The eEgg: Evaluation of a New Device to Measure Pain.

Aim: The aim of this study was to evaluate whether pain stimuli can be measured validly and reliably by the eEgg (electronic Egg), a new device to measure pain intensity, in comparison to the hand dynamometer. Methods: This study consists of screening and diagnostic tests conforming to the standard criterion of handgrip strength measurement. Fifty healthy participants (25 women, 25 men; age, 39.1 ± 13.7 years) participated in this study. The approach of intermodal comparison was used to transfer different degrees of pain sensations into measurable handgrip strength values. This included an intensity comparison of 10-100% of the subjective maximum handgrip strength and an application of thermal stimuli of 34-48°C. The eEgg was compared to the numeric rating scale (NRS) as a categorization method regarding the subjective assessment of pain. An online questionnaire was distributed to test the evaluation of the product's features. Results: Regarding the experiment's validity, the handgrip strength values showed significant (p < 0.05) positive correlations between the eEgg and the hand dynamometer (intensities: r=0.328 to r=0.550; thermal stimuli: r=0.353 to r=0.614). The reliability results showed good to very good correlations (p < 0.05) in the calculated ICC (intraclass correlation coefficient) values between the individual measurement devices: eEgg intensities: ICC=0.621 to 0.851; thermal stimuli: ICC=0.487 to 0.776 and hand dynamometer intensities: ICC= 0.789 to 0.974; thermal stimuli: ICC=0.716 to 0.910. Conclusion: The new eEgg device shows strong correlations with the hand dynamometer. The central limitation focuses on the obligatory use of an arbitrary unit (AU) for the eEgg. The results of the study indicate that this device can be used in medical and therapeutic practice in the future.

[Influence of the corona pandemic on pain patients : Which impacts of the pandemic on their care do patients with chronic pain experience?] / Einfluss der Coronapandemie auf Schmerzpatienten : Welche Auswirkungen der Pandemie auf ihre Versorgung nehmen Patienten mit chronischen Schmerzen wahr?

BACKGROUND: Diseases caused by the novel coronavirus (SARS-CoV-2) have led to a pandemic in a very dynamic manner. The epidemiological situation of national importance required infection control measures with the aim of reducing morbidity and mortality. An overburdening of the healthcare system should be avoided. The measures taken to combat the pandemic have had an impact on public and private life. Patients suffering from chronic pain have also been greatly affected. QUESTION: Which impact on their care do patients with chronic pain experience? METHOD: After multimodal inpatient treatment 70 pain patients were interviewed by telephone in a standardized fashion. They were asked about their condition as follows: did the changes due to the pandemic result in an increase in pain levels, a deterioration in mood and did the pandemic have a negative impact on the supply of pain medication? RESULTS: Changes in the biopsychosocial area were experienced by the patients and affected their overall well-being. Chronically ill pain patients were particularly affected by the lockdown. A large number of patients associated a deterioration in mood and aggravation of the chronic pain with measures resulting from the pandemic. The mood deterioration was clearly associated (70% of respondents). An increase in pain was associated with changes caused by the pandemic in 44% of respondents. Of the patients 39% reported a deterioration of the pain management. The measures taken to combat the pandemic have had and still have an impact on the lives of chronically ill pain patients. DISCUSSION: It is necessary to maintain the limited but still existing options of coordinated care for pain patients following a multimodal inpatient stay, even in difficult situations. The negative effects of a reduction in medical care are an argument in favor of multimodal outpatient care, especially after inpatient treatment.

[Pain in old age]. / Schmerz im Alter.

The prevalence of chronic pain increases with increasing age. Multimorbidity increases the risk of disease-related pain. Addressing the problem of pain in higher age is concerned with an increasing problem of care. The multimorbidity and the resulting multimedication are important for the medical care of pain. The therefore necessary physician-patient verbal communication can hardly be remunerated and carried out in the current care landscape. Existing resources must be bundled. The quality of life of older people and not the absence of pain, must be emphasized. Particularly problematic is the recognition and treatment of pain in patients with dementia. Pain in dementia patients is more rarely detected. In addition to questioning relatives and caregivers, a structured pain interview is necessary. The pharmacology of chronic pain is concerned above all with the prevention of iatrogenic risks through interactions and pharmacological complications. The patient-related treatment priorities must be checked and adjusted during the course of treatment. To be considered are age-related altered metabolic pathways. A sensible therapy option is the training of physical activity with a positive effect on the entire pain experience. Behavioral medical treatment procedures are other important building blocks in pain therapy. In addition to the multimodal therapeutic approaches, a stronger interdisciplinary collaboration of special pain medicine and geriatrics is necessary.

Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy.

BACKGROUND AND AIMS: Recent studies reveal high prevalence rates of patients receiving long-term opioids. However, well designed studies assessing effectiveness with longer than 3 months follow-up are sparse. The present study investigated the outcomes of long-term opioid therapy compared to nonopioid treatment in CNCP patients with respect to measures of pain, functional disability, psychological wellbeing, and quality of life (QoL). METHODS: Three hundred and thirty three consecutive patients at our pain clinic were included and divided into patients with continuous opioid treatment for at least 3 months (51%) and patients receiving nonopioid analgesics (49%). Further, outcome of different doses of opioid (<120mg vs. >120mg morphine equivalents) and differences between high and low potency opioids were examined. RESULTS: The opioid and nonopioid groups did not differ with regard to pain intensity or satisfaction with analgesic. Patients with continuous opioids treatment reported higher neuropathic like pain, longer duration of pain disorder, lower functional level, wellbeing, and physical QoL in comparison to patients receiving nonopioid analgesics. Higher opioid doses were associated with male gender, intake of high potency opioids and depression but there were no differences with regard to pain relief or improvement of functional level between high and low doses. Similarly, patients on high potency opioids reported more psychological impairment than patients on low potency opioids but no advantage with regard to pain relief. Overall, remaining level of pain, functional disability and poor QoL were quite high irrespective of the analgesic used or opioid dosing. CONCLUSION: In the long-term no clear advantage of opioid vs. non-opioid analgesics could be revealed. In terms of remaining pain intensity, functional disability and quality of life, treatment with pain medication proved insufficient. Additionally, with higher doses of opioids the benefit to risk relationship becomes worse and patients on high potency opioids reported more psychological impairment than patients on low potency opioids but no advantage with regard to pain relief. IMPLICATIONS: Our results raise questions about the long-term effectiveness of analgesic treatment regimens irrespective of analgesics type employed and call for more multidisciplinary treatment strategies.

Effects of prolonged-release oxycodone/naloxone on pain control, bowel function and quality of life: A prospective observational study.

Background and aim Strong opioids including oxycodone are amongst the most effective analgesics to combat moderate to severe pain of various aetiologies, but opioid-induced bowel dysfunction (OIBD) represents a relevant problem. The rationale for development of a prolonged-release (PR) fixed combination of oxycodone and naloxone was to counteract OIBD. Due to its negligible oral bioavailability, the µ-opioid receptor antagonist naloxone is able to selectively displace opioids from local µ-receptors in the gastrointestinal tract without affecting central opioid binding sites. Pivotal trials of PR oxycodone/naloxone not only demonstrated improved bowel function but also equivalent analgesic efficacy compared to PR oxycodone alone. Controlled clinical trials comparing PR oxycodone/naloxone with strong opioids other than oxycodone are not available. The present study is the first data set aimed at comparing pain control, bowel function, and quality of life (QoL) in patients newly treated with or switched to PR oxycodone/naloxone or other strong opioids during routine clinical practice. Methods In this three-arm, prospective observational study, 588 patients with moderate to severe pain of varying aetiologies received either PR oxycodone/naloxone (OXN group and OXN 40/20 group with indicated use of the 40 mg/20 mg dose strength at baseline) or other strong opioids (control group), dosed according to pain severity, for 4-6 weeks. Data documented include pain intensity (NRS), bowel function (Bowel Function Index, BFI), pain-related functional impairment (BPI-SF), QoL (EuroQol EQ-5D-3L), and a global assessment of treatment. Results Patients receiving PR oxycodone/naloxone experienced a clinically important reduction in pain intensity and pain-related functional impairment of approximately 40%. The reductions of pain intensity (-2.9 ± 2.3) and pain-related functional impairment (-2.4 ± 2.3) in the OXN group were significantly more pronounced than in the control group (-2.1 ± 2.1 and -1.8 ± 1.7). In the control group, mean reductions in pain intensity did not reach the threshold of ≥30% for at least moderate clinically important differences, although patients were prescribed higher doses of morphine equivalents than OXN group patients. Improvements in bowel function (OXN: -16.0 ± 27.6; control: 3.1 ± 24.4) and QoL (OXN: 20.8 ± 24.2; control: 13.2 ± 23.1) were also significantly more pronounced in the OXN group, with BFI scores reduced to a level that reflects normal bowel function. Results for the OXN 40/20 group receiving higher doses of PR oxycodone/naloxone were in line with those for the OXN group. In the control group, more frequent gastrointestinal adverse events and less favourable ratings of tolerability resulted in a higher rate of treatment discontinuations due to adverse events. Conclusions In patients receiving PR oxycodone/naloxone, more favourable outcomes compared with other strong opioids regarding pain control, bowel function, and QoL were observed. Implications The present findings underline the value of PR oxycodone/naloxone in the management of patients with moderate to severe chronic pain. The data set further adds to our understanding of the benefits and risks of opioid treatment in routine clinical practice.