Pivoting to virtual delivery for managing chronic pain with nonpharmacological treatments: implications for pragmatic research

Abstract

Virtual delivery encompasses all the ways providers interact synchronously or asynchronously with patients using technology, including videoconferencing, audio-only communication, mobile apps, and remote health monitoring. 24 There was prepandemic interest in virtual delivery as a strategy to overcome the pain management evidence-practice gap, but implementation was sluggish. 17 Thus, although the pivot to virtual delivery has been disruptive, it presents unique opportunities to address key questions through ongoing pragmatic research. The National Institutes of Health (NIH)-Department of Defense (DoD)-Department of Veterans Affairs (VA) Pain Management Collaboratory (PMC) supports 11 large, multisite pragmatic clinical trials in military and VA health systems. 45 The PMC pragmatic trials examine a spectrum of NPTs. COVID-19 disruptions have posed a variety of challenges and opportunities for these studies. 13 Pragmatic studies evaluate the effects of treatment provided under usual clinical circumstances. 11,79 Relative to research evaluating treatment efficacy under controlled conditions, pragmatic studies permit greater flexibility in several domains, including Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Experiences of Pediatric Pain Professionals Providing Care during the COVID-19 Pandemic: A Qualitative Study

“…They may also include occupational therapy, social work, and/or child life specialties. Key components include joint goal setting with emphasis on functional rehabilitation (e.g., school attendance, fitness goals, stress management) and active strategies to support pain self-management [ 11 ].…”

Perceptions of Telehealth Physical Therapy Among Patients with Chronic Low Back Pain

“…Considering the low utilization before COVID-19, it is unclear whether patients would consider telehealth physical therapy equivalent to in-person care. 8 If patients with LBP do not perceive telehealth physical therapy as a viable option, it may adversely impact the likelihood of compliance with this nonpharmacological treatment strategy.…”

Child Health and Illness

“…As such, remote or ehealth (i.e., those delivered digitally via computers, smart phones, tablets) programming may be preferable for some. The use of technology as a health care service delivery platform has expanded at an exponential rate in response to the COVID-19 pandemic ( Fritz et al., 2021 ), however ehealth as a platform for psychological interventions for pediatric populations in general, and more specifically for pediatric chronic pain, is not new ( Fisher et al., 2019 ). Thabrew et al.…”

“…ehealth interventions may also provide interim care for those who have a significant wait for specialized services ( Fisher et al., 2019 ). Fritz et al. (2021) outlined additional considerations, that are not necessarily specific to a pediatric chronic pain population, but are important as ehealth service delivery continues and in terms of designing evaluative research.…”