A Delphi Consensus Approach for the Management of Chronic Pain during and after the COVID-19 Era

Abstract

Due to a lack of published evidence on the topic, a modified Delphi approach was used to develop recommendations useful for chronic pain management during and after the COVID-19 pandemic. Focusing on the available literature and personal clinical expertise, an Italian board of nine professionals from different disciplines identified four main topics: prevention of chronic pain, treatment of chronic pain, consequences of inadequate treatment, and perspectives. They elaborated a semi-structured questionnaire. A multidisciplinary panel of experts in the field of pain management was requested to comment on the statements. Based on the answers provided, a structured questionnaire was prepared (Round 1). It included 21 statements divided into three categories (organizational issues; diagnosis and therapies; telemedicine and future perspectives). A five-point Likert scale was adopted. The threshold for consensus was set at a minimum of 70% of the number of respondents (level of agreement ≥ 4, Agree or Strongly Agree). A final questionnaire with rephrasing of the statements that did not reach the consensus threshold was elaborated (Round 2). A total of 29 clinicians were included in the panel. Twenty clinicians (69%) responded in both the first and second round. After two rounds, consensus (≥70%) was achieved in 20 out of 21 statements. The lack of consensus was recorded for the statement regarding the management of post-COVID pain (55%; Median 4; IQR 2.3). Another statement on telemedicine reached the threshold in the first round (70%), but the value was not confirmed in Round 2 (65%; Median 4; IQR 2). Most of the proposed items reached consensus, suggesting the need to make organizational changes, the structuring of careful diagnostic and therapeutic pathways, and the application of new technologies in pain medicine. Long-COVID-19 care is an issue that needs further research. Remote assistance for chronic pain must be regulated.

Strengths and Weaknesses of Cancer Pain Management in Italy: Findings from a Nationwide SIAARTI Survey

“…This study is a part of an ambitious project of the SIAARTI which aims to bridging the gaps in pain medicine in the Italian context. A previous study by the SIAARTI explored non-cancer pain [ 13 ], and selected members of the Society addressed the issue of pain management during the COVID-19 pandemic through a Delphi methodology [ 14 ].…”

Satisfaction with Telemedicine for Cancer Pain Management: A Model of Care and Cross-Sectional Patient Satisfaction Study

“…The need to carry out the first visit “preferably” in person is foreseen by the recent Italian legislation on telemedicine [ 3 ]. Nevertheless, in the absence of well-defined recommendations, we referred to our previous Delphi investigation [ 15 ] and to a recent nationwide survey on cancer pain management [ 16 ]. Notably, almost all the experts on the Delphi panel affirmed that, in such an important problem, preliminary face-to-face access should be required for clinical and regulatory purposes [ 15 ].…”

“…Nevertheless, in the absence of well-defined recommendations, we referred to our previous Delphi investigation [ 15 ] and to a recent nationwide survey on cancer pain management [ 16 ]. Notably, almost all the experts on the Delphi panel affirmed that, in such an important problem, preliminary face-to-face access should be required for clinical and regulatory purposes [ 15 ]. The same suggestion was collected in the subsequent survey [ 16 ].…”

The Effective Management of Fever in Pediatrics and Insights on Remote Management: Experts' Consensus Using a Delphi Approach

“…Currently, there is no gold standard for sample size for Delphi panels. In published studies, the size can range from 10 to 1,000 participants ( 19 ), and many Delphi panels have been conducted on fewer than 15 participants ( 20 ).…”