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Managing pain during the COVID-19 pandemic

Pain management, covid-19 pandemic, recommendations

The COVID-19 pandemic has crucially affected healthcare systems, that have been faced with the challenge of controlling the infection, changing care delivery to protect staff and patients. Many elective surgical procedures and patients visits were postponed or cancelled, impacting the pain management strategy. An international expert panel has formulated recommendations to guide the practice during this pandemic. Important considerations concern different areas of pain management.
In-patient visits: Doctors should suspend any elective in-person patient visits. No elective
pain procedures should be performed, except for specific semi-urgent procedures.
Use of telemedicine: Telemedicine should be used as the first approach and exclusively in most cases:
•    to evaluate the patient, triage the urgency, and make suitable arrangements for treatment
•    to maintain biopsychosocial management of pain
•    to evaluate, initiate and continue prescriptions.
Opioids: Observational studies indicate the potential for increased incidence and severity of infections in patients on opioids. It is, therefore, appropriate to inform patients of the risks and impact of long-term opioid therapy on the immune system. 
Steroids: Steroids increase the potential for altered immune response. However, the duration of immune suppression could be less with the use of dexamethasone and betamethasone. Intraarticular steroid injections could increase the risk of viral infection, therefore evaluating risks and benefits of steroid injections and using a decreased dose should be considered.
NSAIDs: All patients who use non-steroidal anti-inflammatory drugs regularly should continue their use, whilst monitoring for adverse effects. Doctors should educate patients that any mild fever or new myalgia should be promptly reported.