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 Table of Contents  
Year : 2020  |  Volume : 34  |  Issue : 3  |  Page : 171-174

Pain physicians' perspectives on chronic pain management during COVID-19 pandemic: An online survey

1 Department of Anaesthesiology, AIIMS, Raipur, Chhattisgarh, India
2 Department of Anaesthesiology, Hitech Medical College, Bhubaneshwar, Odisha, India
3 Director, IPSC, New Delhi, India
4 In Charge, Pain Clinic, KIMS, Bhubaneshwar, Odisha, India
5 Department of Pain and Palliative Care, SMS Medical College, Jaipur, Rajasthan, India
6 Department of Anesthesiology, NEIGRIHMS, Shillong, Meghalaya, India

Date of Submission15-Oct-2020
Date of Decision11-Nov-2020
Date of Acceptance11-Nov-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Dr. Samarjit Dey
Department of Anaesthesiology, AIIMS, Raipur, Chhattisgarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpn.ijpn_143_20

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Background: The ongoing COVID-19 pandemic has affected the current health care to the core. As a result, there is a shift of focus on health care to control the pandemic. The chronic pain patients, though at risk, are also the sufferers. The aim of this online survey was to evaluate the perspective of the pain physicians on chronic pain management during COVID-19 pandemic in India. Methods: The survey was conducted under the aegis of Indian society for study of pain. The questionnaire in the form of Google Forms was filled by pain physicians online after webinar. Results: In this survey, majority of the pain physicians (71.12%) reported that they are practicing pain even during COVID pandemic but with precautions. Around 65.77% of the pain physicians were using telemedicine for consultation. A prior COVID test for interventional procedures was opted by 85.56% of pain physicians. Total 89.30% feel that personal protective equipment is necessary for doing pain interventions. Meanwhile, during the pandemic, 97.32% of the pain physicians are attending webinars to keep themselves updated. Conclusion: This survey of pain physicians' perspectives on impact of COVID-19 shows that chronic pain practice was greatly affected. Although webinars are a modality to keep the pain physicians updated, telemedicine has taken its stride forward to prove its major role during this pandemic for consultation. The personal protection is the new must-have among pain physicians in clinics and hospitals during and after pandemic.

Keywords: Chronic pain, COVID-19, pain physician

How to cite this article:
Dey S, Rath SK, Surange P, Sahoo R, Sharma G, Dev P. Pain physicians' perspectives on chronic pain management during COVID-19 pandemic: An online survey. Indian J Pain 2020;34:171-4

How to cite this URL:
Dey S, Rath SK, Surange P, Sahoo R, Sharma G, Dev P. Pain physicians' perspectives on chronic pain management during COVID-19 pandemic: An online survey. Indian J Pain [serial online] 2020 [cited 2021 Jun 14];34:171-4. Available from: https://www.indianjpain.org/text.asp?2020/34/3/171/305141

  Introduction Top

Pain physicians prevent, treat, and rehabilitate the chronic pain patients through a multidisciplinary approach. Clinical examination of the patients along with history holds the key to diagnosis; at the outset of COVID-19 pandemic, it is difficult to manage such clinics on an outpatient basis. As a result of the ongoing pandemic, regular health-care services have been severely affected, with health-care resources being diverted to deal with the surge of COVID-19 patients.

COVID-19 is a deadly respiratory illness caused by a virus SARS-CoV-2, which was first reported in the city of Wuhan, Hubei Province, China, which was later reported to be caused by SARS-CoV-2. The presenting features at onset include fever, cough, and shortness of breath, and fatigue with an incubation period of approximately 5 days which may lead to serious respiratory distress requiring intensive care unit admission.[1],[2] The likely route of spread of infection is by person-to-person transmission by respiratory droplets of an infected person when he coughs or sneezes through aerosol, between people who are within about 6 feet of each other, and possibly through contaminated surfaces that have the virus on them with symptoms occurring 2–14 days after exposure.[3],[4] It was found that among the confirmed cases of COVID-19, patients with comorbidities had a poorer clinical outcome than without.[5] The patient demographic in pain practice comprises patients who, many a times, have comorbid conditions and patients with chronic pain conditions on medications and also possesses risk for reduced immunity. This places them at a clinically higher risk of acquiring the infection. However, while the pandemic is still on the go, pain practice too has been affected and we planned to do an online webinar survey with the aim to find the perspectives of pain physicians on chronic pain management.

This survey was conducted at the peak of the pandemic with the objective of identifying the various perspectives of pain physicians toward chronic pain practice during the pandemic to understand how the pain physicians would plan their practice during the pandemic. It would also help us formulate protocols for the new normal pain clinics for the safety of patients as well as pain physicians.

  Methods Top

This survey was conducted online on May 3, 2020, while the pandemic was at its peak. The questionnaire was made on Google Forms and sent to all the participants after a webinar. The pain physicians with more than 5 years of experience were the responders. The questions were directed toward the practice of pain medicine among the pain physicians and their perception during the COVID-19 pandemic. There were total of 18 questions, in English, of which 16 of these questions had either a yes or no as an answer [Table 1]. All questions were mandatory. One question had a multiple-choice answer based on the type of personal protective equipment (PPE) used during the pandemic. Google Forms was chosen as it was an easy to use platform with simple user interface and ease of tabulating data at the end. The questionnaire was distributed to all the participants of the meeting held on Zoom on May 3, 2020.
Table 1: Questionnaire on perspectives of pain physicians during COVID-19

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  Results Top

The questionnaire [Table 1] was sent to pain physicians to survey the effect of COVID-19 on their perspectives about COVID-19 and pain practice. A total of 187 responses were received from 11 countries, with 162 responses being received from India, and 25 from other countries. Majority (87.16%) of the respondents felt that chronic pain patients are at an increased risk of contracting COVID due to immunity and comorbid issues.

A total of 71.12% of the pain physicians are managing chronic pain patients during this pandemic. Telemedicine was seen as an effective means for communication and consultations by 79.14% of the respondents and 65.7% of the respondents used telemedicine for consultations in chronic pain patients. Around 57% of the pain physicians are consulting patients in their clinics or hospitals. Majority of the pain physicians (86.6%) felt that PPE is necessary before interacting with any patient. Interventions for chronic pain were planned by 75.4% of the pain physicians in near future, with 85.5% of them planning to screen their patients for COVID before any intervention.

When asked if they felt pain interventions are routine and can be postponed during the pandemic, 59.8% responded in the negative. A majority (87.7%) of the respondents felt that patients should be triaged according to the urgency/emergency. Majority of the pain physicians (89%) felt that PPE is necessary before performing any intervention on pain patients. Of the respondents, 71.6% were planning to use nonsteroidal anti-inflammatory drugs for chronic pain management and 68.9% of them felt that using steroids in interventions can lead to a decreased immunity and make chronic pain patients susceptible to COVID. Almost all of the respondents (98.93%) felt that attending webinars would help them enhance their knowledge and are useful regarding chronic pain management and COVID.

  Discussion Top

It had been reported that patients with comorbid conditions are at an increased risk of morbidity and mortality, which is a major concern in this COVID-19 pandemic.[5],[6] Most of the pain physicians (87%) are of this opinion, since many patients are on immune-suppressant therapy, which places them at a higher risk of acquiring COVID, and thus adverse outcomes. Pain medicine as a specialty deals with patients with chronic multiple complaints and regular follow-ups, at times requiring interventions. With closure of outpatient departments and clinics, the pain practice has been greatly affected.[7]

A good majority of the pain physicians (65%) are using telemedicine as a medium to see patients of pain. This is an effective way to deal with old patients, but not in case of patients presenting with acute symptoms, where clinical examination is essential to reach a diagnosis. The practice of pain medicine involves detailed and prolonged history and examination which poses providers at a considerable risk of acquiring infection as the route of spread is by transmission of respiratory droplets. A similar risk may be expected during interventions. A large number of pain physicians (60%) think that interventions cannot be postponed due to the pandemic, because those interventional pain procedures are need based and strongly indicated to relieve the pain and as well as to reduce the burden of ongoing systemic medications.

COVID can also be transmitted via contact transmission after contact with virus-contaminated surfaces. If the person is asymptomatic, he or she can infect others.[8] The availability and use of PPE are, therefore, of prime importance to self-protect. The type of PPE used is to be noted. A simple N95 mask also counts as PPE, or a complete gown with face shield and goggles is also considered PPE. A wide majority are of the opinion that PPE is necessary while performing any intervention.[9] The resources in this pandemic are directed toward dealing with critically ill patients, leaving limited resources for other practices such as pain clinic and interventions leaving majority of the patients to suffer.

Many pain physicians are primarily anesthesiologists, and since the beginning of the pandemic, anesthesiologists have been on the forefront in managing critically ill COVID-19 patients and hence they are at a greater risk of acquiring the infection, Health-care workers may be asymptomatic, but nevertheless can be a asymptomatic carrier and a potential source of infection to other non COVID patients like pain patients, if the required PPE is not used. A valveless respirator should be used to prevent transmission of the virus. Chronic pain patients are on a regular follow-up and require constant monitoring and prescriptions for drug dispensing. The shutdown and diversion of medical personnel has impacted this. The use of telemedicine is seen as a step forward toward talking to our patients and continuing the treatment.[10]

A Joint Statement was released by the American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anesthesia and Pain Therapy regarding the practice of the chronic pain practice during pandemic.[10] The Joint Statement points about important aspects of the chronic pain practice. “No elective pain procedures, except specific semi-urgent procedures, should be performed” – as mentioned in the statement. It was suggested that there should be any changes in ongoing opioid treatment or use of during the pandemic.[11],[12],[13] While pain relief is a basic human necessity, formulating protocols as per the setup is required to cope with the current situation.[14] As the pandemic is in action, we all need to formulate our protocol while caring for chronic pain patients in COVID-19 pandemic.[15]

Although many areas are not covered in this survey, a larger number of responses of various pain physicians from either government or private setup would have yielded a better picture.

This preliminary survey of perspectives of pain physicians has not looked into many issues such as impact of telemedicine on practice in detail, procurement or dispensing of opioids, and types of the procedures.

  Conclusion Top

The COVID-19 pandemic has affected the practice of pain physicians and management of chronic pain patients. Majority of the pain physicians feel that PPE is a necessary requirement while handling the pain patients in outpatient departments or for intervention. Pain interventions can be triaged according to the urgency. Telemedicine is an effective way of consultation during this pandemic. The sanitizers and mask with physical distancing are new normal for pain clinics.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433.  Back to cited text no. 1
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 2
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 3
Desai AN, Patel P. Stopping the Spread of COVID-19. JAMA 2020;323:1516.  Back to cited text no. 4
Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-increased-risk.html. [Last accessed on 2020 Oct 14].  Back to cited text no. 5
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020;323:2052-9.  Back to cited text no. 6
Dey S, Usmani H, Hussain A. Pain practice during the COVID-19 pandemic: Transitioning to a new normal. Indian J Pain 2020;34:61.  Back to cited text no. 7
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Day M. COVID-19: Four fifths of cases are asymptomatic, China figures indicate. BMJ 2020;369:m1375.  Back to cited text no. 8
Ip V, Ozelsel TJ, Sondekoppam RV, Tsui BC. Coronavirus disease 2019 (COVID-19) pandemic: Greater protection for healthcare providers in the hospital 'Hot zones'? Anesth Analg 2020;131:e37-8.  Back to cited text no. 9
Telemedicine Practice Guidelines. Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine. [This constitutes Appendix 5 of the Indian Medical Council Professional Conduct, Etiquette and Ethics Regulation, 2002]. BOARD OF GOVERNORS In Supersession of the Medical Council of India; 2020.  Back to cited text no. 10
Van Boxem K, Rijsdijk M, Hans G, de Jong J, Kallewaard JW, Vissers K, et al. Safe use of epidural corticosteroid injections: recommendations of the WIP Benelux Work Group. Pain Pract 2019;19:61-92.  Back to cited text no. 11
U.S. Food and Drug Administration. FDA Advises Patients on Use of Non-Steroidal Anti-Inflammatory 19; March 19, 2020. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19. [Last accessed on 2020 Oct 14].  Back to cited text no. 12
Faculty of Pain Medicine. FPM Response to Concern Related to the Safety of Steroids Injected as Part of Pain Procedures during the Current COVID-19 Virus Pandemic; 2020.  Back to cited text no. 13
Brennan F, Carr D, Cousins M. Access to pain management-still very much a human right. Pain Med 2016;17:1785-9.  Back to cited text no. 14
Shanthanna H, Strand NH, Provenzano DA, Lobo CA, Eldabe S, Bhatia A, et al. Caring for patients with pain during the COVID-19 pandemic: Consensus recommendations from an international expert panel. Anaesthesia 2020;75:935-44.  Back to cited text no. 15


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