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


Although this study offers valuable information regarding the experience of patients with chronic pain during social distancing, some important limitations should be considered when interpreting these findings. This study recruited participants with chronic pain from an urban academic medical center in Massachusetts, and participants were predominately white and female with higher formal education, thus limiting the generalizability to a broader population of patients with chronic pain across the United States or in other countries. The sample size was relatively small, likely precluding sufficient power for the exploratory regression analysis investigating who was had worse pain under social distancing mandates. Despite both these limitations, however, this analysis still observed racial, sex, and educational differences in pain under social distancing, hinting at the perhaps great extent of this problem. In addition, it should be acknowledged that our study participants had online access, as the survey required an email and an Internet connection. Thus, this study may not be adequately representative of individuals who do not have as much access to technologies and who also, unfortunately, would be less likely or unable to participate in remote-based therapies. Further research is needed to better understand the needs of these marginalized patients. In addition, it is possible that a self-selection bias may have impacted findings, with an overrepresentation of participants who were more impacted by the pandemic being willing to participate. Another important limitation is that the cross-sectional study design is open to the potential for recall bias, as we asked patients to reflect back to their condition weeks before the survey. Future research should use a longitudinal design within larger samples, including collection of preratings and postratings in real time, to limit issues around recall bias. In addition, it is important to note that there was a potential for confirmation bias present in the questions regarding social and physical isolation during social distancing mandates. The unforeseen circumstances of the rapidly imposed social distancing precluded this type of design in the current study, making a cross-sectional design a more feasible option to rapidly collect data, and to provide a snapshot of how social distancing impacts chronic pain.