ForMedPage Today's"After the Pandemic" series, we asked our editorial board members to discuss what significant and lasting effects the COVID-19 pandemic will have on medicine and the delivery of healthcare.
Here, we interview Beth Darnall, PhD, associate professor in the department of anesthesiology, perioperative, and pain medicine at Stanford University School of Medicine and director of the Stanford Pain Relief Innovations Lab in Palo Alto, California.
Check out other articles in the series here.
Can you share an anecdote about a patient and how the pandemic affected his or her situation?
Darnall: This story is about a person who is not my patient but whose care I am deeply aware of. Her medical emergency was a confluence of the pandemic and the ice storms that occurred in Texas several months ago.
She has an intrathecal pump for pain management that was due for refill, but travel was impossible. As the medical system often provides patients no back-ups for such emergencies, her situation was such that the pump would run dry, be destroyed, and thus require surgical explant and reimplantation with a new device -- a highly burdensome and costly exercise.
The other emergent issue was opioid withdrawal with no recourse or oral medications available to address this -- an extremely stressful situation occurring while home temperatures were in the 40s and the house ceiling had collapsed.
The clinic had minimal hours due to COVID and then the storm, but she was able to arrange for an 11th-hour emergency visit that required a total of 4 hours of driving (to and from the clinic) during icy conditions when travel was discouraged, forcing her to incur additional risks.
Such weather-related emergencies are rare, though her story illustrates the compounding burdens patients face with obtaining pain management when these situations occur, particularly when options are restricted due to the pandemic.
Chronic pain care changed for patients during the pandemic; many used telehealth for the first time, for example. Will some of these changes continue once the public health emergency ends?
Darnall: For psychologists, restrictions around telehealth and interstate care have been relaxed. We need continuation of this flexible model to ensure patients have access to the care they need.
What are some success stories, either in chronic pain treatment or in research, that emerged during the pandemic? What promise do they hold for post-pandemic times?
Darnall: Clinically, many psychologists are reporting much higher patient engagement rates for behavioral treatments (e.g., pain management classes, cognitive behavioral therapy) since these moved online.
Our group ran a fully online study, a randomized controlled trial of a single-session pain relief skills class, during the pandemic. We enrolled 100 people with chronic pain in the first 11 days that study enrollment was open. People want convenient home-based pain care; we had the highest engagement for this study than any other study we have conducted.
We had similar engagement for another randomized placebo-controlled study of home-based virtual reality treatment for chronic pain. We enrolled about 180 community-based participants in about 1 month and had excellent engagement with both study interventions (therapeutic and sham virtual reality).
Of course, the best part is treatment efficacy: people are showing improvements across a range of outcomes with durability of those effects. Collectively, we are seeing good support for home-based pain care as being scalable and meeting patients' needs and wants.
What did the pandemic teach chronic pain patients and clinicians?
1. We need systems in place to ensure patients have access to their prescribed medication in emergent situations. Otherwise, patients risk iatrogenic harms because the medical system is not prepared to help them navigate environmental issues.
2. Telehealth appears to be acceptable and convenient for many.