Understanding the Complications of Pain Management During COVID-19

While sheltering-in-place and social distancing are vital to limit the spread of coronavirus disease 2019 (COVID-19), those necessary measures may have consequences for patients with chronic pain, according to a recent review.

In addition, patients who recover from COVID-19 but still have lingering pain or heightened pain sensitivity (including myalgias, referred pain, and widespread hyperalgesia) may also be affected by the changes taking place in health care delivery.

Moreover, pain specialists are aware of the biopsychosocial model of pain, which may carry greater weight during this time of COVID-19, as it stresses the intersection of the patient‘s biological, psychological, and social factors.

Ignoring the concerns of individuals with chronic pain, many of which existed before the pandemic, carries certain risks, including “deconditioning, increased mental health concerns, financial burdens, and potential for medication-induced immune-suppression,” according to the authors. Treatment interruptions or delays could have future effects, worsening mental health and substance use disorders, as well as increased future health care spending.

Pre-existing problems include opioid overuse, the rising use of surgery for some procedures that may not be significantly better than rehabilitation, and a lack of education.

Patients who relied on physical therapy or exercise for pain management may have seen a reduction in activity as a result of stay-at-home orders and various closures.

However, the increased use of telemedicine is one bright spot for these patients, who should be engaged in shared decision making, the authors said. Telemedicine could include ongoing services, assessments, treatment, and follow-up.

The review authors suggested 5 factors providers should take into account when treating patients with chronic pain:

• The public health consequences of COVID-19 for those with chronic pain
• The consequences of diminished and alternate/virtual treatments of chronic pain compared with face-to-face visits
• Triaging patients in order to provide immediate care
• Options for remote assessment and management
• Clinical evidence supporting remote therapies and modalities

They also encouraged the use of validated pain assessment tools and scales as well as chronic pain clinics.

For the management of pain linked to COVID-19, the authors said that providers should avoid corticosteroids if a patient has COVID-19 infection, even if asymptomatic.

Pain that was present before COVID-19 may be exaggerated; milder pain symptoms associated with COVID-19 can be relieved with acetaminophen and NSAIDs.

For moderate to severe chronic malignant pain, the review recommended opioids with minimal immunosuppression effects, such as buprenorphine.

Reference

El-Tallawy SN, Nalamasu R, Pergolizzi JV, Gharibo C. Pain management during the COVID-19 pandemic. Pain Ther. Published online August 25, 2020. doi: 10.1007/s40122-020-00190-4