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. 


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


Generic supporting statements already in circulation

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.


Coronavirus and the palliative care response

APM & Northern Care Alliance NHS Group

COVID-19 and Palliative, End of Life and Bereavement Care in Secondary Care: Role of the specialty and guidance to aid care

University of Cambridge DPHPC

Palliative care in the time of coronavirus

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)

Academy of Medical Royal Colleges

COVID-19: Clinical


Reviewing referrals - NHS e-Referral Service

  • 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)


Remote consultations guidance & Flowchart

Chartered Society of Physiotherapy

COVID-19: guide for rapid implementation of remote consultations 

British Medical Journal

BMJ Visual Summary: Covid-19: remote consultations (March 2020)

Digital Health

Downey, A. Exclusive: 11 suppliers chosen to provide video consults during Covid-19. Digital Health. 26 March 2020

Medical Protection Society

Webinar recording: Remote Consulting during the COVID-19 outbreak (June 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

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)


FPM response to concern related to the safety of steroids injected as part of pain procedures during the current COVID-19 virus pandemic (March 2020)

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.

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:


Recommendations for the Management of Implanted Neurostimulation & Intrathecal Drug Delivery Devices During the COVID-19 Pandemic

  • 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

Norton Rose Fulbright

Coronavirus: legal implications of a global pandemic

Nuffield Trust

Coronavirus: how will the NHS cope? (February 2020)


Technology in the NHS: The power of data in a pandemic (March 2020)

Health Service Journal

How Covid19 may impact NHS elective waiting times. (March 2020)

Medications issues

  • Increased risk of medications
  • Increased remote prescribing

European Pain Federation

Statement from the European Pain Federation on ibuprofen and COVID-19 (March 2020)

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)

European Medicines Agency

EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19 (March 2020)

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

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.

Palliative Medicine

Sacerdote P. Opioids and the immune system. Palliat Med. 2006;20 Suppl 1:s9-15.

British Journal of Pharmacology

Plein LM, Rittner HL. Opioids and the immune system - friend or foe. Br J Pharmacol. 2018;175(14):2717-25.


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.