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Background: The COVID-19 outbreak disrupted medical access for patients receiving chronic opioid therapy. This study investigated their prescription opioid dosages before and after the 2020 outbreak in Taiwan. Methods: A prospective questionnaire survey was conducted among registered outpatients receiving long-term opioids before July 2019 in Taiwan. The questionnaire included items from the Taiwanese Brief Pain Inventory and quality of life assessment. Follow-up surveys in outpatient departments through October 2020 were conducted to collect opioid prescription data. Results: After a mean of 531 days, the questionnaire responses of 103 of the initial 117 respondents were reviewed. Daily opioid doses decreased for 31 respondents (30.1%), remained roughly equivalent (defined as ±2.5%) for 27 (26.2%), and increased for 45 (43.7%) after the first wave of the pandemic. The use of strong opioids and nonopioid medications did not significantly differ among the three groups, but less fentanyl patch use was noted in the decreased-dose group after the outbreak. More than 70% of the patients received daily high-dose opioids (≥90 morphine milligram equivalents); moreover, 60% reported constipation. No deaths due to opioid overdose occurred during the study period. Conclusions: The COVID-19 outbreak in 2020 did not interrupt access to long-term opioid prescriptions for most registered patients with chronic pain in Taiwan. Less fentanyl patch use was observed in participants whose opioid dose was tapering.

Neuropathic pain (NeP) is often under-recognized, resulting in poor pain management. Therefore, a Taiwan version of the 10-item Douleur Neuropathique 4 (DN4-T) questionnaire was developed to identify patients with NeP from a mixed population of patients with pain.A prospective, nonrandomized, multicenter study was conducted in the Neurology Departments of four Taiwanese medical centers, to develop and validate the DN4-T questionnaire as a diagnostic tool for identifying patients with NeP. Patients who experienced pain for30 days were classified as having neuropathic, nociceptive, or mixed pain. Patients and physicians also completed the DN4-T questionnaire. The DN4-T scores were assessed with the optimal cut-off score calculated using a receiver operating characteristics (ROC) curve, and sensitivity and specificity assessed and reliability determined statistically using the Cronbach alpha coefficient.Of the 318 patients who completed the DN4-T questionnaire, 189 patients were diagnosed with NeP, seven patients with mixed pain, and 122 patients with nociceptive pain. For statistical analysis, patients were categorized as having NeP (those with neuropathic pain and mixed pain) or non-neuropathic (nociceptive) pain (non-NeP). Using an optimum DN4-T cut-off score of ≥3 (ranging from 0 to 10, determined by a maximum c index value of 1.54), DN4-T scores provided a sensitivity of 0.77 and specificity of 0.78, for predicting NeP. The predictive power of DN4-T in diagnosing NeP was 0.83 (as determined by area under the curve of the ROC curve), and was significantly predictive of pain type (p0.0001) with a concordance of 0.785, a discordance of 0.129, and a Cronbach alpha coefficient of 0.7, suggesting that the DN4-T questionnaire is a useful predictive tool for diagnosing NeP.The DN4-T questionnaire has been reliably translated into Mandarin Chinese and can be used as a diagnostic tool for NeP in conjunction with clinical evaluation.

Background: Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Methods: A cross-sectional multicenter survey was conducted on 170 officially registered outpatients receiving long-term opioid treatment in nine medical centers in Taiwan between October 2018 and July 2019. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. Results: Among 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests. Low serum total testosterone levels were detected in 34 (89.5%) women (&lt, 30 ng/dL) and 31 (50%) men (&lt, 300 ng/dL). Over 60% of women and men reported reduced sexual desire and function despite a nearly 50% reduction in pain intensity and daily function interference over the previous week after opioid treatment. Women generally had higher risks of a depression diagnosis (p = 0.034) and severe depressive symptoms (p = 0.003) and nonsignificantly lower opioid treatment duration (median 81 vs. 120 months) and morphine milligram equivalent (median 134 vs. 165 mg/day) compared with men. Conclusions: This survey demonstrated the high prevalence of depression diagnosis, low sex hormone levels, and reduced sexual function among Taiwanese patients with chronic noncancer pain receiving prolonged opioid therapy. Regular hypogonadal screenings are recommended for further management.

Background: Current postoperative pain management principles are primarily based on the type and extent of surgical interventions. This clinical study measured patient’s self-anticipated pain score before surgery and compared the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received general anesthesia for elective surgeries in E-Da Hospital (Taiwan) between June and August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, NRS 0-10) for their scheduled surgical intervention during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit (PACU) and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on the NRS were regarded as being unacceptable levels of anticipated or postoperative pain.Results: A total of 857 patients were included in the study. The final database included 49.2% males, and 73.7% of them have had previous operations. The mean anticipated pain score was 4.9±2.5 and 72.2% of the patients reported an anticipated NRS ³4 before their operations. Females anticipated significantly higher overall pain intensities than male patients (adjusted odds ratio 1.695, 95% confidence interval 1.252-2.295; P=0.001). Patients over 40 years of age reported significantly lower overall anticipated NRS scores (4.78±2.49 vs 5.36±2.50; P=0.003). Patients scheduled to receive more invasive surgical procedures were more likely to anticipate high pain intensity in the preoperative period (PConclusion: This observational study found that females, younger patients (£40 years), and patients scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and management of exaggerated pain expectation in these patients are necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

Background: Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain.Results: A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.532, 95% confidence interval 1.125-2.086; P=0.007). Patients who took regular benzodiazepine at bedtime (P=0.040) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (PConclusion: This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

Background: Neuropathic pain (NeP) is distinct from nociceptive pain and has different underlying mechanisms requiring specific treatment strategies. To aid diagnosis, self-administered screening questionnaires (such as ID Pain) have been developed to help physicians identify patients with NeP. The aim of this study was to develop and validate a translated ID Pain questionnaire for Taiwanese subjects (ID Pain-T). Methods: ID Pain, a 6-item self-administered questionnaire, score ranged from −1 to 5, was translated from English into Mandarin Chinese using local terms and back-translated by an expert panel. A prospective, non-randomized, multi-center study was performed in four medical centers in Taiwan. Patients aged over 18 years with pain other than headache for more than 30 days in either neurology or pain clinic were prospectively recruited. They completed the ID Pain-T questionnaire themselves. The study investigators, blinded to the subjects' ID Pain-T scores, examined subjects using a standardized clinical and neurological diagnostic procedure. The ID Pain-T questionnaire scores were verified and validated. Results: A total of 317 patients completed the study. Clinical diagnosis of NeP was given for 189 (60%) patients, mixed pain diagnosed in 7 (2%) patients, and nociceptive pain in 121 (38%) patients. The reliability and consistency of the ID Pain-T were acceptable, with a Cronbach's alpha value of 0.6. Statistical analysis of the ID Pain-T questionnaire calculated an optimal cut-off score of ≥2 for determining NeP with 77% sensitivity and 74% specificity for predicting NeP. Ordinary least squares regression analysis showed significant predictive accuracy of the ID Pain-T questionnaire for NeP (P

Objectives To compare the efficacy and safety between leucocyte-rich platelet-rich plasma (LR-PRP) and corticosteroid in fluoroscopically guided caudal epidural injection for patients with complex chronic lumbar spinal pain. Study design A prospective randomized controlled double-blinded study. Methods Fifty eligible patients with complex chronic degenerative spinal pain were randomly assigned with a 1:1 allocation ratio to receive caudal epidural injection of corticosteroid (triamcinolone acetonide, 60 mg) or LR-PRP (isolated from 60 mL autologous blood) under fluoroscopic guidance. Levels of low back pain, quality of life, and complications (or adverse effects) were evaluated at 1, 3, and 6 months after treatment. Pain levels and quality of life were assessed using the VAS and Short Form 36-Item Health Survey (SF-36), respectively. Results No significant difference was shown at baseline between the 2 groups. Compared with the pretreatment values, there were significant reductions in the VAS score in both groups. A significantly lower VAS score at 1-month follow-up was detected in patients who received corticosteroid injection. However, the scores were lower in the LR-PRP group at 3- and 6-month follow-up. SF-36 responses at 6 months showed significant improvement in all domains in the LR-PRP group. There were no complications or adverse effects related to treatment at 6-month follow-up in either group. Conclusions Both autologous LR-PRP and corticosteroid for caudal epidural injections under fluoroscopic guidance are equally safe and therapeutically effective in patients with complex chronic lumbar spinal pain. However, LR-PRP is superior to corticosteroid for a longer pain-relieving effect and improvement in quality of life.

Background Spinal cord ischemia (SCI) leads to variable degrees of neurologic deficit in patients undergoing major cardiovascular surgery. The effect of intraoperative neuroprotection against SCI and the subsequent ischemia-reperfusion injury is still limited. Because isoflurane is a commonly used anesthetic agent during major operation, and its neuroprotective and neurotoxicity effects have both been discussed, this study aimed to investigate the effect of isoflurane on the spinal cord's functional recovery in a rat model of cord ischemia. Methods Rats were randomly anesthetized by parenteral anesthetic (Zoletil) and isoflurane (0% and 1.5% v/v in oxygen). Cord ischemia was induced by cross-clamping of thoracic aorta at the level of T5, and cord perfusion was resumed after 25 minutes. The motor function was assessed independently up to 48 hours after reperfusion. Spinal cords were harvested and analyzed for molecular and histologic changes. Results The locomotor rating scale was significantly reduced in rats that received isoflurane treatment during SCI at 12 to 48 hours after reperfusion. Isoflurane enhanced the expression of heme oxygenase-1, glial fibrillary acidic protein, cleaved caspase-3, and Iba-1 in the spinal cord. Increased apoptotic cells and the presence of axonal damage were also observed in the histologic sections. Conclusion Our results demonstrate that the administration of inhaled isoflurane in spinal cord ischemia-reperfusion injury impairs the recovery of motor function. This response is associated with the neuronal apoptosis and degeneration. This study highlights the potential adverse effect of isoflurane on the functional recovery of ischemic spinal cord during major aortic surgery.

In recent years, privacy preserving data publishing attracted many attentions due to the concern of privacy breaches. The removing of personal identifiable information, such as the naive anonymization, is not sufficient. The privacy preserving data publishing technologies transform data into a form that sensitive personal information cannot be identified and retaining to the greatest extent possible usefulness of published data. In this work, we propose a novel strategy to deal with the sensitive items and quasi-identifier items separately. The proposed algorithm has at least the same or stronger privacy level for k-anonymity on transactional data, 1/ k. According to the numerical experiment results, our proposed strategy has better performance on running time, better data utility.

Background The development of warm–cold ischemia–reperfusion (IR) injury of the kidney grafts is inevitable during renal transplantation. However, there is currently no definite renoprotective strategy available in the protection of the graft tissue. In the present study, we compared the renal protection of preconditioning isoflurane with N-acetylcysteine (NAC) in a novel rat model of warm–cold renal IR injury. Materials and methods Adult Sprague–Dawley rats were randomly assigned to receive inhaled isoflurane (1.5% for 2 h), NAC (1 g/kg, intra-arterial injection) or placebo before the induction of brief warm ischemia (10 min) followed by cold ischemia (45 min) periods. Plasma levels of creatinine and tissue inflammatory reaction in the kidney were analyzed 72 h after reperfusion. Results Elevated plasma level of creatinine and urea indicated the development of acute renal injury secondary to IR injury. The creatinine levels were reduced in animals pretreated with inhaled isoflurane and NAC, and the level was more significantly decreased in the isoflurane-treated group. Preconditioning with volatile isoflurane also significantly suppressed the tissue myeloperoxidase activity and expression of the inducible nitric oxide synthase. Immunostaining confirmed that myeloperoxidase expression was most significantly attenuated in the glomerulus and peritubular capillaries of rats pre-exposed to isoflurane. Conclusions We present the first study demonstrating that the administration of volatile isoflurane before induction of experimental warm–cold renal IR injury provides preconditioning renoprotective effect, which is superior to the treatment with NAC. The beneficial renoprotective effect of isoflurane is most likely mediated by attenuation of proinflammatory reaction in the injured kidney.