Abstract
Aim: During the Covid-19 pandemic, the number of patients examined in the outpatient clinic of many health institutions was limited and some changes were made in the treatment protocols. Regional Anesthesia and Pain Associations also recommended steroid administration and opioid use restriction, especially in chronic pain. In our study, we aimed to evaluate the clinical diagnosis of the patients who applied to our clinic with complaints of pain, the treatments they received, and whether our approach to chronic pain was by the guidelines during the Covid-19 pandemic period.
Material and Methods: Demographic data, clinical diagnoses, interventional procedures, and medical treatments given to the patients who applied to the Ege University Faculty of Medicine, Algology Department outpatient clinic between March 2020 and May 2021 were evaluated statistically by retrospective analysis.
Results: The mean age of 444 patients included in the study was 56.8±15.9 years. It was found that 29 (6.5%) of the patients applied for acute pain and 415 patients (93.5%) for chronic pain. While the number of patients who received only pharmacological treatment was 230 (51.8%), it was determined that 199 (44.8%) patients received both pharmacological treatment and interventional procedure, and 15 (3.3%) patients received only interventional procedure. When the patients were investigated in terms of pharmacological treatment, we observed that 229 (57.1%) patients received only paracetamol treatment, 99 (24.6%) patients received only non-steroidal anti-inflammatory (NSAI) drug therapy, and 73 (18.2%) patients received both paracetamol and NSAI therapy. It was determined that 243 (96.8%) of the patients who received medical treatment received weak opioids, 3 (1.3%) patients received strong opioids, and 5 (1.9%) patients received both weak and strong combined opioid treatment.Steroid injection was observed in only 16.3% of 214 patients who underwent interventional procedures.
Conclusion: It was observed that chronic pain patients were in the majority during the pandemic period and the use of strong opioids and steroid injections were minimized in these patients. Since it may cause changes in immune responses, applications that will pose the least risk in pain patients should be chosen during the pandemic period.
Keywords
References
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395 (10229): 1054-62.
- Pullano G, Pinotti F, Valdano E, Boëlle P-Y, Poletto C, Colizza V. Novel coronavirus (2019-nCoV) early-stage importation risk to Europe, January 2020. Euro Surveill. 2020; 25 (4): 2000057.
- Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Bio Medica: Atenei Parmensis. 2020; 91 (1): 157-60.
- Shanthanna H, Cohen SP, Strand N, Lobo CA, Eldabe S, Bhatia A, et al. Recommendations on chronic pain practice during the COVID-19 pandemic. A Joint Statement by the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anesthesia and Pain Therapy (ESRA). https://www.asra.com/guidelines-articles/original-articles/covid-19-resources/covid-19-resources/legacy-bblog-posts/2020/03/27/recommendations-on-chronic-pain-practice-during-the-covid-19-pandemic 2020.
- Vowles KE, Pielech M, Edwards KA, McEntee ML, Bailey RW. A comparative meta-analysis of unidisciplinary psychology and interdisciplinary treatment outcomes following Acceptance and Commitment Therapy for adults with chronic pain. J Pain 2020; 21 (5-6): 529-45.
- Mills SE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019; 123 (2): e273-e83.
- Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015; 156 (6): 1003-7.
- Jean-Toussaint R, Tian Y, Chaudhuri AD, Haughey NJ, Sacan A, Ajit SK. Proteome characterization of small extracellular vesicles from spared nerve injury model of neuropathic pain. J Proteomics. 2020; 211: 103540.
- Mao B, Liu Y, Chai Y-H, Jin X-Y, Lu H-W, Yang J-W, et al. Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study. Lancet Digit Health. 2020; 2 (6): e323-e30.
- Yao M, Lei Y, Li P, Ye Q, Liu Y, Li X, et al. Shared sensitivity to physical pain and social evaluation. J Pain 2020; 21 (5-6): 677-88.
- Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of longterm opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162 (4): 276-86.
- Ragni E, Mangiavini L, Viganò M, Brini AT, Peretti GM, Banfi G, et al. Management of Osteoarthritis During the COVID‐19 Pandemic. Clin Pharmacol Ther 2020; 108 (4): 719-29.
- Pergolizzi JV, Varrassi G, Magnusson P, LeQuang JA, Paladini A, Taylor R, et al. COVID-19 and NSAIDS: a narrative review of knowns and unknowns. Pain Ther 2020; 9: 353-8.
- FitzGerald GA. Misguided drug advice for COVID-19. Science. 2020; 367 (6485): 1434.
- Plein LM, Rittner HL. Opioids and the immune system–friend or foe. Br journal Pharmacol. 2018; 175 (14): 2717-25.
- Saurer TB, Carrigan KA, Ijames SG, Lysle DT. Suppression of natural killer cell activity by morphine is mediated by the nucleus accumbens shell. J Neuroimmunol. 2006; 173 (1-2): 3-11.
- Franchi S, Moschetti G, Amodeo G, Sacerdote P. Do all opioid drugs share the same immunomodulatory properties? A review from animal and human studies. Front Immunol 2019; 10: 2914.
- Wright EA, Katz JN, Abrams S, Solomon DH, Losina E. Trends in prescription of opioids from 2003–2009 in persons with knee osteoarthritis. Arthritis Care Res 2014; 66 (10): 1489-95.
- Dublin S, Walker RL, Jackson ML, Nelson JC, Weiss NS, Von Korff M, et al. Use of opioids or benzodiazepines and risk of pneumonia in older adults: a population‐based case-control study. J Am Geriatr Soc 2011; 59 (10): 1899-907.
- Deer T, Sayed D, Pope JE, Chakravarthy KV, Petersen E, Moeschler SM, et al. Emergence from the coronavirus disease 2019 pandemic and the care of chronic pain: guidance for the interventionalist. Anesth Analg 2020; 131 (2): 387-94.
- Kurşun YZ, Yıldız F, Kaymaz Ö, Önal SA. Ağrılı kanser hastalarının tedavisinde analjezik basamak tedavisinin yeri. AĞRI. 2015;27(1):26-34.
- Marchand F, Perretti M, McMahon SB. Role of the immune system in chronic pain. Nat Rev Neurosci 2005; 6 (7): 521-32.
- Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012; 345: e6341.
- Smith D, Wilkie R, Uthman O, Jordan JL, McBeth J. Chronic pain and mortality: a systematic review. PloS One 2014; 9 (6): e99048.
- Liu MM, Reidy AB, Saatee S, Collard CD. Perioperative steroid management: approaches based on current evidence. Anesthesiology. 2017; 127 (1): 166-72.
- Habib GS. Systemic effects of intra-articular corticosteroids. Clin Rheumatol 2009; 28 (7): 749-56.
- Arici T, Uzuner B. Algoloji kliniğine başvuran hastaların tanı ve tedavilerinin değerlendirilmesi. Ortadoğu Tıp Dergisi. 2020; 12 (2): 159-64
Abstract
Amaç: Covid-19 pandemisi sırasında birçok sağlık kuruluşunda poliklinikte bakılan hasta sayıları kısıtlanmış ve tedavi protokollerinde bazı değişiklikler yapılmıştır. Rejyonel Anestezi ve Ağrı dernekleri de özellikle kronik ağrıda steroid uygulamasının ve opioid kullanımının kısıtlanmasını önermişlerdir. Çalışmamızda, Covid-19 döneminde, kliniğimize ağrı şikâyeti ile başvuran hastaların klinik tanılarını, aldıkları tedavileri ve kronik ağrıdaki yaklaşımımızın rehberlere uygun olup olmadığını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Mart 2020- Mayıs 2021 tarihleri arasında Ege Üniversitesi Tıp Fakültesi, AlgolojiBilim Dalı polikliniğine ağrı şikâyeti ile başvuran hastaların demografik verileri, klinik tanıları, uygulanangirişimsel işlemler ve verilen medikal tedaviler retrospektif incelenerek istatistiksel olarak
değerlendirildi.
Bulgular: Çalışmaya dahil edilen 444 hastanın yaş ortalaması 56,8±15,9 olarak belirlendi. Hastaların 29'unun (%6,5%) akut ağrı, 415’nin ise (%93,5) kronik ağrı nedeniyle başvurduğu saptandı. Sadece farmakolojik tedavi alan hasta sayısı 230 (%51,8) iken, 199 (%44,8) hastaya hem farmakolojik tedavi hem de girişimsel işlem uygulandığı, 15 (%3,3) hastaya ise sadece girişimsel işlem uygulandığı belirlendi. Farmakolojik tedavi alan hastaların 229 (%57,1)’unun sadece parasetamol tedavisi; 99 (%24,6)’unun sadece non-steroid antiinflamatuar (NSAI) ilaç tedavisi, 73 (%18,2)’ünün ise hem parasetamol hem de NSAI tedavisi aldığı saptandı. Medikal tedavi uygulanan hastaların 243 (%96,8)’ünün zayıf opioid, 3 (%1,3)’ünün güçlü opioid, 5 (%1,9)’inin ise hem zayıf hem de güçlü kombine opioid tedavi aldığı belirlendi. Girişimsel işlem uygulanan toplam 214 hastanın ise %16,3’üne
steroid enjeksiyonu uygulandığı görüldü.
Sonuç: Pandemi döneminde kronik ağrı hastalarının çoğunlukta olduğu ve bu hastalarda güçlü opioidlerin kullanımının ve steroid enjeksiyonlarının en aza indirildiği görüldü. İmmün yanıtlarda değişikliklere yol açabileceğinden pandemi döneminde ağrı hastalarında en az risk oluşturacak uygulamaların seçilmesi gerekir
References
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395 (10229): 1054-62.
- Pullano G, Pinotti F, Valdano E, Boëlle P-Y, Poletto C, Colizza V. Novel coronavirus (2019-nCoV) early-stage importation risk to Europe, January 2020. Euro Surveill. 2020; 25 (4): 2000057.
- Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Bio Medica: Atenei Parmensis. 2020; 91 (1): 157-60.
- Shanthanna H, Cohen SP, Strand N, Lobo CA, Eldabe S, Bhatia A, et al. Recommendations on chronic pain practice during the COVID-19 pandemic. A Joint Statement by the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anesthesia and Pain Therapy (ESRA). https://www.asra.com/guidelines-articles/original-articles/covid-19-resources/covid-19-resources/legacy-bblog-posts/2020/03/27/recommendations-on-chronic-pain-practice-during-the-covid-19-pandemic 2020.
- Vowles KE, Pielech M, Edwards KA, McEntee ML, Bailey RW. A comparative meta-analysis of unidisciplinary psychology and interdisciplinary treatment outcomes following Acceptance and Commitment Therapy for adults with chronic pain. J Pain 2020; 21 (5-6): 529-45.
- Mills SE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019; 123 (2): e273-e83.
- Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015; 156 (6): 1003-7.
- Jean-Toussaint R, Tian Y, Chaudhuri AD, Haughey NJ, Sacan A, Ajit SK. Proteome characterization of small extracellular vesicles from spared nerve injury model of neuropathic pain. J Proteomics. 2020; 211: 103540.
- Mao B, Liu Y, Chai Y-H, Jin X-Y, Lu H-W, Yang J-W, et al. Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study. Lancet Digit Health. 2020; 2 (6): e323-e30.
- Yao M, Lei Y, Li P, Ye Q, Liu Y, Li X, et al. Shared sensitivity to physical pain and social evaluation. J Pain 2020; 21 (5-6): 677-88.
- Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of longterm opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162 (4): 276-86.
- Ragni E, Mangiavini L, Viganò M, Brini AT, Peretti GM, Banfi G, et al. Management of Osteoarthritis During the COVID‐19 Pandemic. Clin Pharmacol Ther 2020; 108 (4): 719-29.
- Pergolizzi JV, Varrassi G, Magnusson P, LeQuang JA, Paladini A, Taylor R, et al. COVID-19 and NSAIDS: a narrative review of knowns and unknowns. Pain Ther 2020; 9: 353-8.
- FitzGerald GA. Misguided drug advice for COVID-19. Science. 2020; 367 (6485): 1434.
- Plein LM, Rittner HL. Opioids and the immune system–friend or foe. Br journal Pharmacol. 2018; 175 (14): 2717-25.
- Saurer TB, Carrigan KA, Ijames SG, Lysle DT. Suppression of natural killer cell activity by morphine is mediated by the nucleus accumbens shell. J Neuroimmunol. 2006; 173 (1-2): 3-11.
- Franchi S, Moschetti G, Amodeo G, Sacerdote P. Do all opioid drugs share the same immunomodulatory properties? A review from animal and human studies. Front Immunol 2019; 10: 2914.
- Wright EA, Katz JN, Abrams S, Solomon DH, Losina E. Trends in prescription of opioids from 2003–2009 in persons with knee osteoarthritis. Arthritis Care Res 2014; 66 (10): 1489-95.
- Dublin S, Walker RL, Jackson ML, Nelson JC, Weiss NS, Von Korff M, et al. Use of opioids or benzodiazepines and risk of pneumonia in older adults: a population‐based case-control study. J Am Geriatr Soc 2011; 59 (10): 1899-907.
- Deer T, Sayed D, Pope JE, Chakravarthy KV, Petersen E, Moeschler SM, et al. Emergence from the coronavirus disease 2019 pandemic and the care of chronic pain: guidance for the interventionalist. Anesth Analg 2020; 131 (2): 387-94.
- Kurşun YZ, Yıldız F, Kaymaz Ö, Önal SA. Ağrılı kanser hastalarının tedavisinde analjezik basamak tedavisinin yeri. AĞRI. 2015;27(1):26-34.
- Marchand F, Perretti M, McMahon SB. Role of the immune system in chronic pain. Nat Rev Neurosci 2005; 6 (7): 521-32.
- Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012; 345: e6341.
- Smith D, Wilkie R, Uthman O, Jordan JL, McBeth J. Chronic pain and mortality: a systematic review. PloS One 2014; 9 (6): e99048.
- Liu MM, Reidy AB, Saatee S, Collard CD. Perioperative steroid management: approaches based on current evidence. Anesthesiology. 2017; 127 (1): 166-72.
- Habib GS. Systemic effects of intra-articular corticosteroids. Clin Rheumatol 2009; 28 (7): 749-56.
- Arici T, Uzuner B. Algoloji kliniğine başvuran hastaların tanı ve tedavilerinin değerlendirilmesi. Ortadoğu Tıp Dergisi. 2020; 12 (2): 159-64
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 15, 2023 |
| Submission Date | March 25, 2022 |
| Published in Issue | Year 2023Volume: 62 Issue: 1 |
