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  1. Article ; Online: Simultaneous application of lidocaine and ketamine during ambulatory infusion therapy: a retrospective analysis.

    Striebel, Julia / Ruppen, Wilhelm / Schneider, Tobias

    Pain management

    2023  Volume 13, Issue 9, Page(s) 539–553

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Humans ; Ketamine/adverse effects ; Lidocaine/therapeutic use ; Retrospective Studies ; Treatment Outcome ; Infusions, Intravenous ; Chronic Pain/drug therapy
    Chemical Substances Ketamine (690G0D6V8H) ; Lidocaine (98PI200987)
    Language English
    Publishing date 2023-10-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 2617136-3
    ISSN 1758-1877 ; 1758-1869
    ISSN (online) 1758-1877
    ISSN 1758-1869
    DOI 10.2217/pmt-2023-0037
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  2. Article: [No title information]

    Ruppen, Wilhelm

    Therapeutische Umschau. Revue therapeutique

    2017  Volume 74, Issue 5, Page(s) 213–214

    Title translation Der chronische Schmerz und seine Facetten: faszinierend und erschreckend zugleich.
    Language German
    Publishing date 2017
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 82044-1
    ISSN 1664-2864 ; 0040-5930
    ISSN (online) 1664-2864
    ISSN 0040-5930
    DOI 10.1024/0040-5930/a000906
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  3. Article: Boosting open-label placebo effects in acute induced pain in healthy adults (BOLPAP-study): study protocol of a randomized controlled trial.

    de Leeuw, Matthijs / Laager, Mirjam / Gaab, Jens / Ruppen, Wilhelm / Schneider, Tobias

    Frontiers in medicine

    2024  Volume 11, Page(s) 1238878

    Abstract: Introduction: Pain is a highly prevalent symptom in the hospital setting, but treatment options remain limited. Harnessing the placebo effect in an ethical manner could provide a new possibility to reduce pain in clinical practice. So called open-label ... ...

    Abstract Introduction: Pain is a highly prevalent symptom in the hospital setting, but treatment options remain limited. Harnessing the placebo effect in an ethical manner could provide a new possibility to reduce pain in clinical practice. So called open-label placebos (OLP) have been shown to elicit significant effects in reducing acute pain. But, before implementation, more knowledge concerning the properties of OLPs is needed. This study aims to assess the duration of analgesic effects from OLP and to determine the possibility of boosting such effects.
    Methods and analysis: This is the protocol of an ongoing (first patient enrolled in March 2023) single-site randomized trial investigating OLPs in two parts (i.e., substudies). In both parts, pain will be induced in healthy adults using an intradermal electrical stimulation model. Participants in Part 1 will have two study visits: An interventional visit with one OLP injection accompanied by an evidence-based treatment rationale and a control visit with no treatment. For Part 2, participants will be randomized into three groups: (1) A fixed-time "Booster" group including one single repetition of the OLP injection at a fixed time point, (2) an on-demand "Booster" group including one single repetition of the OLP injection on-demand, and (3) a control group who will receive just one OLP injection. Differences in pain ratings over time (using the Numeric Rating Scale) will be analyzed with several two-sample
    Discussion: This study aims to further characterize the analgesic effects of OLPs. In doing so, it will provide valuable information needed for later implementation of OLPs in clinical practice, where they could play a role in multimodal analgesic concepts.
    Ethics and dissemination: The "Ethikkommission Nordwest- und Zentralschweiz" (BASEC 2023-00296) approved the study protocol. Results of the analysis will be submitted for publication in a peer-reviewed journal.
    Clinical trial registration: This study is registered at ClinicalTrials.gov (NCT05819476) and is listed in the Swiss National Registry at kofam.ch (SNCTP000005470).
    Language English
    Publishing date 2024-02-14
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2775999-4
    ISSN 2296-858X
    ISSN 2296-858X
    DOI 10.3389/fmed.2024.1238878
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  4. Article: Die Opioid Krise – was nun?

    Ruppen, Wilhelm / Schneider, Tobias

    Therapeutische Umschau. Revue therapeutique

    2020  Volume 77, Issue 1, Page(s) 3–9

    Abstract: Opioid crisis: What now? A pain specialist's point of ... ...

    Title translation Opioid crisis: What now? A pain specialist's point of view.
    Abstract Opioid crisis: What now? A pain specialist's point of view
    MeSH term(s) Analgesics, Opioid/therapeutic use ; Chronic Pain/drug therapy ; Humans ; Opioid Epidemic ; Opioid-Related Disorders/prevention & control ; Pain Management
    Chemical Substances Analgesics, Opioid
    Language German
    Publishing date 2020-05-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 82044-1
    ISSN 1664-2864 ; 0040-5930
    ISSN (online) 1664-2864
    ISSN 0040-5930
    DOI 10.1024/0040-5930/a001143
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  5. Article: Die Opioid Drise - was nun?

    Ruppen, Wilhelm / Schneider, Tobias

    Therapeutische Umschau

    2020  Volume 77, Issue 1, Page(s) 3–9

    Abstract: In akuten Schmerzsituationen können Opioide wirkungsvoll und zusammen mit Co-Analgetika indiziert sein. Dabei ist es besonders wichtig, jeden Patienten individuell bezüglich Indikation und Dosierung zu beurteilen. ...

    Abstract In akuten Schmerzsituationen können Opioide wirkungsvoll und zusammen mit Co-Analgetika indiziert sein. Dabei ist es besonders wichtig, jeden Patienten individuell bezüglich Indikation und Dosierung zu beurteilen.
    Keywords Opioide ; Schmerzen ; Therapie
    Language German
    Document type Article
    ZDB-ID 82044-1
    ISSN 1664-2864 ; 0040-5930
    ISSN (online) 1664-2864
    ISSN 0040-5930
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  6. Article ; Online: Analgesic benefit of metamizole and ibuprofen vs. either medication alone: a randomized clinical trial.

    Schneider, Tobias / Mauermann, Eckhard / Ilgenstein, Bernd / Jaquiery, Claude / Ruppen, Wilhelm

    Minerva anestesiologica

    2022  Volume 88, Issue 6, Page(s) 448–456

    Abstract: Background: Postoperative pain relief remains a key problem after surgery. Multimodal pain therapy has proven beneficial in alleviating pain to a certain extent. However, when combining non-opioids, the focus has been on NSAIDs and paracetamol, but ... ...

    Abstract Background: Postoperative pain relief remains a key problem after surgery. Multimodal pain therapy has proven beneficial in alleviating pain to a certain extent. However, when combining non-opioids, the focus has been on NSAIDs and paracetamol, but effects of combined use are only moderate. Metamizole could be a potent adjunct, due to its preclusion in several countries, data on its combined use are sparse, despite its common use in many countries. The aim of this study was to examine whether the combination of metamizole and ibuprofen is superior in relieving postoperative pain to either drug alone.
    Methods: For this randomized, placebo-controlled, cross-over study, 35 patients undergoing bilateral lower third molar extraction were randomized. Each patient received three applications of 1000 mg metamizole + 400 mg ibuprofen for surgery on one side and either 1000 mg metamizole + placebo or 400 mg ibuprofen + placebo on the other side. Pain ratings, rescue-medication (tramadol), and sleep were assessed for 18 hours.
    Results: The combined treatment of metamizole and ibuprofen showed lower mean pain scores over 12 hours than ibuprofen (2.4±1.3 vs 3.8±1.6; P=0.005). Further, combined treatment showed lower mean pain scores over 6 hours than ibuprofen (2.0±1.2 vs. 3.1±1.6; P=0.022) or metamizole alone (2.0±1.2 vs. 3.3±1.7; P=0.015). Consumption of rescue medication was lowest in the combination-group (25% vs. 46%-metamizole; 50%-ibuprofen). The trial was stopped prematurely as the COVID-pandemic halted elective surgeries.
    Conclusions: Combined use enables superior pain control compared to ibuprofen after molar extraction and tends to be superior to metamizole alone. The premature study-termination may overestimate this effect.
    MeSH term(s) Analgesics/therapeutic use ; COVID-19 ; Cross-Over Studies ; Dipyrone/therapeutic use ; Double-Blind Method ; Humans ; Ibuprofen/therapeutic use ; Pain, Postoperative/drug therapy
    Chemical Substances Analgesics ; Dipyrone (6429L0L52Y) ; Ibuprofen (WK2XYI10QM)
    Language English
    Publishing date 2022-04-13
    Publishing country Italy
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 123584-9
    ISSN 1827-1596 ; 0026-4717 ; 0375-9393
    ISSN (online) 1827-1596
    ISSN 0026-4717 ; 0375-9393
    DOI 10.23736/S0375-9393.22.16346-7
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  7. Article ; Online: A Contextual Analysis to Explore Barriers and Facilitators of Pain Management in Swiss Nursing Homes.

    Brunkert, Thekla / Simon, Michael / Ruppen, Wilhelm / Zúñiga, Franziska

    Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing

    2020  Volume 52, Issue 1, Page(s) 14–22

    Abstract: Purpose: As part of a contextual analysis, this study aimed to generate a comprehensive understanding of barriers and facilitators to pain management in nursing homes to identify potential leverage points for future implementation studies.: Design: ... ...

    Abstract Purpose: As part of a contextual analysis, this study aimed to generate a comprehensive understanding of barriers and facilitators to pain management in nursing homes to identify potential leverage points for future implementation studies.
    Design: An explanatory sequential mixed-methods study embedded in a cross-sectional study in 20 Swiss nursing homes (data collection: July-December 2016).
    Methods: Quantitative data were collected via care worker questionnaire surveys comprising 20 items assessing perceptions of barriers to pain management. Descriptive statistics were computed. In the subsequent qualitative strand we conducted four focus group discussions with care workers (registered nurses, licensed practical nurses, and nursing aides) using a knowledge-mapping approach. Findings of both strands were merged and mapped onto domains of the Capability, Opportunity, and Motivation determine Behavior (COM-B) system, a model for behavior, to identify determinants for behavior change.
    Findings: Data from 343 completed care worker surveys (response rate 67.3%) and four focus groups with care workers were analyzed. Items rated most problematic were as follows: lack of availability of nonpharmacological treatment (60.9%), lack of application of nonpharmacological treatment (53.6%), reluctance of residents to report pain (51.1%), and lack of time for a comprehensive pain assessment (50.5%). Focus groups partly corroborated quantitative findings and complemented them with facilitators, such as close collaboration with physicians and further barriers (e.g., organizational factors such as high turnover and a lack of established routines in pain management).
    Conclusions: Our approach using a behavioral model highlighted a need for implementation strategies that improve pain management knowledge and focus on motivational aspects to establish new routines and habits related to pain management among care workers.
    Clinical relevance: Our findings suggest that future approaches to improve pain management in nursing homes should go beyond provision of education and training. To establish new practices or adapt existing ones, a more complex approach (e.g., introduction of external or internal facilitators) is necessary to influence motivation and ultimately change behavior.
    MeSH term(s) Adult ; Attitude of Health Personnel ; Cross-Sectional Studies ; Female ; Focus Groups ; Health Personnel ; Humans ; Male ; Middle Aged ; Motivation ; Nursing Homes/organization & administration ; Pain ; Pain Management/methods ; Pain Measurement/methods ; Qualitative Research ; Surveys and Questionnaires ; Switzerland
    Language English
    Publishing date 2020-02-27
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2008214-9
    ISSN 1547-5069 ; 1527-6546
    ISSN (online) 1547-5069
    ISSN 1527-6546
    DOI 10.1111/jnu.12508
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  8. Article: [No title information]

    Schneider, Tobias / Ruppen, Wilhelm

    Therapeutische Umschau. Revue therapeutique

    2017  Volume 74, Issue 5, Page(s) 277–283

    Title translation Opiate – Fluch oder Segen? – Eine aktuelle Übersicht.
    Language German
    Publishing date 2017
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 82044-1
    ISSN 1664-2864 ; 0040-5930
    ISSN (online) 1664-2864
    ISSN 0040-5930
    DOI 10.1024/0040-5930/a000915
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  9. Article ; Online: Association between intra-operative fentanyl dosing and postoperative nausea/vomiting and pain: A prospective cohort study.

    Mauermann, Eckhard / Clamer, Damian / Ruppen, Wilhelm / Bandschapp, Oliver

    European journal of anaesthesiology

    2019  Volume 36, Issue 11, Page(s) 871–880

    Abstract: Background: Postoperative nausea and/or vomiting (PONV) is one of the anaesthesia-related effects most dreaded by patients and may delay hospital discharge. Although scores and risk factors are established, many were developed before contemporary ... ...

    Abstract Background: Postoperative nausea and/or vomiting (PONV) is one of the anaesthesia-related effects most dreaded by patients and may delay hospital discharge. Although scores and risk factors are established, many were developed before contemporary anaesthesia regimens and without focussing on modifiable anaesthesia-related variables.
    Objective: To examine whether, in association with a contemporary anaesthesia regimen, there is an association between intra-operative fentanyl dose and PONV, and, second, postoperative pain within the first 24 h.
    Design: Prospective, observational cohort.
    Setting: Single-centre university hospital.
    Patients: Inclusion criteria were opioid-naive patients without chronic pain and with a simplified Apfel score at least 2 undergoing abdominal, gynaecological or otorhinolaryngological inpatient surgery.
    Intervention: None.
    Main outcome measure: With logistic regression, we examined three models of increasing complexity exploring the relationship between PONV and fentanyl dosing: Model 1, simplified Apfel score + intra-operative fentanyl; Model 2, Model 1 + pre-emptive antiemetic prophylaxis; Model 3, Model 2 + postoperative morphine. Model 1 was the primary analysis. Second, we explored whether or not postoperative pain scores were associated with intra-operative fentanyl dosing.
    Results: From the 363 patients, 163 (45%) experienced PONV, despite the use of total intravenous anaesthesia with propofol in more than 80% of the cohort, and some 66% of patients receiving additional antiemetic agents. After adjusting for the simplified Apfel score, higher intra-operative fentanyl dose was associated with PONV: odds ratio per μg h, 1.006 [95% confidence interval (CI) 1.002 to 1.010]. Including intra-operative fentanyl in the simplified Apfel score also increased the area under the receiver operator characteristics curve [0.601 (95% CI 0.555 to 0.662) vs. 0.651 (95% CI 0.594 to 0.707); P = 0.016]. Finally, a higher intra-operative fentanyl dose was associated with higher 24 h pain scores (P = 0.001) and a trend towards higher 24 h morphine requirements (P = 0.055).
    Conclusion: Even when using propofol and antiemetic agents, PONV within the first 24 h remained higher than expected. Intra-operative fentanyl, a modifiable risk factor, is associated with the incidence of PONV and postoperative pain.
    Trial registration: ClinicalTrials.gov, NCT03201315.
    MeSH term(s) Adult ; Aged ; Analgesics, Opioid/administration & dosage ; Anesthetics, Intravenous/administration & dosage ; Anesthetics, Intravenous/adverse effects ; Antiemetics/administration & dosage ; Cohort Studies ; Dose-Response Relationship, Drug ; Female ; Fentanyl/administration & dosage ; Fentanyl/adverse effects ; Humans ; Male ; Middle Aged ; Morphine/administration & dosage ; Pain, Postoperative/epidemiology ; Pain, Postoperative/prevention & control ; Postoperative Nausea and Vomiting/epidemiology ; Postoperative Nausea and Vomiting/etiology ; Propofol/administration & dosage ; Prospective Studies ; Risk Factors
    Chemical Substances Analgesics, Opioid ; Anesthetics, Intravenous ; Antiemetics ; Morphine (76I7G6D29C) ; Fentanyl (UF599785JZ) ; Propofol (YI7VU623SF)
    Language English
    Publishing date 2019-09-26
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001081
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  10. Article ; Online: Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness-Implementation Study.

    Brunkert, Thekla / Simon, Michael / Ruppen, Wilhelm / Zúñiga, Franziska

    Journal of the American Geriatrics Society

    2019  Volume 67, Issue 12, Page(s) 2574–2580

    Abstract: Objectives: To evaluate the effectiveness and implementation of a multilevel pain management intervention in nursing homes (NHs) comprising a pain management guideline, care worker training, and pain champions.: Design: An implementation science ... ...

    Abstract Objectives: To evaluate the effectiveness and implementation of a multilevel pain management intervention in nursing homes (NHs) comprising a pain management guideline, care worker training, and pain champions.
    Design: An implementation science pilot study using a quasi-experimental effectiveness-implementation (hybrid II) design.
    Setting: Four NHs in Switzerland.
    Participants: All consenting long-term residents aged 65 years and older with pain at baseline (N = 62) and all registered and licensed practical nurses (N = 61).
    Intervention: Implementation of a contextually adapted pain management guideline, interactive training workshops for all care workers, and specifically trained pain champions.
    Measurements: Interference from pain, worst and average pain intensity over the previous 24 hours; proxy ratings of pain with the Pain Assessment in Advanced Dementia scale; and care workers' appraisal of the guideline's reach, acceptability, and adoption.
    Results: Pain-related outcomes improved for self-reporting residents (n = 43) and residents with proxy rating (n = 19). Significant improvements of average pain from baseline to T1 (P = .006), and in worst pain from baseline to T1 (P = .003) and T2 (P = .004). No significant changes in interference from pain (P = .18). With regard to the implementation efforts, about 76% of care workers indicated they were familiar with the guideline; 70.4% agreed that the guideline is practical and matches their ideas of good pain assessment (75.9%) and treatment (79.7%).
    Conclusion: Implementation of a multilevel pain management intervention did significantly improve average and worst pain intensity in NH residents. However, to effect clinical meaningful changes in interference from pain, a more comprehensive approach involving other disciplines may be necessary. J Am Geriatr Soc 67:2574-2580, 2019.
    MeSH term(s) Aged ; Aged, 80 and over ; Female ; Health Personnel/education ; Health Personnel/psychology ; Health Plan Implementation ; Humans ; Male ; Nursing Homes ; Pain Management ; Pain Measurement/statistics & numerical data ; Pilot Projects ; Switzerland
    Language English
    Publishing date 2019-08-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.16148
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