scholarly journals Ketamine therapy for chronic pain in The Netherlands: a nationwide survey

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Thomas J.P. Mangnus ◽  
Krishna D. Bharwani ◽  
Dirk L. Stronks ◽  
Maaike Dirckx ◽  
Frank J.P.M. Huygen
Keyword(s):  
Chronic Pain ◽  
The Netherlands ◽  
Maximum Dose ◽  
Nationwide Survey ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Treatment Indications ◽  
Pain Clinics ◽  
Starting Dose ◽  
Median Maximum

Abstract Objectives Ketamine is used to treat chronic refractory pain. However, there are no scientific guidelines for ketamine use in the Netherlands. The aim of this survey was to provide an overview of the use of ketamine for chronic pain in the Netherlands. Methods All pain clinics in the Netherlands were contacted. A digital survey, available from June 2019 to January 2020, was sent to 68 pain clinics. The survey was completed by one pain physician as a representative of the entire pain department. The survey included questions about ketamine treatment indications, administration, dose, duration, treatment repetition and the inpatient or outpatient setting. Results The survey was completed by 51 pain clinics (75.0%). Thirty-one clinics used ketamine for chronic pain treatment. The most common indication was Complex Regional Pain Syndrome (83.9%). Pain clinics administered ketamine via intravenous infusions (96.8%), iontophoresis (61.3%), subcutaneous (3.2%) or oral administration (3.2%). Intravenous ketamine treatment was offered in an inpatient setting in 14 pain clinics, in both an inpatient and outpatient setting in 11 pain clinics and in six pain clinics in an outpatient setting. In the outpatient setting, the median starting dose was 5 mg/h (IQR=17.5–5). The median maximum dose was 27.5 mg/h (IQR=100–11.9). The median infusion duration was 6 h (IQR=8–4). In the inpatient setting, the median starting dose was 5 mg/h (IQR=5–1.5) and the median maximum dose was 25 mg/h (IQR=25–14). Patients were admitted to hospital for a median of 4 days (IQR=5–1). Conclusions The results of this Dutch nationwide survey study show that there are heterogeneous treatment protocols with different indications, treatment setting and dosing regimen for the treatment of chronic pain with ketamine. This study encourages the formulation of a broader consensus and the development of evidence based guidelines for ketamine treatment.

Sleep disturbance in patients attending specialized chronic pain clinics in Denmark: a longitudinal study examining the relationship between sleep and pain outcomes

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Henrik Bjarke Vaegter ◽  
Mette Terp Høybye ◽  
Frederik Hjorth Bergen ◽  
Christine E. Parsons
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Sleep Quality ◽  
Pain Intensity ◽  
Sleep Disturbances ◽  
Pain Disability ◽  
Pain Clinics ◽  
Pain Outcomes

Abstract Objectives Sleep disturbances are highly prevalent in patients with chronic pain. However, the majority of studies to date examining sleep disturbances in patients with chronic pain have been population-based cross-sectional studies. The aims of this study were to 1) examine the frequency of sleep disturbances in patients referred to two interdisciplinary chronic pain clinics in Denmark, 2) explore associations between sleep disturbances and pain intensity, disability and quality of life at baseline and follow-up, and 3) explore whether changes in sleep quality mediated the relationships between pain outcomes at baseline and pain outcomes at follow-up. Methods We carried out a longitudinal observational study, examining patients enrolled in two chronic pain clinics assessed at baseline (n=2,531) and post-treatment follow-up (n=657). Patients reported on their sleep disturbances using the sleep quality subscale of the Karolinska Sleep Questionnaire (KSQ), their pain intensity using 0–10 numerical rating scales, their pain-related disability using the Pain Disability Index (PDI), and quality of life using the EuroQol-VAS scale. The average time between baseline and follow-up was 207 days (SD=154). Results At baseline, the majority of patients reported frequent sleep disturbances. We found a significant association at baseline between self-reported sleep disturbances and pain intensity, pain-related disability, and quality of life, where greater sleep disturbance was associated with poorer outcomes. At follow-up, patients reported significant improvements across all pain and sleep outcomes. In two mediation models, we showed that changes in sleep disturbances from baseline to follow-up were significantly associated with (i) pain intensity at follow-up, and (ii) pain disability at follow-up. However, baseline pain intensity and disability scores were not associated with changes in sleep disturbances and, we did not find evidence for significant mediation of either pain outcome by changes in sleep disturbances. Conclusions Self-reported sleep disturbances were associated with pain outcomes at baseline and follow-up, with greater sleep disturbances associated with poorer pain outcomes. Changes in sleep quality did not mediate the relationships between baseline and follow-up scores for pain intensity and disability. These findings contribute to a growing body of evidence confirming an association between sleep and chronic pain experience, particularly suggestive of a sleep to pain link. Our data following patients after interdisciplinary treatment suggests that improved sleep is a marker for a better outcome after treatment.

Detecting hypothyroidism after treatment for laryngeal or hypopharyngeal carcinomas: a nationwide survey in The Netherlands

2008 ◽  
Vol 266 (5) ◽  
pp. 713-718 ◽  
Author(s):  
Annalisa M. Lo Galbo ◽  
Remco de Bree ◽  
Paul Lips ◽  
C. René Leemans
Keyword(s):  
The Netherlands ◽  
Nationwide Survey

High-Resolution Esophageal Manometry in the Inpatient Setting: A Tertiary Referral Center Experience

2021 ◽  
pp. 263451612110351
Author(s):  
Catiele Antunes ◽  
Elinor Zhou ◽  
Jad Abimansour ◽  
Daniella Assis ◽  
Olaya I. Brewer Gutierrez ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Resolution ◽  
Esophageal Manometry ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Additional Intervention ◽  
Lower Likelihood ◽  
Oral Diet

High-resolution esophageal manometry (HRM) is frequently used in the outpatient setting, but its role in the inpatient setting is unknown. We conducted a retrospective study of patients who underwent inpatient or outpatient HRM. Few differences were noted between groups and 28% of inpatients had an additional intervention. Tolerance of oral diet and diabetes were associated with a lower likelihood of additional intervention. Ultimately, the inpatient HRM group had unique characteristics and few subsequent interventions.

scholarly journals A nationwide survey concerning practices in pessary use for pelvic organ prolapse in The Netherlands: identifying needs for further research

2015 ◽  
Vol 26 (10) ◽  
pp. 1453-1458 ◽  
Author(s):  
Joost Velzel ◽  
Jan Paul Roovers ◽  
C H Van der Vaart ◽  
Bart Broekman ◽  
Astrid Vollebregt ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
The Netherlands ◽  
Nationwide Survey ◽  
Pelvic Organ

scholarly journals Is staged bilateral thalamic radiosurgery an option for otherwise surgically ineligible patients with medically refractory bilateral tremor?

2018 ◽  
Vol 128 (2) ◽  
pp. 617-626 ◽  
Author(s):  
Ajay Niranjan ◽  
Sudesh S. Raju ◽  
Edward A. Monaco ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Median Time ◽  
Rating Scale ◽  
Maximum Dose ◽  
Karnofsky Performance Status ◽  
Dominant Hand ◽  
Complete Restoration ◽  
Increased Risk ◽  
Before And After ◽  
Median Maximum

OBJECTIVEUnilateral Gamma Knife thalamotomy (GKT) is a well-established treatment for patients with medically refractory tremor who are not eligible for invasive procedures due to increased risk of compications. The purpose of this study was to evaluate whether staged bilateral GKT provides benefit with acceptable risk to patients suffering from disabling medically refractory bilateral tremor.METHODSEleven patients underwent staged bilateral GKT during a 17-year period (1999–2016). Eight patients had essential tremor (ET), 2 had Parkinson's disease (PD)–related tremor, and 1 had multiple-sclerosis (MS)–related tremor. For the first GKT, a median maximum dose of 140 Gy was delivered to the posterior-inferior region of the nucleus ventralis intermedius (VIM) through a single isocenter with 4-mm collimators. Patients who benefitted from unilateral GKT were eligible for a contralateral GKT 1–2 years later (median 22 months). For the second GKT, a median maximum dose of 130 Gy was delivered to the opposite VIM nucleus to a single 4-mm isocenter. The Fahn-Tolosa-Marin (FTM) clinical tremor rating scale was used to score tremor, drawing, and drinking before and after each GKT. The FTM writing score was assessed only for the dominant hand before and after the first GKT. The Karnofsky Performance Status (KPS) was used to assess quality of life and activities of daily living before and after the first and second GKT.RESULTSThe median time to last follow-up after the first GKT was 35 months (range 11–70 months). All patients had improvement in at least 1 FTM score after the first GKT. Three patients (27.3%) had tremor arrest and complete restoration of function (noted via FTM tremor, writing, drawing, and drinking scores equaling zero). No patient had tremor recurrence or diminished tremor relief after the first GKT. One patient experienced new temporary neurological deficit (contralateral lower-extremity hemiparesis) from the first GKT. The median time to last follow-up after the second GKT was 12 months (range 2–70 months). Nine patients had improvement in at least 1 FTM score after the second GKT. Two patients had tremor arrest and complete restoration of function. No patient experienced tremor recurrence or diminished tremor relief after the second GKT. No patient experienced new neurological or radiological adverse effect from the second GKT. Statistically significant improvements were noted in the KPS score following the first and second GKT.CONCLUSIONSStaged bilateral GKT provided effective relief for medically refractory, disabling, bilateral tremor without increased risk of neurological complications. It is an appropriate strategy for carefully selected patients with medically refractory bilateral tremor who are not eligible for deep brain stimulation.

Simple screening model for identifying the risk of sleep apnea in patients on opioids for chronic pain

2021 ◽  
pp. rapm-2020-102388
Author(s):  
Janannii Selvanathan ◽  
Rida Waseem ◽  
Philip Peng ◽  
Jean Wong ◽  
Clodagh M Ryan ◽  
...  
Keyword(s):  
At Risk ◽  
Chronic Pain ◽  
Sleep Apnea ◽  
Simple Model ◽  
Oxygen Desaturation ◽  
Desaturation Index ◽  
Oxygen Desaturation Index ◽  
Pain Clinics ◽  
Overnight Oximetry ◽  
Severe Sleep Apnea

BackgroundThere is an increased risk of sleep apnea in patients using opioids for chronic pain. We hypothesized that a simple model comprizing of: (1) STOP-Bang questionnaire and resting daytime oxyhemoglobin saturation (SpO2); and (2) overnight oximetry will identify those at risk of moderate-to-severe sleep apnea in patients with chronic pain.MethodAdults on opioids for chronic pain were recruited from pain clinics. Participants completed the STOP-Bang questionnaire, resting daytime SpO2, and in-laboratory polysomnography. Overnight oximetry was performed at home to derive the Oxygen Desaturation Index. A STOP-Bang score ≥3 or resting daytime SpO2 ≤95% were used as thresholds for the first step, and for those identified at risk, overnight oximetry was used for further screening. The Oxygen Desaturation Index from overnight oximetry was validated against the Apnea-Hypopnea Index (≥15 events/hour) from polysomnography.ResultsOf 199 participants (52.5±12.8 years, 58% women), 159 (79.9%) had a STOP-Bang score ≥3 or resting SpO2 ≤95% and entered the second step (overnight oximetry). Using an Oxygen Desaturation Index ≥5 events/hour, the model had a sensitivity of 86.4% and specificity of 52% for identifying moderate-to-severe sleep apnea. The number of participants who would require diagnostic sleep studies was decreased by 38% from Step 1 to Step 2 of the model.ConclusionA simple model using STOP-Bang questionnaire and resting daytime SpO2, followed by overnight oximetry, can identify those at high risk of moderate-to-severe sleep apnea in patients using opioids for chronic pain.Trial registration numberNCT02513836.

Upper and Middle Lobe Atelectasis

Chest Imaging ◽  
2019 ◽  
pp. 93-97
Author(s):  
Christopher M. Walker
Keyword(s):  
Lung Cancer ◽  
Main Bronchus ◽  
Lower Lobe ◽  
Outpatient Setting ◽  
Middle Lobe ◽  
Inpatient Setting ◽  
Central Mass ◽  
Contrast Enhanced Ct ◽  
Left Hemidiaphragm ◽  
Contrast Enhanced

Upper and middle lobe atelectasis discusses the radiographic and computed tomography (CT) manifestations of upper and middle lobe atelectasis. The most common radiographic signs of right upper lobe atelectasis include upward and medial displacement of the minor fissure, superior displacement of adjacent structures such as the hilum and main bronchus, and ipsilateral shift of the mediastinal structures. The S sign of Golden results from a centrally obstructing lung cancer as the cause of the atelectasis and manifests as a reverse S configuration of the minor fissure outlined by atelectatic lung and central mass. Left upper lobe atelectasis manifests with a veil-like opacity on frontal radiography with leftward shift of upper mediastinal structures such as the trachea and upward shift of the left main bronchus and left hemidiaphragm. The Luftsichel sign or air crescent sign may be seen and represents the hyperexpanded superior segment of the left lower lobe outlining the transverse aortic arch. Lobar atelectasis in the inpatient setting is most commonly secondary to an obstructing mucus plug. Lobar atelectasis in the outpatient setting is often a heralding sign of a centrally obstructing lung cancer and should be further evaluated with contrast-enhanced CT and/or bronchoscopy.

scholarly journals Pain Characteristics and Demographics of Patients Attending a University-Affiliated Pain Clinic in Toronto, Ontario

2007 ◽  
Vol 12 (2) ◽  
pp. 93-99 ◽  
Author(s):  
Angela Mailis-Gagnon ◽  
Balaji Yegneswaran ◽  
SF Lakha ◽  
Keith Nicholson ◽  
Amanda J Steiman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Tertiary Care ◽  
Pain Clinic ◽  
Pain Clinics ◽  
Chronic Pain Patients ◽  
Musculoskeletal Problems ◽  
Pain Duration ◽  
Study Population ◽  
Age Range ◽  
Pain Patients

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices.OBJECTIVE: The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university-affiliated tertiary care pain clinic in Toronto, Ontario.METHODS: Data were collected on 1242 consecutive new patients seen over a three-year period at the Comprehensive Pain Program in central Toronto.RESULTS: Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35- to 49-year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three-quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral.CONCLUSIONS: The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.

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