Management of chronic pain using telehealth during COVID-19

The COVID-19 pandemic has led to the need for rapid introduction of remotely supported pain management services. In a review article, Eccleston et al. (2020) provide recommendations for health professionals in adapting to this.

Prior to the COVID-19 pandemic, telehealth approaches to pain management were gradually being introduced, including via videoconferencing, internet-based programs, mobile apps and telephone. However, the pandemic has accelerated research and the implementation of telehealth for chronic pain. To guide health professionals in this rapid transition to remote care, Eccleston and colleagues outline four related factors that need to be taken into account:

• The public health consequences of COVID-19 for individuals with pain.
• The consequences of not treating individuals with pain for the duration of the pandemic.
• Options for remote assessment and management.
• Evidence supporting remote therapies.

Public health considerations

The reviewers discuss how the pandemic will impact on the prevention and management of chronic pain. Risk factors for pain morbidity and mortality are likely to be magnified during a global health pandemic. Populations with higher existing pain burden are more likely to experience a higher incidence of COVID-19 infections and worse consequences of disrupted healthcare.

Consequences of no treatment

Chronic pain is both prevalent within the community and has a widespread impact on individuals, families and society. For people waiting for assessment and treatment of chronic pain their condition can worsen significantly. Lack of treatment can also increase rates of inappropriate treatment such as overuse of opioids.

Remote assessment and management options

Aspects of clinical assessment can be done remotely, including through online administration of assessment measures, some aspects of physical examination (e.g., assessment of appearance or movement) and use of internet- or app-based self-management interventions. While research supports the use of some of these, caution is needed on the use of commercially developed interventions if they are not supported by research.

Evidence supporting the use of remote treatment

Research supports the use of telehealth for chronic pain management, especially for internet-based chronic pain management programs. Systematic reviews and meta-analyses indicate that some programs show small to moderate reductions in pain, disability and distress compared to control conditions. However, greater understanding is needed about enhancing engagement and adherence and identifying who may find telehealth difficult to use.

http://dx.doi.org/10.1097/j.pain.0000000000001885

Recommendations for remotely supported pain management

• Know your options for providing remote services, including understanding the technology provided and how to give the best experience to the client. Consider factors like audio and video quality, background distractions and lighting. For videoconferencing, position yourself so that you can make contact with the webcam as though making eye contact with the client.
• If you and/or the client experience technological problems during a session, use this as opportunity to practise effective problem-solving skills. Agree on a back-up option in advance, such as a telephone call.
• Schedule appointments when the client will be able to have the least distractions.
• Where relevant, provide remote intervention options for the client, including self-help books, internet-based interventions, smartphone apps and/or remote sessions with a psychologist.
• Reinforce the positives of the remote pain-management experience, such as strategies which have worked and how individuals motivated themselves to use the strategy.
• Work with the client to problem-solve difficulties around managing pain.
• Work with the client on a task that may help them to manage their pain (e.g., developing a daily schedule for the pain management efforts or guiding the client through a relaxation exercise). Ask the client about what about the exercise was easier for them and why and how they might address any challenges they experienced.
• Set goals with the client that they can work on between sessions.
• Integrate self-help activities into overall treatment goals.
• Be flexible and open-minded about how much the client can take on and the influence of other factors (e.g., the extra stressors related to the COVID-19 pandemic, unfamiliar treatment modality).