The COVID-19 pandemic has put an enormous strain on the healthcare system,
delaying nonemergency medical care and potentially creating a higher risk for
pain patients. However, the behavioral health community is adjusting with
transitions to telemedicine and other alternatives that allow their patients to
receive the care they need.
Knowing clinicians are feeling additional stress during this time,
telehealth options are readily available for the healthcare community too. We
cannot expect those working in health care to properly care for others unless
we are prioritizing their mental health needs.
Two of the leading researchers and practitioners in pain medicine joined us
for our special edition Out Front Ideas COVID-19 Briefing Webinar
Series to discuss the challenges of treating pain patients during the
pandemic and how the healthcare landscape is adapting.
- Beth Darnall, PhD—pain psychologist and associate professor of the
Department of Anesthesiology, Perioperative and Pain Management, at Stanford
Health Care
- Steven P. Stanos, DO—medical director of pain medicine and medical
director of Occupational Medicine Services at Seattle's Swedish
Health
Workplace Well-Being
Due to the additional stress that the pandemic has created for healthcare
workers, behavioral health psychology and counseling have become available in
many primary care facilities. The behavioral health industry has a concierge of
services that allows doctors to work with a therapist confidentially in a time
of need. This "care for caregivers" model also includes Zoom-based
videos and lectures covering helpful techniques like tai chi demonstrations,
breathing exercises, guided meditations, and chair yoga. These videos are then
saved in an archive, making them readily available for later use when
caregivers need them. While created to get through the stress of the pandemic,
these videos will help to alleviate tension that healthcare workers face
regularly.
Behavioral health, as well as many other clinical disciplines, had to
rapidly adjust to telehealth visits, creating safer access for patients. Not
only does this alleviate stress for the clinicians, but it also creates a safer
workspace for clinicians and staff alike. In addition to the creation of video
resources for the healthcare community, crisis management and wellness
resources are available. Organizations like the American Psychological
Association have created online resources that collate information for
clinicians and administrative leaders, providing on-demand access when they
need it most.
Patient Well-Being
COVID-19 has created disruptions in all areas of our lives, but it has been
especially challenging for those managing chronic pain. These patients are
seeking stabilization in their lives, but continued disruptions have
complicated their path to wellness. These disruptions can compound mental and
physical ailments for a pain patient, making it especially difficult for those
with comorbidities. The pandemic has exposed the vulnerability of opioid
patients given the difficulty it has created for those that need access to
medications. Some patients have requested options to taper off of opioids or
reduce their usage since the current environment may leave them feeling even
less in control.
Since patients are at the mercy of the elements currently, it is
increasingly critical to utilize patient-centered communication. Many pain
patients that were just beginning to develop regular schedules are now dealing
with the stress from a lack of routine. Refreshing patients on skills learned
through previous treatments may help create structure and give clinicians key
insights into their at-home routines. Understanding a patient's stress
level can make medication refills easier since conditions like anxiety may be
exasperated currently, putting an opioid patient more at risk than usual. This
continued communication will be key moving forward when there is a return to
normalcy, to maintain consistency in the care of an injured worker.
Treating Pain during COVID-19
Accessibility is essential in treating pain patients throughout the
pandemic. Nearly all visits have become telehealth visits, including
psychological follow-ups and physical therapy. Behavioral medicine now offers
options like individual or group sessions and on-demand treatments that can be
utilized without a therapist. Immersive experimental treatments, like virtual
reality (VR), have created more engaging therapy for patients, putting control
in their hands so they can get help when they need it. This portfolio of
options, including Internet-based treatments, creates readily accessible care
for pain patients.
Patients who were involved in rehabilitative programs can now experience
treatment virtually. The same content they would receive in-office, through
physical therapy, pain education, and relaxation training, can be delivered
through courses a few days a week. A couple of options for these treatments
include Zoom group visits or private YouTube videos, which are Health Insurance
Portability and Accountability Act compliant.
All of these virtual programs work to support the hospitals in a time when
they need it most. For those experiencing significant pain and those with
comorbidities, emergency procedure clinics are now open to avoid emergency room
visits and waiting on an approval process through a hospital. These clinics
help to reserve hospital capacity for patients that need it most during the
pandemic.
Current Research
The need for alternative treatments during the pandemic has created a wave
of new research and guidelines for therapy. The National Institutes of Health
introduced its "Heal Initiative" to reduce opioid usage and awards
grants for tools creating alternative pain management. One of those viable
options includes VR, which has shown to be equivalent and sometimes even more
effective than in-person pain therapy. These concepts retrain a patient's
brain and can optimize experiences based on biofeedback. This type of
experimental treatment is especially helpful in areas where there are not
enough trained clinicians to deal with those experiencing acute and chronic
pain. As this technology gets increasingly cheaper, it will create better
long-term tools for patients in need.
New guidelines created by the American Academy of Pain Medicine and American
Society of Regional Anesthesia and Pain Medicine, in conjunction with Veterans
Affairs and the Department of Defense, outline best practices for pain
management during the pandemic. This document also addresses public health
issues and the welfare of providers. It covers the potential issues surrounding
telemedicine, how to treat opioid management, and mental health considerations
for patients and healthcare providers and defines emergency procedures, like
those associated with cancer patients. They discuss emergency procedures for
patients with poorly controlled pain that need opioids and how to help those
experiencing withdrawals from use. The document also advises the use of
acetaminophen to treat pain since the topic is still controversial in its
interactions with the treatment of COVID-19.
While this period of time is transcending longstanding barriers now that
on-demand care has been proven necessary, it is also important to continue
assessing pain from a multidimensional perspective. This includes evaluating
the risk for each patient, so in-person psychological evaluations are being
used to treat the more symptomatic patients. Using resources like patient
records and history to discern their pain can provide insight into which
patients may be more at risk. Though it may seem that telehealth visits could
increase the risk of opioid abuse, there is no evidence on the extent of that
risk when it is still the same patient reporting the same pain value, in-office
or not. It is critical to take a patient's reporting at face value and
remember that pain will always be subjective.
Listen to the full Out Front Ideas with Kimberly and
Mark webinar on this topic. Stay tuned for more from the Out Front
Ideas COVID-19 Briefing Webinar Series, and view the full list of upcoming topics.
Mark Walls is vice president of Communications
& Strategic Analysis for Safety National. See his full bio.