Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220039-en
Brazilian Journal of Pain
Review Article

Impact of the COVID-19 pandemic on the non-cancer chronic pain and its management in the elderly

Impacto da pandemia do COVID-19 na dor crônica não oncológica e sua gestão em pessoas idosas

Joana Isabel Aparício Pereira; Rosa Marina Afonso; Paulo Reis-Pina

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Abstract

BACKGROUND AND OBJECTIVES: Chronic non-cancer pain is considered a public health problem, affecting 37% of the Portuguese population. Pain treatment represents a fundamental human right. However, during the COVID-19 pandemic, the vast majority of these patient care services were considered non-urgent or non-emergent, and clinical appointments and treatment were postponed or un-scheduled. Imposed restrictions, such as measures to prevent a COVID-19 infection, became counterproductive with regard to the management of chronic pain. Its impact should be emphasized especially in the older population, due to the associated physical and psychological comorbidities. This study aimed to analyze the impact of the COVID-19 pandemic on the pain of older people in four aspects: i) intensity, treatment and management of pain; ii) mental health; iii) lifestyles; iv) quality of life.

METHODS: Review in Pubmed, SCOPUS and SCIELO databases using the terms: chronic non-cancer pain, pain management, aged and COVID-19. 86 articles were found and 13 were selected. Articles included cumulatively addressed chronic pain, represented original research of a clinical nature, and analyzed the impact of the COVID-19 pandemic on the management of chronic pain. Preference was given to studies with participants aged 65 years or older. Studies in adults with no mention of age in the context of the COVID-19 pandemic impact on aspects infuencing chronic pain and its management were also included. Only one article exclusively studied the senior population.

RESULTS: The pandemic affected: i) increased pain intensity (n=10), changes in its pharmacological and non-pharmacological treatment (n=3) and its management, that is, the adaption of the health professionals and patients (n=1); ii) negatively affected mental health: symptoms of stress and anxiety/depression (n=9), psychological distress (n=4), social isolation/loneliness (n=6); iii) lifestyles: physical activity (n=4), sleep quality (n=4) and physical performance (n=5); iv) reduction of quality of life (n=5). Despite the heterogeneous results, a worsening of pain and mental health was found, as well as alteration of styles and quality of life and disruption of medical services.

CONCLUSION: The restrictions imposed by the pandemic affected several areas of pain in the short term. Telemedicine has emerged as an adopted solution, but the barriers in the senior population, such as lack of digital literacy and lack of technological equipment, cannot be overlooked. The lack of knowledge of the specific impact of COVID-19 on the pain of the senior population calls for more research that focuses on the long-term consequences, as well as the solutions to be adopted in order to contain the damage in this vulnerable population.

HIGHLIGHTS

  • Worsening of pain and mental health, change in lifestyles and decreased quality of life. Disruption of medical services generated by the pandemic period reinforce the need for a holistic and individual approach to health care.
  • Impact of the pandemic on chronic pain management has been little explored in older people.
  • Need for further research focusing on long-term consequences, as well as the solutions to be adopted in order to contain injuries or dysfunctions in this vulnerable population.

Keywords

Aged, Chronic pain, COVID-19, Pain management

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor crônica não oncológica é considerada um problema de saúde pública, afetando 37% da população portuguesa. O tratamento da dor representa um direito humano fundamental. Entretanto, durante a pandemia do COVID-19, a grande maioria destes serviços de assistência ao paciente foi considerada como não urgente ou não emergente, sendo consultas e tratamentos clínicos adiados ou desmarcados. Restrições impostas, como medidas de prevenção da infecção por COVID-19, tornaram-se contraproducentes no que se refere à gestão da dor crônica. O seu impacto deve ser realçado principalmente na população mais idosa, devido às comorbidades associadas quer físicas quer psicológicas. O objetivo deste estudo foi analisar o impacto da pandemia do COVID-19 na dor de pessoas idosas em quatro aspectos: i) intensidade, tratamento e gestão da dor; ii) saúde mental; iii) estilo de vida; iv) qualidade de vida.

MÉTODOS: Revisão nas bases de dados Pubmed, SCOPUS e Scielo usando os termos: chronic non-cancer pain, pain management, aged e COVID-19. Foram encontrados 86 artigos e selecionados 13. Foram incluídos artigos que cumulativamente versavam sobre dor crônica, representavam pesquisa original de natureza clínica e analisavam o impacto da pandemia do COVID-19 na gestão da dor crônica. A preferência foi dada a estudos com participantes com idade igual ou superior a 65 anos. Também foram analisados estudos realizados em adultos sem menção de idade no âmbito do impacto da pandemia do COVID-19 sobre os aspetos que infuenciam a dor crônica e a sua gestão. Apenas um artigo estudou exclusivamente a população idosa.

RESULTADOS: A pandemia afetou: i) aumento da intensidade da dor (n=10), alterações no seu tratamento farmacológico e não farmacológico (n=3) e a sua gestão, isto é, a adaptação dos profissionais de saúde e dos doentes (n=1); ii) negativamente a saúde mental: sintomas de estresse e ansiedade/depressão (n=9), distresse psicológico (n=4), isolamento social/solidão (n=6); iii) estilos de vida: atividade física (n=4), qualidade do sono (n=4) e desempenho físico (n=5); iv) redução da qualidade de vida (n=5). Apesar dos resultados heterogêneos, verificou-se o agravamento da dor e saúde mental, alteração dos estilos e qualidade de vida, disrupção dos serviços médicos.

CONCLUSÃO: As restrições impostas pela pandemia afetaram vários domínios da dor em curto prazo. A telemedicina surgiu como uma solução adotada, não podendo descurar os entraves na população idosa, como a falta de literacia digital e falta de equipamentos tecnológicos. O desconhecimento do impacto específico da COVID-19 na dor da população idosa sugere mais investigação que incida sobre as consequências em longo prazo, assim como as soluções a adotar de modo a conter lesões ou disfunções nesta população vulnerável.

DESTAQUES

  • Agravamento da dor e saúde mental, alteração dos estilos e diminuição da qualidade de vida. A disrupção dos serviços médicos gerados pelo período pandêmico reforça a necessidade de uma abordagem holística e individual na assistência de saúde.
  • Impacto da pandemia na gestão da dor crônica foi pouco explorado em pessoas idosas.
  • Necessidade de mais investigações que incidam sobre as consequências em longo prazo, assim como as soluções a adotar de modo a conter lesões ou disfunções nesta população vulnerável.

Palavras-chave

COVID-19, Dor crônica, Idoso, Gestão em saúde

References

Cáceres-Matos R, Gil-García E, Barrientos-Trigo S, Porcel-Gálvez AM, Cabrera-León A. Consequences of chronic non-cancer pain in adulthood. Scoping review. Rev Saude Publica. 2020;54:39.

Eccleston C, Blyth FM, Dear BF, Fisher EA, Keefe FJ, Lynch ME, Palermo TM, Reid MC, Williams ACC. Managing patients with chronic pain during the COVID-19 outbreak: considerations for the rapid introduction of remotely supported (eHealth) pain management services. Pain. 2020;161(5):889-93.

Lo Bianco G, Papa A, Schatman ME, Tinnirello A, Terranova G, Leoni MLG, Shapiro H, Mercadante S. Practical advice for treating chronic pain in the time of COVID-19: a narrative review focusing on interventional techniques. J Clin Med. 2021;10(11):2303.

Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. J Pain. 2012;13(8):773-83.

Antunes F, Pereira RM, Afonso V, Tinoco R. Prevalence and characteristics of chronic pain among patients in Portuguese Primary Care Units. Pain Ter. 2021;10(2):1427-37.

Puntillo F, Giglio M, Brienza N, Viswanath O, Urits I, Kaye AD, Pergolizzi J, Paladini A, Varrasi G. Impact of COVID-19 pandemic on chronic pain management: Looking for the best way to deliver care. Best Pract Res Clin Anaesthesiol. 2020;34(3):529-37.

Zambelli Z, Fidalgo AR, Halstead EJ, Dimitriou D. Acute impact of a national lock-down during the COVID-19 pandemic on wellbeing outcomes among individuals with chronic pain. J Health Psychol. 2022;27(5):1099-110.

Li LW, Chew AMK, Gunasekeran DV. Digital health for patients with chronic pain during the COVID-19 pandemic. Br J Anaesth. 2020;125(5):657-60.

Kleinmann B, Abberger B, Kieselbach K, Wolter T. Patients with chronic pain prefer maintenance of pain treatment despite COVID-19 pandemic restrictions. Pain Physician. 2021;24(2):165-73.

Orientações técnicas sobre o controlo da dor crónica na pessoa idosa. Orientação N.º 15/2010. 2010.

Iddon JE, Taylor PJ, Unwin J, Dickson JM. The role of positive goal engagement in increased mental well-being among individuals with chronic non-cancer pain. Br J Pain. 2019;13(4):230-8.

Cristóvão I, Reis-Pina P. Chronic Pain Education in Portugal: perspectives from medical students and interns. Acta Med Port. 2019;32(5):338-47.

Declaration of Montréal: declaration that access to pain management is a fundamental human right. J Pain Palliat Care Pharmacother. 2011;25(1):29-31.

Murphy MT, Latif U. Pain during COVID-19: a comprehensive review and guide for the interventionalist. Pain Pract. 2021;21(1):132-43.

de Moraes EB, Santos Garcia JB, de Macedo Antunes J, Daher DV, Seixas FL, Muniz Ferrari MF. Chronic pain management during the COVID-19 pandemic: a scoping review. Pain Manag Nurs. 2021;22(2):103-10.

Karos K, McParland JL, Bunzli S, Devan H, Hirsh A, Kapos FP, Keogh E, Moore D, Tracy LM, Ashton-James CE. The social threats of COVID-19 for people with chronic pain. Pain. 2020;161(10):2229-35.

Fujiwara A, Watanabe K, Ida M, Kawanishi H, Kimoto K, Yoshimura K, Shinohara K, Kawaguchi M. The short-term effect of COVID-19 pandemic on disability, pain intensity, psychological status, and exercise habits in patients with chronic pain. J Anesth. 2021;35(6):862-9.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(n71).

Yamada K, Wakaizumi K, Kubota Y, Murayama H, Tabuchi T. Loneliness, social isolation, and pain following the COVID-19 outbreak: data from a nationwide internet survey in Japan. Sci Rep. 2021;11(1):18643.

Harnik MA, Blättler L, Limacher A, Reisig F, Grosse Holtforth M, Streitberger K. Telemedicine for chronic pain treatment during the COVID-19 pandemic: do pain intensity and anxiousness correlate with patient acceptance?. Pain Pract. 2021;21(8):934-42.

Yu L, Kioskli K, McCracken LM. The psychological functioning in the COVID-19 pandemic and its association with psychological flexibility and broader functioning in people with chronic pain. J Pain. 2021;22(8):926-39.

García-Esquinas E, Ortolá R, Gine-Vázquez I, Carnicero JA, Mañas A, Lara E. Changes in health behaviors, mental and physical health among older adults under severe lockdown restrictions during the COVID-19 pandemic in Spain. Int J Environ Res Public Health. 2021;18(13):7067.

Macfarlane GJ, Hollick RJ, Morton L, Heddle M, Bachmair E, Anderson RS, Whibley D, Keenan KF. The effect of COVID-19 public health restrictions on the health of people with musculoskeletal conditions and symptoms: the CONTAIN study. Rheumatology. 2021;60(^sSI):SI13-24.

Lassen CL, Siam L, Degenhart A, Klier TW, Bundscherer A, Lindenberg N. Short-term impact of the COVID-19 pandemic on patients with a chronic pain disorder. Medicine. 2021;100(10).

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. Br J Pain. 2021;15(3):357-68.

Pagé MG, Lacasse A, Dassieu L, Hudspith M, Moor G, Sutton K, Tompson JM, Dorais M, Janelle Montcalm A, Sourial N, Choinière M. A cross-sectional study of pain status and psychological distress among individuals living with chronic pain: the Chronic Pain & COVID-19 Pan-Canadian Study. Health Promot Chronic Dis Prev Can. 2021;41(5):141-52.

Mun CJ, Campbell CM, McGill LS, Aaron RV. The early impact of COVID-19 on chronic pain: a cross-sectional investigation of a large online sample of individuals with chronic pain in the United States, April to May, 2020. Pain Med. 2021;22(2):470-80.

Licciardone JC. Impact of COVID-19 on utilization of nonpharmacological and pharmacological treatments for chronic low back pain and clinical outcomes. J Osteopath Med. 2021;121(7):625-33.

Licciardone JC. Demographic characteristics associated with utilization of noninvasive treatments for chronic low back pain and related clinical outcomes during the COVID-19 pandemic in the United States. J Am Board Fam Med. 2021;34(^sSuppl):S77-84.

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. Neurol Sci. 2021;42(2):389-97.

Nieto R, Pardo R, Sora B, Feliu-Soler A, Luciano JV. Impact of COVID-19 Lockdown Measures on Spanish People with Chronic Pain: An Online Study Survey. J Clin Med. 2020;9(11):3558.

Joyce AA, Conger A, McCormick ZL, Kendall RW, Wagner G, Teramoto M, Cushman DM. Changes in interventional pain physician decision-making, practice patterns, and mental health during the early phase of the sars-cov-2 global pandemic. Pain Med. 2020;21(12):3585-95.

Steptoe A, Di Gessa G. Mental health and social interactions of older people with physical disabilities in England during the COVID-19 pandemic: a longitudinal cohort study. Lancet Public Health. 2021;6(6).

Polenick CA, Perbix EA, Salwi SM, Maust DT, Birditt KS, Brooks JM. Loneliness During the COVID-19 Pandemic Among Older Adults With Chronic Conditions. J Appl Gerontol. 2021;40(8):804-13.

Hruschak V, Flowers KM, Azizoddin DR, Jamison RN, Edwards RR, Schreiber KL. Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic. Pain. 2021;162(2):619-29.

Smyrnioti ME, Lyrakos G, Meindani M, Matsota P, Kostopanagiotou G, Batistaki C. The impact of the first wave of the COVID-19 pandemic on patients’ perceptions of chronic pain. J Pain Res. 2021;14:2571-81.

El-Tallawy SN, Nalamasu R, Pergolizzi JV, Gharibo C. Pain management during the COVID-19 pandemic. Pain Ter. 2020;9(2):453-66.

Noroozian M, Raeesi S, Hashemi R, Khedmat L, Vahabi Z. Pain: the neglect issue in old people’s life. Open Access Maced J Med Sci. 2018;6(9):1773-8.

Paterniani A, Sperati F, Esposito G, Cognetti G, Pulimeno AML, Rocco G, Diamanti P, Bertini L, Baldeschi GC. Quality of life and disability of chronic non-cancer pain in adults patients attending pain clinics: a prospective, multicenter, observational study. Appl Nurs Res. 2020;56:151332.

Pakniyat-Jahromi S, Sher L. Pain management and prevention of suicide in the COVID-19 era. Eur Arch Psychiatry Clin Neurosci. 2021;272(1):169-70.

Alonso-Matielo H, da Silva Oliveira VR, de Oliveira VT, Dale CS. Pain in Covid Era. Front Physiol. 2021;12:624154.

Carrillo-de-la-Peña MT, González-Villar A, Triñanes Y. Efects of the COVID-19 pandemic on chronic pain in Spain: a scoping review. Pain Rep. 2021;6(1).

Tang SK, Tse MMY, Leung SF, Fotis T. The effectiveness, suitability, and sustainability of non-pharmacological methods of managing pain in community-dwelling older adults: a systematic review. BMC Public Health. 2019;19(1):1488.

Bonezzi C, Fornasari D, Cricelli C, Magni A, Ventriglia G. Pharmacological Management of Adults with Chronic Non-Cancer Pain in General Practice. Pain Ter. 2020;9(S1^ssuppl 1):17-28.

Emetick T, Alter B, Jarquin S, Brancolini S, Bernstein C, Luong K, Morrisseyand S, Wassan A. Telemedicine for chronic pain in the COVID-19 Era and Beyond. Pain Med. 2020;21(9):1743-8.

Chan DX, Lin XF, George JM, Liu CW. Clinical challenges and considerations in management of chronic pain patients during a COVID-19 pandemic. Ann Acad Med Singap. 2020;49(9):669-73.

Larsson C, Hansson EE, Sundquist K, Jakobsson U. Chronic pain in older adults: prevalence, incidence, and risk factors. Scand J Rheumatol. 2017;46(4):317-25.

Coleman BC, Kean J, Brandt CA, Peduzzi P, Kerns RD. Adapting to disruption of research during the COVID-19 pandemic while testing nonpharmacological approaches to pain management. Transl Behav Med. 2020;10(4):827-34.

Tauben DJ, Langford DJ, Sturgeon JA, Rundell SD, Towle C, Bochman C, Nicholas M. Optimizing telehealth pain care after COVID-19. Pain. 2020;161(11):2437-45.

Dassieu L, Pagé MG, Lacasse A, Lafamme M, Perron V, Janelle-Montcalm A, Hudspith M, Moor G, Sutton K. Chronic pain experience and health inequities during the COVID-19 pandemic in Canada: qualitative findings from the chronic pain & COVID-19 pan-Canadian study. Int J Equity Health. 2021;20(1):147.

Webster F, Connoy L, Sud A, Pinto AD, Katz J. Grappling with chronic pain and poverty during the COVID-19 Pandemic. Can J Pain. 2020;4(1):125-8.


Submitted date:
03/10/2021

Accepted date:
08/24/2022

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