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1.
Front Public Health ; 10: 846042, 2022.
Article in English | MEDLINE | ID: covidwho-1776056

ABSTRACT

Introduction: There is a dearth of research on the incidence and treatment of cancer pain in Africa. Yet Africa, with other developing countries, accounts for more than half of all cancer diagnoses, and it is estimated that cancer incidence in Africa will double by 2030. Objectives: This research protocol outlines an approach to investigate cancer pain in French-speaking African countries. The protocol intends to determine and describe the treatment and management of cancer pain in these countries. Barriers to treating cancer pain will be explored and the results will be collated to make a series of recommendations on policy positions, regulatory frameworks and protocols. Methods: A mixed-methods, co-creation methodology has been selected to ensure the societal impact of the research outcomes. This research will use both qualitative and quantitative data collection methods and analyses. The research will begin with a review of the policies and legislation that exist in relation to cancer pain management and the use of analgesics, in each French-speaking African country. An Experts Steering Committee will then be created to provide guidance on the protocol and research design and access to participants, as well as to execute on the administration of surveys to local structures and international experts. A series of semi-structured, qualitative interviews with experts and clinicians in the field of screening and management of cancer pain and access to treatment will follow. Purposive and snowball sampling will be used to select the respondent experts. The semi-structured interviews will be conducted to determine the main trends and barriers to the treatment of cancer pain in French-speaking African countries. From this qualitative research, two surveys will be developed and then administered: one to validate the policy and regulatory context, and the other to determine experts and healthcare professionals experience and perceptions of cancer pain. Results/Conclusions: The results will be analyzed using quantitative and qualitative methods to determine themes and perceptions of cancer pain and treatment, from the policy level to the healthcare professional level. Evaluation of the results will lead to recommendations for a comprehensive framework for cancer pain treatment in French-speaking Africa.


Subject(s)
Analgesics , Neoplasms , Pain Management , Africa , Analgesics/supply & distribution , Analgesics/therapeutic use , Health Personnel , Humans , Neoplasms/complications , Pain Management/methods
2.
Plast Reconstr Surg ; 149(5): 985e-994e, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1752227

ABSTRACT

BACKGROUND: The conventional way of treating burn victims with mainstream pain control modalities is costly and has many negative side effects. In this study, the authors aim to present the findings from the major clinical trials on three nonpharmacologic interventions-hypnosis, virtual/augmented reality, and yoga-as supplements to conventional pain regimens for burn management. METHODS: A computerized literature search was conducted of the PubMed and ClinicalTrials.gov databases in April of 2020. The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. RESULTS: The search yielded 254 articles from 1955 to 2020. Fifty-eight studies met the authors' inclusion criteria. Yoga reduced cognitive and somatic anxiety in burn survivors, and improved body image. Virtual reality is effective in pain reduction in both the pediatric and the adult burn population, and in faster burn wound reepithelialization. Hypnosis has similar results regarding reducing pain quality and anxiety in burn patients undergoing burn wound care and dressing changes but was not found to significantly accelerate the healing process. CONCLUSIONS: Nonpharmacologic interventions are not a substitute for conventional analgesics; however, they could help patients have better control over their pain, greater self-esteem, and less postburn traumatic experiences. Burn care centers should consider nonpharmacologic interventions to improve patient satisfaction and their participation in the treatment and rehabilitation process.


Subject(s)
Burns , Pain , Adult , Analgesics/therapeutic use , Burns/drug therapy , Burns/therapy , Child , Humans , Pain/psychology , Pain Management/methods , Systematic Reviews as Topic
3.
J Med Internet Res ; 23(2): e26292, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1574360

ABSTRACT

BACKGROUND: Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain. OBJECTIVE: We aimed to conduct a double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic. METHODS: A national online convenience sample of individuals with self-reported nonmalignant low back pain with duration of 6 months or more and with average pain intensity of 4 or more/10 was enrolled and randomized 1:1 to 1 of 2 daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between-within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework. RESULTS: The study sample was 179 adults (female: 76.5%, 137/179; Caucasian: 90.5%, 162/179; at least some college education: 91.1%, 163/179; mean age: 51.5 years [SD 13.1]; average pain intensity: 5/10 [SD 1.2]; back pain duration ≥5 years: 67%, 120/179). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx versus Sham VR (P<.001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest P value=.009), and between-groups Cohen d effect sizes ranged from 0.40 to 0.49, indicating superiority was moderately clinically meaningful. For EaseVRx, large pre-post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between-group comparisons for Physical Function and Sleep Disturbance showed superiority for the EaseVRx group versus the Sham VR group (P=.022 and .013, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (P<.01) but not for Sham VR. CONCLUSIONS: EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand nonpharmacologic treatment for chronic low back pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25291.


Subject(s)
COVID-19 , Chronic Pain/therapy , Health Behavior , Low Back Pain/therapy , Pain Management/methods , Virtual Reality , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Double-Blind Method , Female , Humans , Male , Middle Aged , Pandemics , Self Report , Time Factors , Young Adult
4.
Arch Phys Med Rehabil ; 103(3): 418-423, 2022 03.
Article in English | MEDLINE | ID: covidwho-1509567

ABSTRACT

OBJECTIVE: To explore patients' thoughts and satisfaction with using videoconferencing during the COVID-19 pandemic. The current study aimed to gather (1) patient feedback and satisfaction with videoconferencing across all health professions as well as divided into a subgroup for each profession, (2) patient preferences for either videoconference or face-to-face consultations during the pandemic lockdown, and (3) whether patients would consider using videoconferencing once face-to-face appointments were available. DESIGN: An observational cross-sectional, mixed methods study design. SETTING: Tertiary-level persistent pain center. PARTICIPANTS: Sixty-five patients aged 18 to 85 years with persistent pain lasting more than 12 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data were collected using a patient survey. Descriptive statistics were used to report findings from 5-point Likert scales. Qualitative analysis was guided by content analysis to organize and categorize the open-ended survey response text. RESULTS: Videoconferencing platform features including audiovisual, usability, and privacy worked well for most patients (≥90%). Two-thirds of those surveyed reported the videoconferencing sessions as equal to face-to-face attendance (68%). In the context of the pandemic, almost as many preferred videoconferencing (65%), whereas 26% preferred face-to-face attendance and 9% were unsure. Preferences for videoconferencing over face-to-face in context to the pandemic varied depending on the health discipline involved: pharmacy (83%), occupational therapy (78%), psychology (61%), pain specialist physician (59%), and physiotherapy (53%). Even outside of a pandemic situation, 80% would consider using videoconferencing in the future. Qualitative analysis on an open-ended question asking patients for any further comments regarding their experience with the videoconference consultation, found 3 main categories: (1) overall satisfaction with videoconferencing, (2) technology qualities and (3) clinical interaction. CONCLUSION: In the context of a pandemic, videoconferencing for interdisciplinary persistent pain management services was effective and preferred, and most patients would continue its use into the future. Alternative or mixed modes of support may be needed for the 26% who currently prefer onsite attendance, when that mode of delivery is not available.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/methods , Pain Management/methods , Pain/epidemiology , Pandemics , SARS-CoV-2 , Videoconferencing , Comorbidity , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Patient Preference , Physical Therapy Modalities , Qualitative Research , Queensland/epidemiology , Retrospective Studies , Telemedicine/methods
8.
Pediatr Blood Cancer ; 68(11): e29272, 2021 11.
Article in English | MEDLINE | ID: covidwho-1333028

ABSTRACT

BACKGROUND: Sedation for lumbar punctures (LPs) in pediatric acute lymphoblastic leukemia (ALL) patients has been the standard for decades to reduce pain and anxiety. Recent studies on the potential long-term neurocognitive effects of cumulative propofol exposure have raised concerns about this practice. The recent pandemic introduced additional burdens to patients, with the requirement of a negative COVID-19 test prior to each sedated procedure. PROCEDURE: These factors prompted a quality improvement intervention at our institution where we aimed to reduce postinduction sedated LPs by 50%. Our intervention included patient and family education, followed by a simulation of the procedure for selected patients. Those converted to unsedated LPs were queried for their preference. Comparative cost, clinical time, and LP success rates were collected for sedated and unsedated LPs. RESULTS: Following the intervention, the percentage of LPs performed with sedation dropped from 100% to 48%. All LPs were successful using both techniques. Most patients who experienced the unsedated LP technique, and their guardians, strongly preferred this approach. Unsedated LPs significantly reduced clinical time (169 vs. 83 minutes) for families, decreased expenditures ($5736 reduction per procedure), and improved institutional opportunity cost due to a decrease in last-minute cancelations. CONCLUSION: We have shown that it is feasible to significantly reduce the use of sedation for LPs in patients with ALL, which has the potential to improve health and patient experience at a lower cost.


Subject(s)
Hypnotics and Sedatives/therapeutic use , Pain Management , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Spinal Puncture , Adolescent , Adult , COVID-19/diagnosis , Child , Female , Humans , Hypnotics and Sedatives/adverse effects , Male , Pain Management/adverse effects , Pain Management/methods , Propofol/adverse effects , Propofol/therapeutic use , SARS-CoV-2/isolation & purification , Spinal Puncture/methods , Young Adult
10.
Acupunct Med ; 39(6): 612-618, 2021 12.
Article in English | MEDLINE | ID: covidwho-1255860

ABSTRACT

OBJECTIVE: Chronic pain is a common symptom experienced among patients with sickle cell disease (SCD). Our aims were to assess the feasibility and acceptability of performing acupuncture for the treatment of chronic pain in adults with SCD. METHODS: This was a single-arm, prospective pilot study of six adults with SCD. Participants reported ⩾ 3 months of chronic pain and were > 18 years of age. Per protocol, acupuncture was to be administered twice per week for 5 weeks, for 30 min per session. All treatments were performed in the acupuncture treatment laboratory at the University of Illinois Chicago College of Nursing. Pain intensity, pain interference, and other symptoms were measured at baseline and after the intervention. Participants completed a semi-structured interview and a protocol acceptability questionnaire after the acupuncture intervention. RESULTS: Six participants (mean age 52.5 years, six Black) were enrolled. Although the study was suspended due to COVID-19 and not all participants completed the 10-session protocol, completion rates were high with no missed appointments. One participant did not complete the study due to hospitalization unrelated to acupuncture. No adverse events were reported. At completion of the intervention at 4-5 weeks post-baseline, all participants had reduced pain intensity and pain interference. The mean acceptability score on the protocol acceptability questionnaire was 82%. CONCLUSION: It was feasible and acceptable to implement acupuncture in adults with SCD. This study can be used to guide a larger randomized controlled trial to evaluate the effect of acupuncture on reducing chronic pain in adults with SCD.Trial registration number: NCT04156399 (ClinicalTrials.gov).


Subject(s)
Acupuncture Therapy/methods , Anemia, Sickle Cell/psychology , Chronic Pain/therapy , Patient Acceptance of Health Care/psychology , Acupuncture Therapy/psychology , Adult , Anemia, Sickle Cell/complications , Chronic Pain/congenital , Chronic Pain/psychology , Feasibility Studies , Female , Humans , Male , Middle Aged , Pain Management/methods , Pain Management/psychology , Pain Measurement , Pilot Projects , Prospective Studies , Treatment Outcome
12.
Rev Bras Ter Intensiva ; 33(1): 48-67, 2021.
Article in Spanish, English | MEDLINE | ID: covidwho-1197640

ABSTRACT

OBJECTIVE: To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients' families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. METHODS: A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. RESULTS: Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. DISCUSSION: Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.


OBJETIVO: Proponer estrategias agile para este abordaje integral de la analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente con síndrome de dificultad respiratoria aguda por COVID-19, considerando el alto riesgo de infección que existe entre los trabajadores de salud, el tratamiento humanitario que debemos brindar al paciente y su familia, en un contexto de falta estrategias terapéuticas específicas contra el virus globalmente disponibles a la fecha y una potencial falta de recursos sanitarios. METODOS: Se llevó a cabo una revision no sistemática de la evidencia científica en las principales bases de datos bibliográficos, sumada a la experiencia y juicio clínico nacional e internacional. Finalmente, se realizó un consenso de recomendaciones entre los integrantes del Comité de Analgesia, Sedación y Delirium de la Sociedad Argentina de Terapia Intensiva. RESULTADOS: Se acordaron recomendaciones y se desarrollaron herramientas para asegurar un abordaje integral de analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente adulto con síndrome de dificultad respiratoria aguda por COVID-19. DISCUSIÓN: Ante el nuevo orden generado en las terapias intensivas por la progresión de la pandemia de COVID-19, proponemos no dejar atrás las buenas prácticas habituales, sino adaptarlas al contexto particular generado. Nuestro consenso está respaldado en la evidencia científica, la experiencia nacional e internacional, y será una herramienta de consulta atractiva en las terapias intensivas.


Subject(s)
Analgesia/standards , COVID-19/complications , Consensus , Delirium/therapy , Pain Management/standards , Respiratory Distress Syndrome/therapy , Analgesia/methods , Analgesics/administration & dosage , COVID-19/drug therapy , Checklist , Delirium/diagnosis , Early Ambulation , Family , Humans , Intensive Care Units , Intubation, Intratracheal/methods , Neuromuscular Blockade/methods , Neuromuscular Blockade/standards , Pain Management/methods , Pain Measurement/methods , Pain Measurement/standards , Psychomotor Agitation/therapy
13.
Eur Rev Med Pharmacol Sci ; 25(7): 3116-3121, 2021 04.
Article in English | MEDLINE | ID: covidwho-1194852

ABSTRACT

OBJECTIVE: Since minimally invasive surgery and general anesthesia are both aerosol-generating procedures, their use became controversial during the outbreak of coronavirus disease 2019 (COVID-19). Moreover, social distancing resulted in serious psychological consequences for inpatients. This case report investigates pain distraction during awake laparotomy, as well as new possibilities for emotional postoperative support to inpatients. PATIENTS AND METHODS: A 72-year-old man affected by middle rectal adenocarcinoma underwent lower anterior resection plus total mesorectal excision under combined spinal-epidural anesthesia. A 3D mobile theatre (3DMT) was intraoperatively used for pain distraction. A postoperative "Cuddle delivery" service was instituted: video-messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional correlations were investigated through a clinical interview by the psychologist of our Hospital. RESULTS: Intraoperative, as well as postoperative pain, resulted well-controlled: visual analogue scale (VAS) ≤3. Conversion to general anesthesia and postoperative intensive support/monitoring were unnecessary. The "Cuddle delivery" initiative positively fed our patient's mood and attitude, strengthening his bond to life. CONCLUSIONS: During pandemic, awake laparotomy under loco-regional anesthesia may be a crucial option in delivering acute care surgery to selected patients when intensive care beds are unavailable. Our procedure introduces potential ways to optimize this approach.


Subject(s)
Adenocarcinoma/surgery , Computers, Handheld , Family , Pain Management/methods , Pain, Postoperative/therapy , Pain, Procedural/therapy , Rectal Neoplasms/surgery , Video Recording , Aged , Anesthesia, Epidural/methods , Anesthesia, Spinal/methods , COVID-19/prevention & control , Humans , Laparotomy/methods , Male , Motion Pictures , Pain Measurement , Postoperative Care , Proctectomy/methods , SARS-CoV-2 , Wakefulness
14.
Mayo Clin Proc ; 96(4): 943-951, 2021 04.
Article in English | MEDLINE | ID: covidwho-1135487

ABSTRACT

OBJECTIVES: To determine the prevalence and breakdown of pain symptoms among patients with coronavirus disease 2019 (COVID-19) infection admitted for nonpain symptoms and the association between the presence of pain and intensive care unit (ICU) admission and death. PATIENTS AND METHODS: In this multicenter prospective study, data on the intensity and type of pain were collected on 169 patients with active severe acute respiratory syndrome coronavirus 2 infection at 2 teaching hospitals in the United States and Korea and on 8 patients with acute pain at another large teaching hospital between February 1, 2020, and June 15, 2020. RESULTS: Sixty-five of 169 patients (38.5%) reported an active pain condition. Among the 73 patients with pain, the most common pain symptoms were headache (n=22; 30.1%), chest pain (n=17; 23.3%), spinal pain (n=18; 24.7%), myalgia (n=13; 17.8%), abdominal or pelvic pain (n=13; 17.8%), arthralgia (n=11; 15.1%), and generalized pain (n=9; 12.3%). Those reporting headache as their main symptom were less likely to require ICU admission (P=.003). Acetaminophen or nonsteroidal anti-inflammatory drugs were prescribed to 80.8% (n=59), opioids to 17.8% (n=13), adjuvants to 8.2% (n=6), and ketamine to 5.5% (n=4) of patients with pain. When age 65 years and older and sex were controlled for in multivariable analysis, the absence of pain was associated with ICU admission (odds ratio, 2.92; 95% CI, 1.42 to 6.28; P=.004) and death (odds ratio, 3.49; 95% CI, 1.40 to 9.76; P=.01). CONCLUSION: Acute pain is common during active COVID-19 infection with the most common manifestations being headache, chest pain and spine pain. Individuals without pain were more likely to require intensive care and expire than those with pain. Reasons why pain may be associated with reduced mortality include that an intense systemic stimulus (eg, respiratory distress) might distract pain perception or that the catecholamine surge associated with severe respiratory distress might attenuate nociceptive signaling.


Subject(s)
Acute Pain , COVID-19 , Pain Management/methods , Pain Measurement/methods , Pain Perception/physiology , Acute Pain/diagnosis , Acute Pain/etiology , Acute Pain/physiopathology , Age Factors , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Female , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Outcome and Process Assessment, Health Care , Republic of Korea/epidemiology , Sex Factors , United States/epidemiology
15.
Anesth Analg ; 132(3): 605-615, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1133641

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis of unprecedented proportions that has altered the practice of medicine. The pandemic has required pain clinics to transition from in-person visits to telemedicine, postpone procedures, and cancel face-to-face educational sessions. There are no data on how fellowship programs have adapted. METHODS: A 17-question survey was developed covering topics including changes in education, clinical care, and psychological stress due to the COVID pandemic. The initial survey was hosted by Qualtrics Inc and disseminated by the Association of Pain Program Directors on April 10, 2020, to program directors at Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowships. Results are reported descriptively and stratified by COVID infection rate, which was calculated from Centers for Disease Control and Prevention data on state infections, and census data. RESULTS: Among 107 surveys distributed, 70 (65%) programs responded. Twenty-nine programs were located in states in the upper tertile for per capita infection rates, 17 in the middle third, and 23 in the lowest tertile. Nearly all programs (93%) reported a decreased workload, with 11 (16%) reporting a dramatic decrease (only urgent or emergent cases). Just more than half of programs had either already deployed (14%) or credentialed (39%) fellows to provide nonpain care. Higher state infection rates were significantly associated with reduced clinical demand (Rs = 0.31, 95% confidence interval [CI], 0.08-0.51; P = .011) and redeployment of fellows to nonpain areas (Rs = 0.30, 95% CI, 0.07-0.50; P = .013). Larger program size but not infection rate was associated with increased perceived anxiety level of trainees. CONCLUSIONS: We found a shift to online alternatives for clinical care and education, with correlations between per capita infection rates, and clinical care demands and redeployment, but not with overall trainee anxiety levels. It is likely that medicine in general, and pain medicine in particular, will change after COVID-19, with greater emphasis on telemedicine, virtual education, and greater national and international cooperation. Physicians should be prepared for these changes.


Subject(s)
Anesthesiology/education , Anesthesiology/methods , COVID-19 , Pain Management/methods , Pandemics , Accreditation , Anesthesiologists , Anxiety , Education, Medical, Graduate/methods , Fellowships and Scholarships , Humans , Stress, Psychological , Surveys and Questionnaires , Telemedicine
16.
J Healthc Eng ; 2021: 8831114, 2021.
Article in English | MEDLINE | ID: covidwho-1090826

ABSTRACT

The coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic since March 2020. Although most patients complain of moderate or severe pain, these symptoms are generally underestimated and appropriate treatment is not applied. This study aims to guide physicians in selecting and ranking various alternatives for the treatment of pain in COVID-19 patients. However, the choice of treatment for pain requires the consideration of many different conflicting criteria. Therefore, we have studied this problem as a multicriteria decision-making problem. Throughout the solution procedure, first, the criteria and subcriteria affecting the preferences are defined. Then, weight values are determined with respect to these criteria, as they have different degrees of importance for the problem. At this stage, hesitant fuzzy linguistic term sets (HFLTSs) are used, and thus, experts can convey their ideas more accurately. In this first phase of the study, an HFLTS integrated Analytic Hierarchy Process (AHP) method is utilized. Subsequently, possible treatment alternatives are evaluated by using the Vise Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method. According to the results obtained by considering expert evaluations, the most preferred treatment is the administration of paracetamol, followed by interventional treatments, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs), respectively. With this study, it is ensured that a more accurate method is followed by eliminating possible mistakes due to the subjective evaluations of experts in the process of determining pain treatment. This method can also be used in different patient and disease groups.


Subject(s)
COVID-19 , Decision Making , Fuzzy Logic , Linguistics , Pain Management , Pain Measurement , Humans , Pain Management/methods , Pain Measurement/methods , Pandemics , SARS-CoV-2
17.
Pain Med ; 21(12): 3585-3595, 2020 12 25.
Article in English | MEDLINE | ID: covidwho-1066386

ABSTRACT

BACKGROUND AND OBJECTIVES: The novel coronavirus outbreak (SARS-CoV-2) began in late 2019 and dramatically impacted health care systems. This study aimed to describe the impact of the early phase of the pandemic on physician decision-making, practice patterns, and mental health. METHODS: An anonymous survey was distributed to physician members of the Spine Intervention Society (SIS) on March 24 and April 7, 2020. Respondents provided information regarding changes in clinical volume, treatment, and mental health (Patient Health Questionnaire [PHQ-4]) before April 10, 2020. RESULTS: Of the 1,430 individuals who opened the survey, 260 completed it (18.2%). Overall clinical and procedural volume decreased to 69.6% and 13.0% of prepandemic volume, respectively. Mean in-person clinic visits were reduced to 17.7% of total prepandemic clinic volume. Ongoing clinical visits were predominantly completed via telemedicine (video) or telephone (74.5%), rather than in-person (25.5%). Telemedicine and telephone visits represented 24.6% and 27.3% of prepandemic clinical volume, respectively. Respondents decreased in-person visits of select groups of high-risk patients by 85.8-94.6%. Significantly more providers reported increasing rather than decreasing prescriptions of the following medications: opioids (28.8% vs 6.2% of providers, P < 0.001), muscle relaxants (22.3% vs 5.4%, P < 0.001), neuropathic pain medications (29.6% vs 3.8%, P < 0.001), and acetaminophen (26.2% vs 4.2%, P < 0.001). Respondents' mean PHQ-4 score was 3.1, with 19% reporting moderate or severe psychological distress. Several demographic factors were significantly associated with practice changes. CONCLUSIONS: The novel coronavirus pandemic dramatically altered the practice and prescribing patterns of interventional pain physicians.


Subject(s)
COVID-19 , Clinical Decision-Making , Pain Management/methods , Physicians/psychology , Practice Patterns, Physicians' , Adult , Female , Humans , Male , Mental Health , Middle Aged , SARS-CoV-2 , Surveys and Questionnaires
19.
J Med Chem ; 64(1): 890-904, 2021 01 14.
Article in English | MEDLINE | ID: covidwho-997768

ABSTRACT

The sigma 1 receptor (S1R) is a molecular chaperone protein located in the endoplasmic reticulum and plasma membranes and has been shown to play important roles in various pathological disorders including pain and, as recently discovered, COVID-19. Employing structure- and QSAR-based drug design strategies, we rationally designed, synthesized, and biologically evaluated a series of novel triazole-based S1R antagonists. Compound 10 exhibited potent binding affinity for S1R, high selectivity over S2R and 87 other human targets, acceptable in vitro metabolic stability, slow clearance in liver microsomes, and excellent blood-brain barrier permeability in rats. Further in vivo studies in rats showed that 10 exhibited negligible acute toxicity in the rotarod test and statistically significant analgesic effects in the formalin test for acute inflammatory pain and paclitaxel-induced neuropathic pain models during cancer chemotherapy. These encouraging results promote further development of our triazole-based S1R antagonists as novel treatments for pain of different etiologies.


Subject(s)
Pain Management/methods , Receptors, sigma/antagonists & inhibitors , Triazoles/chemistry , Animals , Binding Sites , Blood-Brain Barrier/metabolism , Drug Design , Guinea Pigs , Half-Life , Humans , Microsomes, Liver/metabolism , Molecular Dynamics Simulation , Neuralgia/chemically induced , Neuralgia/drug therapy , Protein Structure, Tertiary , Quantitative Structure-Activity Relationship , Rats , Receptors, sigma/metabolism , Triazoles/metabolism , Triazoles/therapeutic use
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