Managing Patients With Chronic Pain During the COVID-19 Outbreak

Considerations for the Rapid Introduction of Remotely Supported (ehealth) Pain Management Services

Christopher Eccleston; Fiona M. Blyth; Blake F. Dear; Emma A. Fisher; Francis J. Keefe; Mary E. Lynch; Tonya M. Palermo; M. Carrington Reid; Amanda C de C Williams


Pain. 2020;161(5):889-893. 

In This Article

Abstract and Introduction


Across the world, pain treatment centres have closed their doors. Because of the COVID-19 pandemic, healthcare providers are abruptly changing their care delivery to protect patients and staff from infection and to reallocate resource towards the greatest acute needs. Elective, routine, and nonemergency casework has stopped in secondary and tertiary centres, while in primary care, patients are requested to stay away or "socially distance," and in residential care facilities and hospices, strict isolation and separation protocols have been introduced.

Before the COVID-19 pandemic, telemedicine and eHealth approaches were being developed and tested in a gradual fashion with many studies focusing on lessons learned and barriers to using digital solutions.[3,37,39,51] Overnight, however, treating or supporting people with non-urgent and long-term conditions at a distance from healthcare providers has become imperative. These immediate changes are happening across healthcare systems. Telemedicine is being used to demand-manage the flow of patients with respiratory distress accessing emergency departments;[25] video consultation is being introduced in multiple settings;[23] and using social media is being discussed positively for its potential to direct people to trusted resources, to counteract misinformation, and to provide psychological first aid.[36]

Pain management providers face the challenge of delivering face-to-face service through different modes. Fortunately, there is a rich stream of research and clinical experience in the use of different technological solutions. Table 1 provides a summary of the definitions and terminology in use.

We consider 4 related factors to help guide healthcare professionals caring for patients with chronic pain: (1) the public health consequences of COVID-19 for patients with pain; (2) the consequences of not treating these patients for the unknown duration of this pandemic; (3) options for remote assessment and management; and (4) clinical evidence supporting remote therapies. Finally, we provide guidance for those attempting to rapidly transition to remote care with technology and discuss the lessons for the future of the pain treatment centre.