Pivoting to Virtual Delivery for Managing Chronic Pain With Nonpharmacological Treatments

Implications for Pragmatic Research

Julie M. Fritz; Alison F. Davis; Diana J. Burgess; Brian Coleman; Chad Cook; Shawn Farrokhi; Christine Goertz; Alicia Heapy; Anthony J. Lisi; Donald D. McGeary; Daniel I. Rhon; Stephanie L. Taylor; Steven Zeliadt; Robert D. Kerns


Pain. 2021;162(6):1591-1596. 

In This Article

Abstract and Introduction


Coronavirus disease 2019 (COVID-19) created rapid disruptions throughout health care. Before the pandemic, chronic pain was the leading cause of disability worldwide[30] and one of the most common reasons for health care visits.[17,31,70,71] COVID-related restrictions interrupted in-person care and have had other detrimental effects for individuals with chronic pain. Co-occurring mental health conditions are common among persons with chronic pain[40,64] and may be intensified by the social isolation and psychological consequences of COVID-19.[35,74] Chronic pain is more prevalent in older adults[18] whose activities are most restricted. Pandemic-related disruptions present unique challenges for individuals with chronic pain and may have enduring consequences.

Pain care has been undergoing a transformation to increase focus on nonpharmacological treatments (NPTs).[58] Recommended NPTs for chronic pain include exercise, acupuncture, manipulation, mindfulness, cognitive-behavioral therapy (CBT), and other approaches.[69,75] Although guidelines recommend NPTs, implementation into routine care has lagged.[28] Overuse of imaging, interventional pain procedures, and medications, particularly opioid therapy, continues to characterize chronic pain care.[43] The considerable gap between guidelines and practice has motivated pragmatic research studying implementation in "real-world" settings. Implementation of NPTs was difficult before COVID-19. The pandemic has imposed additional challenges. COVID-19 could result in losing ground on efforts to narrow the pain management evidence-practice gap, raising concerns that overreliance on opioids and other low value care will increase.[41,53]