Patients with Chronic Pain Prefer Maintenance of Pain Treatment Despite COVID-19 Pandemic Restrictions

Abstract

BACKGROUND: Worldwide, the COVID-19 pandemic has a significant impact on daily life. First studies describe a negative impact of pandemic stressors even on individuals without previous mental illnesses. The home lockdown and the shutdown of pain clinics make it difficult for all patients to get the healthcare they need. OBJECTIVES: The aim of this study was to investigate to what extent patients with chronic pain felt affected by the pandemic and its consequences on pain treatments, focussing on the beginning of the outbreak. STUDY DESIGN: A prospective noninterventional study. SETTING: Medical University Center . METHODS: One-hundred and forty-nine patients, suffering from chronic pain, treated at a large German interdisciplinary pain center, were studied over a period of 2 months at the beginning of the pandemic. Data from patient charts and questionnaires were evaluated. Patients were asked about postponements or cancellations of pain therapy, the possible effect on pain levels, depression, anxiety and stress, and the impact of intensified hygiene measures. Results were compared to those from standardized and validated questionnaires from the same patients (German version of the depression, anxiety, and stress scale = DASS) at the time of the first contact in the pain clinic. RESULTS: Eighty-four (56.4%) patients reported cancelled or postponed treatments during the pandemic. Those chronic pain patients with delayed or cancelled treatments reported significantly more pain and psychological distress. The delay or discontinuation of treatments resulted in a deterioration of symptoms. From the patients’ point of view this deterioration was unrelated to the timing of treatment and not secondary to increased hygiene measures. In both groups, patients showed a significant amelioration of the DASS values compared to the values they had at the beginning of treatment, despite the negative effects of the COVID-19 pandemic on care structures. The majority of the patients do not think that the quality of pain treatment was significantly affected by the intensified hygiene requirements. LIMITATIONS: The limitations of the study are the small number of patients because of the limitation to a short period of time at the beginning of the pandemic and the return rate of 40.2% of the study consents. CONCLUSIONS: Even in the event of a pandemic-related restriction of the care structures, patients with chronic pain benefit from pain therapy. Limitations such as the increased hygiene measures caused by the pandemic were not considered detrimental to the therapeutic measures. KEY WORDS: COVID-19 pandemic, hygiene measures, chronic pain, anxiety, depression, stress

Chronic pain and continuity of analgesic treatment during the COVID‐19 pandemic

“…This analysis allowed the identification of some of the sociodemographic and pharmacological variables of patients with chronic pain, especially the proportion of these patients who experienced the interruption of their analgesic or pain modulator management during the first year of the COVID-19 pandemic. The median age of these chronic pain patients was higher than that documented in other studies conducted in America and Europe, 8,9,12,15,16 while the predominance of women was consistent with that reported in other publications. 1,5,8,9,12,15,16 The geographical variation on analgesic drug usage has been reported previously in the country.…”

“…The median age of these chronic pain patients was higher than that documented in other studies conducted in America and Europe, 8,9,12,15,16 while the predominance of women was consistent with that reported in other publications. 1,5,8,9,12,15,16 The geographical variation on analgesic drug usage has been reported previously in the country. 17 Among patients with chronic pain in Spain, Greece, Italy and the United Kingdom, the most frequently reported type of pain was of musculoskeletal origin, 3,5,18,19 consistent with the findings of this report.…”

“…7,9,18 Additionally, it is possible that fear of infection kept many patients from seeking medical help, even when they had serious health problems. 8,10 Furthermore, as a result of the impact of many economic activities, many people lost their jobs and, consequently, their health insurance. 7,30 Finally, the inconsistency of treatment may have also been due to medication shortages, 31 which in turn affected pain control, with reports of worsening pain in 38.3%-69.0% of patients.…”

“…5 In Colombia, restrictive measures began on March 25, 2020 with the mandatory preventive isolation of most people to mitigate the spread of SARS-CoV-2, 6 a policy that, as in other countries, affected all aspects of economic and social life, including access to hospitals, healthcare centers and pharmacies, potentially compromising the delivery of medications for patients with chronic pathologies. [7][8][9][10] As a result of these measures, face-to-face access to the health system was limited, and care took place predominantly via telemedicine. Although the switch to telemedicine has been beneficial for maintaining contact with patients and has allowed some treatments to continue, there have been delays in the diagnosis and comprehensive multimodal management of chronic pain, which includes medications, physiotherapy, rehabilitation therapy, psychological therapy and medical procedures.…”

“…Although the switch to telemedicine has been beneficial for maintaining contact with patients and has allowed some treatments to continue, there have been delays in the diagnosis and comprehensive multimodal management of chronic pain, which includes medications, physiotherapy, rehabilitation therapy, psychological therapy and medical procedures. 8,11 In addition to the emotional, psychosocial and economic stressors related to the pandemic, there is a high possibility that adequate pain control is not achieved in these patients. 11,12 It is clear that interruptions in treatment can exacerbate pain intensity and worsen mood, sleep quality and social support.…”