Optimizing Telehealth Pain Care After COVID-19

David J. Tauben; Dale J. Langford; John A. Sturgeon; Sean D. Rundell; Cara Towle; Christina Bockman; Michael Nicholas

Disclosures

Pain. 2020;161(11):2437-2445. 

In This Article

Abstract and Introduction

Abstract

"If you have ever thought of doing telehealth, now's the time to get started."

—Peter McGough, MD (Medical director of the University of Washington neighborhood clinics: KUOW/National Public Radio, 2020.)

Introduction

The COVID-19 pandemic has presented major challenges to pain care, as pain clinicians face severe restrictions in their ability to provide usual in-person assessments and treatments. COVID-19 has also exposed prepandemic problems in providing comprehensive pain care. Yet, despite this crisis, there have been encouraging developments for long-term delivery of pain services, most notably the explosive growth in the adoption of telehealth technology and clinical resourcefulness in its applications. Furthermore, the size and urgency of the COVID-19 pandemic has seen many cumbersome local, regional, and national health policy rules regarding the access, delivery, and reimbursement of telehealth temporarily waived. These changes have afforded an opportunity to develop new ways of operating and a glimpse of how life could be for pain services under a "new normal."[81] Importantly, telehealth has the potential to transform pain management, particularly for those with complex pain care needs living remotely from pain facilities or in low-resource settings, removing barriers to multidisciplinary pain management delivered in a collaborative, interdisciplinary way—the optimal treatment approach for chronic pain.[21]

Pain researchers have provided timely reports of the available evidence for treatment modalities capable of being delivered remotely.[25,81] However, the provision of pain services at local, regional, and national levels entails more than a consideration of evidence for individual service components. A broader framework is needed. This topical review considers the value case for telehealth-based multidisciplinary pain management approaches, reviews available evidence, delineates obstacles, and proposes solutions across the domains of health systems, public health, and reimbursement policies. We should not turn back; rather, we should advance the potential gains of telehealth pain services. At the same time, it is imperative that we implement a research agenda evaluating outcomes, costs, and acceptability alongside these new clinical developments.

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