Comparison of the Efficacy Between Intradiscal Gelified Ethanol (Discogel) Injection and Intradiscal Combination of Pulsed Radiofrequency and Gelified Ethanol (Discogel) Injection for Chronic Discogenic Low Back Pain Treatment. A Randomized Double-Blind Clinical Study.

OBJECTIVE: The aim of the present study was to compare two new techniques, intradiscal gelified ethanol injection (Discogel) and the combination of intradiscal pulsed radiofrequency and gelified ethanol injection (PRF+Discogel), regarding their efficacy in discogenic low back pain treatment. DESIGN: Randomized, double-blind, clinical study. METHODS: The final sample was randomized into group A (N = 18, D) and group B (N = 18, PRF+D). During the procedure, four patients from group B were excluded from the study. Groups A and B were assessed regarding the pain score (VAS 0-10), before the interventional procedures, and one, three, six, and 12 months after. Secondary objectives of the study were to compare the two groups regarding the results of the Roland Morris Disability Questionnaire, Lanss score, and quality of life score (EQ-5D). RESULTS: There was no significant evidence for an overall difference in pain score between the two groups (analysis of variance, F = 3.24, df = 1, P = 0.084), except for the sixth and 12th months, when group B presented a statistically important difference compared with group A (Wilcoxon test). Group B appeared to be more effective, with a statistically significant difference, compared with group A regarding the secondary objectives of the study. CONCLUSIONS: After rigorous and comprehensive assessment by an independent observer, both Discogel alone and Discogel in combination with pulsed radiofrequency produced tangible improvements in pain, function, quality of life, and consumption of analgesics, which were sustained at 12 months.

CYP2D6 Basic Genotyping of Patients with Chronic Pain Receiving Tramadol or Codeine. A Study in a Greek Cohort.

OBJECTIVE: To assess CYP2D6 genotype prevalence in chronic pain patients treated with tramadol or codeine. DESIGN: Prospective cohort study. SETTING: General hospital, pain management unit. SUBJECTS: Patients with chronic pain, treated with codeine or tramadol. METHODS: Patients' pain was assessed at baseline (numeric rating scale [NRS]; 0-10). Prescription of codeine or tramadol was selected randomly. The assessment of patients' response to the drug in terms of pain relief and adverse effects was performed after 24 hours. Reduction of pain intensity of >50% or an NRS <4 was considered a positive response. Patients' blood samples were collected during the first visit. Genotyping for the common variants CYP2D6 *2, *3, *4, *5, *6, *9, *10, *14, and *17 was performed, and alleles not carrying any polymorphic allele were classified as CYP2D6*1 (wild-type [wt]). RESULTS: Seventy-six consecutive patients were studied (20 males, 56 females), aged 21-85 years. Thirty-four received tramadol and 42 codeine. The main genotypes of CYP2D6 identified were the wt/wt (35.5%), the *4/wt (17.1%), and the *6/wt (10.5%). Adverse effects were common, especially in carriers of *9/*9, *5/*5, *5/*4, and *10/*10, as well as in variants including the 4 allele (*4/*1 [38.4%] and *4/*4 [42.8%]). CONCLUSIONS: Genotyping can facilitate personalized pain management with opioids, as specific alleles are related to decreased efficacy and adverse effects.

Lessons learned from first case of Cesarean delivery in a COVID-19 positive parturient in Greek region.

We report the successful anesthetic management of a 24-year-old patient, with an active COVID-19 viral infection, scheduled for elective Cesarean section at 40th week of pregnancy. This was the first case in Greek region, and we report and discuss the difficulties and safety issues regarding a COVID-19 positive patient during an elective cesarean delivery. Regional anesthesia with full protective equipment for health personnel involved, along with careful planning and adherence to guidelines achieved safe completion of the operation.

A Systematic Review of Sexuality and Depression of Cervical Cancer Patients.

Objectives: The goal of this article is to investigate the correlation between sexuality and depression of cervical cancer (CC) patients. Methods: A bibliographical search was carried out in the databases CINAHL, PubMed, and Cochrane Library with the following terms in English for the years 2006 to 2017: sexuality, sexual function, sexual dysfunction, sexual problems, mood, depression, emotional distress, cervical cancer. Results: Fourteen studies were included. They present heterogeneity in the stage of the disease, the selected treatments, and their sample. From the studies, only 7 are evaluated as good methodologically. Sexual dysfunction and depression of CC patients persist for many years after treatments. The younger women, those who underwent radiotherapy, and those who had chronic fatigue, as an aftereffect of treatments, had increased depression. Women that underwent surgery and adjuvant therapy experienced the highest rates of depressive symptoms. There is a positive relationship between sexuality and depression in patients with CC. Conclusions: Sexuality and depression οf women with CC are affected by their therapies to a significant extent. There is a positive correlation between the two variables. The existing methodologically good studies are scarce, and for this reason the results cannot be generalized in all CC patients.

Is there an interaction between dexamethasone and sugammadex in real clinical conditions? A randomized controlled trial in patients undergoing laparoscopic cholecystectomy.

BACKGROUND AND AIMS: There is evidence that sugammadex can encapsulate other substances except rocuronium, such as dexamethasone. The aim of this study was to investigate the possible clinical interaction between dexamethasone and sugammadex, in patients undergoing laparoscopic cholecystectomy. MATERIAL AND METHODS: This was a randomized, double-blind controlled trial, performed in patients aged 18-75 years, American Society of Anesthesiologists (ASA) I-III, who underwent a laparoscopic cholecystectomy under deep neuromuscular blockade with rocuronium. Patients received 5 mg of dexamethasone or placebo (N/S 0.9%) during induction of anesthesia. Sugammadex 4 mg/kg was administered at the end of surgery at post-tetanic count 1-2. The outcome measures assessed were the time from sugammadex administration until train-of-four (TOF) 0.9, and until patient's extubation, postoperative pain (measured by numeric rating scale 0-10), nausea and vomiting, as well as rescue analgesics and antiemetics required during the first 24 hours postoperatively. The total dose of rocuronium required in both groups was also recorded. RESULTS: Overall, 44 patients were studied. No difference was detected regarding the demographic and surgical characteristics of patients. The time from sugammadex administration until TOF 0.9 and until patients' extubation did not differ significantly between the groups (P = 0.21 and 0.17). Operating conditions, pain scores, nausea/vomiting, and rescue analgesics and antiemetics during the first 24 hours postoperatively, did not differ between the groups. The total dose of rocuronium, however, was significantly more in patients who received dexamethasone (P = 0.01). CONCLUSION: No significant clinical interaction was revealed between dexamethasone and sugammadex during reversal of deep neuromuscular blockade in patients undergoing laparoscopic cholecystectomy.

A multicenter survey on the use of neuromuscular blockade in Greece. Does the real-world clinical practice indicate the necessity of guidelines?

BACKGROUND AND AIMS: The aim of this study was to investigate the current status of clinical practice regarding neuromuscular blocking drugs and their antagonists in Greece. MATERIAL AND METHODS: This is a multicenter survey, including a questionnaire based on previous studies, which was translated and modified by a Task Force of the Hellenic Society of Anaesthesiology. It was completed on a web-based database after invitation via e-mail and was left online for a period of 2 months. RESULTS: A total of 1,100 questionnaires were sent, with a response rate of 7.9%. 13.7% stated that they do not use neuromuscular monitoring. Rocuronium was most commonly used for intubation ["often" stated by 19 (21.8%) and "very often" by 62 (71.2%)], followed by cis-atracurium, atracurium, and succinylcholine. Neostigmine and sugammadex were both used, with reversal not always administered by 23 (26.4%). Both agents were mostly used at fixed doses and not calculated based on TOF monitoring or body weight. Sugammadex was preferred in special patient groups and in operations of short duration. Reversal was most often administered based on clinical signs of neuromuscular recovery rather than objective monitoring. A significant percentage of respondents used an inadequate TOF ratio for extubation [37 (43.2%) used a TOF ratio <90%]. The reported incidence of observed residual neuromuscular blockade (RNMB) was 44.8%. CONCLUSION: Great variability was observed in Greek clinical practice regarding the use of neuromuscular blockade, which indicates serious issues that must be addressed. The needs for educating anesthesia providers and developing official guidelines are obvious in order to improve patient outcomes.

Factors associated with the presence of postoperative headache in elective surgery patients: a prospective single center cohort study.

PURPOSE: Headache is an important cause of minor postoperative morbidity. In this study we evaluated the association of anesthesia and surgery with the occurrence of postoperative headache in elective surgery patients. METHODS: After obtaining ethical approval, 446 patients were enrolled in this prospective, single-centre cohort study. Participants were interviewed preoperatively, and for five days postoperatively, regarding the appearance of headache, while demographics, lifestyle, type of anesthesia and surgery, the anesthetic drugs administered and intraoperative adverse effects were recorded. Multiple logistic regression analysis was conducted in order to identify independent factors associated with postoperative headache, both in the total sample and in patients without previous history of headache. RESULTS: The observed overall frequency of postoperative headache was 28.3% (N = 126) in the total sample. In patients with previous history of headache, the frequency of postoperative headache was 41% (N = 89), while in those with no history the frequency of postoperative headache was 16.2% (N = 37). Female gender [p = 0.024; odds ratio (OR) = 2.1], sevoflurane administration (p < 0.001; OR = 3.66), intraoperative hypotension (p = 0.008; OR = 2.12) and smoking (p = 0.006; OR = 1.74) were independently associated with postoperative headache. In patients without previous history, female gender (p = 0.005; OR = 4.77), sevoflurane administration (p = 0.001; OR = 6.9), intraoperative hypotension (p = 0.006; OR = 6.7) and caffeine consumption (p = 0.041; OR = 5.28) presented greater likelihood for postoperative headache, while smoking revealed no association. CONCLUSION: Female gender, sevoflurane, smoking and intraoperative hypotension were documented as independent risk factors for postoperative headache. In patients with no previous history of headache, caffeine consumption was an additional independent factor for postoperative headache, while smoking revealed no association.

N-acetylcysteine ameliorates liver injury in a rat model of intestinal ischemia reperfusion.

BACKGROUND: N-acetylcysteine (NAC) is an antioxidant with direct and indirect antioxidant actions used in the clinical setting. Oxidative stress is known to play a pivotal role in the intestinal ischemia reperfusion (IIR). Therefore, we studied the effect of different pretreatment regimens with NAC on the IIR injury in rats. MATERIALS AND METHODS: Thirty-five male Wistar rats were randomly assigned to five groups. In group sham, only laparotomy was performed. Group control underwent IIR without NAC. In the other groups, NAC was administered intraperitoneally with different regimens: 150 mg/kg before ischemia (NAC 150), 300 mg/kg before ischemia (NAC 300), and 150 mg/kg before ischemia plus 150 mg/kg 5 min before reperfusion (NAC 150 + 150). Measurements in tissues and blood were conducted at 4 h of reperfusion following exsanguination. RESULTS: Histological score of the liver was significantly improved in NAC 300 compared with control (1.7 ± 0.5 versus 2.9 ± 1.1, respectively, P = 0.05). In addition, NAC treatment significantly reduced liver transaminases in all groups of treatment, mostly in group NAC 300. Plasma malondialdehyde levels were lower with NAC treatment, although not statistically significant. Lung glutathione peroxidase was significantly increased in group NAC 300 (P = 0.04), while the other oxidation biomarkers showed no significant differences. CONCLUSIONS: NAC exerts a significant protective role in liver injury following IIR, which seems to be independent of an intestinal protective effect. Additional administration of NAC before reperfusion was of no further benefit. The most effective regimen among the compared regimens was that of 300 mg/kg before ischemia.

Translation, Cultural Adaptation, and Validation of Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Self-Complete Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) Questionnaires into the Greek Language.

BACKGROUND: The LANSS and S-LANSS questionnaires represent two widely accepted and validated instruments used to assist the identification of neuropathic pain worldwide. OBJECTIVE: The aim of this study was to translate, culturally adapt, and validate the LANSS and S-LANSS questionnaires into the Greek language. METHODS: Forward and backward translations of both questionnaires were performed from the English to Greek language. The final versions were assessed by a committee of clinical experts, and they were then pilot-tested in 20 patients with chronic pain. Both questionnaires were validated in 200 patients with chronic pain (100 patients for each questionnaire), using as the "gold standard" the diagnosis of a clinical expert in pain management. Sensitivity and specificity of questionnaires were assessed, as well as the internal consistency (using Cronbach's alpha coefficient) and correlation with the "gold standard" diagnosis (using Pearson correlation coefficient). RESULTS: Sensitivity and specificity of the LANSS questionnaire were calculated to be 82.76% and 95.24%, while for the S-LANSS 86.21% and 95.24%, respectively. Positive predictive value for neuropathic pain was 96% for the LANSS and 96.15% for the S-LANSS. Cronbach's alpha was revealed to be acceptable for both questionnaires (0.65 for LANSS and 0.67 for the S-LANSS), while a significant correlation was observed compared to the "gold standard" diagnosis (rLANSS   = 0.79 και tSLANSS   = 0.77, respectively, P = 0.01). CONCLUSIONS: The LANSS and the S-LANSS diagnostic tools have been translated and validated into the Greek language and can be adequately used to assist the identification of neuropathic pain in everyday clinical practice.

A Comparative Study of the Impact of the Covid-19 Pandemic on Mental Health, Healthcare Access, and Pain Levels of Patients with Chronic Pain from Spring 2020 to Spring 2021.

Purpose: The short-term impact of the Covid-19 pandemic on patients with chronic pain has been under the microscope since the beginning of the pandemic. This time-lag design study aimed to track changes in pain levels, access to care, mental health, and well-being of Greek chronic pain patients within the first year of the Covid-19 pandemic. Patients and Methods: 101 and 100 chronic pain patients were contacted during the Spring of 2020 and 2021, respectively. A customized questionnaire was used to evaluate the perceived impact of the pandemic on pain levels and healthcare access. Psychological responses, personality characteristics, and overall well-being were evaluated using the Depression, Anxiety, and Stress Scale (DASS-42), the Ten-Item Personality Index (TIPI) and the Personal Wellbeing Index (PWI). Results: The perceived effect of the pandemic and the Covid-related restrictions affected significantly access to healthcare, pain levels and quality of life. Differences were detected in the PWI sub-scales regarding Personal Safety, Sense of Community-Connectedness, Future Security, Spirituality-Religiousness, and General Life Satisfaction. Marital status, parenthood, education and place of residence were associated with differences in pain levels, emotional and psychological responses. Conclusion: Changes in chronic pain levels, emotional responses, and overall well-being took place throughout the year. Also, an evident shift took place in the care delivery system. Both tendencies disclose an ongoing adaptation process of chronic pain patients and healthcare services that needs further monitoring.

Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia.

PURPOSE: Epidural and intravenous patient-controlled analgesia (PCA) are established methods for pain relief after total hip arthroplasty (THA). Periarticular infiltration is an alternative method that is gaining ground due to its simplicity and safety. Our study aims to assess the efficacy of periarticular infiltration in pain relief after THA. METHODS: Sixty-three patients undergoing THA under spinal anaesthesia were randomly assigned to receive postoperative analgesia with continuous epidural infusion with ropivacaine (epidural group), intraoperative periarticular infiltration with ropivacaine, clonidine, morphine, epinephrine and corticosteroids (infiltration group) or PCA with morphine (PCA group). PCA morphine provided rescue analgesia in all groups. We recorded morphine consumption, visual analog scale (VAS) scores at rest and movement, blood loss from wound drainage, mean arterial pressure (MAP) and adverse effects at 1, 6, 12, 24 h postoperatively. RESULTS: Morphine consumption at all time points, VAS scores at rest, 6, 12 and 24 h and at movement, 6 and 12 h postoperatively were lower in infiltration group compared to PCA group (p < 0.05), but did not differ between infiltration and epidural group. There was no difference in adverse events in all groups. At 24 h, MAP was higher in the PCA group (p < 0.05) and blood loss was lower in the infiltration group (p < 0.05). CONCLUSIONS: In our study periarticular infiltration was clearly superior to PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.

Herpes Zoster Reactivation After COVID-19 Vaccine with Focus on Postherpetic Neuralgia Prevention: A Case Series.

Introduction: Herpes zoster (HZ), also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV). There have been several reports of HZ associated with COVID-19 vaccination, and the outcomes have varied. Case Presentation: In this report, we present 4 cases of patients who experienced HZ reactivation after receiving a COVID-19 vaccine. These individuals sought treatment at a pain management center due to postherpetic neuralgia (PHN). While HZ itself can be treated, post-herpetic neuralgia can persist for years, significantly impacting the patients' quality of life. Therefore, early recognition of this adverse effect is crucial, and patients should receive specialized analgesic support promptly to prevent the development of chronic pain.

Analgesia with remifentanil versus anesthesia with propofol-alfentanil for transvaginal oocyte retrieval: a randomized trial on their impact on in vitro fertilization outcome.

BACKGROUND: The aim of this study was to compare the effects of analgesia with remifentanil versus anesthesia with propofol and alfentanil on in vitro fertilization outcome. METHODS: The study included 58 women undergoing ultrasound transvaginal oocyte retrieval, who were randomized to receive either analgesia with remifentanil (n = 29) or anesthesia with propofol and alfentanil (n = 29). The subjects were compared for number of collected and matured oocytes, fertilization rate, cleavage rate, implantation rate, pregnancy rate, and embryo quality. Anesthesia related side effects and both patient and gynecologist satisfaction were recorded. RESULTS: There were no significant differences in collected oocytes, matured oocytes, fertilization and cleavage rate, embryo quality and implantation and pregnancy rate between the two groups. There was no difference regarding side effects and both patient and gynecologist satisfaction. CONCLUSIONS: Analgesia with remifentanil compared with anesthesia with propofol and alfentanil, provided equally effective and safe anesthesia during ultrasound transvaginal oocyte retrieval.

Opioid-Free Anesthesia and Postoperative Cognitive Dysfunction After Minor Urological Surgery: A Case Series Study.

Background: Postoperative cognitive dysfunction (POCD) is a complication that mainly occurs in adult patients and refers to a new-onset decline in cognitive function after anesthesia and surgery. The literature lacks evidence regarding opioid-free anesthesia and its impact on mental function postoperatively. Objectives: The effect of opioid-free anesthesia on POCD following urological surgery has not been previously reported. Accordingly, we present a case series of 15 adult patients undergoing transurethral urological surgery under general anesthesia using an opioid-free protocol with dexmedetomidine, ketamine, and lidocaine. Methods: Patients that underwent simple transurethral elective urological procedures under general opioid-free anesthesia were included. This case series is part of a prospective clinical study regarding opioid-free anesthesia and served as a pilot sample. The mini-mental state examination (MMSE) test, performed preoperatively and 12 hours postoperatively, was applied to assess POCD. Results: Fifteen patients with a mean age of 68 years old were included in the study. The opioid-free protocol was associated with non-statistically significant changes of the MMSE test after minor urological procedures. Conclusions: In our study, an opioid-free protocol of general anesthesia, using a mixture of dexmedetomidine, ketamine, and lidocaine, did not seem to have a negative impact on postoperative cognitive function in patients undergoing transurethral urological surgery. Further studies specifically designed to identify this effect are certainly required to further prove such an effect.

Relationship between breakthrough cancer pain, background cancer pain and analgesic treatment - case series and review of the literature.

The assessment and treatment of breakthrough cancer pain (BTcP) remain a major challenge in medicine due to its high impact on several aspects of health-related quality of life. BTcP should be carefully monitored in all cancer care settings by a multidisciplinary team to provide an appropriate and personalized clinical approach. The aim of this paper is to provide healthcare professionals involved in cancer pain management with a review of the relevant literature on the relationship between background cancer pain and BTcP which, by definition, occurs despite adequately controlled background cancer pain. The clinical cases presented contribute to a better understanding of this issue and underline its impact in daily clinical practice. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pain.

Effectiveness of a hybrid arts-based Cognitive Behavioral Therapy intervention for patients with non-malignant chronic pain.

Chronic Pain (CP) is defined as pain that persists or recurs for more than 3 to 6 months and may be conceived as a health condition in its own right. CP is a frequent condition, affecting an estimated 20% of people worldwide and requires special treatment and care. CP can contribute to depression, anxiety, sleep disturbances, poor quality of life and increased health care costs. Psychosocial approaches based on a cognitive conceptualization of pain can provide a solid foundation for research and clinical work. The development of a 10 week-session group treatment was based on key principles from the literature on Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) and Creative Arts Therapy, integrated with advances in research on CP management framework. The aim of this study is to evaluate a CBT-CP arts-based group intervention for patients with non-malignant CP addressing the biopsychosocial factors that influence pain perception. A total of 100 University Pain Management Unit outpatients participated, 50 in the intervention group and 50 in the control group (treatment as usual). In analyses of the pretest-posttest research design intervention including all participants, treatment gains were observed in almost all domains examined: severity of pain measured by the Brief Pain Inventory, conceptualization of mental pain measured by the Orbach and Mikulincer Mental Pain Scale, tolerance for psychological pain measured by the Tolerance for Mental Pain Scale, anxiety and depression levels measured by the Hospital Anxiety and Depression Scale, and quality of life measured by the WHO Quality of Life-BREF Questionnaire. The participants' mean age was 52.3 years and most were female (84%). Findings suggest that postprogram, there was significant reduction in pain intensity (p<0.001), depressive symptoms (p<0.001), confusion about pain (p=0.037), and improvement of emotional distress tolerance (p=0.012) and global health-related quality of life (p<0.001) in the intervention group. Beneficial effects can be expected from the implementation of an integrated CP intervention (including: creative and CBT techniques) reappraising some of the coping responses defined as adaptive within current psychosocial non-malignant CP regimens.

Rocuronium antagonized by sugammadex for series of electroconvulsive therapy (ECT) in a patient with pseudocholinesterase deficiency.

We report the anesthetic management of a patient with catatonic schizophrenia and pseudocholinesterase deficiency, using the nondepolarizing neuromuscular blocking drug, rocuronium, reversed by its specific reversal agent, sugammadex, for a series of electroconvulsive therapy sessions. Rocuronium and sugammadex were used every 48 hours for 8 consecutive times and proved to be an effective and safe combination in a situation where succinylcholine was contraindicated.

Pulsed Radiofrequency of the Occipital Nerves: Results of a Standardized Protocol on Chronic Headache Management.

BACKGROUND: Pulsed radiofrequency (PRF) of the occipital nerves has neuromodulative properties and is used for chronic pain management. However, its role in various types of chronic headaches has not been adequately investigated so far. OBJECTIVES: Τhis was an observational, open-label, prospective study aiming to assess the efficacy of PRF of occipital nerves on various types of chronic headache management. METHODS: Patients with chronic headaches followed up at the pain management unit were scheduled for PRF of both occipital nerves after a positive diagnostic nerve block. PRF was applied following a standardized protocol at 42°C, and the number of headaches per month was assessed as a primary outcome at baseline (before treatment), as well as after 1, 3, and 6 months. Pain intensity during headache crises was recorded using the Numeric Rating Scale (NRS, 0 - 10). RESULTS: Fifty-seven patients suffering from chronic migraines, cluster headaches, tension-type headaches, and occipital neuralgia were studied. PRF significantly improved the number of headache episodes per month, as well as the pain intensity of the crises. The median number of headache episodes per month was significantly reduced in patients with migraine, from 14.5 to 4 after 1 month, and to 6.5 after 6 months. The same was seen for patients with clusters, who were also improved. A statistically significant reduction in NRS values over time was seen for all types of headaches. CONCLUSIONS: PRF of the occipital nerves can lead to a reduction of the number of headache episodes per month, improving the intensity of pain during each episode.

The Impact of the First Wave of the COVID-19 Pandemic on Patients' Perceptions of Chronic Pain.

PURPOSE: On 10 March 2020, Greece entered an increasingly restrictive 42-day lockdown, in order to contain the first wave of the COVID-19 pandemic. All scheduled appointments and activities of the pain clinics around the country were postponed indefinitely. The aim of this prospective study was to assess the perceived impact of the first wave of the pandemic on pain, quality of life, and access to treatment, during the first austere lockdown in Greece. PATIENTS AND METHODS: In this cross-sectional study, 101 patients suffering from chronic pain completed a structured questionnaire. Levels of depression, anxiety, stress, personal wellbeing, optimism and personality traits were also evaluated, using the Depression, Anxiety and Stress Scale (DASS42), the Ten Item Personality Index (TIPI), the Life Orientation Test-Revised (GrLOT-R) and the Personal Wellbeing Index (PWI). RESULTS: Despite the dramatic decrease in health care visitations before, during and after the imposed lockdown, most patients did not feel that access to pain physicians and medication was significantly affected. Higher levels of stress, anxiety, depression, neuroticism, openness to experience and general satisfaction with life seemed to be important determinant factors in how patients experienced their level, intensity and duration of pain, quality of life and response to medication. CONCLUSION: The effects of the lockdown had a more severe impact on patients than the pandemic itself. For most, the level of their pain was not affected by the pandemic and was affected only slightly by the lockdown. Quality of life, however, was affected formost participants. Both the necessity and the complications of introducing the use of telemedicine to Greek chronic pain patients became evident during the study.