Caring for Pain During the COVID-19 Pandemic: Consensus Recommendations from an International Expert Panel

Outcomes

Learners completing this activity report improved abilities in:

• Mitigating the risks of exposure to SARS-CoV-2 for patients, providers, and staff
• Assessing patient function and wellbeing during a pandemic
• Modifying treatment plans

Overview

This presentation will provide insight into solutions to mitigate the clinical challenges induced by COVID-19.

Abstract

The global COVID-19 pandemic has resulted in significant clinical and economic consequences for medical practices of all specialties across the nation. Of primary relevance to this audience, outpatient pain practices have had to significantly change their clinical care pathways, including the incorporation of telemedicine. Elective medical and interventional care has been postponed.

With regards to the treatment of persons with chronic pain, there are important considerations that need to be recognized, including: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti-inflammatory drugs; use of steroids; and prioritizing necessary procedural visits. 

Learning Objectives

As a result of participating in this activity, learners will be better able to:

• Implement or modify risk mitigation strategies to protect patients and/or staff during the COVID-19 pandemic
• Modify their clinical care to account for factors of the COVID-19 pandemic and/or the SARS-CoV-2 virus

Outline

1. Clinical Care During the Pandemic & Upon Reopening
   1. Telehealth
   2. Safety precautions within the office
   3. Impact on healthcare workers
2. Effect of COVID-19 on Pain Management
   1. Analgesia vs. Immunosuppression 
   2. Steroids & Viruses
   3. Opioid treatment
   4. Ibuprofen & COVID-19
   5. Implantable pain therapies
   6. Effectiveness of eHealth-guided physical therapy
   7. Telehealth
   8. Biopsychosocial management

Desirable Physician Attributes

• Medical Knowledge [ACGME/ABMS] about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
  
• Employ Evidenced-based Practice [IOM] Integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible
• Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
• Provide Patient-centered Care [IOM] Identify, respect, and care about patients’ differences, values, preferences and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health
• Interpersonal and Communication Skills [ACGME/ABMS] Effective information exchange and teaming with patients, their families, and other health professionals
  
• Professionalism [ACGME/ABMS] As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
• Apply Quality Improvement [IOM}  Identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality
• Systems-Based Practice [ACGME/ABMS]  as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value)

Pain management domains and core competencies

• 1. Multidimensional nature of pain: What is pain?
  • Present theories and science for understanding pain
  • Define terminology for describing pain and associated conditions

• 3. Treatment: How is pain safely and effectively treated?
  • Demonstrate knowledge of risk stratification, patient selection, and ongoing monitoring for pharmacological pain treatment
  • Identify pain treatment options that can be accessed in a comprehensive pain management plan
  • Develop a pain treatment plan based on benefits and risks of available treatments

Accreditation & Designation

Release date: This activity was released 8/15/2020.

Termination date: The content of this activity remains eligible for CME Credit until 8/14/2023, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

[Speaker] David Provenzano discloses the following financial relationships: Research Support: Abbott, Avanos, Medtronic, Nevro, Stimgenics Consulting: Avanos, Boston Scientific, Medtronic, Nevro, Heron, Esteve

Neither the peer reviewers nor any other person with control of, or responsibility for, the development, management, presentation or evaluation of the CME activity has, or has had within the past 12 months, any financial relationships to disclose. This includes any relationships of an involved person's spouse/partner.

Materials were peer-reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Additional Reading

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2. Provenzano, D. A., Sitzman, B. T., Florentino, S. A., & Buterbaugh, G. A. (2020). Clinical and economic strategies in outpatient medical care during the COVID-19 pandemic. Regional Anesthesia & Pain Medicine.
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