The influence of Covid-19 on chronic pain

In this article I want to review the implications that the Covid-19 pandemic that we have been suffering, has or presumably will have on the management of patients with chronic pain from the perspective of the individual patient, the Pain Treatment Units or from the damage it has caused to the health system itself.

What are the risks of isolation?

Several studies, both clinical and experimental and social, have long focused their interest on these situations to which patients with chronic pain are subjected, pointing out that loneliness, social distancing and uncertainty in the provision of health care are not good for the prognosis and course of a painful process.

The closure of centers and care units has led to the neglect of patients with chronic pain, treatment cycles and the periodic check-ups essential for this type of patient have been suspended, and the operating rooms where block techniques were performed have been closed. This has resulted in many patients experiencing a feeling of abandonment that is very detrimental psychologically for their process.

The response of my Unit has been to set up telematic consultations and to maintain constant telephone and e-mail support so that patients at least had a contact person and could prescribe certain medications or advise on changes in their pain. Telematic medicine has offered that feeling of support and closeness that these patients demand and that has been denied to them during these months. In this regard, the Spanish Pain Treatment Society itself recommended closing care units and published guidelines on physical activity during confinement and the use of drugs during confinement.

How have techniques changed to avoid contagion?

To avoid subjecting patients to the risk of contagion, I have been forced to modify the protocol for performing certain techniques. The philosophy consists of avoiding patient access to the operating room or hospital centers, where the risk of contagion is greater due to the influx of patients and contact with healthcare personnel. To this end, I have reduced the number of appointments in the consultation room in order to be able to ventilate between one patient and another adequately, as well as placing HEPA filters in the consultation room and waiting room.

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Among the techniques we have modified, the most important have been the performance of lumbar and epidural facet blocks, which instead of being performed in the operating room, are performed in the office under ultrasound control. We have also replaced certain blocks (trigger points, some superficial blocks, etc.) with the application of Qtenza (capsaicin patches, which has been shown to be very effective in neuropathic, diabetic and neuralgic pain without the need for punctures or hospitalization.

What are the pain syndromes due to Covid-19?

Although the acute picture of Covid-19 presents in a high proportion of cases pain, especially myalgic pain, its treatment lacks specificity and interest. It should be noted that we use several NSAIDs due to their potentially beneficial effect in these patients against platelet aggregation and vasculitis, which is part of the worst prognostic evolution of the disease.

A worrisome condition that is frequently seen is the “post Covid 19 syndrome”. It is characterized by muscle pain and chronic fatigue, and its pathogenesis is still unknown, but it is reminiscent of some forms of fibromyalgia. I am treating these patients as if they were fibromyalgic, with central analgesics such as amitriptyline and NSAIDs, as well as using coenzyme Q10, which seems to be effective in these cases.

The role of zinc and vitamin D

Vitamin D, in addition to being known for its role in bone and mineral metabolism, is important in patients with more severe cases of Covid-19, since persistently low levels of this vitamin have been found. In addition, due to the confinement and reduced mobility, patients have not filled their reservoirs this spring and summer. I am finding low levels of this vitamin in most of the patients, so I am using it systematically, especially in patients at risk of developing severe forms in case of infection.

Zinc has proven to be a good option to prevent Covid-19 infection and in case of infection, patients with adequate zinc levels develop milder forms. Zinc levels are usually low in malnourished or older patients, or with associated diseases, so I am recommending its preventive use in many patients.