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Kruppa C, Maier C, Dietrich JW, Schildhauer TA, Kaisler M, Meyer-Frießem CH. [Frequency of Chronic Pain after Work-Related Trauma: A Preliminary Status Survey during Workers' Compensation Rehabilitation in a Tertiary Clinic]. Gesundheitswesen 2024; 86:137-147. [PMID: 37813346 PMCID: PMC10882997 DOI: 10.1055/a-2098-3271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Chronic pain after trauma and surgery is a long-term complication. Its relevance for patients within the workers' compensation rehabilitation process has not been adequately investigated. OBJECTIVES Initial evaluation of frequency of chronic pain after occupational accidents. METHODS In 2017, surgical inpatients (18-65 y) treated in a tertiary hospital were asked about chronic pain arising from an occupational trauma recognized by statutory occupation insurance (interval 2.8±6.9 years), regardless of care received, first at the time of hospitalization and then by telephone interview 6 months later. The focus was on patients with a work-related trauma (A) within the past month or (B) >6 months. PRIMARY OUTCOME frequency of work trauma-related chronic pain (>6 months) at the initial interview (point prevalence), secondary outcomes: frequency of chronicity at 6 months (A) and persistence of chronic pain (B). Tertiary outcomes: ability to work, occupational injury classification, burden based on pain intensity, localization, and medication, functional deficits due to the existence of chronic pain, and comorbidity. RESULTS Out of 415 patients included in the survey, 85% (160/188) reported accident-related chronic pain (predominantly moderate to highly severe in intensity, localized at joints and bones). 90% (131/145) also reported this pain six months later. 67% (64/96) reported chronic pain for the first time. Patients with chronic pain at follow-up (281/369) were less likely to return to work (p=0.003), required analgesics in 60%, were more often comorbid (p<0.002) and had greater functional deficits (p<0.002). CONCLUSION Despite the preliminary nature of the data, chronic pain seems to be common after occupational trauma and negatively affects the recovery of work ability in the long term. Based on the present observational data, a further differentiated re-evaluation of prospective data considering therapeutic measures is strongly recommended.
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Affiliation(s)
- Christiane Kruppa
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Germany
| | - Christoph Maier
- Klinik für Kinder- und Jugendmedizin, Kinderklinik - St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Johannes W Dietrich
- Medizinische Klinik I, Allgemeine Innere Medizin, Endokrinologie und Diabetologie sowie Gastroenterologie und Hepatologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Germany
- Sektion Diabetologie, Endokrinologie und Stoffwechsel, Klinik für Innere Medizin I, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
- Diabeteszentrum Bochum/Hattingen, Klinik Blankenstein, Hattingen, Germany
- Zentrum für Seltene Endokrine Erkrankungen (ZSE), Centrum für Seltene Erkrankungen Ruhr (CeSER), Ruhr-Universität Bochum, Witen/Herdecke Universität, Bochum, Germany
- Zentrum für Diabetestechnologie, Katholisches Klinikum Bochum, Bochum, Germany
| | - Thomas A Schildhauer
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Germany
| | - Miriam Kaisler
- Universitätsklinik für Anästhesiologie, Intensiv- und Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bochum, Germany
| | - Christine H Meyer-Frießem
- Universitätsklinik für Anästhesiologie, Intensiv- und Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Bochum, Germany
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Meyer-Frießem CH, Hüsken S, Kaisler M, Malewicz NM, Zahn PK, Baumann A. Isoflurane not at the expense of postoperative nausea and vomiting in cardiac anesthesia - an observational study. Curr Med Res Opin 2021; 37:2035-2042. [PMID: 34515599 DOI: 10.1080/03007995.2021.1980776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Inhalative anesthesia is of common use, but is generally known to potentiate postoperative nausea and vomiting (PONV). With an internal change of anesthesia regimen from total intravenous anesthesia (TIVA) to isoflurane (in terms of myocardial protection) in cardiac anesthesia a higher incidence of PONV was to be expected. Therefore, we evaluated the incidence of PONV after the simultaneous implementation of PONV prophylaxis. METHODS The incidence of PONV, prospectively assessed in 197 cardiac surgery patients (68 y ± 10.4, 66.5% male) having isoflurane plus dual PONV prophylaxis with dexamethasone and droperidol, was compared with previous data of 190 controls (67 y ± 9.6, 71% male) having TIVA without and with single or dual PONV prophylaxis (n = 64 dexamethasone and droperidol, n = 25 dexamethasone, n = 101 only TIVA), and the Apfel-scoring (0-4 depending on PONV-risk). DRKS00014275. Statistics: Chi2-test, p < .05 (Bonferroni). RESULTS The incidence of PONV under isoflurane with antiemetic prophylaxis was 20.8% (95% confidence interval (CI) 15.4; 27.4) compared to 30.5% (95%CI 24; 37.6) under TIVA (p = .029; dexamethasone and droperidol 23.4% (95%CI 13.8; 35.7); dexamethasone 32% (95%CI 14.9; 53.5); only TIVA 34.7% (95%CI 25.5; 44.8)), but was not lower in high-risk patients than predicted according to Apfel-scoring 4 (71.4 vs. 78%). CONCLUSION In cardiac anesthesia, the use of isoflurane is not at the expense of PONV when using a risk-independent two-drug-prophylaxis. It is even beneficial resulting surprisingly in a lower incidence of PONV than under TIVA unless with and without prophylaxis. Patients with the highest risk for PONV and receiving isoflurane should receive a third antiemetic prophylactic drug.
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Affiliation(s)
- Christine H Meyer-Frießem
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical Faculty of Ruhr, University Bochum, BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany
| | - Sabeth Hüsken
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical Faculty of Ruhr, University Bochum, BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany
| | - Miriam Kaisler
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical Faculty of Ruhr, University Bochum, BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany
| | - Nathalie M Malewicz
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical Faculty of Ruhr, University Bochum, BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany
| | - Peter K Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical Faculty of Ruhr, University Bochum, BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany
| | - Andreas Baumann
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical Faculty of Ruhr, University Bochum, BG-Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany
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Meyer-Frießem CH, Malewicz NM, Rath S, Ebel M, Kaisler M, Tegenthoff M, Schildhauer TA, Pogatzki-Zahn EM, Maier C, Zahn PK. Incidence, Time Course and Influence on Quality of Life of Intensive Care Unit-Acquired Weakness Symptoms in Long-Term Intensive Care Survivors. J Intensive Care Med 2021; 36:1313-1322. [PMID: 32799703 DOI: 10.1177/0885066620949178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Intensive care unit-acquired weakness (ICUAW) can manifest as muscle weakness or neuropathy-like symptoms, with diagnosis remaining a challenge. Uncertainties surround the long-term cause and sequelae. Therefore, the purpose was to assess incidence, time course and long-term influence on quality of life (QoL) of symptoms in ICU survivors. METHODS After ethical approval and registration (www.drks.de: DRKS00011593), in a single-center cohort study all patients admitted to the ICU in 2007-2017 in a German university hospital were screened. Out of 1,860 patients (≥7d ICU care including ventilation support for ≥72 h, at least 6mo-10y after ICU) 636 were deceased, 912 survivors were contacted. RESULTS 149 former patients (age: 63.5 ± 13.1y; males: 73%; duration in ICU: 20.8 ± 15.7d; duration of ventilation: 16.5 ± 13.7 h; time post-ICU: 4.4 ± 2.7y, 5-10y: 43%) consented to be interviewed concerning occurrence, duration, recovery and consequences of ICUAW-associated muscle weakness or neuropathy-like symptoms after ICU. In 75% at least 1 persistent or previous symmetrical symptom was reported (myopathy-like muscle weakness: 43%; neuropathy-like symptoms: 13%; both: 44%) and rated as incidence of ICUAW. However, only 18% of participants had received an ICUAW diagnosis by their physicians, although 62% had persistent symptoms up to 10y after ICU (5-10y: 46%). Only 37% of participants reported a complete recovery of symptoms, significantly associated with an initially low number of symptoms after ICU (p < 0.0001), myopathy-like symptoms (p = 0.024), and younger age at the time of ICU admission (55.7 ± 13.1 vs. 62.6 ± 10.6y, p < 0.001). ICUAW still impaired the QoL at the time of the interview in 74% of affected survivors, with 30% reporting severe impairment. CONCLUSION ICUAW symptoms were disturbingly common in the majority of long-term survivors, indicating that symptoms persist up to 10y and frequently impair QoL. However, only a small number of patients had been diagnosed with ICUAW. Trial registry: Deutsches Register Klinischer Studien (DRKS), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011593, registration number: DRKS00011593.
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Affiliation(s)
- Christine H Meyer-Frießem
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, Medical Faculty of Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
| | - Nathalie M Malewicz
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, Medical Faculty of Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
| | - Sabrina Rath
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, Medical Faculty of Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
| | - Melanie Ebel
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, Medical Faculty of Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
| | - Miriam Kaisler
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, Medical Faculty of Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
- Department of Pain Medicine, Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
| | - Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, 39060University Hospital of Muenster, Muenster, Germany
| | - Christoph Maier
- Department of Pediatrics and Adolescent Medicine, 39060University Children's Hospital, Bochum, Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, Medical Faculty of Ruhr-University Bochum, 39060BG University Hospital Bergmannsheil, Bochum, Germany
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Meyer-Frießem CH, Eitner LB, Kaisler M, Maier C, Vollert J, Westermann A, Zahn PK, Avila González CA. Perineural injection of botulinum toxin-A in painful peripheral nerve injury - a case series: pain relief, safety, sensory profile and sample size recommendation. Curr Med Res Opin 2019; 35:1793-1803. [PMID: 31148462 DOI: 10.1080/03007995.2019.1626228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Subcutaneous injection of botulinum toxin-A (sBONT-A) is a novel treatment for peripheral neuropathic pain. While its analgesic effects are well documented, this treatment is often not comfortable and fails in patients who show signs of sensory loss but rarely allodynia. There are some case reports about perineural BONT-A injection (pBONT-A) which could be an alternative approach. Here we present a retrospective, open label case series of pBONT-A's efficacy and safety regarding neurological consequences involving changes in somatosensory profiles of both responders and non-responders. Methods: Sixty patients (53 ± 13years, 77% males) with PNI were treated with pBONT-A after a test injection with a local anesthetic, which prompted distinctive pain relief. Quantitative sensory testing (QST; DFNS protocol) and pain intensity were assessed before and ≥7 days post pBONT-A injection. Definition of response: satisfactory pain reduction of ≥30% NRS (numerical rating scale: 0 = no pain, 10 = worst pain) for ≥4 days. Statistics: Paired t-test, Mann-Whitney U-test, χ2 test. Results: A temporary weak paresis in one case was clinically verified. The QST -parameters remained unchanged, but patients with more frequent hyperalgesia signs reported less analgesia (p = .04). The pBONT-A injection prompted pain relief by 24.8% (NRS: 6.0 ± 1.7 vs. 4.5 ± 2.1; p < .0001); 57% (n = 34) were responders (NRS: 6.0 ± 1.6 vs. 3.4 ± 1.6, relief of 43.4%; p < .0001). Based on these results, we suggest that future parallel design trials on pBONT-A need to include at least 84 patients. Discussion: Ultrasound-guided pBONT-A injection seems to be a safe treatment leading to a sufficient pain relief for some months without sensory changes. Surprisingly, pBONT-A showed a pronounced analgesic effect also in patients without signs of hyperalgesia.
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Affiliation(s)
- Christine H Meyer-Frießem
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, Medical Faculty of Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
| | - Lynn B Eitner
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Neuropediatrics, Ruhr-University Bochum, University Children's Hospital , Bochum , Germany
| | - Miriam Kaisler
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
| | - Christoph Maier
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Neuropediatrics, Ruhr-University Bochum, University Children's Hospital , Bochum , Germany
| | - Jan Vollert
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Pain Research, Department of Surgery and Cancer, Imperial College , London , UK
- Neurophysiology, Center of Biomedicine and Medical Technology Mannheim CBTM, Medical Faculty Mannheim, Heidelberg University , Heidelberg , Germany
| | - Andrea Westermann
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, Medical Faculty of Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
| | - Carla A Avila González
- Department of Pain Medicine, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, Medical Faculty of Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum , Bochum , Germany
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hessing Foundation , Augsburg , Germany
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Bienek N, Maier C, Kaisler M, Michel-Lauter B, Schwarzer A, Meyer-Frießem CH. Intensity of Withdrawal Symptoms During Opioid Taper in Patients with Chronic Pain—Individualized or Fixed Starting Dosage? Pain Medicine 2019; 20:2438-2449. [DOI: 10.1093/pm/pny320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractObjectiveControlled opioid withdrawal is recommended for patients with chronic noncancer pain (CNCP) with insufficient pain reduction or intolerable side effects while on opioid treatment. Few studies have investigated the management of opioid withdrawal (OW). Most common are protocols with an individualized starting dosage (ISD), calculated from the last opioid intake. After two cases of overdose, we introduced a novel withdrawal protocol using a low fixed starting dosage (FSD) for safety reasons. The present study compares the intensity of withdrawal symptoms using the Subjective Opioid Withdrawal Scale (SOWS) and incidences of serious adverse events (SAE) and dropouts in each taper schedule in 195 CNCP patients with OW in an inpatient facility.MethodsTwo protocols were compared: FSD (2014–2016): N = 68, starting dose: 90 mg morphine/d; and ISD (2010–2014): N = 127, starting dose: 70% of the patient’s daily morphine equivalent dose (MED). Outcome criteria: primary: mean daily SOWS score during the first 10 days (16 questions, daily score 0–64); secondary: change in pain intensity on a numeric rating scale (0–10), rate of dropouts and SAEs. Statistics: Student test, Mann-Whitney U test, chi-square test, analysis of variance, P < 0.05.ResultsThe mean daily SOWS score was lower in the FSD group (14.9 ± 9.4 vs 16.1 ± 10, P < 0.05) due to a lower rate of high-intensity withdrawal symptoms (12.4% vs 17.6%, P < 0.01), particularly in patients on >180 mg MED (9.7% vs 18.4%, P < 0.01). Pain intensity decreased after withdrawal, and the incidence of SAEs and dropouts was low in both groups.ConclusionsThe FSD protocol provides a lesser burden of withdrawal symptoms and equal patient safety. It can be recommended for OW in CNCP patients.
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Affiliation(s)
- Natalia Bienek
- Department of Pain Medicine, Ruhr-University Bochum
- Department of Anaesthesiology and Intensive Care, Klinikum Dortmund, Dortmund, Germany
| | | | | | | | | | - Christine H Meyer-Frießem
- Department of Pain Medicine, Ruhr-University Bochum
- Department of Anaesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, Medical Faculty of Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH Bochum, Bochum, Germany
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Schwarzer A, Kaisler M, Kipping K, Seybold D, Rausch V, Maier C, Vollert J. Opioid intake prior to admission is not increased in elderly patients with low-energy fractures: A case-control study in a German hospital population. Eur J Pain 2018; 22:1651-1661. [PMID: 29758586 DOI: 10.1002/ejp.1247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent studies revealed an increased prescription rate of opioids for elderly patients suffering bone fractures. To gain further insight, we conducted face-to-face interviews in the present study to compare the opioid intake between patients with low-energy fractures and patients suffering from internal diseases. METHODS In this case-control study, 992 patients, aged 60 years and older, were enrolled between March 2014 and February 2015. The interview comprised a fall and medication history, comorbidities, mobility and other risk factors for fractures. Odds ratios (OR) and a multiple logistic regression model were calculated. RESULTS The number of patients with pre-admission opioid intake in the last 12 months was comparable in the fracture (n = 399, 13.3%) and the control group (n = 593, 14.7% OR: 0.89, CI: 0.62-1.29). The number of patients with current opioid intake of short duration (<3 months) was similar in both groups (14% vs. 20%; OR: 0.66, CI: 0.23-1.93). Patients with opioid intake in the fracture group reported more frequently fatigue as an adverse event of opioid medication (58% vs. 30%; OR: 3.32, CI: 1.48-7.45). Patients with opioid intake showed more severe comorbidities and significantly decreased mobility compared to those without opioids. CONCLUSION Elderly patients internalized due to low-energy fractures did not take opioids more frequently than patients with internal admission, for both short (<3 months) and longer duration intake. Patients with opioid intake were generally in poorer physical condition. The risk of fracture might increase in patients suffering from fatigue as a side effect of opioid medication. SIGNIFICANCE This study is based on face-to-face interviews with patients, including details about side effects and fracture history, providing a more pronounced picture of the relation of opioid intake and risk of fracture.
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Affiliation(s)
- A Schwarzer
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - M Kaisler
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - K Kipping
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - D Seybold
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - V Rausch
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - C Maier
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - J Vollert
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany.,Pain Research, Department of Surgery and Cancer, Imperial College London, UK.,Medical Faculty Mannheim, Center of Biomedicine and Medical Technology Mannheim CBTM, Heidelberg University, Germany
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Brechmann T, Maier C, Kaisler M, Vollert J, Schmiegel W, Pak S, Scherbaum N, Rist F, Riphaus A. Propofol sedation during gastrointestinal endoscopy arouses euphoria in a large subset of patients. United European Gastroenterol J 2017; 6:536-546. [PMID: 29881609 DOI: 10.1177/2050640617736231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/17/2017] [Indexed: 12/27/2022] Open
Abstract
Background Propofol is recommended for sedation in gastrointestinal endoscopy (GE), but preliminary data suggest addictive potentials. Objective The objective of this article is to evaluate the frequency of predominantly euphoric reaction after GE and patients' subsequent reminiscences. Methods Eighty-two patients undergoing elective GE under propofol sedation were enrolled in a prospective observational study. The grade of anxiety, expectation or relief about the examination's result and affective state in terms of cheerfulness, relaxation, activation, sedation and anxiety were surveyed using a numeric rating scale (1 to 10) immediately before (t1), after GE (t2) and seven days (t3) later. Statistics: hierarchical cluster analysis, heat map, χ2 test and paired t test. Results Mean propofol dosage was 264 ± 120 mg. Two clusters of mood changes emerged (t1 vs. t2). One (n = 46, 56.1%) was characterized by an unease reaction pattern with equal values regarding cheerfulness, relaxation and anxiety, while relaxation decreased; the other cluster showed a euphoric reaction pattern (n = 36, 43.9%) with markedly increased cheerfulness, relaxation and decreased anxiety. These effects intensified at recall (t3). Despite similar endoscopy results, euphoric cluster patients rated these more positively. Conclusion Propofol induces euphoria in nearly half of the patients undergoing elective GE with persisting, even enhanced reminiscence (germanctr.de, trial number DRKS00011202).
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Affiliation(s)
- Thorsten Brechmann
- 1Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University Bochum, Department of Gastroenterology and Hepatology, Germany
| | - Christoph Maier
- 2Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University Bochum, Department of Pain Medicine, Germany
| | - Miriam Kaisler
- 2Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University Bochum, Department of Pain Medicine, Germany
| | - Jan Vollert
- 2Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University Bochum, Department of Pain Medicine, Germany
| | - Wolff Schmiegel
- 1Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-University Bochum, Department of Gastroenterology and Hepatology, Germany
| | - Svetlana Pak
- 3KRH Klinikum Agnes Karll Laatzen, Department of Internal Medicine and Gastroenterology, Laatzen, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Fred Rist
- University of Münster, Department of Psychology, Münster, Germany
| | - Andrea Riphaus
- 3KRH Klinikum Agnes Karll Laatzen, Department of Internal Medicine and Gastroenterology, Laatzen, Germany
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