department of Pain Medicine, Division of Anesthesiology, Critical Care Medicine, & Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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12
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Rockholt MM, Addae G, Chee A, Chin W, Cuff G, Wang J, Umeh UO, Doan LV. Implementing Telemedicine During the COVID-19 Pandemic: Disparities in Utilization in an Urban Pain Medicine Practice. J Pain Res 2023; 16:2763-2775. [PMID: 37577160 PMCID: PMC10422968 DOI: 10.2147/jpr.s415415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/19/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The COVID-19 pandemic led to a drastic expansion in utilizing telemedicine, circumventing some of the geographical barriers to accessing pain care. However, uncertainties around the impact of telemedicine across various sociodemographic groups still exist, prompting further exploration. Therefore, this study aimed to evaluate the impact of sociodemographic factors in telemedicine utilization during and after the COVID-19 pandemic. Patients and methods All outpatient non-procedural visits at the pain medicine division of a large academic institution in the epicenter of the pandemic (New York, USA), between March 2019 and October 2021, were retrospectively included. Sociodemographic data including gender, age, ethnicity/race, postal code, and type of health insurance, across three time periods associated with the COVID-19 pandemic - pre-lockdown (in-office visits only), lockdown (telemedicine visits only) and post-lockdown (offering both in-office and telemedicine visits) - were analyzed and compared. Results In total, 12,615 unique patients - The majority being women (58%) - were seen during the whole study period. In the post-lockdown period, telemedicine was utilized by 42% of all patients. Follow-up visits, younger patients, white patients, patients residing further away from the hospital, and privately insured patients were more likely to utilize telemedicine post-lockdown (p <0.05). Older patients, minorities, Manhattan residents, and Medicare/Medicaid recipients, were more likely to use in-office visits post-lockdown (p <0.05). Conclusion We identified disparities in the utilization of telemedicine in Pain Medicine, which may be due to socioeconomic factors such as lack of access to reliable internet access, cost of devices, and technological know-how. This emphasizes the need for further studies to better understand the reasons for and barriers to telemedicine use. This could help inform policymaking to safeguard equitable access to telemedicine use for pain care.
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Affiliation(s)
- Mika M Rockholt
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Gifty Addae
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Alexander Chee
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Wanda Chin
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Germaine Cuff
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Uchenna O Umeh
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Lisa V Doan
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, 10016, USA
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Albright DL, Suntai Z, McDaniel JT, Johnson K, Henson H, Robertson E, McIntosh S. Opioid Use Disorder Among the Economically Disadvantaged in the Rural South. J Addict Med 2023; 17:418-423. [PMID: 37579099 DOI: 10.1097/adm.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to identify county-level hotspots and associated risk factors for opioid use disorder (OUD) in the state of Alabama. METHODS Using 2015 to 2019 Alabama Medicaid administrative claims data, Medicaid recipients with OUD were identified. We performed local indicators of spatial association analysis to identify hotspots of OUD rates. Using logistic regression, we examined county-level social determinants of health associated with county OUD hotspots. RESULTS There was a +14.13% percentage change from 2015 to 2019. The county level local indicators of spatial association analysis found that 5 counties in the northwestern part of Alabama remained "hotspots" throughout the entire study period. Results of the logistic regression model showed that location within the Appalachian region was an independent predictor of high OUD rates ( b = 2.58; adjusted odds ratio, 13.27, P = 0.04). CONCLUSIONS The high rates of OUD may reflect the economic distress and lack of access to resources germane to the Appalachian region in Alabama.
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Affiliation(s)
- David L Albright
- From the School of Social Work, University of Alabama, Tuscaloosa, AL (DLA, KJ, ER, SM); Diana R. Garland School of Social Work, Baylor University, Waco, TX (ZS); School of Human Sciences, Southern Illinois University, Carbondale, IL (JTM); and STEM Education Research Center, Southern Illinois University, Carbondale, IL (HH)
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14
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Costeira C, Paiva-Santos F, Pais N, Sousa AF, Paiva I, Carvalho DH, Rocha A, Ventura F. Cancer Patients with Chronic Pain and Their Caregivers during COVID-19: A Descriptive Study. NURSING REPORTS 2023; 13:934-945. [PMID: 37489404 PMCID: PMC10366767 DOI: 10.3390/nursrep13030082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/26/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The sanitary measures imposed by COVID-19 intensified challenges in the pain management of cancer patients. METHODS A descriptive study was conducted in a chronic pain unit of an oncological hospital aiming to explore the experiences of cancer patients with chronic pain and their caregivers during the pandemic period, as well as identify strategies to improve care in chronic pain management. An electronic questionnaire was developed containing sociodemographic variables, the Depression, Anxiety and Stress Scale-21, and open-ended questions exploring the experiences and circumstances of pain management. RESULTS A total of 30 patients and 13 caregivers filled in the questionnaire. Patients revealed a higher level of depression, anxiety, and stress than caregivers, without statistically significant differences. Both groups mentioned having experienced difficulties in self-care, particularly in relation to sleep, nutrition, and recreation. In total, 83.7% patients needed pain relief medication related to uncontrolled pain. Both mentioned that they would have benefited from a digital application to ease the communication with the healthcare professionals of the chronic pain unit, as well as non-pharmacological interventions, such as therapeutic massage. CONCLUSIONS Recognizing that chronic pain leads to significant limitations, it is essential to implement and anticipate objective and effective responses in pain management.
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Affiliation(s)
- Cristina Costeira
- ciTechCare, Rua de Santo André-66-68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - Filipe Paiva-Santos
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
- Portuguese Oncology Institute of Coimbra, 3004-011 Coimbra, Portugal
| | - Nelson Pais
- Portuguese Oncology Institute of Coimbra, 3004-011 Coimbra, Portugal
| | - Ana Filipa Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
- Portuguese Oncology Institute of Coimbra, 3004-011 Coimbra, Portugal
| | - Ivo Paiva
- Portuguese Oncology Institute of Coimbra, 3004-011 Coimbra, Portugal
| | | | - Ana Rocha
- Portuguese Oncology Institute of Coimbra, 3004-011 Coimbra, Portugal
| | - Filipa Ventura
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
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15
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Fernández‐de‐las‐Peñas C, Parás‐Bravo P, Ferrer‐Pargada D, Cancela‐Cilleruelo I, Rodríguez‐Jiménez J, Nijs J, Arendt‐Nielsen L, Herrero‐Montes M. Sensitization symptoms are associated with psychological and cognitive variables in COVID-19 survivors exhibiting post-COVID pain. Pain Pract 2022; 23:23-31. [PMID: 35757896 PMCID: PMC9350126 DOI: 10.1111/papr.13146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the association between demographic, clinical, psychological, cognitive, and health-related variables and the Central Sensitization Inventory (CSI) in previously hospitalized COVID-19 survivors exhibiting "de novo" post-COVID pain. METHODS Seventy-seven (n = 77) COVID-19 survivors with "de novo" post-COVID pain completed demographic (age, height, and weight), clinical (duration and intensity of the pain), psychological (depressive/anxiety levels and sleep quality), cognitive (catastrophizing and kinesiophobia levels), and health-related quality of life variables as well as the CSI. A multivariable correlation analysis was conducted to determine the association between variables, and a stepwise multiple linear regression model was performed to identify CSI predictors. RESULTS Patients were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Twenty-six (33.7%) individuals showed indications of sensitization-associated symptoms (CSI score ≥40 points). The CSI score was positively associated with pain intensity (r: 0.371), anxiety (r: 0.784), depressive (r: 0.709), catastrophizing (r: 0.620), and kinesiophobia (r: 0.359) levels (all, p < 0.001). The stepwise regression analysis revealed that 60.2% of CSI was explained by anxiety levels and pain intensity. CONCLUSION This study found that psychological and cognitive variables were associated with the CSI score in previously hospitalized COVID-19 survivors with "de novo" post-COVID pain. Anxiety levels and the intensity of pain symptoms were independently associated with CSI score suggesting a significant overlap with psychological construct. The "de novo" post-COVID pain association with CSI may indicate changes in the pain processing important for managing the pain.
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Affiliation(s)
- César Fernández‐de‐las‐Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and RehabilitationUniversidad Rey Juan Carlos (URJC)MadridSpain,Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMIAalborg UniversityAalborgDenmark
| | - Paula Parás‐Bravo
- Departamento de EnfermeríaUniversidad de CantabriaSantanderSpain,Grupo de Investigación en EnfermeríaInstituto de Investigación Sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - Diego Ferrer‐Pargada
- Servicio de NeumologíaHospital Universitario Marqués de ValdecillaCantabriaSpain
| | - Ignacio Cancela‐Cilleruelo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and RehabilitationUniversidad Rey Juan Carlos (URJC)MadridSpain
| | - Jorge Rodríguez‐Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and RehabilitationUniversidad Rey Juan Carlos (URJC)MadridSpain
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & PhysiotherapyVrije Universiteit BrusselBrusselsBelgium,Department of Physical Medicine and PhysiotherapyUniversity Hospital BrusselsBrusselsBelgium,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Lars Arendt‐Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMIAalborg UniversityAalborgDenmark,Department of Medical Gastroenterology, Mech‐SenseAalborg University HospitalAalborgDenmark
| | - Manuel Herrero‐Montes
- Departamento de EnfermeríaUniversidad de CantabriaSantanderSpain,Grupo de Investigación en EnfermeríaInstituto de Investigación Sanitaria Valdecilla (IDIVAL)SantanderSpain
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16
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Vorenkamp KE, Kochat S, Breckner F, Dimon C. Challenges in Utilizing Telehealth for Chronic Pain. Curr Pain Headache Rep 2022; 26:617-622. [PMID: 35751799 PMCID: PMC9244466 DOI: 10.1007/s11916-022-01067-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Chronic pain in the USA has presented with higher prevalence rates among women, older adults, those unemployed, living in poverty, living in rural environments, and adults with public health insurance. The COVID-19 pandemic has heavily played into the biopsychosocial model of pain. Consequently, greater impacts have affected patients with mood disorders, opioid abuse, and chronic pain. Concurrently, telemedicine has become a popular vehicle during the COVID-19 pandemic in continuing to provide quality patient care. The purpose of this article is to review the benefits and challenges related to the delivery of telemedicine for patients with chronic pain. Recent Findings The benefits of telemedicine have been examined from patient psychosocial and convenience factors as well in relation to medical practice efficiency. Within chronic pain management, one of telemedicine’s most effective utilization is seen via post-injection follow-up and assessment of further necessary interventions. Challenges also exist in this framework, from lack of physical examination and convenient close therapeutic monitoring and drug screening, to technological and resource cost capabilities of older and disadvantaged chronic pain patients, to barriers in establishing patient-provider rapport. During the COVID-19 pandemic, telehealth services were covered at rates comparable to in-person visits. Health insurance coverage and payment were major barriers for implementation of telemedicine prior to the pandemic. It is difficult to predict ongoing coverage and payment of telehealth services, although the benefits in terms of access and patient satisfaction have clearly been demonstrated. Summary While telemedicine has proven to be a very useful tool with a wealth of advantages, the delivery of virtual healthcare for chronic pain poses a set of challenges that will need to be met to ensure the quality and standard of care continue to be upheld.
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Affiliation(s)
- Kevin E Vorenkamp
- Duke University Department of Anesthesiology, Duke University Health System, 4314 Orange Zone, Durham, NC, 27710, USA.
| | - Suhas Kochat
- Duke University Department of Anesthesiology, Duke University Health System, 4314 Orange Zone, Durham, NC, 27710, USA
| | | | - Cain Dimon
- Duke University Department of Anesthesiology, Duke University Health System, 4314 Orange Zone, Durham, NC, 27710, USA
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17
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Gondal H, Abbas T, Choquette H, Le D, Chalchal HI, Iqbal N, Ahmed S. Patient and Physician Satisfaction with Telemedicine in Cancer Care in Saskatchewan: A Cross-Sectional Study. Curr Oncol 2022; 29:3870-3880. [PMID: 35735418 PMCID: PMC9221857 DOI: 10.3390/curroncol29060309] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 01/23/2023] Open
Abstract
Background: Telemedicine is a useful tool that connects patients to their care team remotely and improves access to medical care for rural residents. This study aimed to determine the telemedicine experience of both rural patients with cancer and their physicians, and to explore factors associated with a positive patient experience. Methods: In this cross-sectional study, cancer patients and physicians in Saskatchewan completed a paper-based survey composed of 32 items or an electronic survey of 18 items, respectively. Logistic regression analysis was performed to assess patient satisfaction in relation to various sociodemographic and cancer-related factors. Results: Overall, 25 physicians and 165 patients participated in the study. Among the physicians, 94% were confident in their telemedicine assessment, 58% agreed that telemedicine improved clinical efficiency, and 73% agreed that doctor−patient rapport was unimpaired with telemedicine. Of 165 patients, 61% had used telemedicine for the first time, 81% felt that their needs were met, 83% were satisfied with the quality of their care, and 88% had a positive experience. Overall, 83% patients vs. 45% physicians preferred telemedicine to a face-to-face clinic visit (p = 0.005). On univariate analysis, patients ≥ 65 years old had a greater positive telemedicine experience compared to patients < 65 years old (odds ratio 4.1 [1.2−13.8], p = 0.02). Conclusion: Both patients and physicians have a high rate of positive experiences with telemedicine. However, patients have a higher preference for telemedicine over face-to-face visits compared to physicians. In addition, elderly patients have more positive telemedicine experiences compared to younger patients.
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Affiliation(s)
- Hurria Gondal
- Division of Oncology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N5E5, Canada;
| | - Tahir Abbas
- Saskatchewan Cancer Agency-Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada; (D.L.); (N.I.)
- Correspondence: (T.A.); (S.A.); Tel.: +1-306-655-2710 (S.A.); Fax: +1-306-655-0633 (S.A.)
| | - Heather Choquette
- Community Oncology Service, Saskatchewan Cancer Agency, Regina, SK S4T7T1, Canada;
| | - Duc Le
- Saskatchewan Cancer Agency-Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada; (D.L.); (N.I.)
| | - Haji Ibraheem Chalchal
- Saskatchewan Cancer Agency-Allan Blair Cancer Centre, University of Saskatchewan, Regina, SK S4T7T1, Canada;
| | - Nayyer Iqbal
- Saskatchewan Cancer Agency-Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada; (D.L.); (N.I.)
| | - Shahid Ahmed
- Saskatchewan Cancer Agency-Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada; (D.L.); (N.I.)
- Correspondence: (T.A.); (S.A.); Tel.: +1-306-655-2710 (S.A.); Fax: +1-306-655-0633 (S.A.)
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18
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Lan X, Yu H, Cui L. Application of Telemedicine in COVID-19: A Bibliometric Analysis. Front Public Health 2022; 10:908756. [PMID: 35719666 PMCID: PMC9199898 DOI: 10.3389/fpubh.2022.908756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTelemedicine as a tool that can reduce potential disease spread and fill a gap in healthcare has been increasingly applied during the COVID-19 pandemic. Many studies have summarized telemedicine's technologies or the diseases' applications. However, these studies were reviewed separately. There is a lack of a comprehensive overview of the telemedicine technologies, application areas, and medical service types.ObjectiveWe aimed to investigate the research direction of telemedicine at COVID-19 and to clarify what kind of telemedicine technology is used in what diseases, and what medical services are provided by telemedicine.MethodsPublications addressing telemedicine in COVID-19 were retrieved from the PubMed database. To extract bibliographic information and do a bi-clustering analysis, we used Bicomb and gCLUTO. The co-occurrence networks of diseases, technology, and healthcare services were then constructed and shown using R-studio and the Gephi tool.ResultsWe retrieved 5,224 research papers on telemedicine at COVID-19 distributed among 1460 journals. Most articles were published in the Journal of Medical Internet Research (166/5,224, 3.18%). The United States published the most articles on telemedicine. The research clusters comprised 6 clusters, which refer to mental health, mhealth, cross-infection control, and self-management of diseases. The network analysis revealed a triple relation with diseases, technologies, and health care services with 303 nodes and 5,664 edges. The entity “delivery of health care” was the node with the highest betweenness centrality at 6,787.79, followed by “remote consultation” (4,395.76) and “infection control” (3,700.50).ConclusionsThe results of this study highlight widely use of telemedicine during COVID-19. Most studies relate to the delivery of health care and mental health services. Technologies were primarily via mobile devices to deliver health care, remote consultation, control infection, and contact tracing. The study assists researchers in comprehending the knowledge structure in this sector, enabling them to discover critical topics and choose the best match for their survey work.
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19
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Bavarian R, Pharr CA, Handa S, Shaefer J, Keith DA. The Utility of Telemedicine in Orofacial Pain: Guidelines for Examination and a Retrospective Review at a
Hospital‐Based
Practice. J Oral Rehabil 2022; 49:778-787. [DOI: 10.1111/joor.13335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/13/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Roxanne Bavarian
- Orofacial Pain Division, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St Boston, MA, 02114 USA
- Harvard School of Dental Medicine 188 Longwood Ave, Boston, MA, 02115 USA
| | - Cameron A. Pharr
- Harvard School of Dental Medicine 188 Longwood Ave, Boston, MA, 02115 USA
| | - Shruti Handa
- Orofacial Pain Division, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St Boston, MA, 02114 USA
| | - Jeffry Shaefer
- Orofacial Pain Division, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St Boston, MA, 02114 USA
- Harvard School of Dental Medicine 188 Longwood Ave, Boston, MA, 02115 USA
| | - David A. Keith
- Orofacial Pain Division, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St Boston, MA, 02114 USA
- Harvard School of Dental Medicine 188 Longwood Ave, Boston, MA, 02115 USA
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Reilly ED, Chamberlin ES, Duarte BA, Harris JI, Shirk SD, Kelly MM. The Impact of COVID-19 on Self-Reported Substance Use, Well-Being, and Functioning Among United States Veterans: A Cross-Sectional Study. Front Psychol 2022; 13:812247. [PMID: 35478735 PMCID: PMC9035845 DOI: 10.3389/fpsyg.2022.812247] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
As the COVID-19 pandemic sweeps the globe, many veterans with substance use issues have faced the closure of treatment facilities, mandates to shelter in place, and social distancing measures. To better understand their pandemic experiences, substance use changes, and functioning, a survey was nationally administered to a sample of United States veterans reporting substance use issues during the pandemic. The purpose of this cross-sectional online survey for veterans (N = 409) was to report on COVID-19 experiences, safety behaviors, and infection experiences while also investigating the relationship among addictive behaviors, mental and physical health, and COVID-19 impact. Measures also assessed specific substance use concerns, pandemic-related loneliness, and functioning. Though few veterans reported personally receiving a confirmed COVID-19 medical diagnosis (10.5%), the impact of pandemic stressors was evident, with a majority reporting anxiety related to contracting COVID-19 (61.4%) or fear of a family member or close friend contracting COVID-19 (58.7%). Participants reported increased use of alcohol (45.3%), sedatives (36.6%), inhalants (35.7%), tobacco (35.0%), and cannabis (34.9%), attributed specifically to the pandemic. Regression analyses revealed that even when controlling for the contribution of problematic substance use issues, negative pandemic impacts and self-reported COVID-19 related loneliness were related to more impaired physical and mental health functioning during the pandemic. Findings from this sample of veterans with addiction issues add to the growing literature suggesting unique and adverse effects of COVID-19 stressors on functioning while also revealing specific pandemic impacts for this group.
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Affiliation(s)
- Erin D. Reilly
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
- The Department of Psychiatry and Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- *Correspondence: Erin D. Reilly,
| | - Elizabeth S. Chamberlin
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
| | | | - J. Irene Harris
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Steven D. Shirk
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
- The Department of Psychiatry and Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Megan M. Kelly
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
- The Department of Psychiatry and Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Wang L, Yang N, Yang J, Zhao S, Su C. A Review: The Manifestations, Mechanisms, and Treatments of Musculoskeletal Pain in Patients With COVID-19. FRONTIERS IN PAIN RESEARCH 2022; 3:826160. [PMID: 35295802 PMCID: PMC8915767 DOI: 10.3389/fpain.2022.826160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/02/2022] [Indexed: 12/19/2022] Open
Abstract
The outbreak of COVID-19 poses a serious threat to global health. Musculoskeletal (MSK) pain is the most frequent symptom in patients with COVID-19 besides fever and cough. There are limited studies addressing MSK symptoms in patients with COVID-19. This review aims to provide an overview of current studies related to MSK pain in patients with COVID-19, summarize the possible mechanisms of myalgia, and describe the current management options. In addition to acute respiratory manifestations, COVID-19 might also affect neurological systems which include skeletal manifestations and muscular injury. A possible mechanism of MSK pain and myalgia in COVID-19 may be related to the distribution of angiotensin-converting enzyme 2 (ACE-2) and the occurrence of cytokine storms. ACE-2 has been shown to be the receptor of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2). Moreover, studies have shown that inflammatory cytokines could cause myalgia by inducing prostaglandin E2 (PGE2) production. In addition, it was also found that the plasma levels of IL2, IL7, IL10, IL-6, TNFα, and e lymphopenia were higher in patients with COVID-19. In general, the treatment of MSK pain in patients with COVID-19 falls into pharmacological and non-pharmacological interventions. Various treatments of each have its own merits. The role of vaccination is irreplaceable in the efforts to prevent COVID-19 and mitigates its subsequent symptoms.
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Affiliation(s)
- Lijuan Wang
- Department of Anesthesiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Department of Medicine, University of South China, Hengyang, China
| | - Na Yang
- Department of Anesthesiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jinfeng Yang
- Department of Anesthesiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Shuwu Zhao
- Department of Anesthesiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- *Correspondence: Shuwu Zhao
| | - Chen Su
- Department of Anesthesiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Chen Su
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22
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Herrero-Montes M, Fernández-de-las-Peñas C, Ferrer-Pargada D, Tello-Mena S, Cancela-Cilleruelo I, Rodríguez-Jiménez J, Palacios-Ceña D, Parás-Bravo P. Prevalence of Neuropathic Component in Post-COVID Pain Symptoms in Previously Hospitalized COVID-19 Survivors. Int J Clin Pract 2022; 2022:3532917. [PMID: 35685491 PMCID: PMC9159239 DOI: 10.1155/2022/3532917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/18/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of neuropathic pain symptoms and to analyze the correlation between neuropathic symptoms with pain-related, psychological, and cognitive variables in COVID-19 survivors exhibiting "de novo" post-COVID pain. METHODS Seventy-seven (n = 77) previously hospitalized COVID-19 survivors presenting with post-COVID pain completed demographic (such as age, height, and weight), pain-related (the duration and intensity of pain), psychological (depressive/anxiety levels), and cognitive (catastrophizing and kinesiophobia) variables. The Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire was also assessed. After conducting multivariable correlation analyses, a stepwise multiple linear regression model was performed to identify S-LANSS predictors. RESULTS Participants were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Nineteen (24.6%) exhibited neuropathic pain symptoms (S-LANSS score≥12 points). The S-LANSS score was positively associated with the duration of post-COVID pain (r: 0.262), anxiety levels (r: 0.275), and kinesiophobia level (r: 0.291) (all, P < 0.05). The stepwise regression analysis revealed that 12.8% of the S-LANSS variance was just explained by kinesiophobia. CONCLUSION This study found that almost 25% of previously hospitalized COVID-19 survivors with "de novo" post-COVID pain reported a neuropathic pain component. The presence of neuropathic pain symptomatology was associated with more anxiety and kinesiophobia, but only kinesiophobia level was significantly associated explaining 12.8% of the variance of the S-LANSS score.
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Affiliation(s)
- Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria, Santander 39008, Spain
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Enfermería, Santander 39008, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid 28922, Spain
| | - Diego Ferrer-Pargada
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander 39008, Spain
| | - Sandra Tello-Mena
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander 39008, Spain
| | - Ignacio Cancela-Cilleruelo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid 28922, Spain
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid 28922, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid 28922, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria, Santander 39008, Spain
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Enfermería, Santander 39008, Spain
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Shiner CT, Gardner T, Haskelberg H, Li I, Faux SG, Millard M, Mahoney AEJ. OUP accepted manuscript. PAIN MEDICINE 2022; 23:1621-1630. [PMID: 35312759 PMCID: PMC8996725 DOI: 10.1093/pm/pnac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Objectives Societal and health system pressures associated with the coronavirus disease 2019 (COVID-19) pandemic exacerbated the burden of chronic pain and limited access to pain management services for many. Online multidisciplinary pain programs offer an effective and scalable treatment option, but have not been evaluated within the context of COVID-19. This study aimed to investigate the uptake and effectiveness of the Reboot Online chronic pain program before and during the first year of the COVID-19 pandemic. Methods Retrospective cohort analyses were conducted on routine service users of the Reboot Online program, comparing those who commenced the program during the COVID-19 pandemic (March 2020–March 2021), to those prior to the pandemic (April 2017–March 2020). Outcomes included the number of course registrations; commencements; completion rates; and measures of pain severity, interference, self-efficacy, pain-related disability, and distress. Results Data from 2,585 course users were included (n = 1138 pre-COVID-19 and n = 1,447 during-COVID-19). There was a 287% increase in monthly course registrations during COVID-19, relative to previously. Users were younger, and more likely to reside in a metropolitan area during COVID-19, but initial symptom severity was comparable. Course adherence and effectiveness were similar before and during COVID-19, with moderate effect size improvements in clinical outcomes post-treatment (g = 0.23–0.55). Discussion Uptake of an online chronic pain management program substantially increased during the COVID-19 pandemic. Program adherence and effectiveness were similar pre- and during-COVID. These findings support the effectiveness and scalability of online chronic pain management programs to meet increasing demand.
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Affiliation(s)
- Christine T Shiner
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
- Department of Pain Medicine, St Vincent’s Hospital, Sydney, Australia
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Correspondence to: Christine Shiner, Department of Rehabilitation and Pain Medicine, St Vincent’s Hospital Sydney, 170 Darlinghurst Rd, Darlinghurst NSW 2010, Australia. Tel: + 61 2 8382 9542; Fax: +61 2 8382 9518; E-mail:
| | - Tania Gardner
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
- Department of Pain Medicine, St Vincent’s Hospital, Sydney, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
| | - Steven G Faux
- Department of Pain Medicine, St Vincent’s Hospital, Sydney, Australia
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent’s Hospital Sydney and the University of New South Wales, Sydney, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Cascella M, Miceli L, Cutugno F, Di Lorenzo G, Morabito A, Oriente A, Massazza G, Magni A, Marinangeli F, Cuomo A. A Delphi Consensus Approach for the Management of Chronic Pain during and after the COVID-19 Era. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413372. [PMID: 34948983 PMCID: PMC8706033 DOI: 10.3390/ijerph182413372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
Abstract
Due to a lack of published evidence on the topic, a modified Delphi approach was used to develop recommendations useful for chronic pain management during and after the COVID-19 pandemic. Focusing on the available literature and personal clinical expertise, an Italian board of nine professionals from different disciplines identified four main topics: prevention of chronic pain, treatment of chronic pain, consequences of inadequate treatment, and perspectives. They elaborated a semi-structured questionnaire. A multidisciplinary panel of experts in the field of pain management was requested to comment on the statements. Based on the answers provided, a structured questionnaire was prepared (Round 1). It included 21 statements divided into three categories (organizational issues; diagnosis and therapies; telemedicine and future perspectives). A five-point Likert scale was adopted. The threshold for consensus was set at a minimum of 70% of the number of respondents (level of agreement ≥ 4, Agree or Strongly Agree). A final questionnaire with rephrasing of the statements that did not reach the consensus threshold was elaborated (Round 2). A total of 29 clinicians were included in the panel. Twenty clinicians (69%) responded in both the first and second round. After two rounds, consensus (≥70%) was achieved in 20 out of 21 statements. The lack of consensus was recorded for the statement regarding the management of post-COVID pain (55%; Median 4; IQR 2.3). Another statement on telemedicine reached the threshold in the first round (70%), but the value was not confirmed in Round 2 (65%; Median 4; IQR 2). Most of the proposed items reached consensus, suggesting the need to make organizational changes, the structuring of careful diagnostic and therapeutic pathways, and the application of new technologies in pain medicine. Long-COVID-19 care is an issue that needs further research. Remote assistance for chronic pain must be regulated.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, 80100 Napoli, Italy;
- Department of Electrical Engineering and Information Technologies, Università di Napoli “Federico II”, 80100 Napoli, Italy;
- Correspondence:
| | - Luca Miceli
- Department of Pain Medicine, IRCCS C.R.O. National Cancer Institute of Aviano, 33081 Aviano, Italy;
| | - Francesco Cutugno
- Department of Electrical Engineering and Information Technologies, Università di Napoli “Federico II”, 80100 Napoli, Italy;
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
- Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, IRCCS “Fondazione G. Pascale”, 80100 Napoli, Italy;
| | - Alfonso Oriente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, 80100 Napoli, Italy;
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University di Torino, 10121 Torino, Italy;
| | - Alberto Magni
- Italian College of General Practitioners and Primary Care (SIMG), Via Del Sansovino 179, 50142 Firenze, Italy;
| | - Franco Marinangeli
- Department of Life, Health & Environmental Sciences, University of l’Aquila, 67100 l’Aquila, Italy;
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, 80100 Napoli, Italy;
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Cascella M, Marinangeli F, Vittori A, Scala C, Piccinini M, Braga A, Miceli L, Vellucci R. Open Issues and Practical Suggestions for Telemedicine in Chronic Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312416. [PMID: 34886140 PMCID: PMC8656645 DOI: 10.3390/ijerph182312416] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022]
Abstract
Telemedicine represents a major opportunity to facilitate continued assistance for patients with chronic pain and improve their access to care. Preliminary data show that an improvement can be expected of the monitoring, treatment adherence, assessment of treatment effect including the emotional distress associated with pain. Moreover, this approach seems to be convenient and cost-effective, and particularly suitable for personalized treatment. Nevertheless, several open issues must be highlighted such as identification of assessment tools, implementation of monitoring instruments, and ability to evaluate personal needs and expectations. Open questions exist, such as how to evaluate the need for medical intervention and interventional procedures, and how to define when a clinical examination is required for certain conditions. In this context, it is necessary to establish dynamic protocols that provide the right balance between face-to-face visits and telemedicine. Useful tips are provided to start an efficient experience. More data are needed to develop precise operating procedures. In the meantime, the first experiences from such settings can pave the way to initiate effective care pathways in chronic pain.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori—IRCCS—Fondazione Pascale, 80131 Napoli, Italy;
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Rome, Italy
- Correspondence: or ; Tel.: +39-06-68592397
| | - Cristina Scala
- UOC Anesthesia, Intensive Care and Pain Therapy, Senigallia Hospital, 60123 Ancona, Italy;
| | - Massimo Piccinini
- Anesthesia, Critical Care, Palliative Medicine and Pain Therapy Service, L’Aquila ASL1 Abruzzo, 67100 L’Aquila, Italy;
| | | | - Luca Miceli
- Department of Clinical and Experimental Pain Medicine, IRCCS CRO of Aviano, 33081 Aviano, Italy;
| | - Renato Vellucci
- Pain and Palliative Care Clinic, University Hospital of Careggi, 50121 Florence, Italy;
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Jain A, Gee S, Malayala SV, Laboe CW. Chronic Pediatric Pain and Mental Illness During the COVID-19 Era: A Case Series From Inpatient Child Psychiatry Unit. Cureus 2021; 13:e20032. [PMID: 34987917 PMCID: PMC8716159 DOI: 10.7759/cureus.20032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic pain is defined as pain that persists following tissue injury or disease processes and is believed to have taken place after healing. It is a functional impairment that causes discomfort and leads to the inability to perform various essential daily activities. Chronic pain in pediatrics can be of various types, the most commonly prevalent types being headaches, abdominal pain, and limb pain. Adolescents with chronic pain have been found to have generalized anxiety scores twice that of the average population, along with significant impairment of family dynamics. Some forms of chronic pain respond effectively to medication and psychotherapy, and recurrence is common when stress is triggered by external or environmental factors, most recently in the form of COVID-19. In this case series, we discuss three cases of worsening mental health presentations and chronic pain exacerbation in the context of the COVID-19 pandemic. We talk about the unique perspective of chronic pain in the pediatric population and comorbid mental illnesses and their management from a psychiatric standpoint.
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Affiliation(s)
- Ankit Jain
- Psychiatry & Behavioral Health, Penn State College of Medicine, Hershey, USA
| | - Sage Gee
- Psychiatry & Behavioral Health, Penn State College of Medicine, Hershey, USA
| | | | - Christopher W Laboe
- Psychiatry & Behavioral Health, Penn State College of Medicine, Hershey, USA
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Sangalli L, Fernandez-Vial D, Moreno-Hay I, Boggero I. Telehealth Increases Access to Brief Behavioral Interventions in Orofacial Pain Clinic during COVID-19 Pandemic: A Retrospective Study. PAIN MEDICINE 2021; 23:799-806. [PMID: 34623433 PMCID: PMC8524454 DOI: 10.1093/pm/pnab295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/09/2021] [Accepted: 10/04/2021] [Indexed: 01/25/2023]
Abstract
Objective Aim of the study was to test if orofacial pain patients were more likely to start and complete a brief psychological intervention for managing certain chronic orofacial pain conditions (physical self-regulation, PSR) via telehealth (during the COVID-19 pandemic) vs. in-person (prior to the COVID-19 pandemic). Exploratory aim was to describe demographic factors that may influence the patients to start and complete PSR. Methods Retrospective medical charts of all patients seen at a university-affiliated tertiary orofacial pain clinic between July–December 2019 (in person, pre-pandemic) and July–December 2020 (telehealth, during pandemic) were reviewed. Charts were examined for demographic information and to compare the number of patients who started and completed PSR during each study period (chi-squared test). Results Of 248 new patients seen in the clinic during 2019 period, 25 started PSR in-person (10.08%). Of 252 new patients seen during 2020 period, 53 started PSR via telehealth (21.03%). Patients were more likely to start PSR (OR = 6.21, p<.001, CI = 2.499 to 15.435) and more likely to complete all three sessions of PSR (OR = 5.69, p<.001, CI = 2.352 to 13.794) when it was offered via telehealth than in-person. Among those who started PSR via telehealth, patients from metropolitan areas were more likely to start the intervention than those from non-metropolitan areas (p=.045). Conclusions Offering brief psychological pain interventions via telehealth in tertiary orofacial pain clinics has demonstrated feasibility and may improve willingness to participate in psychological treatments. Results need to be replicated with prospective data as modality was confounded with pandemic in the current study.
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Affiliation(s)
- Linda Sangalli
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
| | - Diego Fernandez-Vial
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
| | - Isabel Moreno-Hay
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
| | - Ian Boggero
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
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Serrat M, Coll-Omaña M, Albajes K, Solé S, Almirall M, Luciano JV, Feliu-Soler A. Efficacy of the FIBROWALK Multicomponent Program Moved to a Virtual Setting for Patients with Fibromyalgia during the COVID-19 Pandemic: A Proof-of-Concept RCT Performed Alongside the State of Alarm in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10300. [PMID: 34639600 PMCID: PMC8508552 DOI: 10.3390/ijerph181910300] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022]
Abstract
FIBROWALK is a multicomponent program including pain neuroscience education, therapeutic exercise, cognitive behavioral therapy and mindfulness training that has recently been found to be effective in patients with fibromyalgia (FM). This RCT started before the COVID-19 pandemic and was moved to a virtual format (i.e., online videos) when the lockdown was declared in Spain. This study is aimed to evaluate the efficacy of a virtual FIBROWALK compared to Treatment-As-Usual (TAU) in patients with FM during the first state of alarm in Spain. A total of 151 patients with FM were randomized into two study arms: FIBROWALK plus TAU vs. TAU alone. The primary outcome was functional impairment. Secondary outcomes were kinesiophobia, anxiety and depressive symptomatology, and physical functioning. Differences between groups at post-treatment assessment were analyzed using Intention-To-Treat (ITT) and completer approaches. Baseline differences between clinical responders and non-responders were also explored. Statistically significant improvements with small-to-moderate effect sizes were observed in FIBROWALK+TAU vs. TAU regarding functional impairment and most secondary outcomes. In our study, the NNT was 5, which was, albeit modestly, indicative of an efficacious intervention. The results of this proof-of-concept RCT preliminarily support the efficacy of virtual FIBROWALK in patients with FM during the Spanish COVID-19 lockdown.
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Affiliation(s)
- Mayte Serrat
- Unitat d’Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
- Escoles Universitàries Gimbernat, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Mireia Coll-Omaña
- Eodyne Systems, Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O) Research Group, University of Vic, 08500 Vic, Spain;
| | - Klara Albajes
- Department of Basics, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain;
| | - Sílvia Solé
- Faculty of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain;
| | - Miriam Almirall
- Unitat d’Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
| | - Juan V. Luciano
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain; (J.V.L.); (A.F.-S.)
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Albert Feliu-Soler
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain; (J.V.L.); (A.F.-S.)
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
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Pain experience and mood disorders during the lockdown of the COVID-19 pandemic in the United States: an opportunistic study. Pain Rep 2021; 6:e958. [PMID: 34589641 PMCID: PMC8476053 DOI: 10.1097/pr9.0000000000000958] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The unknown and uncontrollable situation of the coronavirus disease 2019 (COVID-19) pandemic may have triggered changes in pain, anxiety, and depression along with a perception of nonspecific COVID-19 symptoms. OBJECTIVES We determined how anxiety, depression, and pain outcomes varied during the "Stay-at-Home" order compared with the prepandemic period and whether nonspecific COVID-19 symptoms would occur. METHODS We conducted an online survey to opportunistically reassess clinical anxiety, depression, pain intensity, and pain interference while controlling for somatic symptom severity during the prepandemic and Stay-at-Home order period. During the Stay-at-Home period, anxiety, depression, pain intensity, and pain interference were reassessed. Coping strategies were assessed as a critical factor influencing pain behaviors. In addition, we explored the occurrence of nonspecific COVID-19 symptoms with an ad hoc survey referencing the Centers for Disease Control and Prevention publicly available COVID-19 symptoms. RESULTS We observed a significant increase in depression and anxiety levels during the Stay-at-Home period. Coping strategy changes (eg, increased exercise) were linked to lower pain severity and interference which improved overall. Participants who self-reported nonspecific COVID-19 symptoms had higher prepandemic depression. Among the 72 participants not diagnosed with COVID-19, 70.8% of the participants experienced symptoms resembling those associated with COVID-19. CONCLUSION We suggest the parallel between pain outcome improvement and worsening anxiety and depression during the Stay-at-Home order might reflect a shift in symptoms, indicating that those patients with underlying mood disorders may require more help than they did before the pandemic.
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Abstract
BACKGROUND Patients received care over telemedicine during the COVID-19 pandemic, and their perspective is useful for hand surgeons. METHODS Online surveys were sent October-November 2020 to 497 patients who received telemedicine care. Questions were free-response and multi-item Likert scales asking about telehealth in general, limitations, benefits, comparisons to in-person visits, and opinions on future use. RESULTS The response rate was 26% (n = 130). Prior to the pandemic, 55% had not used telemedicine for hand surgery consultation. Patients liked their telemedicine visit and felt their provider spent enough time with them (means = 9/10). In all, 48% would have preferred in-person visits despite the pandemic, and 69% would prefer in-person visits once the pandemic concludes. While 43% had no concerns with telemedicine, 36% had difficulties explaining their symptoms. Telemedicine was easy to access and navigate (M = 9/10). However, 23% saw telemedicine of limited value due to the need for an in-person visit soon afterward. Of these patients, 46% needed an in-person visit due to inadequate physical examination. Factors that make telemedicine more favorable to patients included convenience, lack of travel, scheduling ease, and time saved. Factors making telemedicine less favorable included need for in-person examination or procedure, pain assessment, and poor connectivity. There was no specific appointment time the cohort preferred. Patient recommendations to improve telemedicine included decreasing wait times and showing patient queue, wait time, or physician status online. CONCLUSIONS Telemedicine was strongly liked by patients during the COVID-19 pandemic. However, nearly 70% of patients still preferred in-person visits for the future.
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Affiliation(s)
- Farhan Ahmad
- Rush University Medical Center, Chicago, IL, USA
- Farhan Ahmad, Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA.
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31
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Dario A, Frigerio G. Commentary: Management of Intractable Pain in Patients With Implanted Spinal Cord Stimulation Devices During the COVID-19 Pandemic Using a Remote and Wireless Programming System. Front Neurosci 2021; 15:696830. [PMID: 34421521 PMCID: PMC8374167 DOI: 10.3389/fnins.2021.696830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alessandro Dario
- Department of Neurosurgery, ASST Settelaghi, Insubria University, Varese, Italy
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Alter BJ, Navlani R, Abdullah L, Wasan AD, Heres E. The use of telemedicine to support interventional pain care: case series and commentary. PAIN MEDICINE 2021; 22:2802-2805. [PMID: 34086929 PMCID: PMC8194915 DOI: 10.1093/pm/pnab183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Incorporating indicated interventions in a multimodal approach to manage musculoskeletal pain has become standard of care. For example, in patients with radicular pain associated with intervertebral disc herniation or lumbar spinal stenosis, epidural steroid injections (ESI) are commonly used and often improve pain and function while avoiding more invasive surgical approaches. Recently, the coronavirus disease 2019 (COVID-19) pandemic has allowed remote evaluations to mitigate COVID-19 transmission using telemedicine. In this article, we review our experience in using telemedicine for interventional pain care and current literature, providing a framework for current practice and future study. During restrictive periods of COVID-19 mitigation, patients were referred for ESI, evaluated by telemedicine, and then seen in-person for a physical exam and possible ESI. After a chart review of these patients, we found that telemedicine evaluation was successfully used to support decision making about the ESI. The majority of patients referred received an ESI. During the interval between telemedicine evaluation and ESI, there was no evidence of progression of disease or neurologic deterioration. There were no emergency room visits due to pain complaints. In our literature review, similar case series supported the use of telemedicine in planning and supporting procedural care in several clinical specialties, including interventional pain management. Future research in larger cohorts will help rigorously evaluate safety and query satisfaction for both patients and providers. In conclusion, we suggest that using telemedicine to support procedural care requires more research but shows promise in increasing access to interventional pain care. The use of telemedicine has recently seen a sharp increase in frequency due to the ongoing global COVID-19 pandemic. According to the World Health Organization, telemedicine represents "healing at a distance"1 . They define telemedicine as "the delivery of healthcare services…by health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries." Telemedicine has become an important and effective option for providing patient care. However, the use of telemedicine in the context of procedural therapies for pain management is new and rapidly evolving. In this commentary, we aimed to review literature and share our experience in integrating telemedicine in procedural care.
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Affiliation(s)
- Benedict J Alter
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Rohit Navlani
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Leath Abdullah
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ajay D Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Edward Heres
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Expectations about pain and analgesic treatment are shaped by medical providers' facial appearances: Evidence from five online clinical simulation experiments. Soc Sci Med 2021; 281:114091. [PMID: 34126294 DOI: 10.1016/j.socscimed.2021.114091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/23/2021] [Accepted: 05/29/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE There is a robust link between patients' expectations and clinical outcomes, as evidenced by the placebo effect. Expectations depend in large part on the context surrounding treatment, including the patient-provider interaction. Prior work indicates that providers' behavior and characteristics, including warmth and competence, can shape patient outcomes. Yet humans rapidly form trait impressions of others before any in-person interaction. It is unknown whether these first impressions influence subsequent health care choices and expectations. OBJECTIVE Our goal was to test whether trait impressions of hypothetical medical providers, based exclusively on facial images, influence the choice of medical providers and expectations about pain and analgesia following hypothetical painful medical procedures. METHOD Across five online experiments, participants (total N = 1108) viewed and made judgments about hypothetical healthcare providers. Experiments 1-4 included computer-generated faces that varied in features associated with competence, while experiment 5 included real faces. We measured how apparent competence affected expectations about pain and anticipated analgesic use in all studies. We also measured warmth and similarity. RESULTS Across five online studies, participants selected providers who appeared more competent, based on facial visual information alone. Further, providers' apparent competence predicted participants' expectations about post-procedural pain and medication use. Participants' perception of their similarity to providers also shaped expectations about pain and treatment outcomes. CONCLUSIONS Results from our experimental simulations suggest that humans develop expectations about pain and health outcomes before even setting foot in the clinic, based exclusively on first impressions. These findings have strong implications for health care, as individuals increasingly rely on digital services to select healthcare providers and even receive treatment, a trend that is exacerbated as the world embraces telemedicine.
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Licciardone JC. Impact of COVID-19 on utilization of nonpharmacological and pharmacological treatments for chronic low back pain and clinical outcomes. J Osteopath Med 2021; 121:625-633. [PMID: 33770828 DOI: 10.1515/jom-2020-0334] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/02/2021] [Indexed: 12/23/2022]
Abstract
CONTEXT The novel coronavirus 2019 (COVID-19) pandemic has impacted the delivery of health care services throughout the United States, including those for patients with chronic pain. OBJECTIVES To measure changes in patients' utilization of nonpharmacological and pharmacological treatments for chronic low back pain and related outcomes during the COVID-19 pandemic. METHODS A pre-post study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data in the 3 months before and 3-6 months after the declaration of a national emergency related to COVID-19. Participants 21-79 years old with chronic low back pain were included in the study and provided self reported data at relevant quarterly encounters. Use of exercise therapy, yoga, massage therapy, spinal manipulation, acupuncture, cognitive behavioral therapy, nonsteroidal antiinflammatory drugs, and opioids for low back pain was measured. The primary outcomes were low back pain intensity and back related functioning measured with a numerical rating scale and the Roland Morris Disability Questionnaire, respectively. Secondary outcomes included health related quality of life scales measured with the Patient Reported Outcomes Measurement Information System, including scales for physical function, anxiety, depression, low energy/fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities. RESULTS A total of 476 participants were included in this study. The mean age of participants at baseline was 54.0 years (standard deviation, ±13.2 years; range, 22-81 years). There were 349 (73.3%) female participants and 127 (26.7%) male participants in the study. Utilization of exercise therapy (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.23-0.57), massage therapy (OR, 0.46; 95% CI, 0.25-0.83), and spinal manipulation (OR, 0.53; 95% CI, 0.29-0.93) decreased during the pandemic. A reduction in NSAID use was also observed (OR, 0.67; 95% CI, 0.45-0.99). Participants reported a significant, but not clinically relevant, improvement in low back pain intensity during the pandemic (mean improvement, 0.19; 95% CI, 0.03-0.34; Cohen's d, 0.11). However, White participants reported a significant improvement in low back pain intensity (mean improvement, 0.28; 95% CI, 0.10-0.46), whereas Black participants did not (mean improvement, -0.13; 95% CI, -0.46 to 0.19; p for interaction=0.03). Overall, there was a significant and clinically relevant improvement in pain interference with activities (mean improvement, 1.11; 95% CI, 0.20-2.02; Cohen's d, 0.20). The use of NSAIDs during the pandemic was associated with marginal increases in low back pain intensity. CONCLUSIONS Overall, decreased utilization of treatments for chronic low back pain did not adversely impact pain and functioning outcomes during the first 6 months of the pandemic. However, Black participants experienced significantly worse pain outcomes than their White counterparts.
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Affiliation(s)
- John C Licciardone
- The Osteopathic Research Center and the Department of Family Medicine, University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, TX, USA
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Gallagher RM. The Social Forces Healing Patients with Painful Conditions: What Happens After COVID-19? PAIN MEDICINE 2021; 22:239-242. [PMID: 33484145 PMCID: PMC7928671 DOI: 10.1093/pm/pnaa486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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