Op-Ed: COVID and Chronic Pain

The COVID-19 pandemic has made access to crucial healthcare services a challenge for many patients, especially those with chronic pain.

According to the CDC, chronic pain is one of the most common reasons adults seek medical care. In the United States, an estimated 20.4% (50 million) of adults had chronic pain according to 2016 National Health Interview Survey data.

Chronic pain has been linked to a lack of mobility and daily activity, socioeconomic status, access to healthcare, and opioid dependence. These correlations have recently been intensified as the pandemic has exacerbated income inequity, lack of access to affordable healthcare, and physical and emotional isolation making the treatment of chronic pain even more challenging.

The consequences of not seeking essential medical treatment for chronic pain can be dire. Patients waiting for a medical assessment often report high levels of pain that interfere with their ability to function and reports of severe pain are associated with increased levels of depression in 50% of patients and suicidal thinking in 34.6% of patients. In addition, as chronic pain patients are increasingly isolated many of them are at a higher risk for opioid addiction or overdose.

The pandemic has highlighted the necessity for patient care to encompass an individualized, multi-disciplinary, and multimodal approach that can include both telehealth and in-person care. And the multidimensional complexity of chronic pain with both pathophysiologic and psychosocial issues reinforces the need for patients to receive pain care under a physician-led team. Pain medicine physicians are specifically trained over many years through medical school, residency, and subspecialty training to diagnose and manage complex acute and chronic pain conditions, including those with life-threatening illnesses.

Many patients who are prescribed opioids need access to in-person medical treatment as monitoring opioid use is difficult through telemedicine and administering urine drug screenings are most effective and accurate in person. When in-person care is not feasible, it is important for physicians in California, for example, to meet state medical board mandates by documenting a patient’s inability to receive drug testing during the pandemic.

For other patients, telemedicine is a good option — especially those with low mobility or comorbidities — as long as there is a focus on ensuring equitable access as disadvantaged groups, older adults, and people with disabilities tend to use technology less often.

Future legislation must not create barriers for chronic pain patients to receive safe, effective treatment. The CDC has already issued guidelines for both opioid and nonopioid treatments for chronic pain. Regulations need to ensure and allow for individualized pain management strategies for patients dealing with chronic pain. Those patients who are stable and functional on opioids should be allowed continued access to opioids, just as all patients seeking nonopioid treatments, including interventional pain treatments, such as spinal cord stimulation, peripheral nerve stimulation, and others with high-quality evidence, should be allowed access to those therapies.

As noted in the journal PAIN: “Not treating chronic pain will have consequences for individuals, healthcare systems, and providers in the short- and long-term, increasing quantity, severity, and complexity of need.” The research also highlighted “the risks of harm from undertreatment can be exacerbated further by the risk of harm from inappropriate treatment.”

Patients need access to a variety of pain management techniques and physicians need access to a variety of tools and resources to support a multimodal care approach. The pandemic has highlighted the need to be innovative in delivering patient care — not only for those suffering from COVID-19 — but for the enormous numbers of Americans who suffer from chronic pain on a daily basis.

We are at a crossroads. The medical community must double down on its efforts to ensure that patients have access to the appropriate treatment for chronic pain. At the same time, policymakers must ensure that regulations improve access to care and do not have unintended consequences of marginalizing patient populations.

Shalini Shah, MD, is vice-chair and associate professor, Department of Anesthesiology & Perioperative Care, and enterprise director of pain services at UC Irvine Health. Michael Leong, MD, is director of neuromodulation in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University.

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