Background & Aims
Initially COVID-19 necessitated rapid alteration & reduction of services available to those living with persistent pain. Resource was redirected towards critical care, non-urgent care was minimised to reduce risk of acquired infection1. Empirical data on the impact of COVID-19 for Persistent Pain sufferers is only emerging2. The impact of enforced social restriction for those living with chronic conditions, has not been widely reported. Evidence from chronic musculoskeletal & cardiovascular disease highlights a negative association between social isolation, quality of life and increased morbidity3. It was therefore important to explore the experience of enforced routine change & reduced healthcare access, on the local Pain population, to futureproof services. Aim: to assess how the COVID-19 pandemic & associated restrictions affected pain experience, healthcare access, function, emotional well-being, and quality of life of people living with chronic pain in an Island community.
Methods
The evaluation team consisted of Pain specialist clinicians (physiotherapists, psychologists & a pain medicine specialist) working from redeployed positions within an Island based secondary care system, or whilst managing an urgent triage based system for Pain referrals, that could signpost to emergency department access only for patients that had been assessed as requiring urgent specialist care via telephone or online; as well as support from the local Pain charity committee. Questionnaires developed to evaluate the impact of the pandemic on persistent pain sufferers in other jurisdictions were reviewed and the team adapted a questionnaire utilised by the US Pain Foundation4 to survey the experiences of persistent pain sufferers who were registered members of a local Pain Support charity during the initial phases of lockdown (August 2020 to July 2021).
Results
27 responses: 81% female, median age 55-64; median pain duration 5-10 years. 37% lived alone. 33% employed; 67% retired/unemployed/homemaker. 59% immunocompromised. Pandemic reportedly triggered increased pain 44%; decreased function 37%; lower mood 48%. 11% worked in person; 44% switched to remote work; 33% temporarily laid off; 11% permanently laid off. 55% felt financial worries increased stress. 48% had pain appointments cancelled/postponed; only 22% accessed telehealth appointments. Priorities were: advice about activity 33%; treatment for pain 29%; health questions answered 22%; improved access to healthcare providers in person 18%. Commonest emotions (on likert scale) Sadness (M5.5, SD2.7) Powerlessness (M5.1, SD2.8) & Hope (M4.8, SD3.5). Sadness correlated with increased pain r(26)=.52, p=.01, functional impact r(26)=.53, p=.01 & immunocompromise r(26)=.40, p=.04. Powerlessness correlated with immunocompromise r(25)=.42, p=.03 & being unemployed/retired r(25)=.46, p=.02.
Conclusions
Reduced healthcare access & enforced social isolation negatively impacted on pain intensity, function & mood, which has previously been shown to be associated with increased mortality5,6. Work alteration or cessation increased reports of stress linked to increased financial worries. Living with immunocompromise increased difficulty for pain sufferers in relation to mood (sadness & powerlessness) but the population surveyed still reported feeling somewhat hopeful. Those unemployed or retired (most distanced from the social & financial benefits of work) had an increased risk of feeling powerless. Nearly half of respondents had appointments cancelled or postponed but only 22% accessed telehealth consultations. Telehealth had the potential to address half of the most commonly reported priorities (advice about exercise; ability to ask questions of healthcare providers). Accessing pain treatment & being able to do this in person remained important respondents despite the pandemic.
References
1.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 161, 889 (2020).
2.Ziadni, M.S., You, D.S., Cramer, E.M. et al. The impact of COVID-19 on patients with chronic pain seeking care at a tertiary pain clinic. Sci Rep 12, 6435 (2022).
3.Smith TO, Dainty JR, Williamson E, Martin KR. Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing. Br J Pain. 2019 May;13(2):82-90. doi: 10.1177/2049463718802868. Epub 2018 Sep 20. PMID: 31019689; PMCID: PMC6463349.
4.US Pain Foundation, Chronic Pain & COVID-19 Survey report, 2021, Middletown, Connecticut, USA.
5.Steptoe A, Shankar A, Demakakos P, et al. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A 2013; 110: 5797–5801.
6.Smith SG, Jackson SE, Kobayashi LC, et al. Social isolation, health literacy, and mortality risk: findings from the English Longitudinal Study of Ageing. Health Psychol 2018; 37: 160–169.
Presenting Author
Julia Morris
Poster Authors
Julia Morris
PhD
Government of Jersey Health & Community Services
Lead Author
Michael Du Feu BSc
Government of Jersey Health & Community Services
Lead Author
Jonathan Bond MSc
Government of Jersey Health & Community Services
Lead Author
Chad Taylor
MB ChB FRCA FFPMRCA
Government of Jersey Health & Community Services
Lead Author
Topics
- Other