Covid and Pain
Rita Agarwal MD
And in other news…. Just kidding, there is no other news, COVID still rages on, and we are in the midst of huge Omicron surge in my highly vaccinated and relatively protected enclave of Stanford. Last week we had more Covid positive admissions to Lucile Packard Children’s’ Hospital than at ANY OTHER TIME during the pandemic, we also had more staff members (faculty, trainees, nurses, techs, and others) testing positive for Covid than ever before. Interestingly our sickest patients still have the delta variant, while we suspect that many of the new positive tests are more than likely the Omicron variant. During all this, I was struck by the increasing number of patients with chronic pain and other chronic diseases getting admitted due to increased pain and wondered if this was a local phenomenon or a national trend. My colleagues in our Outpatient Pediatric Pain Clinic are seeing more patients as well. Despite two now going on three years of this pandemic there is not a lot of literature on the topic of the impact of the Covid-19 pandemic on children with pain. This review is of one the few studies that examined patient and parents’ perceptions of the pandemic and it restrictions on the children’s mental health, pain, socio-emotional development and access to care
Original article
Alexandra Neville, Tatiana Lund, Sabine Soltani, Abbie Jordan, Jennifer Stinson, Tieghan Killackey, Kathryn A Birnie, Melanie Noel. Pediatric chronic pain in the midst of the COVID-19 pandemic: Lived experiences of youth and parents. J Pain. 2021 Dec 13;S1526-5900(21)00384-9. doi: 10.1016/j.jpain.2021.11.012. PMID: 34915200 PMCID: PMC8710941
Children with chronic pain faced many challenges prior to the pandemic, including social isolation, internalization of mental health symptoms, and disruption of typical adolescent development. The onset of the pandemic lead to additional barriers to treatment with many services being cancelled or converted to virtual care. Parenting children with chronic pain is also very stressful and anxiety producing. Many parents suffer from chronic pain themselves (up to 50%) and others may struggle with depression and other mental health issues. Since family factors are influential in a youth’s experience of chronic pain, the parents’ perspective was considered important for the purposes of this study. Parents and patients who had been part of the Pain and Mental Health in Youth (PATH) study were interviewed using a semi-structured interview process.1,2 Participants for the PATH study had been recruited from the Complex Pain and Headache clinics of a tertiary chronic pain program in Western Canada, and prospectively followed from 2017-2020. The semi-structured interview process allowed interviewers to elicit further details and clarification from subjects for a richer narrative review. For this study 20 patients and families were recruited during the months of June-August 2020 and were asked about the past (pre-pandemic), present (during the pandemic) and future (post-pandemic) which allowed participants to describe their experiences of the COVID-19 pandemic as they unfolded over time according to their own unique perspectives. At this time in Western Canada, schools had converted to virtual, and increasingly restrictive public health and isolation requirements were being enacted.
As expected, the results were complicated and sometimes contradictory. There were 4 broad themes generated from the analysis of their data. There themes were labeled ‘temporality, mental health, and pain’, ‘coping with pain during a global pandemic, ‘impact on care’, and ‘re-appraisal in the context of development and pandemic life’
Temporality, Mental Health and Pain-most patients and families describe increased worry, anxiety, sadness and social isolation
Coping with Pain During a Global Pandemic -interestingly many felt that the pandemic helped decrease pain because of decreased expectations to physically move and improved ability to avoid pain provoking activities. Others report difficulty with engaging in their hard won coping strategies such as peer support, recreational activities, and social engagement .
Impact on Care—uncertainty, appointment changes and cancellations, loss of support from the health care system, loss of interpersonal interactions and a shift to virtual care was distressing and unsatisfactory for the majority of respondants
Reappraisal In The Context Of Adolescent Development And Pandemic Life-many describe feelings of loss, restricted opportunities, and futility. A few expressed gratitude and appreciated the silver linings. Most were surprised at their ability to adapt in the face of adversity
The patient and family quotes were insightful and fascinating and while the article didn’t answer my central question “are we seeing more hospitalized patients with chronic pain?”, it did give an interesting perspective into how these (and I suspect other patients with chronic illness ) are coping during a pandemic. I will be really interested in future studies, because the long term effects of this pandemic on children’s overall health is still undetermined. The quote below from a patient’s father perfectly summarizes where many of us are now.
“It’s strange that you adapt, and you think you can’t, and you can, and I think it probably showed, I’m stronger than I thought I was... it [the pandemic] made us stronger as a family unit, but it’s um, it’s had its challenges that’s for sure, but, um, and we’re still in it. “