Objective: Chronic pain management is complex and often involves multi-disciplinary input ranging from pharmacological, physical to psychological interventions. The COVID-19 pandemic has led to a shift in chronic pain services globally. There is concern that this may exacerbate some of the challenges faced in chronic pain management. We present here a narrative review discussing this topic.

Methods

The PubMed database of the National Institutes of Medicine was used to search for keywords ‘COVID-19’, ‘chronic’, ‘pain’, and ‘management’. Articles pertaining to social deprivation and health inequalities were also considered.

Results

Several challenges of chronic pain management have been cited including: medication compliance, patients who are at risk of opioid overuse or withdrawal, risk of worsening conditions, resource availability, interventional procedural considerations and risk of infection and immunosuppression. Another challenge highlighted was patients utilising implantable drug delivery systems or intrathecal drug pumps. The main issues were accessing services for refilling and maintenance. This coupled with a change in lifestyle behaviours such as inactivity and increased levels of psychological distress cause us to consider more so the role of the multi-disciplinary team. However, authors also cite telemedicine as being a positive way to engage with patients. Amongst cost effectiveness, many studies highlight its benefit in triaging, emotional treatment and monitoring of specific patient groups.

Evidence shows that during the pandemic, chronic pain management was further compounded by health inequalities and specifically household income. Those living in areas of deprivation displayed negative changes in coping, social support and mood compared with those from areas with little or no deprivation.

Conclusion

Whilst the degree of change to chronic pain management varies between areas of different socioeconomic status, it is apparent that the focus should remain on a patient-centred, multi- disciplinary approach.