IMPACT OF THE COVID-19 PANDEMIC ON CHRONIC PAIN MANAGEMENT
Interventional Pain during COVID-19
Keywords:
chronic pain, interventional pain management, COVID-19, telemedicine, opioids, steroids, vaccines
Abstract
Introduction The COVID-19 pandemic has generated considerable turmoil in the interventional pain management (IPM) community. Due to IPM being classified as “elective”, numerous pain practices across the United States were forced to close during the pandemic, leaving chronic pain patients untreated for indefinite periods and IPM physicians with increased stress and burnout.
Results In response to these detrimental effects, various re-opening tools and techniques were created to facilitate a cautious resumption of in-person interventional pain practice. Due to their ability to minimize person-to-person contact, telehealth and pharmacotherapy played a more significant role in IPM during the pandemic, but their increased utilization has COVID-19 vaccine has also arisen as an issue of concern as well. also led to the exacerbation of substance abuse and the opioid epidemic. The interplay between steroid use and its immunosuppressive effects between COVID-19 infection and the
Conclusion As practices begin to safely re-open throughout the United States, the effects felt by chronic pain patients during the pandemic must be emphasized and not ignored. This review emphasizes the struggles pain patients have had to face during the pandemic and the need to update and redefine regulations regarding interventional and chronic pain management.
References
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38. Brill, S., U. Hochberg, and I. Goor-Aryeh, Neuro-axial steroid injection in pain management and COVID-19 vaccine. Eur J Pain, 2021. 25(4): p. 945-946.
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40. Yildiz, N., et al., Hepatitis B virus vaccination in children with steroid sensitive nephrotic syndrome: immunogenicity and safety? Vaccine, 2013. 31(33): p. 3309-12.
41. Hottinger, A.F., et al., A prospective study of the factors shaping antibody responses to the AS03-adjuvanted influenza A/H1N1 vaccine in cancer outpatients. Oncologist, 2012. 17(3): p. 436-45.
42. Jackson, M.L., et al., Low-dose aspirin use does not diminish the immune response to monovalent H1N1 influenza vaccine in older adults. Epidemiol Infect, 2016. 144(4): p. 768-71.
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44. Lee, H., et al., Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of Adenovirus Vector-Based COVID-19 Vaccines? Pain Med, 2021. 22(6): p. 1441-1464.
2. Gharibo, C., et al., Triaging Interventional Pain Procedures During COVID-19 or Related Elective Surgery Restrictions: Evidence-Informed Guidance from the American Society of Interventional Pain Physicians (ASIPP). Pain Physician, 2020. 23(4S): p. S183-204.
3. Wan, W. and H. Long, "Cries for help": Drug overdoses are soaring during the coronavirus pandemic, in The Washington Post. 2020.
4. Eccleston, C., et al., Managing patients with chronic pain during the COVID-19 outbreak: considerations for the rapid introduction of remotely supported (eHealth) pain management services. Pain, 2020. 161(5): p. 889-893.
5. Smith, T.J., et al., Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol, 2002. 20(19): p. 4040-9.
6. Manchikanti, L., et al., Update on Reversal and Decline of Growth of Utilization of Interventional Techniques In Managing Chronic Pain in the Medicare Population from 2000 to 2018. Pain Physician, 2019. 22(6): p. 521-536.
7. Chang, H.Y., et al., Prevalence and treatment of pain in EDs in the United States, 2000 to 2010. Am J Emerg Med, 2014. 32(5): p. 421-31.
8. Jha, S.S., et al., The Effect of COVID-19 on Interventional Pain Management Practices: A Physician Burnout Survey. Pain Physician, 2020. 23(4S): p. S271-S282.
9. Centers for Disease Control. Managing Healthcare Operations During COVID-19. [cited 2021 06/22]; Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/facility-planning-operations.html.
10. Shah, S., et al., Evidence-Based Risk Mitigation and Stratification During COVID-19 for Return to Interventional Pain Practice: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician, 2020. 23(4S): p. S161-S182.
11. Uppal, V., et al., Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia, 2020. 75(10): p. 1350-1363.
12. Whitlock, E.L., et al., Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med, 2017. 177(8): p. 1146-1153.
13. IsHak, W.W., et al., Pain and Depression: A Systematic Review. Harv Rev Psychiatry, 2018. 26(6): p. 352-363.
14. Sheng, J., et al., The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plast, 2017. 2017: p. 9724371.
15. Elbinoune, I., et al., Chronic neck pain and anxiety-depression: prevalence and associated risk factors. Pan Afr Med J, 2016. 24: p. 89.
16. Nijs, J., et al., Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Phys Ther, 2018. 98(5): p. 325-335.
17. Racine, M., Chronic pain and suicide risk: A comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry, 2018. 87(Pt B): p. 269-280.
18. Da Silva, J.A.P., R. Geenen, and J.W.G. Jacobs, Chronic widespread pain and increased mortality: biopsychosocial interconnections. Ann Rheum Dis, 2018. 77(6): p. 790-792.
19. American College of Surgeons. COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures. [cited 2021 06/22]; Available from: https://www.facs.org/covid-19/clinical-guidance/triage.
20. Huynh, L., et al., Reopening Interventional Pain Practices during the Early Phase of the COVID-19 Global Pandemic. Pain Med, 2021.
21. Cohen, S.P., et al., Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises. Pain Med, 2020. 21(7): p. 1331-1346.
22. Murphy, M.T. and U. Latif, Pain During COVID-19: A Comprehensive Review and Guide for the Interventionalist. Pain Pract, 2021. 21(1): p. 132-143.
23. Berwick, R.J., K. Herron, and H. Kee Tsang, A survey of chronic pain telephone consultations during COVID-19 at an inner-city secondary care center. Pain Pract, 2021.
24. O'Brien, K.M., et al., Effectiveness of telephone-based interventions for managing osteoarthritis and spinal pain: a systematic review and meta-analysis. PeerJ, 2018. 6: p. e5846.
25. Manchikanti, L., et al., COVID-19 and the Opioid Epidemic: Two Public Health Emergencies That Intersect With Chronic Pain. Pain Ther, 2021. 10(1): p. 269-286.
26. Coluzzi, F., F. Marinangeli, and J. Pergolizzi, Managing chronic pain patients at the time of COVID-19 pandemic. Minerva Anestesiol, 2020. 86(8): p. 797-799.
27. Gharaei, H. and S. Diwan, COVID-19 Pandemic: Implications on Interventional Pain Practice-a Narrative Review. Pain Physician, 2020. 23(4S): p. S311-S318.
28. Wei, G., J. Moss, and C.S. Yuan, Opioid-induced immunosuppression: is it centrally mediated or peripherally mediated? Biochem Pharmacol, 2003. 65(11): p. 1761-6.
29. Food and Drug Administration. FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19. 2020 [cited 2021 6/24]; Available from: fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19.
30. Olive, G., [Analgesic/Antipyretic treatment: ibuprofen or acetaminophen? An update]. Therapie, 2006. 61(2): p. 151-60.
31. Manchikanti, L., et al., Steroid Distancing in Interventional Pain Management During COVID-19 and Beyond: Safe, Effective and Practical Approach. Pain Physician, 2020. 23(4S): p. S319-S350.
32. Helm Ii, S., et al., Transforaminal Epidural Steroid Injections: A Systematic Review and Meta-Analysis of Efficacy and Safety. Pain Physician, 2021. 24(S1): p. S209-S232.
33. Knezevic, N.N., et al., Lack of Superiority of Epidural Injections with Lidocaine with Steroids Compared to Without Steroids in Spinal Pain: A Systematic Review and Meta-Analysis. Pain Physician, 2020. 23(4S): p. S239-S270.
34. Manchikanti, L., et al., Does Epidural Bupivacaine with or Without Steroids Provide Long-Term Relief? A Systematic Review and Meta-analysis. Curr Pain Headache Rep, 2020. 24(6): p. 26.
35. Popescu, A., et al., Spinal Injections in Immunosuppressed Patients and the Risks Associated with Procedural Care: To Inject or Not to Inject? Pain Med, 2019. 20(6): p. 1248-1249.
36. Miller, D.C., et al., Corticosteroid Injections and COVID-19 Infection Risk. Pain Med, 2020. 21(8): p. 1703-1706.
37. Sytsma, T.T., L.K. Greenlund, and L.S. Greenlund, Joint Corticosteroid Injection Associated With Increased Influenza Risk. Mayo Clin Proc Innov Qual Outcomes, 2018. 2(2): p. 194-198.
38. Brill, S., U. Hochberg, and I. Goor-Aryeh, Neuro-axial steroid injection in pain management and COVID-19 vaccine. Eur J Pain, 2021. 25(4): p. 945-946.
39. Chakravarthy, K., et al., Recommendations and Guidance for Steroid Injection Therapy and COVID-19 Vaccine Administration from the American Society of Pain and Neuroscience (ASPN). J Pain Res, 2021. 14: p. 623-629.
40. Yildiz, N., et al., Hepatitis B virus vaccination in children with steroid sensitive nephrotic syndrome: immunogenicity and safety? Vaccine, 2013. 31(33): p. 3309-12.
41. Hottinger, A.F., et al., A prospective study of the factors shaping antibody responses to the AS03-adjuvanted influenza A/H1N1 vaccine in cancer outpatients. Oncologist, 2012. 17(3): p. 436-45.
42. Jackson, M.L., et al., Low-dose aspirin use does not diminish the immune response to monovalent H1N1 influenza vaccine in older adults. Epidemiol Infect, 2016. 144(4): p. 768-71.
43. Saleh, E., M.A. Moody, and E.B. Walter, Effect of antipyretic analgesics on immune responses to vaccination. Hum Va chronic pain, elective procedures, interventional techniques, COVID-19 protocol, telemedicine, opioid, steroids, vaccines ccin Immunother, 2016. 12(9): p. 2391-402.
44. Lee, H., et al., Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of Adenovirus Vector-Based COVID-19 Vaccines? Pain Med, 2021. 22(6): p. 1441-1464.
Published
2021/10/06
Section
Original articles