Evolving challenges in delivering a pain service during the COVID-19 pandemic

This page provides a snapshot of the current challenges faced by pain services during COVID-19 and relevant guidance and information. It is intended as a live resource to support and enable best local decision-making.

Introduction

The COVID-19 pandemic is placing substantial demands on the NHS. The Faculty of Pain Medicine of the Royal College of Anaesthetists is aware that pain services across the country are facing 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 and will be updated regularly.

 

Resuming services

The FPM has also developed Guidance on resumption of pain services following disruption by the COVID-19 pandemic, which highlights considerations to help achieve the reset of pain services locally from both strategic and operational perspectives

 

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.

EAPC

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

Academy of Medical Royal Colleges

COVID-19: Clinical

NHS

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

GMC

Remote consultations guidance & Flowchart

Chartered Society of Physiotherapy

COVID-19: guide for rapid implementation of remote consultations (1 April)

British Medical Journal

BMJ Visual Summary: Covid-19: remote consultations

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

  • Identification of urgent intervention procedures e.g. intrathecal refills, intrathecal pump implantation and troublshooting
  • Assessment of evidence of risks of steroid injections as experience evolves
  • Implanted spinal cord stimulators: maintenance and trouble shooting

FPM

FPM response to concern related to the safety of steroids injected as part of pain procedures during the current COVID-19 virus pandemic (17 March)

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.

NHS England

Clinical guide for the management of patients with musculoskeletal and rheumatic conditions on corticosteroids during the coronavirus pandemic

NSUKI

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

The Medical Defence Unit

COVID-19: The Medical Defence Union (MDU) is working with doctors to answer any medico-legal queries about coronavirus

Nuffield Trust

Coronavirus: how will the NHS cope?

DHSC

Technology in the NHS: The power of data in a pandemic

Health Service Journal

How Covid19 may impact NHS elective waiting times.

Medications issues

  • Increased risk of medications
  • Increased remote prescribing

European Pain Federation

Statement from the European Pain Federation on ibuprofen and COVID-19 (24 March)

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 (17 March)

European Medicines Agency

EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19 (18 March)

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.

NICE

NG163. COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community (3 April)