COVID-19: the provision of pain services
Information on the challenges faced by pain services during COVID
This page provides a snapshot of the challenges faced due to COVID-19, along with relevant guidance and information.
The Faculty of Pain Medicine will at this time be issuing no further guidance on the provision of pain services in relation to COVID-19. We are keeping this topic under review and will publish new guidance if the need arises. Existing guidance is dated and listed below.
Introduction
The COVID-19 pandemic has placed substantial demands on the NHS. The Faculty of Pain Medicine of the Royal College of Anaesthetists is aware that pain services across the country have faced new challenges, including redeployment of multidisciplinary members of pain teams, lack of access to outpatient and imaging facilities and increased risks of pain intervention procedures. In addition, GP referrals may have reduced significantly, which may not be representative of current patient need.
As Pain Specialists, we must strive to adapt and deliver effective safe pain management in a difficult and changing environment.
As a first response, the FPM has created a list of key challenges faced by pain services as a result of COVID-19 as well as selected statements and resources. This information is intended to support and enable best local decision-making.
Resuming services
The FPM has also developed Guidance on resumption of pain services following disruption by the COVID-19 pandemic (May 2020), which highlights considerations to help achieve the reset of pain services locally from both strategic and operational perspectives.
Findings of the second survey sent to FPM Fellows capturing the state of re-opening of Chronic Pain services were published in April 2021 and can be found here.
Clinical guidance
- Commissioning of Chronic Pain services and COVID-19 (March 2021)
- Update on the role of steroids used in pain intervention techniques during the current COVID-19 pandemic (July 2020)
- Pain Interventions during the COVID-19 Recovery Phase (Joint FPM/BPS guidance) ( June 2020)
- Pain Practice Post COVID-19: Triage & Conducting Quality Consultations (June 2020)
- Covid vaccines and single shot steroid injections (Updated April 2022)
Generic supporting statements already in circulation
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British Pain Society |
Pain Management during COVID-19 viral infection (March 2020) |
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NHS England |
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Pain News Network |
People With Chronic Pain Must Prepare for Coronavirus (March 2020) |
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PAIN: The Journal of the IASP |
Eccleston, C et al. Managing patients with chronic pain during the Covid-19 outbreak: considerations for the rapid introduction of remotely supported (e-health) pain management services. PAIN. April 2020 |
| COVID Trauma Response Working Group | Rapid Guidance: Screening and active monitoring for post-traumatic stress disorder (PTSD) and other mental health consequences in people recovering from severe COVID-19 illness (June 2020) |
Acute Pain Services
- Management of the redeployment of anaesthetists and nursing staff from pain to intensive care
- Potential reduced availability of pumps for infusions
- Risks of cross infection
- Policy and training of PPE
- Increased medicine risks e.g. NSAIDS, transdermal medication (see Medications issues)
- Increased supportive role in Palliative care as more patients likely to require palliation.
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EAPC |
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APM & Northern Care Alliance NHS Group |
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University of Cambridge DPHPC |
Chronic Pain Services
- Prioritisation of referrals to the service
- Selection for treatment of urgent cases but proportionate focus on more routine cases if pandemic lasts much longer
| FPM | Pain Practice Post COVID-19: Triage & Conducting Quality Consultations (June 2020) |
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Academy of Medical Royal Colleges |
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NHS |
- Managing remote consultations: New and Follow-up Patients
- Managing remote multidisciplinary consultations
- Challenges and pitfalls of telephone consultations and video linked consultations
- Governance issues for remote consultations
| FPM | Pain Practice Post COVID-19: Triage & Conducting Quality Consultations (June 2020) |
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GMC |
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Chartered Society of Physiotherapy |
COVID-19: guide for rapid implementation of remote consultations |
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British Medical Journal |
BMJ Visual Summary: Covid-19: remote consultations (March 2020) |
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Digital Health |
Downey, A. Exclusive: 11 suppliers chosen to provide video consults during Covid-19. Digital Health. 26 March 2020 |
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Medical Protection Society |
Webinar recording: Remote Consulting during the COVID-19 outbreak (June 2020) |
- Managing patients who need to be seen face to face, including PPE considerations
- Infection control issues; policy and training
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PHE, DHSC, and NHSE |
Press release: New personal protective equipment (PPE) guidance for NHS teams (April 2020) |
- Identification of urgent intervention procedures e.g. intrathecal refills, intrathecal pump implantation and troubleshooting
- Assessment of evidence of risks of steroid injections as experience evolves
- Implanted spinal cord stimulators: maintenance and troubleshooting
| ARMA |
COVID-19 Vaccinations and steroid injections FPM supporting statement (February 2021) |
| FPM | Update on the role of steroids used in pain intervention techniques during the current COVID-19 pandemic (July 2020) |
| FPM & BPS | Joint Guidance on Pain Interventions during the COVID-19 Recovery Phase (June 2020) |
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Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
Sytsma TT, Greenlund LK, Greenlund LS. Joint corticosteroid injection associated with increased influenza risk. Mayo Clin Proc Innov Qual Outcomes. 2018;2(2):194-8. doi:10.1016/j.mayocpiqo.2018.01.005. |
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British Society for Rheumatology, British Association of Orthopaedics, British Association of Spinal Surgeons, Royal College of General Practitioners, British Society of Interventional Radiology, FPM, British Pain Society and Chartered Society of Physiotherapy |
Management of patients with musculoskeletal and rheumatic conditions who: |
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NSUKI |
- Managing changes in access to radiological procedures and theatres and waiting lists.
- Ensuring the best standards of record-keeping and copying of letters to patients to ensure understanding especially with telephone consultations
- Careful waiting list management to ensure patients are not lost
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Norton Rose Fulbright |
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Nuffield Trust |
Coronavirus: how will the NHS cope? (February 2020) |
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DHSC |
Technology in the NHS: The power of data in a pandemic (March 2020) |
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Health Service Journal |
How Covid19 may impact NHS elective waiting times. (March 2020) |
- Disruption to training of pain medicine trainees
- Wellbeing of staff members under increased stress
- Supervision and redeployment of allied health professionals within the pain team
Medications issues
- Increased risk of medications
- Increased remote prescribing
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European Pain Federation |
Statement from the European Pain Federation on ibuprofen and COVID-19 (March 2020) |
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British Medical Journal |
Day M. COVID-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ 2020 2020;368:m1086. doi:10.1136/bmj.m1086 (March 2020) |
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European Medicines Agency |
EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19 (March 2020) |
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Expert Opinion on Drug Delivery |
Hao J, Ghosh P, Li SK, Newman B, Kasting GB, Raney SG. Heat effects on drug delivery across human skin. Expert Opin Drug Deliv. 2016;13(5):755–768. doi:10.1517/17425247.2016.1136286 |
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Frontiers in Immunology |
Franchi S, Moschetti G, Amodeo G, Sacerdote P. Do all opioid drugs share the same immunomodulatory properties? a review from animal and human studies. Front Immuno. 2019;10:2914. doi:10.3389/fimmu.2019.02914. |
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Palliative Medicine |
Sacerdote P. Opioids and the immune system. Palliat Med. 2006;20 Suppl 1:s9-15. |
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British Journal of Pharmacology |
Plein LM, Rittner HL. Opioids and the immune system - friend or foe. Br J Pharmacol. 2018;175(14):2717-25. |
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NICE |
NG163. COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community (April 2020, updated October 2020) |
Want more COVID information and guidance?
You can also visit the joint anaesthesia and
intensive care medicine COVID Hub.
