Optimizing telehealth pain care after COVID-19

Tauben, David; Langford, Dale J.; Sturgeon, John A.; Rundell, Sean D.; Towle, Cara; Bockman, Christina; Nicholas, Michael K.

doi:10.1097/j.pain.0000000000002048

Cited by 49 publications

(47 citation statements)

References 86 publications

(104 reference statements)

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“…These were also likely functions of having pivoted so quickly to virtual care, 32 which may result in gaps in education and training for health care professionals and patients, limited resources to guide practice (i.e., practice standards), and challenges in obtaining funding for technology and licenses. Decisions such as selecting a virtual care platform (if given the choice) can be challenging, and health care professionals face many conflicting considerations such as the purpose of the platform, 33 , 34 audio/video quality, 17 and the ability of patients to engage with the platform. A recent topical review further outlined similar challenges with implementing telehealth multidisciplinary pain care in the context of COVID-19 and suggested an agenda of research, education, and policy recommendations to address many of the challenges highlighted in this study, including access, equity, safety, and security.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals

Killackey

Noel

Birnie

et al. 2021

Canadian Journal of Pain

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Background:The COVID-19 pandemic presents one of the greatest threats to pediatric pain care seen in generations. Due to public health restrictions, many pediatric pain clinics halted inperson appointments, delaying and disrupting access to care. There is no existing research on the impacts of COVID-19 on pediatric chronic pain care in Canada, nor the challenges experienced by healthcare professionals and pain clinics. Aims:To evaluate the impact of COVID-19 on Canadian pediatric chronic pain care by documenting how healthcare professionals provided care during the first six months of the pandemic.Methods: Two Canadian online cross-sectional surveys were conducted: one among Canadian pediatric pain clinic directors (Study 1) and another among multidisciplinary pediatric pain healthcare professionals (Study 2).Results: Responses from 13/13 Canadian pediatric pain clinics/rehabilitation programs indicated that all clinics provided virtual care during the pandemic. No significant changes were reported in the frequency of appointment requests. Most clinics reported no perceived change in patient pain levels (n=9/13, 69%) or occurrence of pain flares (n=10/13, 77%). Results from 151 individual healthcare professionals indicated that the majority (90%) of non-emergency department respondents were providing virtual care. The main challenges of virtual care included technological barriers, financial concerns, infrastructure and logistics, privacy, and clinical challenges.Conclusions: This study documented the impact of the COVID-19 pandemic on pediatric chronic pain care in Canada and highlighted the rapid shift to using virtual solutions. Simultaneously, respondents outlined current challenges and potential solutions to consider in the development of virtual care guidelines and policy in Canada.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals

Killackey

Noel

Birnie

et al. 2021

Canadian Journal of Pain

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“…There is also further need to address the challenges related to virtual physical examinations for pain. 25 , 72 This current review identified articles focused predominantly on virtual care at lower levels of the stepped care continuum (eg, apps and websites). This is important to note because best practices for virtual care identified here do not incorporate evidence from virtual care interventions higher in the stepped care continuum (eg, tertiary care interdisciplinary chronic pain clinics) that are rapidly being delivered remotely in response to the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Best practices for virtual care to support youth with chronic pain and their families: a rapid systematic review to inform health care and policy during COVID-19 and beyond

Birnie

Killackey

Stinson

et al. 2021

PR9

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“…The experience accumulated in the management of patients with cancer pain during the pandemic suggests that many episodes of NP-BTcP are not reported during periodic consultations but are recorded by the patient in the monitoring system [29]. In other words, the impact on quality of life is always present, but both patients and clinicians tend to underestimate the effect [30,31].…”

Section: Discussionmentioning

confidence: 99%

Multidimensional Statistical Technique for Interpreting the Spontaneous Breakthrough Cancer Pain Phenomenon. A Secondary Analysis from the IOPS-MS Study

Cascella

Crispo

Esposito

et al. 2021

Cancers

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Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that “breaks through” a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) is a subtype of BTcP that occurs in the absence of any specific activity. Since NP-BTcP has an important clinical impact, this analysis is aimed at characterizing the NP-BTcP phenomenon through a multidimensional statistical technique. This is a secondary analysis based on the Italian Oncologic Pain multiSetting—Multicentric Survey (IOPS-MS). A correlation analysis was performed to characterize the NP-BTcP profile about its intensity, number of episodes per day, and type. The multiple correspondence analysis (MCA) determined the identification of four groups (phenotypes). A univariate analysis was performed to assess differences between the four phenotypes and selected covariates. The four phenotypes represent the hierarchical classification according to the status of NP-BTcP: from the best (phenotype 1) to the worst (phenotype 4). The univariate analysis found a significant association between the onset time >10 min in the phenotype 1 (37.3%)’ vs. the onset > 10 min in phenotype 4 (25.8%) (p < 0.001). Phenotype 1 was characterized by the gastrointestinal type of cancer (26.4%) with respect to phenotype 4, where the most frequent cancer affected the lung (28.8%) (p < 0.001). Phenotype 4 was mainly managed with rapid-onset opioids, while in phenotype 1, many patients were treated with oral, subcutaneous, or intravenous morphine (56.4% and 44.4%, respectively; p = 0.008). The ability to characterize NP-BTcP can offer enormous benefits for the management of this serious aspect of cancer pain. Although requiring validation, this strategy can provide many indications for identifying the diagnostic and therapeutic gaps in NP-BTcP management.

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Optimizing telehealth pain care after COVID-19

Cited by 49 publications

References 86 publications

COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals

COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals

Best practices for virtual care to support youth with chronic pain and their families: a rapid systematic review to inform health care and policy during COVID-19 and beyond

Multidimensional Statistical Technique for Interpreting the Spontaneous Breakthrough Cancer Pain Phenomenon. A Secondary Analysis from the IOPS-MS Study

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