Background & Aims
The COVID-19 pandemic prompted unexpected changes in the healthcare system, most notably the widespread adoption of telehealth. In addition, recent studies describe direct health impacts of COVID-19 including the development of pain symptoms [1] and prolonged symptomatology [2] in both specific subgroups and the global population at large. However, to date, evidence on the impact of COVID-19 among patients with pain is mixed [3-6], with increasing evidence of disproportionate impacts on specific subgroups and marginalized individuals [7-9]. This current longitudinal study had 2 aims: 1) describe the trajectory of pandemic-associated stressors and patient-reported health outcomes among patients receiving treatment at a tertiary pain clinic over 2 years (May 2020 to June 2022); and 2) identify vulnerable subgroups. We assessed changes in pandemic-associated stressors and patient-reported health outcome measures.
Methods
This observational cross-sectional study included consecutive data collection from patient surveys collected during initial and follow-up visits to a tertiary pain clinic, and who agreed to complete additional surveys related to COVID-19. Data was collected for 26 months through CHOIR, a digital learning health-care system, to characterize patients’ physical, psychological, and social function, in addition to COVID-19 impacts following the pandemic lockdown, enaction of the stay-at-home order in San Mateo County. The study sample included 1270 adult patients who were predominantly female (74.6%), White (66.2%), non-Hispanic (80.6%), married (66.1%), not on disability (71.2%), college-educated (59.45%), and not currently working (57.9%). We conducted linear mixed effect modeling to examine the main effect of time with controlling for a random intercept.
Results
Over time, patients reported increased proximity to COVID-19, but decreased pandemic-associated stressors. A significant improvement was also observed in pain intensity, pain catastrophizing, and PROMIS-pain interference, sleep, anxiety, anger, and depression scores. Demographic-based subgroup analyses for pandemic-associated stressors revealed that younger adults, Hispanics, Asians, and patients receiving disability compensation were vulnerable groups either during the initial visit or follow-up visits. We observed additional differential pandemic effects between groups based on participant sex, education level, and working status. In conclusion, despite unanticipated changes in pain care services during the pandemic, patients receiving pain treatments adjusted to pandemic-related stressors and improved their health status over time.
Conclusions
Over a 2-year timeframe, the pandemic did not adversely influence physical and mental health among treatment-seeking patients with chronic pain. Patients reported small but significant improvements across indices of physical and psychosocial health. Differential impacts emerged among patients who were younger, women, not currently working, on disability, racial minorities, and those who report more widespread pain. As the current study observed differential pandemic impacts on patient subgroups, future studies should investigate and address the unmet needs of vulnerable subgroups.
References
[1] Weng L-M, Su X, Wang X-Q. Pain symptoms in patients with coronavirus disease (COVID-19): a literature review. J Pain Res 2021;14:147.
[2] Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, Pujol JC, Klaser K, Antonelli M, Canas LS. Attributes and predictors of long COVID. Nature medicine 2021;27(4):626-631
[3] Consonni M, Telesca A, Grazzi L, Cazzato D, Lauria G. Life with chronic pain during COVID-19 lockdown: the case of patients with small fibre neuropathy and chronic migraine. Neurological Sciences 2021;42(2):389-397.
[4] Fallon N, Brown C, Twiddy H, Brian E, Frank B, Nurmikko T, Stancak A. Adverse effects of COVID-19-related lockdown on pain, physical activity and psychological well-being in people with chronic pain. British Journal of Pain 2021;15(3):357-368
[5] Flowers KM, Colebaugh CA, Hruschak V, Azizoddin DR, Meints SM, Jamison RN, Edwards RR, Schreiber KL. Introversion buffers pandemic-related increases in chronic pain impact. J Pain 2021;22(5):611-612.
[6] Smith BW, Zautra AJ. Vulnerability and resilience in women with arthritis: test of a two-factor model. Journal of consulting and clinical psychology 2008;76(5):799
[7] Carethers JM. Insights into disparities observed with COVID?19. Journal of internal medicine 2021;289(4):463-473.
[8] Hooper MW, Nápoles AM, Pérez-Stable EJ. COVID-19 and racial/ethnic disparities. Jama 2020;323(24):2466-2467
[9] Lopez L, Hart LH, Katz MH. Racial and ethnic health disparities related to COVID-19. Jama 2021;325(8):719-720
Presenting Author
Maisa Ziadni
Poster Authors
Topics
- Racial/Ethnic/Economic Differences/Disparities