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

Abstract

IntroductionThe COVID-19 pandemic has had a variable effect on vulnerable populations, including patients with chronic pain who rely on opioid treatment or have comorbid opioid use disorder. Limited access to care due to isolation measures may lead to increased pain severity, worse mental health symptoms, and adverse opioid-related outcomes. This scoping review aimed to understand the impact of the COVID-19 pandemic on the dual epidemics of chronic pain and opioids in marginalized communities worldwide.MethodsSearches of primary databases including PubMed, Web of Science, Scopus, and PsycINFO were performed in March 2022, restricting the publication date to December 1, 2019. The search yielded 685 articles. After title and abstract screening, 526 records were screened by title and abstract, 87 through full-text review, of which 25 articles were included in the final analysis.ResultsOur findings illuminate the differential distribution of pain burden across marginalized groups and how it serves to heighten existing disparities. Service disruptions due to social distancing orders and infrastructural limitations prevented patients from receiving the care they needed, resulting in adverse psychological and physical health outcomes. Efforts to adapt to COVID-19 circumstances included modifications to opioid prescribing regulations and workflows and expanded telemedicine services.ConclusionResults have implications for the prevention and management of chronic pain and opioid use disorder, such as challenges in adopting telemedicine in low-resource settings and opportunities to strengthen public health and social care systems with a multidisciplinary and multidimensional approach.

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“…Opioid medications are among the most prevalent pain treatments. Despite their benefits in pain relief, opioids possess highly addictive properties, with the risk of overdose increasing with dose escalation (such as to counter the effects of opioid-induced hyperalgesia) and duration of use [17] .…”

“…Effective pain management is crucial in the treatment of PICS, and healthcare providers should adopt a comprehensive approach that includes non-pharmacological and pharmacological interventions [18] . Managing chronic pain can be challenging due to its complexity, but prescription medication and physical therapy are common interventions [17] .…”