[Updated S1 guideline on long/post-COVID: relevant aspects for pain medicine]. / Aktualisierte S1-Leitlinie Long/Post-COVID: Relevante Aspekte für die Schmerzmedizin.

BACKGROUND: The S1 guideline on long/post-COVID of the AWMF [German Association of the Medical Scientific Societies] registration number 020-027) was updated in August 2022. METHODS: Under the coordination of the German Society of Pneumology, the guideline was updated by 21 scientific associations, two professional associations and clinical centers each and one institute and statutory accident insurance each. Each scientific association was responsible for its own chapter. The German Pain Society prepared the chapter "Pain". The coordinators of each chapter performed a selective literature search and also received approval for the chapter within their scientific association. During an internal period of comments, all representatives of the participating institutions could comment on all chapters. The AWMF task force commented on the draft of the guideline, which was then finally approved by the boards of all participating institutions. RESULTS: Coronavirus disease 2019 (COVID-19) increases the risk of persistent headache and musculoskeletal pain. Long/Post-COVID pain is frequently associated with fatigue and cognitive problems. A specialist assessment might be considered if symptoms with limitations of daily activities persist 3 months after the infection. The diagnostic workup of long/post-COVID-associated pain should be performed according to the standards of pain medicine. Management should follow the pain guidelines of the AWMF. CONCLUSIONS: The updated S1 guideline on long/post-COVID is a clinical manual which offers orientation for diagnostics and treatment despite limited data.

[Attitudes toward digital tools in pain medicine : Survey of German Pain Society health professional members and members of self-help groups]. / Einstellung zur digitalen Medizin im Schmerzbereich : Eine Umfrage unter Ärzten und Patienten der Deutschen Schmerzgesellschaft und Patientenorganisationen.

Digital medicine has increasing influence on the German healthcare system. In times of social distancing during the ongoing coronavirus disease 2019 (COVID-19) pandemic, digital tools enable health professionals to maintain medical care. Furthermore, digital elements have potential to provide effective guideline-oriented treatment to a broad range of patients independently from location and time. This survey was used to assess the attitudes of members of the German Pain Society (health professionals) and of associated self-help groups (patients) towards digital medicine. It was sent out as an online survey to health professionals in September 2020 and to patients in February 2021. The survey referred especially to present usage, attitude and potential concerns regarding particular digital elements. Furthermore, technical affinity was assessed. In total, 250 health professionals and 154 patients participated in the survey. The results show that-although digital elements are already known-a substantial proportion of health professionals still lack broad transfer to regular treatment. The potential of digital tools seems to be recognized by both groups; interestingly, patients consider digital medicine as more useful than health professionals. Nevertheless, concerns about for example data security or digital competence remain in both groups. Taken together, our results indicate that disruptive changes, as the implementation of digital medicine in the healthcare system, have to be guided by intense education and channeled by political policies in order to successfully integrate digital elements into medicine on a long-term basis. This would be in favor for all involved parties and is demanded especially by patients.

A Pilot Survey: Retention in Pain Medicine Among Fellowship Trained Anesthesiologists

Background: We aim to explore the factors related to job satisfaction among pain physicians and identify the reasons why individuals minimize or stop practicing outpatient pain medicine.Objectives/Study Design: This is a survey-based study with the primary goal to identify factors determining job satisfaction and dissatisfaction among pain medicine fellowship graduates who continue to practice and those who are no longer practicing interventional pain. A secondary goal is to elucidate reasons for anesthesiologists trained in pain medicine to leave pain medicine, despite an additional year of training, and to work as general anesthesiologists.Methods: In this study, all 114 pain program directors listed on the Accreditation Council for Graduate Medical Education (ACGME) website, or their administrative assistants were directly contacted via email. All email addresses were obtained from the ACGME website. The survey opened in September 2021, with reminder emails sent before the closing of the survey in December 2021. A final reminder email was sent 4 weeks prior to the closing of the survey.Results: Of all the respondents, 79 (89.77%) were currently practicing pain medicine, and 9 (10.23%) were no longer practicing pain medicine.Limitations: Our study has a major limitation as we are unable to determine the response rate and are limited in the data points gathered.Conclusion: We hope this study will allow for pain medicine fellowship program directors to improve recruitment and retention of pain fellows in the field while addressing the pros and cons of future career aspirations with anesthesiology residents prior to fellowship selection. A larger, more thorough study with an exact response rate can compare the various outcomes based upon different types of settings, such as private practice, partnership, and academia, as well as geographical locations.

Telemedicine Implementation in Pain Medicine: A Survey Evaluation of Pain Medicine Practices in Spring 2020.

BACKGROUND: The COVID-19 pandemic resulted in a novel challenge for healthcare delivery and implementation in the United States (US) in 2020 and beyond. Telemedicine arose as a significant and effective medium for safe and efficacious physician-patient interactions. Prior to the COVID-19 pandemic, telemedicine while available, had infrequently been utilized in pain medicine practices due to difficulties with reimbursement, the learning curve associated with new technology usage, and the need for new logistical systems in place to implement telemedicine effectively. Given the unique constraints on the healthcare system during the COVID-19 pandemic, the ubiquitous utilization of telemedicine among pain medicine physicians increased, giving insight into potential future roles for the technology beyond the pandemic. OBJECTIVES: To survey and understand the state of implementation of telemedicine into pain medicine practices across practice settings and geographical areas; to identify potential barriers to the implementation of telemedicine in pain medicine practice; and to identify the likelihood of telemedicine continuing beyond the pandemic in pain medicine practice. STUDY DESIGN: Online questionnaire targeting Pain Medicine physicians in the US. Participants were asked questions related to the use of telemedicine during the first peak of the COVID-19 pandemic. SETTING: Online-based questionnaire distributed to academic and private practice pain medicine physicians nationally in the United States. METHODS: A 34 web-based questionnaires were distributed by the American Society of Regional Anesthesia and Pain Medicine and the Society of Interventional Spine to all active members. Data were analyzed using SAS v9.4. RESULTS: Between December 3, 2020, and February 18, 2021, 164 participants accessed the survey with a response rate of 14.3%. Overall, academic physicians were more likely to implement telemedicine than private practice physicians. Telemedicine was also more frequently utilized for follow-up appointments rather than initial visits. LIMITATIONS: Although our n = 164, the overall low response rate of 14.3% warrants further investigation into the utilization of telemedicine throughout the COVID-19 pandemic. CONCLUSIONS: Telemedicine as an emerging technology for efficient communication played a key role in mitigating the adverse effects of the COVID -19 pandemic on chronic pain patients. The utilization of telemedicine remarkably increased after the start of the pandemic within 1 to 2 weeks. Overall, private hospital-based centers were significantly less likely to implement telemedicine than academic centers, possibly due to limited access to secure telemedicine platforms and high start-up costs. Telemedicine was used more frequently for follow-up visits than initial visit encounters at most centers. In spite of the unforeseen consequences to the healthcare system and chronic pain practices in the US from COVID-19, telehealth has emerged as a unique model of care for patients with chronic pain. Although it has flaws, telehealth has the ability to increase access to care beyond the end of the pandemic. Further identification of barriers to the use of telemedicine platforms in private practices should be addressed from a policy perspective to facilitate increased care access.

Doctor@Home: New perspectives on telemedicine for women during the COVID pandemic

At present, telemedicine and remote visits represent one alternative to in-person visits to meet patients’ ambulatory care needs during the COVID-19 pandemic and its enforced social distancing requirements. Telemedicine is becoming popular in several clinical disciplines, including pain medicine and oncology. Two out of three chronic pain patients are women. Moreover, most women can be considered vulnerable patients, as they often need to take care of their families and jobs while under chronic pain or oncological treatment. By employing a case study, this chapter aims to delve deep into how this new paradigm can benefit patients’ quality of life. This chapter broadens the gender perspective on e-health, seeing this as an opportunity for patients, clinicians, and entrepreneurs in the field. © 2022 Elsevier Inc. All rights reserved.

Challenges in Utilizing Telehealth for Chronic Pain.

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. 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.

Transforming Standard of Care for Spine Surgery: Integration of an Online Single-Session Behavioral Pain Management Class for Perioperative Optimization.

Estimates suggest that 10-40% of lumbar spine surgery patients experience persistent post-surgical pain (PPSP). PPSP is associated with 50% greater healthcare costs, along with risks of emotional distress and impaired quality of life. In 2019, U.S. Health and Human Services identified brief and digital behavioral treatments as important for pain management after surgery. Indeed, brief behavioral pain treatments delivered in the perioperative period may offer patients a low burden opportunity to acquire essential pain coping strategies for enhanced surgical recovery. Additionally, the COVID-19 pandemic has diminished in-person pain treatment access during extended perioperative time frames, thus underscoring the need for on-line options and home based care. This report describes the integration of an online, live-instructor delivered single-session pain self-management intervention (Empowered Relief) into the standard of care for lumbar spine surgery. Here, we apply the RE-AIM framework; describe systems implementation of the Empowered Relief intervention in a large, academic medical center during the COVID-19 pandemic; describe operational challenges and financial considerations; and present patient engagement data. Finally, we discuss the scalable potential of Empowered Relief and other single-session interventions in surgical populations, their importance during extended perioperative periods, practical and scientific limitations, and new directions for future research on this topic.

The Impact of Isolation During COVID-19 on Chronic Musculoskeletal Pain in the Geriatric Population: A Narrative Review

BACKGROUND: During the COVID-19 pandemic, social distancing has been employed to decrease the spread of COVID-19, especially within the geriatric population;however, the resulting loneliness and isolation carry their own detrimental effects. Loneliness resulting from the COVID-19 pandemic may also have negative implications on those with chronic musculoskeletal pain. OBJECTIVES: The aim of this review was to identify the role of loneliness specific to the recent COVID-19 pandemic as it relates to the prevalence and severity of chronic pain in the geriatric population and to provide an overview for clinicians. STUDY DESIGN: Narrative review. METHODS: A literature search was conducted using combinations of relevant search terms. Databases included PubMed and relevant grey literature sources. Reference lists of selected articles were also searched for additional relevant literature. RESULTS: Recent literature supports that social isolation and loneliness stemming from the COVID-19 pandemic have negative implications on chronic musculoskeletal pain. Loneliness has been well documented to have deleterious effects on physical and mental health, and it is increasingly linked to worsening debility and pain interference for those with chronic musculoskeletal pain. This has been found to be most prominent in the geriatric population, who are at the greatest risk for social decline and loneliness. Loneliness has also been found to have negative effects on cardiovascular disease, infectious disease, and mental health, as well as cognitive decline. LIMITATIONS: Potential selection bias due to the narrative review design. Some included studies required the use of online questionnaires, which may not be accessible for the geriatric population, those without technology literacy, or low socioeconomic status populations. Future studies should emphasize screening patients for access to technological devices and reliable internet while partnering with community programs focused on digital literacy and resource access. CONCLUSIONS: A myriad of deleterious effects stemming from social isolation and loneliness have been documented, of which geriatric populations are especially susceptible. Both early identification of at-risk patients and safe interventions are essential to mitigate loneliness and stop the progression of debility. Further resources and research are necessary to illuminate how best to proceed, both in the setting of the ongoing pandemic and how interventions can be applied to alleviate suffering in those with limited ability to receive hospital or clinic-based care.

Pain Medicine Fellowship Video Interviews: A COVID-19 Trend or Here to Stay?

BACKGROUND: The COVID-19 pandemic ushered in a shift to a video format for pain medicine fellowship interviews for the 2021-2022 academic year, which represented a major change in the fellowship interview paradigm. OBJECTIVES: Our aim was to assess the experience of a video-only format in place of in-person interviews for Pain Medicine fellowship program directors and applicants after the 2020 fellowship interview season to determine the feasibility for continuation beyond COVID-19 travel restrictions. STUDY DESIGN: Survey via Qualtrics. SETTING: Academic pain medicine programs. METHODS: A consortium of program directors converged to discuss methods for determining the effectiveness and future direction of the video format for pain medicine fellowship interviews. Two surveys were formulated, one targeting pain medicine fellowship program directors and the other for candidates interviewing for the year 2021-2022. RESULTS: For applicants, 55 out of 170 responded for a response rate of 32.3%, and for program directors, 38 out of 95 responded for a response rate of 40%. Of the applicants, 45.7% stated that they would prefer video interviews, whereas 27.3% of program directors preferred video interviews. Savings of time and money were the most common reason for preferring video interviews. LIMITATIONS: The number of pain fellowship applicants invited was limited to those who interviewed at a subset of pain fellowships, which may not have been representative of all pain fellow applicants. CONCLUSIONS: The video format for pain medicine fellowship interviews was viewed positively by both candidates and program directors. We suspect that the video format alone or as a part of a hybrid model will become a routine method for the interview process in the future, given its time and cost benefits.

Interdisciplinary interactive blended learning concept in times of a pandemic - pain medicine "totally digital".

Introduction: Pain medicine is located in different sections of the medical curriculum. In the pandemic situation, an online teaching concept for Q14 which includes several disciplines had to be developed. The goal of the project was to create a fully digitized learning platform for the cross-sectional area Q14 that allows all participating disciplines to address the various learning goals without losing a practical component. Project description: First, the students' expectations regarding education in the field of pain medicine were recorded by means of a survey among medical students. Based on this, a teaching module in a blended learning format was developed, which consisted of two parts. Within a digital learning platform, students were first required to complete consecutive learning units using an interactive learning management system. This was followed by a presence phase (online ZOOM seminar) in which, under the guidance of teaching staff, the therapy suggestions of the individual case studies from the previous learning program were reflected. In the second part, the acquired knowledge was applied to a simulated patient. An evaluation of the online module was carried out through free-text answers and self-assessment of the completion time. The ZOOM seminar was evaluated on the basis of an assessment by the teachers. Results: The survey among students revealed a desire for practical training without "frontal teaching". The resulting project realized this aspect by teaching theory during an online module with case vignettes and interactive learning tasks. The subsequent online presence time during the ZOOM meeting enabled the students to repeat and deepen contents and to ask questions. 170 students completed the entire online program, of which evaluation data were available for 75 students. Self-assessment of completion time averaged at 4-6 hours. In the feedback, 90 aspects were addressed, including mainly comments on content (43%), praise (33%) and comments on technical problems (23%). According to the assessment of the presenters, the students were able to carry out the pain anamnesis survey in a structured manner. The submission of the therapy proposal, however, represents a particular hurdle. Conclusion: With the presented blended learning concept it is possible to address the different learning goals and the interdisciplinarity of Q14 sufficiently. After further processing and improvement of the project, a controlled and more extensive collection of evaluation data is required to further investigate the benefit of the platform for the students regarding achievement of defined learning goals.