Collaboration between a tertiary pain centre and community teams during the pandemic

Abstract

People with chronic pain faced potential treatment disruption during the COVID-19 pandemic in Singapore, as the focus of healthcare shifted. A model of rapid integration of a pain centre with community healthcare teams was implemented to care for vulnerable older patients with chronic pain and multiple comorbidities. Telemedicine and home visits by community nurses were used, with risk-mitigation measures, ensuring comprehensive assessment and treatment compliance. Medications from pain physicians were delivered at home through a hospital pharmacy. A secure national electronic health records system used by all teams ensured seamless access and documentation. Potential emergency department visits, admissions and delayed discharges were thus avoided. Integration of community teams with chronic pain management services can be recommended to ensure pandemic preparedness.

Impact of COVID-19 pandemic on chronic pain and opioid use in marginalized populations: A scoping review

“…Significant reductions, postponements, or cancelations of pain management and other relevant healthcare services were reported globally ( 3 , 78 , 79 , 81 , 84 , 86 , 88 , 90 , 98 ), including decreases in interventional pain techniques and elective surgical procedures, outpatient procedures, patient visits ( 78 , 82 , 99 ), and non-urgent yet vital healthcare services ( 81 ). Estimates from a US health system tracker found reductions as high as 86% in elective surgical volume and 15.1% in pain-related prescriptions ( 3 ).…”

“…The proportion of patients with chronic pain receiving opioids varied across the different phases of the pandemic ( 86 , 88 , 90 , 92 ). Patients were more likely to receive longer opioid prescriptions and higher doses in the early pandemic period (e.g., March through June 2020) than in 2019 in the US ( 90 ).…”

“…Those who were older and less 'tech savvy' expressed hesitation over telehealth, and would prefer telephone over video platforms or in-person consultations altogether (86). The combined challenges of using technology, living alone with little to no provision of medication, and an insufficient supply of medication and telehealth appointments contributed to inadequate and disrupted care (81,86). Some healthcare systems lacked infrastructural support for telehealth, especially when telemedicine had not yet been integrated into pain management services before the pandemic (86,98).…”

“…The combined challenges of using technology, living alone with little to no provision of medication, and an insufficient supply of medication and telehealth appointments contributed to inadequate and disrupted care (81,86). Some healthcare systems lacked infrastructural support for telehealth, especially when telemedicine had not yet been integrated into pain management services before the pandemic (86,98). In addition to reductions in in-person activity, some clinics endured major staffing cuts or lacked appropriately trained staff (i.e., nurse practitioners, general practitioners) in their new telemedicine treatment centers.…”

SARS-COV-2: A Current Update About Miscellaneous Symptoms

“…On the other hand patients with chronic pain who have multiple comorbidities faced potential treatment disruption during the SARS-CoV-2 pandemic. 38 Central sensitization describes the change in the brain that develops in response to repetitive nerve stimulation. This condition is also called nerve neuroplasticity.…”