Chronic Pain Treatment Converts to Telemedicine for COVID-19 Pandemic

Michael Alexander Harnik, MD

With recent recommendations indicating that chronic pain patients utilize telemedicine treatment instead of in-person treatment during the COVID-19 pandemic, investigators wanted to know if chronic pain patients are receptive to the use of telemedicine and how that might interfere with care.

In this study, investigators including Michael Alexander Harnik, MD, Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, assessed patients’ acceptance of telemedicine during the COVID-19 pandemic in Switzerland by examining the correlation of acceptance with pain intensity and anxiousness.

The main finding was that acceptance was satisfactory, however, the higher the pain and anxiousness of a patient, the lower the acceptance. Therefore, for the more urgent patients, telemedicine might not be adequate as the restrictions in treatment may be detrimental to their recovery.

Correlations

Investigators found that patients who reported lower average pain intensity (r = -0.44, P < .001), less worries (r = -0.42, P < .001), and a lower level of fear of a severe COVID infection (r = -0.40, P < .001), showed higher acceptance of telemedicine. Only completed questionnaires were included as research, which resulted in a total of 61 surveys.

Reported anxiousness was low and reported worries were infrequent. The results showed an average level of acceptance of telemedicine. On a scale from 0-10 the mean acceptance was 6.25.

There was a negative correlation between the acceptance of telemedicine and current pain level, worries, and fear of COVID-19. Acceptance and the general condition of a patient correlated positively.

The Process

The study consisted of an anonymous, voluntary survey which was conducted between March 2020 and July 2020 at the Pain Center of the Bern University Hospital Inselspital in Bern, Switzerland.

First, the investigators separated all the pain patients who were referred to the Pain Center into urgent, semi-urgent, and non-urgent cases. They were then scheduled by urgency.

Next, urgent and semi-urgent patients received an immediate exam as the usual procedure. Non-urgent patients were offered a telephone consultation. Each patient completed a preclinical screening survey to inform about demographics, pain and psychometric scores.

The non-urgent patients were scheduled for a telephone interview where they reviewed their patient history, current treatments, and established a therapeutic relationship with a physician at the Pain Center. Depending on the urgency of their condition, patients received a follow-up telephone call or they were scheduled for an in-person appointment when the Pain Clinic reopened.

The evaluation of patients’ acceptance of the telemedicine service and its possible relationship to the COVID-19 pandemic was assessed by a cross-sectional online survey that each patient had the option of completing either online or in paper-pencil form.

The Study

Investigators developed a survey that consisted of 21 items and collected information regarding demographic and clinical data, gender, age, pain duration, opioid medication, and previous interventional pain treatments.

In order to determine the acceptance of telemedicine, patients were asked to rank the feasibility and appropriateness of the telephone consultation they received. This included aspects of their pain disorder, previous pain treatment and the COVID-19 pandemic (confidence regarding the pandemic, impression regarding political and medical steps).

An 11-point numeric rating scale ranging from 0-10 was used to assess each item. The primary focus was on the correlations between acceptance of telemedicine, current mean pain, worries, anxiousness and fear of COVID-19.

“Using telemedicine for chronic pain treatment during the COVID-19 crisis was accepted to a sufficient degree by a considerable proportion of patients,” investigators wrote. “However, the higher the mean levels of pain and anxiousness, the lower the acceptance, indicating that these severely burdened patients may suffer most from treatment restrictions. For this subgroup, telemedicine might not suffice and in-person visits should be considered.”

The study, “Telemedicine for Chronic Pain Treatment During the COVID-19 Pandemic: Do Pain Intensity and Anxiousness Correlate with Patient Acceptance?” was published in PAIN Practice.