The Use of Telemedicine in Outpatient Pain Management: A Scoping Review.

BACKGROUND: Telemedicine is an increasingly important tool in outpatient pain management. Telemedicine can be implemented through various strategies and a multitude of approaches have been described in existing literature. OBJECTIVES: This scoping review aims to survey how telemedicine has been approached in published literature, providing insight for continued implementation. STUDY DESIGN: Scoping review. SETTING: Outpatient pain management. METHODS: Ovid MEDLINE and Embase databases were queried. Two board-certified pain management physicians screened search results for relevant publications based on predetermined criteria. Included publications focused on outpatient pain management via live video or telephone and reported empirical outcomes. Publications were excluded that focused on acute pain, progressive muscle relaxation, physical therapy, or psychiatry, including cognitive behavioral therapy, or that primarily described educational modules, apps, mobile tracking, or automated calls. Nonfull publications (abstracts) and articles not available in English were also excluded. A third reviewer performed full-text screening, extracting variables of interest. Systematic reviews and meta-analyses were excluded from final selection. RESULTS: Text and abstract screening of 3,302 results yielded 88 publications. Upon full-text screening, 64 additional publications were excluded, yielding 24 publications. High-quality randomized controlled trials (RCTs) were described in 5 (21%) publications, pilot RCTs in 4 (17%), prospective studies in 1 (4%), retrospective studies in 5 (21%), survey-based studies in 7 (29%), and other types of studies in 2 (8%). Cancer pain was the focus of 3 (13%) studies, headache/facial pain the focus of 4 (17%), musculoskeletal the focus of 3 (13%), and unspecified chronic pain the focus of 14 (58%). Patient experiences were the focus of 18 (75%) publications, provider experiences the focus of 2 (8%), and both patient and provider experiences the focus of 4 (17%). Outcome improvement measures were studied in 17 (71%) publications, process improvement measures in 5 (21%), and both types of measures in 2 (8%). Standard visits without on-site support were described in 4 (17%) publications, while standard visits with on-site support were described in 9 (38%). The remaining 11 (46%) described structured/integrated pain management programs. Positive pain-related outcomes were reported in 9 (38%) studies. Increased access or decreased barriers to care were reported in 9 (38%). Patient satisfaction was reported in 12 (50%) publications, with 10 (42%) describing positive results. LIMITATIONS: This scoping review focused on telemedicine delivered via telephone or live video communication, excluding a substantial body of literature focused on virtual courses, modules, and other telehealth programs not involving live communication. CONCLUSIONS: Current literature describes telemedicine implementation with various levels of technological and logistical support. Models of telemedicine represented in current literature include: standard visits with on-site support, standard visits without on-site support, and structured/integrated pain management programs. Presently, no literature has directly compared outcomes from these different approaches. Choice of model will depend on the specific goals and available resources. Patient satisfaction was studied most frequently and generally demonstrated positive results. Though current literature is heterogeneous and lacks RCTs, it consistently demonstrates benefits of telemedicine to patient satisfaction, pain, and access to care.

New mouse models for high resolution and live imaging of planar cell polarity proteins in vivo.

The collective polarization of cellular structures and behaviors across a tissue plane is a near universal feature of epithelia known as planar cell polarity (PCP). This property is controlled by the core PCP pathway, which consists of highly conserved membrane-associated protein complexes that localize asymmetrically at cell junctions. Here, we introduce three new mouse models for investigating the localization and dynamics of transmembrane PCP proteins: Celsr1, Fz6 and Vangl2. Using the skin epidermis as a model, we characterize and verify the expression, localization and function of endogenously tagged Celsr1-3xGFP, Fz6-3xGFP and tdTomato-Vangl2 fusion proteins. Live imaging of Fz6-3xGFP in basal epidermal progenitors reveals that the polarity of the tissue is not fixed through time. Rather, asymmetry dynamically shifts during cell rearrangements and divisions, while global, average polarity of the tissue is preserved. We show using super-resolution STED imaging that Fz6-3xGFP and tdTomato-Vangl2 can be resolved, enabling us to observe their complex localization along junctions. We further explore PCP fusion protein localization in the trachea and neural tube, and discover new patterns of PCP expression and localization throughout the mouse embryo.