Evolving challenges delivering pain services during COVID-19
Information on the challenges faced by pain services during COVID
This page provides a snapshot of the current challenges, along with relevant guidance and information. It is intended as a live resource to support and enable best local decision-making.
Introduction
The COVID-19 pandemic is placing substantial demands on the NHS. The Faculty of Pain Medicine of the Royal College of Anaesthetists is aware that pain services across the country are facing new challenges, including redeployment of multidisciplinary members of pain teams, lack of access to outpatient and imaging facilities and increased risks of pain intervention procedures. In addition, GP referrals may have reduced significantly, which may not be representative of current patient need.
As Pain Specialists, we must strive to adapt and deliver effective safe pain management in a difficult and changing environment.
As a first response, the FPM has created a list of key challenges faced by pain services as a result of COVID-19 as well as selected statements and resources. This information is intended to support and enable best local decision-making and will be updated regularly.
Resuming services
The FPM has also developed Guidance on resumption of pain services following disruption by the COVID-19 pandemic, which highlights considerations to help achieve the reset of pain services locally from both strategic and operational perspectives.
Findings of the second survey sent to FPM Fellows capturing the state of re-opening of Chronic Pain services can be found here.
More specific guidance has been developed on:
- Commissioning of Chronic Pain services and COVID-19
- Update on the role of steroids used in pain intervention techniques during the current COVID-19 pandemic
- Pain Interventions during the COVID-19 Recovery Phase (Joint FPM/BPS guidance)
- Pain Practice Post COVID-19: Triage & Conducting Quality Consultations
Generic supporting statements already in circulation
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British Pain Society |
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ASRA & ESRA |
COVID-19 Guidance for Chronic Pain Patients (27 March) |
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NHS England |
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Pain News Network |
People With Chronic Pain Must Prepare for Coronavirus (12 March) |
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PAIN: The Journal of the IASP |
Eccleston, C et al. Managing patients with chronic pain during the Covid-19 outbreak: considerations for the rapid introduction of remotely supported (e-health) pain management services. PAIN. April 2020 |
| COVID Trauma Response Working Group | Rapid Guidance: Screening and active monitoring for post-traumatic stress disorder (PTSD) and other mental health consequences in people recovering from severe COVID-19 illness (June 2020) |
Acute Pain Services
- Management of the redeployment of anaesthetists and nursing staff from pain to intensive care
- Potential reduced availability of pumps for infusions
- Risks of cross infection
- Policy and training of PPE
- Increased medicine risks e.g. NSAIDS, transdermal medication (see Medications issues)
- Increased supportive role in Palliative care as more patients likely to require palliation.
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EAPC |
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APM & Northern Care Alliance NHS Group |
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University of Cambridge DPHPC |
Chronic Pain Services
- Prioritisation of referrals to the service
- Selection for treatment of urgent cases but proportionate focus on more routine cases if pandemic lasts much longer
| FPM | Pain Practice Post COVID-19: Triage & Conducting Quality Consultations (18 June) |
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Academy of Medical Royal Colleges |
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NHS |
- Managing remote consultations: New and Follow-up Patients
- Managing remote multidisciplinary consultations
- Challenges and pitfalls of telephone consultations and video linked consultations
- Governance issues for remote consultations
| FPM | Pain Practice Post COVID-19: Triage & Conducting Quality Consultations (18 June) |
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GMC |
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Chartered Society of Physiotherapy |
COVID-19: guide for rapid implementation of remote consultations (1 April) |
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British Medical Journal |
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Digital Health |
Downey, A. Exclusive: 11 suppliers chosen to provide video consults during Covid-19. Digital Health. 26 March 2020 |
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Medical Protection Society |
Webinar recording: Remote Consulting during the COVID-19 outbreak |
- Managing patients who need to be seen face to face, including PPE considerations
- Infection control issues; policy and training
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PHE, DHSC, and NHSE |
Press release: New personal protective equipment (PPE) guidance for NHS teams |
- Identification of urgent intervention procedures e.g. intrathecal refills, intrathecal pump implantation and troublshooting
- Assessment of evidence of risks of steroid injections as experience evolves
- Implanted spinal cord stimulators: maintenance and trouble shooting
| ARMA | |
| FPM | Update on the role of steroids used in pain intervention techniques during the current COVID-19 pandemic (29 July) |
| FPM & BPS | Joint Guidance on Pain Interventions during the COVID-19 Recovery Phase (8 June) |
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Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
Sytsma TT, Greenlund LK, Greenlund LS. Joint corticosteroid injection associated with increased influenza risk. Mayo Clin Proc Innov Qual Outcomes. 2018;2(2):194-8. doi:10.1016/j.mayocpiqo.2018.01.005. |
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British Society for Rheumatology, British Association of Orthopaedics, British Association of Spinal Surgeons, Royal College of General Practitioners, British Society of Interventional Radiology, FPM, British Pain Society and Chartered Society of Physiotherapy |
Management of patients with musculoskeletal and rheumatic conditions who: |
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NSUKI |
- Managing changes in access to radiological procedures and theatres and waiting lists.
- Ensuring the best standards of record-keeping and copying of letters to patients to ensure understanding especially with telephone consultations
- Careful waiting list management to ensure patients are not lost
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Norton Rose Fulbright |
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Nuffield Trust |
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DHSC |
Technology in the NHS: The power of data in a pandemic |
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Health Service Journal |
- Disruption to training of pain medicine trainees
- Wellbeing of staff members under increased stress
- Supervision and redeployment of allied health professionals within the pain team
Medications issues
- Increased risk of medications
- Increased remote prescribing
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European Pain Federation |
Statement from the European Pain Federation on ibuprofen and COVID-19 (24 March) |
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British Medical Journal |
Day M. COVID-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ 2020 2020;368:m1086. doi:10.1136/bmj.m1086 (17 March) |
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European Medicines Agency |
EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19 (18 March) |
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Expert Opinion on Drug Delivery |
Hao J, Ghosh P, Li SK, Newman B, Kasting GB, Raney SG. Heat effects on drug delivery across human skin. Expert Opin Drug Deliv. 2016;13(5):755–768. doi:10.1517/17425247.2016.1136286 |
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Frontiers in Immunology |
Franchi S, Moschetti G, Amodeo G, Sacerdote P. Do all opioid drugs share the same immunomodulatory properties? a review from animal and human studies. Front Immuno. 2019;10:2914. doi:10.3389/fimmu.2019.02914. |
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Palliative Medicine |
Sacerdote P. Opioids and the immune system. Palliat Med. 2006;20 Suppl 1:s9-15. |
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British Journal of Pharmacology |
Plein LM, Rittner HL. Opioids and the immune system - friend or foe. Br J Pharmacol. 2018;175(14):2717-25. |
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NICE |
NG163. COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community (3 April) |
Want more COVID information and guidance?
You can also visit the joint anaesthesia and
intensive care medicine COVID Hub.
