Cross-sectional Study of Psychosocial and Pain-related Variables Among Patients With Chronic Pain During a Time of Social Distancing Imposed by the Coronavirus Disease 2019 Pandemic

Valerie Hruschaka; K. Mikayla Flowers; Desiree R. Azizoddin; Robert N. Jamison; Robert R. Edwards; Kristin L. Schreiber


Pain. 2021;162(2):619-629. 

In This Article

Abstract and Introduction


The COVID-19 pandemic has had a tremendous impact, including on individuals with chronic pain. The social distancing policies necessary to slow the spread of SARS-CoV-2 have involved increased levels of social isolation. This cross-sectional survey study examined pain severity and interference among individuals with chronic pain during an early phase of social distancing mandates and identified characteristics of individuals who were most impacted. Approximately 4 to 8 weeks after social distancing mandates commenced in the state of Massachusetts, 150 patients with fibromyalgia, chronic spine, and postsurgical pain completed demographic, pain, social distancing, and validated psychosocial questionnaires. Patients self-reported an overall significant increase in pain severity and pain interference, compared with before social distancing, although both pain severity and interference were quite variable among individuals under conditions of social distancing. Several demographic, socioeconomic, and psychosocial factors were associated with greater pain severity and interference during social distancing. Multivariable linear regression demonstrated that female sex, nonwhite race, lower education, disability, fibromyalgia, and higher pain catastrophizing were independently associated with greater pain severity, while female sex and pain catastrophizing were independently associated greater pain interference. The findings suggest that individual differences among patients with chronic pain should be considered in the planning, development, and prioritization of interventions to improve pain care and to prevent worsening of symptoms during the continuing COVID-19 pandemic.


Pain is modulated not only by sensory, emotional, and cognitive components but also by social factors including social connection.[68] Despite the recognition of the importance of social factors in shaping the pain experience under the biopsychosocial model,[46] their influence remains understudied. Unfortunately, the COVID-19 pandemic has imposed significant changes in social conditions of the majority of individuals worldwide, including persons with chronic pain. The World Health Organization has encouraged governments to regard slowing the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a top priority,[55] in which social distancing mandates have become an essential tool. As a result, individuals were relatively suddenly subjected to elevated levels of social isolation.[9,54,69,72] Although the first wave of COVID-19 has abated in some areas, spread continues in other areas. It is projected that subsequent waves of recurrence may necessitate social distancing to varying degrees in years to come, possibly into 2022.[38]

Previous research has suggested that social isolation can result in adverse health outcomes in general, including worsening mental and physical health, and is associated with increased likelihood of emergency department admissions and greater length of hospital stay.[20,30,61] Social interactions may also play an important role in modulating pain and the ability to cope with chronic pain.[46] Thus, individuals with chronic pain may be at an increased risk of both physical and mental health deterioration[31] during social distancing.[36] Worsening of pain may contribute to a reliance on maladaptive coping strategies, such as substance abuse and increased suicidal ideation, which are already elevated among individuals with chronic pain.[35] In addition, social distancing mandates have restricted or eliminated access to many adjunctive therapies for pain, including acupuncture, massage, physical therapy, rehabilitation therapy, and counseling services, potentially further contributing to worsening pain and stress.[3,7,23]

The aim of this study was to measure the impact of the externally imposed social isolation during the COVID-19 pandemic on pain. We queried patients with chronic pain about the degree of current social and physical isolation as well as patient pain severity and interference under the social distancing mandate and compared current reports with patient recalled isolation and pain from before social distancing. We hypothesized that current pain severity and interference would be greater while under conditions of increased social isolation. In addition, as an exploratory analysis to see whose current pain was impacted the most by changes imposed by social distancing, we carefully assessed the relationship between pain outcomes and psychosocial factors known to be important to impact the modulation of pain with the intentions of gaining greater insight into where to focus innovative pain management during future waves of COVID-19.