The coronavirus disease 2019 (COVID-19) pandemic has presented broad challenges that have touched nearly every aspect of society. Successive waves of infection and rising caseloads have required healthcare organizations to make drastic changes to the delivery of urgent and non-urgent services to reduce virus exposure risks. The impact of these service changes extends to the delivery of care for patients with chronic pain. For example, elective medical procedures, in-person visits, and multidisciplinary services for chronic pain have been often reduced since the start of the pandemic, while telehealth, digital treatment, and virtual reality treatments have been greatly expanded. As a result, patients and clinicians have been required to adjust to this rapidly changing healthcare environment.
In our recent paper, published in Scientific Reports, we sought to understand the impact of the pandemic on the health status of patients seeking treatment for pain. By characterizing the impacts of the pandemic on chronic pain experience, we ultimately sought to identify areas of growing need, evaluate any gaps in services, and promote optimal pain care in the future. We predicted that pain and pain-related symptoms, psychological distress, and social function would become worse for patients with chronic pain after the onset of the COVID-19 pandemic. We also predicted that female patients with chronic pain would report greater negative health impacts of the pandemic compared to male patients, given that worse health status has been observed in female patients seeking treatment for chronic pain.
We examined patient-reported health symptom data among 7,535 patients at the Stanford Pain Management Center between 2017 and 2020. Among these patients, we examined data from 1,798 patients who completed surveys collected between April-October 2020 (post-COVID-19 onset cohort), and a control sample of 5,737 patients who completed surveys collected between April-October 2017, 2018, and 2019 (pre-COVID-19 cohort). To account for any effect of season on our results, we limited our control pre-COVID-19 cohort to the same months as the post-COVID-19 onset cohort for the preceding three years.
Figure 1. New COVID-19 cases in San Mateo county where the Stanford Pain Management Center is located. Data were obtained from https://www.smchealth.org/coronavirus-health-data
We found that there were small but significant decreases in pain catastrophizing, a negative cognitive and emotional response style to pain, in June and July 2020 compared to pre-pandemic months. Pain catastrophizing was significantly lower in patients measured after the onset of the pandemic in June 2020 when the Stanford Pain Management clinic was re-opened for in-person visits. Pain catastrophizing increased, however, in July 2020 when COVID-19 cases reached a new peak in the San Francisco Bay Area at that point in the pandemic. These changes in pain catastrophizing were not paralleled by changes in patients’ pain ratings.
Interestingly, we also found potential signs of encouraging resilience in the patients that we surveyed. For example, we found significant improvements in patients’ pain interference, physical function, and sleep impairment in the post-COVID-19 cohort. We further found that female patients in the post-COVID-19 cohort showed significant improvements in their fatigue symptoms. Further suggesting potential resilience in patients, we found that patients in the post-COVID-19 onset cohort reported small but significant improvements in emotional support compared to the pre-COVID-19 cohort. These patients also did not report significant worsening of depression, anxiety, anger, social isolation, or satisfaction with social roles and activities post-pandemic onset.
Overall, we found that the pandemic did not adversely influence markers of physical and mental health among patients seeking treatment for pain in our clinic. Although this is contrary to some published findings to date on the adverse impacts of the pandemic, there have also been studies suggesting encouraging resilience during the pandemic. Several factors related to our sample may also help explain our positive findings. For example, an important distinction in our study is that our sample was in treatment at the Stanford Pain Management Center and continued to receive virtual treatment during the pandemic. There was no interruption in care, and care was still provided until face-to-face care could be re-introduced. In addition, patients reported increases in emotional support post-pandemic onset, which may have buffered the impacts of COVID-19 and contributed to the improvements that we observed. Most of our patients were married or living together, and there were no significant differences in employment status, disability status, and the numbers of doctor’s office visits and ER visits for the past six months between the pre- and post-pandemic onset cohorts.
Taken together, we found evidence of encouraging resilience among patients seeking treatment for pain conditions in the face of the COVID-19 pandemic. However, our finding that patients’ pain catastrophizing increased when COVID-19 cases peaked points to the need for future study and monitoring of patients as the effects of the pandemic continue.
(Image credit: Direct Media on StockSnap)
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