The experience of adults living with chronic pain in the context of a neurological condition

Background: Sudden onset neurological conditions, such as spinal cord injury and stroke, are unexpected, life-changing events. Research suggests that survivors grieve the life they knew, while commonly trying to cope with significant impairments impacting their everyday life. Some impairments are condition specific while others are shared across conditions, such as chronic pain. Aim: This research portfolio aimed to increase understanding of the experience of chronic pain following two sudden onset neurological conditions, namely spinal cord injury and stroke, in adults. Design: The portfolio consists of two main research papers, a systematic review which thematically synthesises qualitative findings on adults’ experience of chronic neuropathic pain following spinal cord injury and an interpretative phenomenological analysis (IPA) study which investigates the experience of working age adults living with chronic post-stroke pain. These are presented alongside an introduction, bridging section, extended methodology, and overall discussion. Findings: The systematic review identified six themes; ‘The pain as an unusual, intense, unpredictable and uncontrollable sensation’, ‘The pain’s influence on life’, ‘Trying to understand the pain’, ‘The challenge of describing the pain to others’, ‘The search for pain relief’ and ‘Learning pain acceptance over time’. The IPA study identified three master themes: ‘The solitude of the pain experience’, ‘Unsatisfactory healthcare and the need for self-care’ and ‘The development of pain acceptance’. Conclusions: The findings suggest that spinal cord injury and stroke patients have similar experiences of living with chronic pain. The pain is described as an invisible impairment, which is difficult to relate to others and can easily be overlooked in the context of other visible, more prototypical impairments. Primary healthcare settings are described as lacking specialist knowledge, leading to unsatisfactory identification, diagnosis and treatment. Recommendations for clinical applications and future research are provided

“I will try anything” the experience of working age stroke survivors living with chronic post-stroke pain: an interpretative phenomenological analysis

Purpose: To investigate the experience of working age adults living with chronic post-stroke pain in the United Kingdom (UK). Methods: Semi-structured interviews were conducted with eight working age (46–64 years) UK-based stroke survivors who experience chronic post-stroke pain (≥3 months). The interviews were analysed using interpretative phenomenological analysis. Results: The analysis led to three Group Experiential Themes: “The Solitude of the Pain Experience,” “Unsatisfactory Healthcare and the Need for Self-Care” and “The Development of Pain Acceptance.” Findings suggest that individuals see their post-stroke pain as an invisible disability, which is overlooked and misunderstood by others. Furthermore, in the absence of a differential post-stroke pain diagnosis, clear, accurate information and alternatives to pharmacological treatments, individuals with post-stroke pain invest their own resources in finding answers and a way to live with the pain. Conclusions: The findings suggest the need for further education on post-stroke pain for healthcare professionals, the consideration of pain in post-stroke assessments, the need for clear differential pain diagnoses and the provision of accurate information to patients. Research is needed to establish non-pharmacological evidence-based treatment approaches, such as pain management programmes, peer support and psychological interventions

Spatially resolved qualified sewage spot sampling to track SARS-CoV-2 dynamics in Munich - One year of experience

Rubio-Acero R, Beyerl J, Muenchhoff M, et al. Spatially resolved qualified sewage spot sampling to track SARS-CoV-2 dynamics in Munich - One year of experience. Science of The Total Environment. 2021;797: 149031

The representative COVID-19 cohort Munich (KoCo19): from the beginning of the pandemic to the Delta virus variant

Le Gleut R, Plank M, Pütz P, et al. The representative COVID-19 cohort Munich (KoCo19): from the beginning of the pandemic to the Delta virus variant. BMC Infectious Diseases. 2023;23(1): 466.**Background** Population-based serological studies allow to estimate prevalence of SARS-CoV-2 infections despite a substantial number of mild or asymptomatic disease courses. This became even more relevant for decision making after vaccination started. The KoCo19 cohort tracks the pandemic progress in the Munich general population for over two years, setting it apart in Europe. **Methods** Recruitment occurred during the initial pandemic wave, including 5313 participants above 13 years from private households in Munich. Four follow-ups were held at crucial times of the pandemic, with response rates of at least 70%. Participants filled questionnaires on socio-demographics and potential risk factors of infection. From Follow-up 2, information on SARS-CoV-2 vaccination was added. SARS-CoV-2 antibody status was measured using the Roche Elecsys® Anti-SARS-CoV-2 anti-N assay (indicating previous infection) and the Roche Elecsys® Anti-SARS-CoV-2 anti-S assay (indicating previous infection and/or vaccination). This allowed us to distinguish between sources of acquired antibodies. **Results** The SARS-CoV-2 estimated cumulative sero-prevalence increased from 1.6% (1.1-2.1%) in May 2020 to 14.5% (12.7-16.2%) in November 2021. Underreporting with respect to official numbers fluctuated with testing policies and capacities, becoming a factor of more than two during the second half of 2021. Simultaneously, the vaccination campaign against the SARS-CoV-2 virus increased the percentage of the Munich population having antibodies, with 86.8% (85.5-87.9%) having developed anti-S and/or anti-N in November 2021. Incidence rates for infections after (BTI) and without previous vaccination (INS) differed (ratio INS/BTI of 2.1, 0.7-3.6). However, the prevalence of infections was higher in the non-vaccinated population than in the vaccinated one. Considering the whole follow-up time, being born outside Germany, working in a high-risk job and living area per inhabitant were identified as risk factors for infection, while other socio-demographic and health-related variables were not. Although we obtained significant within-household clustering of SARS-CoV-2 cases, no further geospatial clustering was found. **Conclusions** Vaccination increased the coverage of the Munich population presenting SARS-CoV-2 antibodies, but breakthrough infections contribute to community spread. As underreporting stays relevant over time, infections can go undetected, so non-pharmaceutical measures are crucial, particularly for highly contagious strains like Omicron