Change in Pain Severity With Open Label Venlafaxine Use in Patients With a Depressive Symptomatology: An Observational Study in Primary Care

AbstractPurpose.Venlafaxine has shown benefit in the treatment of depression and pain. Worldwide data are extensively lacking investigating the outcome of chronic pain patients with depressive symptoms treated by venlafaxine in the primary care setting. This observational study aimed to elucidate the efficacy of venlafaxine and its prescription by Swiss primary care physicians and psychiatrists in patients with chronic pain and depressive symptomatology.Subjects and methods.We studied 505 patients with depressive symptoms suffering from chronic pain in a prospective naturalistic Swiss community based observational trial with venlafaxine in primary care. These patients have been treated with venlafaxine by 122 physicians, namely psychiatrists, general practitioners, and internists.Results.On average, patients were treated with 143 ± 75 mg (0–450 mg) venlafaxine daily for a follow-up of three months. Venlafaxine proved to be beneficial in the treatment of both depressive symptoms and chronic pain.Discussion.Although side effects were absent in most patients, physicians might have frequently omitted satisfactory response rate of depression by underdosing venlafaxine. Our results reflect the complexity in the treatment of chronic pain in patients with depressive symptoms in primary care.Conclusion.Further randomized dose-finding studies are needed to learn more about the appropriate dosage in treating depression and comorbid pain with venlafaxine.

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Physician speciality and pain reduction in patients with depressive symptoms under treatment with venlafaxine

European Psychiatry ◽

10.1016/j.eurpsy.2009.10.004 ◽

2010 ◽

Vol 25 (8) ◽

pp. 455-460 ◽

Cited By ~ 1

Author(s):

S. Begré ◽

M. Traber ◽

M. Gerber ◽

R. von Känel

Keyword(s):

Primary Care ◽

Depressive Symptoms ◽

General Practitioners ◽

Primary Care Physicians ◽

Depressive Symptomatology ◽

Pain Reduction ◽

Integrated Treatment ◽

Medical Speciality ◽

Iatrogenic Complications ◽

The Impact

AbstractObjectivesExcessive pain perception may lead to unnecessary diagnostic testing or invasive procedures resulting in iatrogenic complications and prolonged disability. Naturalistic studies on patients with chronic pain and depressive symptoms investigating the impact of medical speciality on treatment outcome in a primary care setting are lacking.MethodsIn this observational study, we examined whether the magnitude of pain reduction in 444 patients with depressive symptomatology under venlafaxine would relate differently to the medical speciality of the 122 treating physicians, namely psychiatrists (n = 110 patients), general practitioners (n = 236 patients), and internists (n = 98 patients).ResultsIndependent of age, gender, patient's region of origin, comorbidity, severity and duration of pain, and depressive symptoms at study entry, patients seemed to benefit significantly less in terms of pain reduction (p < 0.001) and of reduction in severity of depressive symptomatology by psychiatrists as compared to general practitioners (p < 0.019) and internists (p < 0.002).ConclusionsThe findings suggest that patients referred to psychiatrists are more difficult to treat than those referred to general practitioners and internists, and might not have been adequately prepared for psychiatric interventions. A supporting cooperation and networking between psychiatrists and primary care physicians may contribute to an integrated treatment concept and therefore, may lead to a better outcome in this challenging patient group.

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Feasibility Study of Rapid Opioid Rotation and Titration

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/71 ◽

2011 ◽

Vol 1;14 (1;1) ◽

pp. 71-82

Author(s):

Marco Pappagallo

Keyword(s):

Chronic Pain ◽

Primary Care Physicians ◽

Randomized Study ◽

Brief Pain Inventory ◽

Immediate Release ◽

Dose Titration ◽

Open Label ◽

Opioid Rotation ◽

Ambulatory Treatment

Background: Opioid guidelines recommend opioid rotation and switching for patients who do not achieve adequate pain relief or who experience intolerable adverse events (AEs) with their current opioid. However, specific recommendations and protocols for opioid rotation are lacking, making the practice time consuming and difficult for primary care physicians to accomplish independently or coordinate with a pain specialist. Objectives: To assess the safety and feasibility of using 24-hour intravenous patientcontrolled analgesia (IV-PCA) to achieve rapid opioid rotation and titration (RORT). Study design: Open-label pilot study. Setting: Hospital research center. Methods: At admission, patients (aged ≥ 18 years) with treatment-refractory chronic pain who were taking morphine or oxycodone for ≥ 3 months and had pain scores ≥ 4 on a 10- point scale, underwent opioid rotation to oral oxymorphone extended release (ER). They also received IV-PCA oxymorphone for 24 hours as needed. At discharge, the participants were taking oral oxymorphone ER with oxymorphone immediate release (IR) as needed based on their total 24-hour oral plus IV-PCA oxymorphone use. During a 2-week follow-up, their oxymorphone usage was titrated as needed. Main outcome measures were AEs, Patient Global Impression of Change (PGIC), Brief Pain Inventory (0 = no pain/interference, 10 = worst pain/ complete interference), treatment satisfaction, and change in oxymorphone dose. Results: Twelve patients enrolled and completed the 24-hour IV-PCA; 10 completed the 2- week follow-up post–24-hour IV-PCA. PGIC status improved by 12 hours (odds ratio [OR], 0.19, 95% CI, 0.08−0.44; P < 0.001), and both PGIC status and activity scores improved by 24 hours (OR, 0.23, 95% CI, 0.09−0.55; P = 0.001; OR, 0.49, 95% CI, 0.25−0.96; P = 0.04, respectively) and 2 weeks (OR, 0.14, 95% CI, 0.04−0.46; P = 0.001; OR, 0.21, 95% CI, 0.06−0.72; P = 0.01) versus 6 hours. During the 24-hour IV-PCA time period, 6 of 10 patients accomplished ≥ 50% of their overall dose titration. At 2 weeks, 8 of 10 participants were Greatly Satisfied or Somewhat Satisfied with the overall RORT procedure. RORT was well tolerated, with no serious AEs. Limitations: This was a pilot open-label study in a small number of participants. A larger randomized study with long-term follow-up and comparison to traditional protocols is necessary. Conclusions: Preliminary data suggest that RORT can be performed safely and effectively by incorporating IV-PCA during the first 24 hours. Further investigations are needed to determine whether RORT can become an ambulatory treatment intervention in pain practice. Clinicaltrials.gov registration: NCT00580294 Key words: chronic pain, opioid rotation, opioid switching, opioid substitution, opioid conversion, oxymorphone, oxycodone, morphine

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The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

BMC Family Practice ◽

10.1186/s12875-021-01471-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ingmar Schäfer ◽

Heike Hansen ◽

Agata Menzel ◽

Marion Eisele ◽

Daniel Tajdar ◽

...

Keyword(s):

Primary Care ◽

Observational Study ◽

Rural Areas ◽

Longitudinal Observational Study ◽

Multivariable Analyses ◽

Gastrointestinal Complaints ◽

Urban And Rural Areas ◽

Quota Sampling ◽

Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

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Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

BMC Medical Education ◽

10.1186/s12909-020-02459-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M.-C. Audétat ◽

S. Cairo Notari ◽

J. Sader ◽

C. Ritz ◽

T. Fassier ◽

...

Keyword(s):

Primary Care ◽

Clinical Reasoning ◽

Primary Care Physicians ◽

Video Sequence ◽

Structured Interview ◽

Ambulatory Setting ◽

Structured Interviews ◽

Stimulated Recall ◽

Study Results

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.

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Optimizing childhood oncology care transition from pediatric to adult settings: A survey of primary care physicians’ and residents’ perspectives

Clinical & Investigative Medicine ◽

10.25011/cim.v43i2.33566 ◽

2020 ◽

Vol 43 (2) ◽

pp. E14-23

Author(s):

Sophie Marcoux, MD, PhD Marcoux ◽

Caroline Laverdière

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Childhood Cancer ◽

Primary Care Physicians ◽

Adult Survivors ◽

Likert Scale ◽

Care Transition ◽

Term Care

Purpose: The majority of childhood cancer survivors suffer from late adverse effects after the completion of treatment. The prospect of most survivors reaching middle-age is a relatively new phenomenon, and the ways by which current and future primary care physicians (PCPs) will address this novel public health challenge are uncertain. Methods: A survey assessing knowledge level and information delivery preferences regarding long-term follow-up guidelines for adult patients having survived a childhood cancer was distributed by e-mail through the Quebec (Canada) national associations of PCPs and residents (n=238). Results: Participants reported an estimated average of 2.9 ± 1.9 cancer survivors in their yearly caseload, and only 35.3% recalled having provided services to at least one survivor in the last year. Most participants indicated ignoring validated follow-up guidelines for these patients (average score 1.66 on a Likert scale from “1—totally disagreeing” to “5—totally agreeing”). Scarce access to personalized follow-up guidelines and lack of clinical exposure to cancer survivors were identified as main obstacles in providing optimal care to these patients (respective averages of 1.66 and 1.84 on a Likert scale from “1— is a major obstacle” to “5—is not an obstacle at all”). Conclusion: The PCPs and residents rarely provide care for childhood cancer adult survivors. On an individual basis, there is a clear need for increased awareness, education and collaboration regarding long-term care of childhood cancer adult survivors during medical training. On a more global basis, structural, organizational and cultural changes are also needed to ensure adequate care transition.

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Transcranial Direct-Current Stimulation (tDCS) Versus Venlafaxine ER In The Treatment Of Depression: A Randomized, Double-Blind, Single-Center Study With Open-Label, Follow-Up

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s226577 ◽

2019 ◽

Vol Volume 15 ◽

pp. 3003-3014 ◽

Cited By ~ 1

Author(s):

Martin Bares ◽

Martin Brunovsky ◽

Pavla Stopkova ◽

Martin Hejzlar ◽

Tomas Novak

Keyword(s):

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Single Center ◽

Open Label ◽

Double Blind ◽

Direct Current Stimulation ◽

Treatment Of Depression ◽

Single Center Study ◽

Center Study

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Screening and management of cardiovascular disease in Australian adults with HIV infection

Sexual Health ◽

10.1071/sh13009 ◽

2013 ◽

Vol 10 (6) ◽

pp. 495 ◽

Cited By ~ 7

Author(s):

Derek Chan ◽

David Gracey ◽

Michael Bailey ◽

Deborah Richards ◽

Brad Dalton

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

Clinical Practice ◽

Hiv Infection ◽

Primary Care Physicians ◽

Management Practices ◽

Cvd Risk ◽

Online Forms ◽

Current Screening

Background Cardiovascular disease (CVD) is common in HIV infection. With no specific Australian guidelines for the screening and management of CVD in HIV-infected patients, best clinical practice is based on data from the general population. We evaluated adherence to these recommendations by primary care physicians who treat HIV-infected patients. Methods: Primary care physicians with a special interest in HIV infection were asked to complete details for at least 10 consecutive patient encounters using structured online forms. This included management practices pertaining to blood pressure (BP), blood glucose, electrocardiogram, lipid profile and CVD risk calculations. We assessed overall adherence to screening and follow-up recommendations as suggested by national and international guidelines. Results: Between May 2009 and March 2010, 43 physicians from 25 centres completed reporting for 530 HIV-infected patients, of whom 93% were male, 25% were aged 41–50 years and 83% were treated with antiretrovirals. Risk factors for CVD were common and included smoking (38%), hyperlipidaemia (16%) and hypertension (28%). In men aged >40 years and women aged >50 years without evidence of ischaemic heart disease, only 14% received a CVD risk assessment. Lipid and BP assessments were performed in 87% and 88% of patients, respectively. Conclusions: This Australian audit provides unique information on the characteristics and management of HIV and CVD in clinical practice. We have found a high burden of risk for CVD in HIV-infected Australians, but current screening and management practices in these patients fall short of contemporary guidelines.

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