Chronic pain sufferers struggling
Isolation during COVID-19 limiting access to treatment, therapy, and adding stress, official says
Athena Knight, who served nearly 20 years in the U.S. military, has undergone multiple surgeries for injuries from her military service. She has had to cope with chronic pain for many years. She also struggles with debilitating migraines and suffers from post-traumatic stress disorder, having been inside the Pentagon during the 9/11 terrorist attack.
Until the pandemic hit, Knight had been able to manage her pain with physical therapy, acupuncture, meditation, electro-stimulation, non-opioid medications and — for PTSD — in-person counselling. The coronavirus disrupted those strategies for her and many others.
“My pain got worse,” she says. “It got worse every day.”
First, surgery scheduled on her shoulder was postponed. Then, one by one, her other appointments were cancelled. She couldn't get physical therapy or acupuncture, and — because many providers initially didn't do telemedicine — her trauma therapist halted their sessions.
“I really went backwards in my recovery,” she says. “It was also mentally draining, since I also was trying to deal with my PTSD and couldn't see my therapist. It's been a very painful year.”
About 50 million American (and around seven million Canadian) adults suffer from chronic pain, which is among the most frequent conditions prompting people to seek medical help, says the Centers for Disease Control and Prevention and other research. It often results from injury, surgery or long-term diseases such as arthritis or autoimmune disorders, among others. Chronic pain can seriously impair ability to work, sleep and manage other routine functions of daily life. Many also suffer from depression and anxiety.
“Chronic pain can be incredibly burdensome,” says Linda Porter, director of the Office of Pain Policy at the U.S. National Institute of Neurological Disorders and Stroke. “It seems to have become a bigger problem during COVID than before COVID. Isolation makes your pain worse. People couldn't get where they needed to go for care. Also, the pain cycle often includes depression and anxiety and all of this taken together has really, really affected peoples' lives.”
Research conducted before the pandemic has found that social isolation worsens chronic pain for many people.
“It is an underappreciated aspect of chronic pain,” says Sean Mackey, professor of anesthesiology, perioperative and pain medicine at the Stanford University Medical Center and one of the study authors. “We lose sight of the fact that we are social creatures by nature. We want to make medicine so much about the structure and function of the person. But all of it is influenced by our social connectedness.
“Historically, (my) field has been driven by a biological
model: Find the source of pain and eliminate it. That hasn't worked well. We tend to think all we need to do is figure out where the problem is — the back, spine or leg — and treat it, but it's so much more complicated than that.”
A voluntary online survey conducted by the American Chronic Pain Association among more than 1,000 of its members found that nearly half of the respondents reported both their pain and stress had increased during the past year. More than onethird felt depressed. Many described feeling isolated and have been exercising less.
“All of these emotions are normal for people with chronic pain, but (the pandemic) only increased those feelings, making it even harder to cope,” says Penney Cowan, founder and chief executive of the group. “Everything has been shut down and people have had to stay at home, which only increases stress.”
Many, for example, find swimming helpful but “with the pandemic, swimming — as well as acupuncture, biofeedback and massage — were suddenly gone from their tool-bag of pain management,” she says. “Once you break that routine, it's so hard to get back into it.”
Gone, too, were such incentives as social occasions.
“It's easy to just get down in the chair or bed, and not want to move because it hurts,” says Jacqueline Winfield Fincher, immediate past president of the American College of Physicians. “But it's basic human psychology that when you have something to look forward to, you have a goal that motivates you to want to get better.”
Fincher, an internist and primary care physician, says that in her small rural town, social structure revolves around civic organizations and churches. For her patients, the loss of those activities “has been really tough and made all their medical problems worse, including pain,” she says.
“We have a wonderful YMCA that holds classes that cater to our older population, ... (but) it's been closed. Everything has been shut down for a year, and we've seen people deteriorate in physical function as a result.”
This hasn't been true for everyone. Some found more resilience. Mackey found some of his patients have been doing better — sleeping more and feeling less fatigued — probably because they are spending more time at home.
Probably the single most important action a pain patient can take right now is to get vaccinated. “Vaccination is key,” Mackey says, “because it's going to help them re-engage with other people, friends and society sooner.”
We tend to think all we need to do is figure out where the problem is ... and treat it, but it's so much more complicated than that.”
Sean Mackey, professor