Survey: Re-opening of Chronic Pain Services during COVID-19

Demographics

Responding clinicians were distributed widely from England, Scotland, Wales and Northern Ireland.  The collation of names of institutions indicated that responses were received from large teaching hospitals through to smaller district general hospitals. 

General Issues

Only 20% of the respondents indicated that their pain services had returned to full activity.   Only half of respondents indicated that all pain team members were back at their normal roles.  Just under 10% of respondents reported that staff had taken leave through sickness because of burn out or stress.  A small minority of respondents indicated that they were not at work and this was either due to psychological consequences of COVID, sickness or a need to self-isolate.  In-patient services were heavily affected by the pandemic, with 50% of respondents reporting that after March 2020 in-patient services were providing only ‘minimal care’.  Only one in five respondents indicated their in-patient services were able to continue as normal. 

Type of appointments

Around 78% of respondents were providing one or both telephone and video consultations. More telephone consultations were undertaken than video consultations.  However, 17% of units reported not undertaking remote consultations.  

Triage and consultation type

A common approach to the allocation of consultations involved offering an initial remote consultation - around 40% of respondents. Around a third of respondents offered more than 50% of patient consultations remotely.  There is divided experience on whether arrangements for new and follow ups differed with just under half the units stating that they did differ.   

Duration and effectiveness of remote consultations

10% of respondents were very satisfied with video consultations and 32% less so [quite satisfied]; around 10% of respondents were dissatisfied.  There was divided experience about whether remote consultations for new patients took longer, shorter or the same.  Most thought they took around about the same time.  The majority - 54%- thought that remote consultations were less effective though more respondents stated that they were easier for patients than harder. Some stated video consultations were used due to a lack of better alternatives.    

70% were satisfied (very or quite satisfied) with telephone consultations while the greatest number (around 40%) viewed these to be similar in time required as for face to face consultations with a mixed distribution of respondents to “less time” [27%] and “more time” [17%].    

The majority thought that remote consultations were better for review appointments. The highest number of respondents felt that the remote consultation was about the same length (40%). There was an equal number reporting they took either longer or shorter.  The majority of other services relating to the multi-disciplinary team and the majority of other team members were similarly undertaking remote consultations. 

Redeployed staff

Around a quarter of respondents indicated that multi-disciplinary pain management team members were entirely re-deployed and 62% said that they were partially deployed indicating that at the time of the survey there was still significant ongoing deployment of staff due to the COVID pandemic.

Injections

It seems that around 40% of units were (gradually) increasing the number of injection procedures but 30% were still offering only a small number of injections for most urgent cases.  Around 30% indicated that their injection services had not resumed.  

Pain Management Programmes 

Regarding pain management programmes only 8% of respondents indicated their units were offering these in a socially distanced environment with other respondents indicating a spectrum of other strategies employed including online courses, face to face appointments in a socially distanced environment, remote assessments and online resources.   Around a quarter of units stopped pain management programmes after lock down and had not reinstated activities.   Most respondents were satisfied with video MDT meetings. 

Safety

Around 25% of respondents felt that a lack of safety equipment and PPE had impacted their ability to deliver care.