Impact of the Pandemic on Hospital Care for Chronic Pain Patients in Germany

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Sep 26

PMID 39323471

Authors

Thomas Cegla

Sven Hohenstein

Andreas Bollmann

Vincent Pellissier

Veronika Bencheva

Sven Schmiedl

Affiliations

Soon will be listed here.

Abstract

Objectives: The COVID-19 pandemic affected patients' access to health services, including patients with severe chronic pain. Since limited data on pandemic-caused changes in pain therapy is available, we analyzed its effect on hospital-based pain treatment.

Methods: For this retrospective claims data analysis conducted in = 37 hospitals, we included patients treated for a chronic pain-related diagnosis. Discharge rates stratified by region and pain unit size were analyzed for different time periods between January 2019 and June 2022.

Results: There was a significant decrease in day-care, inpatient interdisciplinary multimodal pain management, from a total of 5,533 hospital pre-pandemic treatments in 2019, to 3,942 in 2020 and 4,262 in 2021, with a slight increase in the first half of 2022. The extent of COVID-19-related changes differed depending on region and pain unit size.

Conclusion: The decreased number of hospital pain treatments during the pandemic implies a relevant analgesic undertreatment. During future pandemics, the ethical dimension of potentially non-sufficient pain treatment should be weighted against social, medical and hygienic restrictions influencing the hospitalization rate.

References

Leiner J, Hohenstein S, Pellissier V, Konig S, Winklmair C, Nachtigall I . COVID-19 and Severe Acute Respiratory Infections: Monitoring Trends in 421 German Hospitals During the First Four Pandemic Waves. Infect Drug Resist. 2023; 16:2775-2781. PMC: 10178997. DOI: 10.2147/IDR.S402313. View

Jacob L, Oh H, Smith L, Koyanagi A, Konrad M, Kostev K . Impact of the coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of neck and low back pain in outpatient practices in Germany. Prev Med Rep. 2022; 31:102096. PMC: 9762039. DOI: 10.1016/j.pmedr.2022.102096. View

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D . Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2005; 10(4):287-333. DOI: 10.1016/j.ejpain.2005.06.009. View

Koesling D, Kieselbach K, Bozzaro C . [Chronic pain and society : Sociological analysis of a complex interconnection]. Schmerz. 2019; 33(3):220-225. DOI: 10.1007/s00482-019-0361-7. View

Tanaka S . What changes occurred in patients with chronic pain in the early phase of the COVID-19 pandemic?. J Anesth. 2022; 36(3):332-334. PMC: 8809068. DOI: 10.1007/s00540-022-03042-x. View

Rikard S, Strahan A, Schmit K, Guy Jr G . Chronic Pain Among Adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023; 72(15):379-385. PMC: 10121254. DOI: 10.15585/mmwr.mm7215a1. View

Engel G . The clinical application of the biopsychosocial model. Am J Psychiatry. 1980; 137(5):535-44. DOI: 10.1176/ajp.137.5.535. View

Konig S, Hohenstein S, Pellissier V, Leiner J, Hindricks G, Nachtigall I . Changing trends of patient characteristics and treatment pathways during the COVID-19 pandemic: A cross-sectional analysis of 72,459 inpatient cases from the German Helios database. Front Public Health. 2022; 10:1028062. PMC: 9678052. DOI: 10.3389/fpubh.2022.1028062. View

van Hecke O, Torrance N, Smith B . Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013; 111(1):13-8. DOI: 10.1093/bja/aet123. View

10.

Wolff R, Clar C, Lerch C, Kleijnen J . [Epidemiology of chronic non-malignant pain in Germany]. Schmerz. 2011; 25(1):26-44. DOI: 10.1007/s00482-010-1011-2. View

11.

Dobrovanov O, Dmytriiev D, Prochotsky A, Vidiscak M, Furkova K . Chronic pain in post-COVID syndrome. Bratisl Lek Listy. 2023; 124(2):97-103. DOI: 10.4149/BLL_2023_014. View

12.

Mussgens D, Burgard L, Kleine-Borgmann J, Frettloh J, Sorgatz H, Bingel U . Impact of the COVID-19 pandemic on patients with chronic pain in Germany: Associations with expectations and control beliefs. Eur J Pain. 2022; 26(6):1343-1354. PMC: 9087415. DOI: 10.1002/ejp.1955. View

13.

Rohr S, Muller F, Jung F, Apfelbacher C, Seidler A, Riedel-Heller S . [Psychosocial Impact of Quarantine Measures During Serious Coronavirus Outbreaks: A Rapid Review]. Psychiatr Prax. 2020; 47(4):179-189. PMC: 7295307. DOI: 10.1055/a-1159-5562. View

14.

Kaiser U, Treede R, Sabatowski R . Multimodal pain therapy in chronic noncancer pain-gold standard or need for further clarification?. Pain. 2017; 158(10):1853-1859. DOI: 10.1097/j.pain.0000000000000902. View

15.

Munch U, Muller H, Deffner T, Schmude A, Kern M, Kiepke-Ziemes S . [Recommendations for the support of suffering, severely ill, dying or grieving persons in the corona pandemic from a palliative care perspective : Recommendations of the German Society for Palliative Medicine (DGP), the German Interdisciplinary...]. Schmerz. 2020; 34(4):303-313. PMC: 7265165. DOI: 10.1007/s00482-020-00483-9. View

16.

Moore B, White S, Washington R, Coenen N, Elixhauser A . Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data: The AHRQ Elixhauser Comorbidity Index. Med Care. 2017; 55(7):698-705. DOI: 10.1097/MLR.0000000000000735. View

17.

Musazzi U, Di Giorgio D, Minghetti P . New regulatory strategies to manage medicines shortages in Europe. Int J Pharm. 2020; 579:119171. PMC: 7125892. DOI: 10.1016/j.ijpharm.2020.119171. View

18.

Valladales-Restrepo L, Gaviria-Mendoza A, Machado-Duque M, Prado-Echeverry J, Cortes-Navarro J, Machado-Alba J . Chronic pain and continuity of analgesic treatment during the COVID-19 pandemic. Pain Pract. 2022; 23(4):359-367. DOI: 10.1111/papr.13197. View

19.

Giesche F, Streicher H, Maiwald M, Wagner P . [Inpatient multimodal pain therapy : Additive value of neuromuscular core stability exercises for chronic back pain]. Schmerz. 2016; 31(2):115-122. DOI: 10.1007/s00482-016-0178-6. View

20.

Lungen M, Lauterbach K . [Applicability of diagnostic related groups (DRG) in an international comparison]. Chirurg. 2000; 71(10):1288-95. DOI: 10.1007/s001040051218. View