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

Expiration Date: Aug 13, 2023

Credits: None available.


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


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


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


  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

  1. Shanthanna, H., Strand, N. H., Provenzano, D. A., Lobo, C. A., Eldabe, S., Bhatia, A., ... & Narouze, S. (2020). Caring for patients with pain during the COVID‐19 pandemic: consensus recommendations from an international expert panel. Anaesthesia.
  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.
  3. Silva, M. J., & Kelly, Z. (2020). The Escalation of the Opioid Epidemic Due to COVID-19 and Resulting Lessons About Treatment Alternatives. American Journal of Managed Care, 26(7), 202-204.
  4. Meier, C. A., Fitzgerald, M. C., & Smith, J. M. (2013). eHealth: extending, enhancing, and evolving health care. Annual review of biomedical engineering, 15, 359-382.
  5. Schäfer, A. G. M., Zalpour, C., von Piekartz, H., Hall, T. M., & Paelke, V. (2018). The Efficacy of Electronic Health–Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review. Journal of medical Internet research, 20(4), e152.
  6. Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-998. DOI: http://dx.doi.org/10.15585/mmw...
  7. Chew, N. W., Lee, G. K., Tan, B. Y., Jing, M., Goh, Y., Ngiam, N. J., ... & Sharma, A. K. (2020). A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain, Behavior, and Immunity.
  8. Ripp, J., Peccoralo, L., & Charney, D. (2020). Attending to the emotional well-being of the health care workforce in a New York City health system during the COVID-19 pandemic. Academic Medicine.
  9. Douglas, M., Katikireddi, S. V., Taulbut, M., McKee, M., & McCartney, G. (2020). Mitigating the wider health effects of COVID-19 pandemic response. BMJ, 369.
  10. Cohen, S. P., Baber, Z. B., Buvanendran, A., McLean, L. T. C., Chen, Y., Hooten, W. M., ... & King, L. T. C. (2020). Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises. Pain Medicine.
  11. Moore, N., Carleton, B., Blin, P., Bosco-Levy, P., & Droz, C. (2020). Does Ibuprofen Worsen COVID-19? Drug Safety.
  12. Ranganathan, P., Chen, H., Adelman, M. K., & Schluter, S. F. (2009). Autoantibodies to the δ-opioid receptor function as opioid agonists and display immunomodulatory activity. Journal of Neuroimmunology, 217(1-2), 65-73.
  13. Friedman, H., Newton, C., & Klein, T. W. (2003). Microbial infections, immunomodulation, and drugs of abuse. Clinical Microbiology Reviews, 16(2), 209-219.
  14. Wang, J., Barke, R. A., Charboneau, R., & Roy, S. (2005). Morphine impairs host innate immune response and increases susceptibility to Streptococcus pneumoniae lung infection. The Journal of Immunology, 174(1), 426-434.
  15. Daniell, H. W. (2008). Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. The Journal of Pain, 9(1), 28-36.
  16. Deyo, R. A., Smith, D. H., Johnson, E. S., Donovan, M., Tillotson, C. J., Yang, X., ... & Dobscha, S. K. (2011). Opioids for back pain patients: primary care prescribing patterns and use of services. The Journal of the American Board of Family Medicine, 24(6), 717-727.
  17. Nelson, A. M., Battersby, A. S., Baghdoyan, H. A., & Lydic, R. (2009). Opioid-induced decreases in rat brain adenosine levels are reversed by inhibiting adenosine deaminase. Anesthesiology: The Journal of the American Society of Anesthesiologists, 111(6), 1327-1333.
  18. Moore, J. T., & Kelz, M. B. (2009). Opiates, Sleep, and Pain: The Adenosinergic Link. Anesthesiology: The Journal of the American Society of Anesthesiologists, 111(6), 1175-1176.
  19. Wenk, M., Pöpping, D. M., Chapman, G., Grenda, H., & Ledowski, T. (2013). Long-term quality of sleep after remifentanil-based anaesthesia: a randomized controlled trial. British Journal of Anaesthesia, 110(2), 250-257.
  20. Coutinho, A. E., & Chapman, K. E. (2011). The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Molecular and Cellular Endocrinology, 335(1), 2-13.
  21. Abdul, A. J., Ghai, B., Bansal, D., Sachdeva, N., Bhansali, A., & Dhatt, S. S. (2017). Hypothalamic pituitary adrenocortical axis suppression following a single epidural injection of methylprednisolone acetate. Pain Physician, 20(7), E991-1001.
  22. Sytsma, T. T., Greenlund, L. K., & Greenlund, L. S. (2018). Joint corticosteroid injection associated with increased influenza risk. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(2), 194-198.
  23. Popma, J. W., Snel, F. W., Haagsma, C. J., Brummelhuis-Visser, P., Oldenhof, H. G., van der Palen, J., & van de Laar, M. A. (2015). Comparison of 2 dosages of intraarticular triamcinolone for the treatment of knee arthritis: results of a 12-week randomized controlled clinical trial. The Journal of Rheumatology, 42(10), 1865-1868.
  24. Cohen, S. P., Baber, Z. B., Buvanendran, A., McLean, L. T. C., Chen, Y., Hooten, W. M., ... & King, L. T. C. (2020). Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises. Pain Medicine.
  25. Baranidharan, G., Bretherton, B., Eldabe, S., Mehta, V., Thomson, S., Sharma, M. L., ... & Hall, S. (2020). The impact of the COVID-19 pandemic on patients awaiting spinal cord stimulation surgery in the United Kingdom: a multi-centre patient survey. British Journal of Pain.



  • 0.75 - Physician
  • 0.75 - Non-Physician

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Paul Leo
12/4/20 5:34 pm

Thank you ! some good stuff to take home

Harris Gellman
12/4/20 5:34 pm

Excellent lecture

Ginger Luna
12/4/20 5:35 pm

Thank you. Great presentation. Very applicable to the current situation :)

Megan Waninger
12/4/20 5:38 pm

Terrific presentation, thank you!

Alisa Freas
12/4/20 5:38 pm

Excellent lecture!

Obinna Uzodinma
12/4/20 5:39 pm

Thank you; thought-provoking presentation!

Jane Wang
12/4/20 5:40 pm

Thank you!

Edgardo Perez
12/4/20 5:41 pm

Great practical presentation

Kimberley Smith
12/4/20 5:42 pm

Awesome lecture

Ripu Arora
12/4/20 5:43 pm

thanks Dr D Provenzano

Jose Chavez
12/4/20 5:44 pm

Thank you!

Avinash Ramchandani
12/4/20 5:44 pm

Great talk Dr. P. Awesome.

Deborah Nelson
12/4/20 5:46 pm

Great lecture!

Jeffrey Young
12/4/20 5:47 pm

ty, great

Kevin Chaitoff
12/4/20 5:48 pm

Great presentation Dave!

Susan Aull
12/4/20 5:48 pm

Excellent lecture.

Taruna Penmetcha
12/4/20 5:49 pm

Great presentation

Peter Staats
12/4/20 5:51 pm

One of the best lectures on this topic

Sandra Kroll
12/4/20 5:51 pm

Excellent presentation!

Anilkumar Vinayakan
12/4/20 5:52 pm

Great talk David

Gail McGlothlen
12/4/20 5:53 pm


Joysree Subramanian
12/4/20 5:54 pm

Excellent lecture !

Maria Torres
12/4/20 5:54 pm

Superb lecture with clarification of many controversial issues in pain Thank you!

Douglas Stamp
12/4/20 5:55 pm

Excellent lecture. Very informative.

Sri Nalamachu
12/4/20 5:56 pm

very useful info. Dr. P

Cynthia Troiano
12/4/20 5:56 pm

very clinically relevant presentation

Quanetta Bazile
12/4/20 5:57 pm

Awesome presentation!

Michael Saulino
12/4/20 5:58 pm

Nicely done

Richard Weiner
12/4/20 5:59 pm

Very well researched, organized and presented. Nice work, Dave

Patricia Ratliff
12/4/20 5:59 pm

Great lecture.

Margarita Kurinets
12/4/20 6:00 pm

excellent lecture

Susan Stickevers
12/4/20 6:01 pm

Excellent presentation

A. Cuneyt Ozaktay
12/4/20 6:02 pm

Excellent Presentation, Thank you Dr. Provenzano