Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Eva Katharina Masel, Patrick Huber, Tobias Engler, Herbert Hans WatzkeClinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria Background: Decisions on the intensity of analgesic therapy and judgments regarding its efficacy are difficult at the end of life, when many patients are not fully conscious and pain is a very common symptom. In healthy individuals and in postoperative settings, nociception and subsequent pain relief have been shown to induce changes in the autonomic nervous system (ANS), which can be detected by measuring heart rate variability (HRV). Objectives: The changes in the ANS were studied by measuring HRV during opioid therapy for cancer breakthrough pain (CBTP) in palliative-care patients with cancer and compared these changes with patient-reported pain levels on a numeric rating scale (NRS). Patients and methods: The study included ten patients with advanced cancer and baseline opioid therapy. In each patient, a 24-hour peak-to-peak HRV measurement with a sampling rate of 4,000 Hz was performed. High frequency (HF), low frequency (LF), total power, pNN50 (indicating parasympathetic activity), and log LF/HF were obtained in two intervals prior to therapy and in four intervals thereafter. Intensity of CBTP was recorded using a patient-reported NRS prior to therapy and 30 minutes afterward. Results: CBTP occurred in seven patients (three males and four females; mean age: 62 ± 5.2 years) and was treated with opioids. A highly significant positive correlation was found between opioid-induced reduction in patient-reported pain intensity based on NRS and changes in log LF/HF (r > 0.700; p < 0.05). Log LF/HF decreased in patients who had a reduction in pain of >2 points on the NRS but remained unchanged in the other patients. Conclusion: Our data suggest that log LF/HF may be a useful surrogate marker for alleviation of CBTP in patients with advanced cancer and might allow detection of pain without active contribution from patients. Keywords: heart rate variability, cancer breakthrough pain, advanced cancer, palliative car

Global Health - vermittle es mit einem Comic!

Aim: The topic of global health affects us all. In order to spread the word about this important medical field, a bilingual brochure containing medical comics on the subject was published at the Medical University of Vienna.Method: Medical comics are well established internationally, have a long history in the communication of medical information, and - under the umbrella of graphic medicine - are both popular and widely used. In the context of the exhibition project art-action-attitude/body, 6 panels were transformed into a 12-page brochure on the topic of global health in cooperation with an artist and a graphic designer.Results: The brochure was made available for free to visitors of the exhibition, published online, handed out at various fairs by the artist, and presented at an international conference.Summary: The collaboration with an artist and a graphic designer (Renate Mowlam, Bettina Jarosch) gave rise to a high-quality product that explains the subject matter clearly and in a way that is accessible to all, with the written word supported by images. In the brochure, 46 pictures shed light on the topics "health as a human right", "global health" (definition and examples), and "one health" (definition and examples). This enabled readers to quickly become informed about this complex subject, to contemplate it, and to reflect on their own behavior.Zielsetzung: Das Thema Global Health betrifft uns alle. Um dieses wichtige Forschungsfeld zu vermitteln, wurde an der Medizinischen Universität Wien anhand von Medical Comics eine Broschüre zu diesem Thema in zwei Sprachen herausgebracht.Methodik: Medical Comics sind international etabliert, mit langer Geschichte in der Kommunikation von medizinischen Informationen und finden - eingebettet in die Dachorganisation der Graphic Medicine - großen Zuspruch und Anwendung. Im Rahmen des Ausstellungsprojektes "Art-Action-Attitude/Körper" wurde aus 6 Panelen in Zusammenarbeit mit einer Künstlerin und einer Grafikerin zum Thema "Global Health" eine 12 Seiten umfassende Broschüre gestaltet. Ergebnisse: Die Broschüre wurde bei der Ausstellung gratis zur Mitnahme aufgelegt, online gestellt, von der Künstlerin auf diversen Messen ausgeteilt und auf einer internationalen Tagung vorgestellt.Resümee: Die Zusammenarbeit mit Professionistinnen (Renate Mowlam: Künstlerin; Bettina Jarosch: Grafikerin) hat sich in einem hochwertigen Produkt materialisiert, das Inhalte entsprechend klar und niederschwellig erklärt und bildlich unterstützt. Dabei wurden in 46 Bildern die Themen "Gesundheit als Menschenrecht", "Global Health" (Begriffserklärung und Beispiele) und "One Health" (Begriffserklärung und Beispiele) beleuchtet. So konnten sich Lesende rasch zu diesem komplexen Thema informieren, darüber nachdenken und das eigene Verhalten reflektieren