COVID-19 and pain
Re iew
E ec s o he COVID-19 pandemic on ch onic pain
in Spain: a scoping e iew
Ma ´
ıa T. Ca illo-de-la-Pen
˜a
a,
*, Albe o Gonz ´alez-Villa
b
, Yolanda T in
˜anes
a,c
Abs ac
The COVID-19 ou b eak has been a g ea challenge in he managemen o ch onic pain pa ien s. We ha e conduc ed a apid
scoping e iew o assess he impac o he pandemic (and he associa ed public heal h measu es) on he heal h s a us and
managemen p ac ices o ch onic pain pa ien s in Spain. To his end, we pe o med a bibliog aphic sea ch in Li COVID and
PubMed, and e iewed o icial websi es and documen s, and expe epo s. The e iew showed ha (1) he s udies consis en ly
indica e ha he pandemic has had a e y nega i e impac on he physical and psychological heal h o ch onic pain pa ien s; (2)
he e a e sca ce da a on how he pandemic a ec ed pain uni consul a ions and a lack o p o ocols o o ganize heal h ca e in he
ace o u u e wa es o con agion, wi h li le implemen a ion o eleheal h. We make p oposals o imp o e managemen o ch onic
pain pa ien s in pandemic si ua ions, which should pi o a ound 3 axes: (1) a coo dina ed esponse o all he ele an s akeholde s o
de ine a u u e oadmap and esea ch p io i ies, (2) a biopsychosocial app oach in pain managemen , and (3) de elopmen and
implemen a ion o no el elemedicine solu ions.
Keywo ds: COVID-19 pandemic, Ch onic pain, Teleheal h, Pain clinics
1. In oduc ion
F om 14 Ma ch o 18 May, he Spanish Go e nmen decla ed a
na ionwide s a e o ala m wi h s ic measu es o educe sp ead o
he SARS-CoV-2 i us. This unp eceden ed si ua ion in ol ed a
gene alized lockdown o he popula ion wi h es ic ion o mo e-
men s, excep o some essen ial ac i i ies (eg, wo king, buying ood
o medicine, and aking pe s ou ). People we e equi ed o s ay
con ined in hei habi ual esidences, o no pa icipa e in social
ga he ings, and o limi ace- o- ace in e ac ions o household
membe s. Howe e , some es ic ions we e emo ed du ing his
pe iod; on 26 Ap il, child en 13 yea s old o younge we e pe mi ed
o go ou o an hou /d; on 2 May, people o e 14 yea s old we e
allowed o e u n o ou doo physical ac i i y a speci ic ime slo s.
The na ionwide s a e o ala m ended on 21 June, wi h o icial epo s
o 246,272 people in ec ed and 28,323 dea hs.
20
Howe e , an
epidemiological s udy o se op e alence es ima ed ha app oxi-
ma ely 5.2% o he Spanish popula ion had been in con ac wi h he
i us, ie, mo e han 2,400,000 people migh ha e been in ec ed.
23
Al hough a he beginning o he summe he e was a pe iod o calm
wi h ew in ec ions and mo e elaxed es ic ions, ou b eaks began
o appea a he end o his season, leading o eimposi ion o
a ge ed con ol measu es in some loca ions. Du ing he au umn, he
second wa e o ansmission no ably inc eased he o icial igu es,
wi h a o al o 1,773,290 in ec ions (se op e alence es ima ions o
a ound 10% o he popula ion being in ec ed
22
) and 48,596 dea hs
as o 16 Decembe 2020.
21
Rega dless o he e ec s o SARS-CoV-2 in ec ion on he
occu ence o pain- ela ed p oblems, he heal h measu es aken o
hal he COVID-19 pandemic ha e had signi ican consequences on
he managemen o ch onic pain pa ien s and on hei heal h s a us. In
he ea ly s ages o he ale , heal h au ho i ies had o p io i ize measu es
o p e en massi e sp ead o he co ona i us, mi iga e he isk o
heal h ca e s a and pa ien s and, ese e medical esou ces o
COVID-19 pa ien s. This esul ed in limi ed access o pain manage-
men se ices and unde ea men o ch onic pain pa ien s. Al hough
he consequences o dis up ing ea men s o ch onic pain ha e ye o
be es ima ed, hey a e likely o be subs an ial, p obably inc easing he
quan i y, se e i y, and complexi y o pain symp oms. I is expec ed ha
he isola ion/social dis ancing due o he COVID-19 pandemic will
wo sen he physical and emo ional condi ion o ch onic pain pa ien s.
19
Ne e heless, we ha e no solid da a on he eal impac o he pandemic
and lockdown measu es on ch onic pain pa ien s in Spain.
Thus, in his a icle, we a emp ed o e iew epo s published in
scien i ic jou nals, o icial documen s p oduced by heal h agencies,
ecommenda ions by scien i ic socie ies, and epo s om pain
Sponso ships o compe ing in e es s ha may be ele an o con en a e disclosed
a he end o his a icle.
a
B ain and Pain (BaP) Lab, Facul y o Psychology, Depa men o Clinical
Psychology and Psychobiology, Uni e si y o San iago de Compos ela, San iago de
Compos ela, Spain,
b
Psychological Neu oscience Lab, Psychology Resea ch
Cen e, School o Psychology, Uni e si y o Minho, B aga, Po ugal,
c
Galician
Heal h Knowledge Agency (ACIS), San iago de Compos ela, Spain
*Co esponding au ho . Add ess: B ain and Pain (BaP) Lab, Facul y o Psychology,
Uni e si y o San iago de Compos ela (Spain), San iago, 15782, Spain. Tel.: 134
881813798. E-mail add ess: m e e[email p o ec ed] (M.T. Ca illo-de-la-Pen
˜a).
Copy igh ©2021 The Au ho (s). Published by Wol e s Kluwe Heal h, Inc. on behal
o The In e na ional Associa ion o he S udy o Pain. This is an open access a icle
dis ibu ed unde he C ea i e Commons A ibu ion-NoDe i a i es License 4.0 (CC
BY-ND) which allows o edis ibu ion, comme cial and non-comme cial, as long as
i is passed along unchanged and in whole, wi h c edi o he au ho .
PR9 6 (2021) e899
h p://dx.doi.o g/10.1097/PR9.0000000000000899
6 (2021) e899 www.pain epo sonline.com 1
obse a o ies and pa ien s’ associa ions. The objec i e was o
assess he impac o he pandemic in Spain: (1) on he physical and
psychological heal h s a us o ch onic pain pa ien s and (2) on
changes in pain managemen p ac ices, including elemedicine
expe iences. Also, we p opose ecommenda ions o imp o e
a en ion o ch onic pain pa ien s in u u e wa es o con agion.
2. Me hods
To map he a ailable e idence on he impac o COVID-19 in ch onic
pain managemen , he e, we conduc ed a scoping e iew. This ype
o e iew p o ides an o e iew o he eme ging esea ch.
3,25
We sea ched s udies collec ed in Li Co id, a esou ce
con aining up- o-da e scien i ic in o ma ion abou COVID-19,
using “pain” as keywo d and selec ing hose e e ed o Spain.
Also, we sea ched in PubMed using he e ms ([COVID* o
co ona i us o SARS-CoV-2] and [“ch onic pain*” o “pain
disease*” o “pain pa ien *” o “ch onic disease” o “pain
managemen ” o “pain uni *” o “pain clinic*” o “pain consul a-
ion*” o “pain ea men ” o “pain medicine”] and Spain). The
sea ch was pe o med on he 16 h o Decembe 2020.
We addi ionally sea ched ongoing sys ema ic e iews (PROS-
PERO) and egis e ed clinical ials (clinical ials.go and Eu o-
pean Clinical T ials Regis y).
To complemen he sea ch in da abases, we pe o med a
manual sea ch on Google and on he pages o ele an
ins i u ions, agencies, and o ganiza ions (eg, websi e o he
Spanish Minis y o Heal h, egional heal h sys ems, scien i ic
socie ies and pa ien associa ions). In addi ion, we con ac ed wi h
3 expe s in he ield o ch onic pain.
We expo ed he ob ained e e ences o Rayyan,
29
a ee
so wa e ha acili a es sys ema ic e iews. Two au ho s double‐
sc eened all i les and abs ac s, excluding all s udies ha we e
ou o scope. We included s udies conduc ed in Spain, e alua ing
he e ec o he pandemic on he heal h s a us o pa ien s wi h
ch onic pain and on pain uni s ac i i y, ega dless o hei design.
We included s udies published in English o Spanish.
Gi en he na u e o his e iew, only a desc ip i e analysis o he
s udies, and no isk o bias analysis was pe o med. The e iew aims
o p o ide an o e iew o he exis ing e idence, ega dless o
me hodological quali y o isk o bias, and ou lines he main
implica ions o clinical p ac ice, esea ch, and heal h policy.
3. Resul s
The PRISMA low cha is shown in Figu e 1. A e he ini ial
sc eening by i le and abs ac , and elimina ion o duplica es, we
ob ained 14 a icles. In addi ion, we iden i ied 6 eco ds om
addi ional sou ces. A e ull- ex eading, we elimina ed 8 s udies
because hey we e no pe o med in ou a ge popula ion (ie,
heal h ca e wo ke s, olde people, o gene al popula ion) and 1
because i was no e e ed o he ac i i y o pain uni s. Finally, 11
published a icles we e included.
In addi ion, we iden i ied 3 websi es wi h he esul s o online
s udies, which a e also included in his na a i e e iew.
We classi ied he eco ds in o he 2 ca ego ies desc ibed
below.
3.1. Assessmen o he impac o COVID-19 on ch onic pain
pa ien s’ heal h
We ound 4 published epo s speci ically analysing he e ec s o
lockdown and ea men discon inua ion on ch onic pain
pa ien s’ heal h.
6,17,26,30
L´opez-Medina e al.
17
eleased an online su ey h ough
pa ien o ganisa ions and social media, which was e en ually
comple ed by 644 heuma ic pa ien s. They ound ha 37.4% o
he pa ien s epo ed wo sening o pain, a igue, and s i ness
(compu ed in a composi e index) du ing he con inemen . Also,
75.5% epo ed mood diso de s, which we e signi ican ly
associa ed wi h he wo sening o physical symp oms. They
au ho s explained hose esul s as a consequence o he lack o
daily physical ac i i y and he dis up ion o ea men s (obse ed
in 20.3% o he pa ien s).
Simila ly, an online su ey explo ed he e ec s o he pandemic
( om 27 Ap il o 25 May 2020) in a sample o 502 pa ien s wi h
ch onic pain.
26
The main indings we e as ollows: (1) he
lockdown was ela ed o a wo sening in mos o he clinical
domains assessed (pain in ensi y and equency, pain- ela ed
in e e ence and dis ess, sleep p oblems, among o he s); (2) he
pa ien s inc eased es ing and medica ion in ake o cope wi h
hei p oblems du ing he lockdown; posi i ely, 48.2% inco po-
a ed s e ching in hei daily ou ine; and (3) he pa ien s
pe cei ed ha sleep p oblems, seden a ism, and psychological
ac o s (wo ies abou he u u e, ea o su e ing om COVID-19,
insecu i y, sadness, and loneliness) we e he main igge s o
hei pain.
One s udy explo ed he emo ional dis ess de i ed om he
pandemic si ua ion among 362 pa ien s wi h cen al sensi iza ion
pain ( ib omyalgia, ch onic widesp ead pain, and low back
pain).
30
They ound ha he di icul ies in ecei ing medical ca e
o main aining daily ou ines, and he loss o social suppo we e
he a iables ha bes p edic ed emo ional dis ess. In addi ion,
changes in daily ou ines and emo ional dis ess we e signi ican ly
associa ed wi h pain in ensi y.
B ocale o-Camacho e al.
6
analysed he e ec o discon inu-
a ion o a neu os imula ion ea men o pain. In a phone
in e iew, 81 pa ien s we e asked o quan i y hei pain on a
nume ical a ing scale. They obse ed ha pa ien s who
discon inued hei ea men epo ed wo sened pain ( om 5.0
o 6.7 on a scale o 10), whe eas hose who con inued hei
ea men a home (8.6%) epo ed no change in hei pain
a ings. The s udy concluded ha he e ec s did no depend on
he lockdown pe se bu on he discon inua ion o he he apeu ic
p ocedu e. These esul s ein o ce he need o de elop in e en-
ions ha can be pe o med a home.
In addi ion, we ound 2 epo s published online on he
consequences o he qua an ine and o inac ion on ch onic pain
pa ien s. The In e na ional Obse a o y 4 D,
28
in collabo a ion
wi h Spanish ede a ions and associa ions o ib omyalgia and
ch onic a igue disease, pe o med an online su ey wi h 274
ch onic pain pa ien s du ing he i s week o May 2020.
Rega ding he impac o con inemen on physical heal h, mo e
han 70% o he pa ien s epo ed a signi ican wo sening o
ch onic pain and 73.7% had o inc ease hei medica ion (33.2%
almos daily). In addi ion, mo e han 70% epo ed inc eased
a igue (36.5% o which we e a maximum le els), 60.6% epo ed
ha ing o s ay in bed longe han usual, and 82.1% epo ed mo e
di icul y in sleeping (45.6% o a high deg ee). Conce ning
psychological heal h, a ound 80% o he pa icipan s epo ed
inc eased le els o anxie y and dep ession, ouble concen a ing
and social isola ion. Also, 71% epo ed changes in unc ionali y
doing hei habi ual wo k because o inc eased pain. In e es ingly,
91.6% o he pa icipan s epo ed ha he pandemic si ua ion
a ec ed hei access o heal h ca e se ices.
The Spanish Pain Socie y (Sociedad Espan
˜ola del Dolo [SED])
33
also published he esul s o a su ey made du ing he
lockdown among ch onic pain pa ien s (a ound 260 esponses).
2M.T. Ca illo-de-la-Pen
˜a e al.·6 (2021) e899 PAIN Repo s
®
The su ey e ealed ha 61% o he pa ien s epo ed ha hei
pain a ha ime wo sened, 42% epo ed ha he si ua ion had a
nega i e e ec on hei mood, and 36% inc eased hei use o
medica ion. Also, sleep wo sened o he 63.3% o he su eyed.
Al hough no di ec ly pe o med wi h ch onic pain pa ien s, he
Pain Obse a o y su eyed mo e han 670 employees ( eache s,
esea che s, and adminis a i e s a ) o a Spanish Uni e si y by e-
mail.
27
They ound ha 46.8% o he pa icipan s did less physical
exe cise han be o e, and 23.3% o hem slep badly o e y
badly. Al hough he esponden s epo ed no di e ence in heal h
pe cep ion du ing he pandemic, 41.9% o he pa icipan s who
had p e iously su e ed ch onic pain epo ed ha i was wo se
han be o e he con inemen .
In sum, he s udies pe o med used online/ elephone p oce-
du es and al oge he su eyed mo e han 2,000 pa ien s wi h
ch onic pain. All o hem consis en ly ound nega i e e ec s o he
pandemic and lockdown measu es (including closu e o clinics)
on clinical symp oms, mood, and unc ionali y.
3.2. Changes in ch onic pain managemen du ing he COVID-
19 pandemic
We ound 5 a icles analysing he e ec o he pandemic in pain
managemen p ac ices.
1,2,9,12,15,16,18
I is widely acknowledged ha he pandemic si ua ion also
caused delays in p ocedu es, ea men s, and in e en ions o
ch onic pain pa ien s. We ha e no ound da a on how much
ac i i y in he pain uni s o Spain was cancelled du ing he ala m
s a e, bu we can es ima e i om online su eys pe o med in
headache uni s
15
o heuma ology se ices.
12
The pe cen age o
cancelled consul a ions in headache uni s di e ed among
egions depending on he a e o COVID-19 in ec ions ( anging
be ween 29% and 100%), wi h mo e han 75% o cancella ions in
app oxima ely hal o he egions. Mos o he esponden s
an icipa ed an inc ease in wai ing lis s in he ollowing mon hs and
mani es ed hei desi e o inc ease he use o elemedicine, which
could also be inc easingly demanded by pa ien s. In Spain,
almos 90% o he heuma ology se ices we e locked down, and
in mo e han 60% o he se ices su eyed, he closu e was
comple e du ing mo e han 7 weeks.
12
Coma e al.
9
analysed 34
indica o s o Heal hca e Quali y S anda d in p ima y ca e
a en ion o ch onic diseases, and ound a nega i e e ec o he
pandemic on 85% o he indica o s ( ela ed o he adequacy o
ea men , ollow-up and con ol o ch onic diseases, sc eening,
accina ions, o qua e na y p e en ion). They ound ha he
lockdown measu es signi ican ly educed he ollow-up and
con ol o pa ien s.
Conce ning he measu es o mi iga e he impac o he
pandemic on he managemen o ch onic pain, we ound a
epo p oposing speci ic measu es o he ees ablishmen o he
pain uni s ac i i y.
1
In his a icle, he au ho s e iewed di e en
pain ea men s and made p oposals o in e en ions wi h
minimal in e e ence on he immune sys em, as well as
ecommenda ions o gua an ee he sa e y o he pa ien s. In his
line, o he publica ion made ecommenda ions abou pha ma-
cological he apy o ch onic pain pa ien s depending on he
p esence o no o COVID-19 in ec ion o immuni y.
2
We did no ind any p e egis e ed clinical ial ( e iew o
Clinical ials.go and Eu opean Clinical T ials Regis y) on he
e ec o managemen p ac ices o in e en ions o a enua e he
impac o he pandemic si ua ion on ch onic pain, wi h he
excep ion o one ial consis ing o an educa ional and
psychological in e en ion p og amme—in ol ing people
in ec ed wi h SARS-Co -2—aimed a educing he conse-
quences on he pos in ensi e ca e synd ome and ch onic pain
(ClinicalT ials.go Iden i ie : NCT04394169).
Al hough bo h clinicians and pa ien s look a ou ably on
eleheal h ca e,
15
i is di icul o know exac ly he ex en o which
In o ma ion and Communica ion Technologies (ICTs) we e used
in pain uni s du ing he pandemic. Again, we could ex apola e
da a om headache consul a ions
15
: a ound 92% o he uni s
eplaced isi s by elephone con ac s. A su ey o 244 heuma ic
pa ien s conduc ed o assess he le el o sa is ac ion wi h phone
consul a ions ound ha 52.7% we e sa is ied wi h he se ice,
Figu e 1. Flow diag am depic ing he selec ion p ocess.
6 (2021) e899 www.pain epo sonline.com 3
whe eas 47.3% we e no sa is ied.
16
The pa ien s who consid-
e ed phone consul a ion o be use ul we e signi ican ly younge
(abou 3.5 mean yea s less) and showed lowe le els o s i ness
and axial pain.
We also e iewed o icial documen s and expe ecommen-
da ions o know wha measu es we e unde aken o mi iga e he
impac o closu e o pain clinics. The Spanish Minis y o Heal h
(h ps://www.mscbs.gob.es) published a se ies o ecommen-
da ions o he managemen o pa ien s, o hose in ec ed wi h
COVID-19 and o ulne able g oups, such as oncology pa ien s
and pa ien s in dialysis uni s o in pallia i e ca e. The e we e no
speci ic ecommenda ions o he managemen o ch onic pain
pa ien s du ing he pandemic, which we e aken up by scien i ic
socie ies.
The Spanish Pain Socie y (SED; h ps://www.sedolo .es) has
p o ided in o ma ion esou ces o p o essionals and pa ien s
wi h ch onic pain. In ela ion o pa ien s, apa om he basic
ecommenda ions o p e en ion (hygiene, isola ion, and ace-
masks) and o beha iou in he case o COVID-19 in ec ion, a he
beginning o he s a e o ala m, he SED published speci ic
in o ma ion o ch onic pain pa ien s on 3 subjec s: consump ion
o analgesics, pain managemen in he pandemic, and a p oposal
o o ganizing pain clinics o ace his c isis. Rega ding he use o
medica ion, he ecommenda ion was o con inue wi h he
egula consump ion o analgesics, in he absence o any
e idence ha hese ha e nega i e e ec s on COVID-19. In
addi ion, pa ien s we e gi en ecommenda ions o coping wi h
con inemen , such as s aying ac i e, exe cising, main aining
p ope sleep hygiene, and managing emo ions in a posi i e way.
Rega ding he unc ioning o pain uni s, i was epo ed ha all
nonu gen isi s we e cancelled, and ha on-si e ca e would only
be a ailable o u gen and nonde e able cases (eg, con ol o
ecen su ge ies o illing in a hecal pumps), whe eas he use o
elema ic me hods was ecommended.
A he beginning o he de-escala ion phase (May 2020), he
SED made ecommenda ions o p o essionals on how o manage
ch onic pain p oblems when ca e ac i i y in pain uni s esumed
(www.sedolo .es).
18
Those ecommenda ions we e based on a
na a i e e iew made in he middle o May 2020 and gene ally
ollowed ecommenda ions om he EU oadmap, ask o ces
om in e na ional scien i ic socie ies, o g oups o expe s.
8,11,31
In addi ion o sa e p ocedu es in ace- o- ace consul a ions, he
guidelines included iage no ms, p io i iza ion o pha macolog-
ical and ehabili a ion se ices (nonin e en ional), and assess-
men o pa ien s’ como bidi ies o isk s a i ica ion be o e
p oceeding wi h in e en ional echniques. A his s age, he
ad ice was o limi on-si e consul a ions o p e e en ial cases
(such as uncon olled oncological pain, any se e e pain wi h
ala m signs, high in ensi y neu algia (eg, pos he pe ic and
c anio acial), complex egional pain synd ome, o sudden onse
o wo sening o adiculalgia), and o p omo e he use o
eleconsul a ion (p e e en ially by ideocon e ence). Simila ec-
ommenda ions ha e been published in he Spanish Jou nal o
Anaes hesiology and Reanima ion (Re is a Espan
˜ola de Anes-
esiolog´
ıa y Reanimaci ´on, SEDAR).
4
We ha e also iden i ied one posi ion s a emen on s anda d
headache and neu algia ea men in he con ex o he COVID-19
pandemic, de eloped by he Headache S udy G oup o he Spanish
Socie y o Neu ology.
24
In his documen , he au ho s ecommen-
ded he use o con en ional ea men s because hey did no ind any
scien i ic e idence o con aindica e hese. In addi ion, guidelines on
d ug in e ac ion wi h d ugs used o ea COVID-19 we e p o ided.
We iden i ied some p oposals on ela ed disciplines wi h ch onic
ca e such as ehabili a ion, desc ibing ac ions o expand he use o
new echnologies such as ele ehabili a ion and wea able assess-
men de ices.
7
The Spanish Socie y o Rheuma ology (Sociedad
Espan
˜ola de Reuma olog´
ıa) also published a posi ion a icle on
unc ioning and es o a ion o he ac i i y o heuma ology se ices in
he ace o he COVID-19 c isis.
32
We also e iewed ecommenda ions om Spanish egional
heal h se ices conce ning elemedicine use du ing he pan-
demic. A ecen s udy e iewed he o ma s, uses, ad an ages,
and dange s o elemedicine ools du ing he pandemic.
34
Al hough he heal h applica ion o ICTs is included in he agenda
o all he go e nmen s, which encou aged hei use in he
pandemic si ua ion, we ound ha hese ins umen s we e
p e e ably placed a he se ice o COVID pa ien s, and egional
heal h sys ems in Spain show une en de elopmen and
applica ion o ICTs.
4. Discussion
The i s wa e o he epidemic by COVID-19 was e y ha sh in
Spain, and his o ced he adop ion o he s ic es measu es,
compa ed wi h o he coun ies. In his s udy, we aimed o e iew
how he managemen o pa ien s wi h ch onic pain was
pe o med, and how hey we e a ec ed by he pandemic
si ua ion, in case his lea ning can be used in u u e compa able
si ua ions.
The pandemic has con on ed humankind wi h an unknown
si ua ion and posed an unp eceden ed challenge o heal h
sys ems and socie y. I is unde s andable ha in his con ex
heal h esou ces ha e mainly been alloca ed o he igh agains
COVID-19. In Spain, as in o he coun ies, we ha e su e ed wha
has been called “ he dis ac ion e ec ,” namely, he abili y o
COVID-19 o o e shadow all o he heal h conce ns wi h
consequen nega i e e ec s on pa ien heal h and he limi a ion
o economic esou ces a ailable o o he heal h p oblems.
10
Al hough li le esea ch has been conduc ed in Spain on
COVID-19 and ch onic pain, he a ailable e idence e eals ha
he lockdown has had a s ong impac on he physical and
psychological heal h o ch onic pain pa ien s. The con inemen
and social isola ion ha e esul ed in inc eased seden a y
beha iou and anxie y, wi h nega i e consequences on pain,
medica ion use, sleep, and a igue. The da a show ha he
impac o he COVID-19 c isis on heal h has been g ea e in
people wi h ch onic pain han in he gene al popula ion. Howe e ,
he s udies e iewed ocused on he ea ly phases o he
pandemic (Ma ch o May 2020), and we ha e no da a on how
he con inued si ua ion o heal h and socioeconomic unce ain y
is a ec ing pa ien s wi h ch onic pain.
In e es ingly, we ound ha he di icul y in ecei ing medical
ca e was a signi ican p edic o o emo ional dis ess
30
and
inc eased pain.
6
Ch onic pain pa ien s a e a ulne able pop-
ula ion, and hey should ecei e special a en ion in si ua ions o
heal h ca e eme gency. Al hough he expe s did ecognize ha
he a en ion gi en o pa ien s du ing he pandemic was limi ed,
because o he cancella ion o ace- o- ace consul a ions and he
delay in in e en ional p ocedu es, we ound ew ini ia i es o
mi iga e he e ec s o he closu e o pain uni s. In addi ion, we did
no ind any in o ma ion ega ding plans o imp o e he esponse
in second o successi e wa es o con agion. We ound a cu en
clinical ial aimed a educing ch onic pain a e COVID-19
in ec ion. In he coming mon hs, i would be in e es ing o
de e mine he numbe o people su e ing om ch onic pain a e
his in ec ion. We ha e con ac ed pain specialis s om 2 la ge
hospi als in he egion (NW Spain), and hey epo ed only 1 case
o pain a e emo al h ombosis.
4M.T. Ca illo-de-la-Pen
˜a e al.·6 (2021) e899 PAIN Repo s
®
Mos o he ace- o- ace consul a ions cancelled we e
subs i u ed by phone consul a ions, wi h li le use o online
pla o ms o homeca e and pa ien moni o ing. The s udies
e ealed a la ge p opo ion o unsa is ied people, so he challenge
is o imp o e pa ien s’ sa is ac ion wi h elemedicine se ices,
iden i y hose who a e mos likely o ecei e success ul online
ca e, and o de elop iage p o ocols o iden i y pa ien s who
need ace- o- ace isi s. This e iew iden i ied a lack o any plan o
p o ocol o use elemedicine esou ces o op imize he ca e o
ch onic pain pa ien s in pe iods o pandemic. In o he ields, we
ound ha he Spanish Socie y o Ca diology has p epa ed a
consensus documen o imp o e he quali y o ca e in hei
elephone consul a ions, de ining which aspec s can be ea ed
elema ically and which equi e ace- o- ace consul a ion.
5
As a limi a ion o his e iew, we may ha e o e looked some
esea ch in p og ess. Gi en he ecen eme gence o he
pandemic and he ime scale a which science usually p o-
g esses, i is possible ha some esea ch in Spain has no ye
been published o p e egis e ed in esea ch da abases. Indeed,
we a e awa e o o he s udies being pe o med in Galicia (NW
Spain).
5. Conclusions and p oposal o he u u e
The excep ional ci cums ances de i ed om his pandemic ha e
been pa icula ly ex eme in ou coun y (high a e o in ec ions,
e y s ic con inemen , cancella ion o ac i i ies in pain clinics,
and huge economic c isis...). Thus, he s udy o he pe sonal and
socioeconomic consequences on pa ien s wi h ch onic pain is
especially ele an in Spain.
This scoping e iew e idenced a la ge impac o he lockdown
measu es on he physical and psychological heal h o ch onic
pain pa ien s. To imp o e he heal h ca e o ch onic pain pa ien s,
adap ed o he new challenges gene a ed by he pandemic, we
p oposed he ollowing ecommenda ions.
Fi s , a coo dina ed esponse o heal h au ho i ies, scien i ic
socie ies, esea che s, and pa ien associa ions o de ine a u u e
oad map and changes in heal h ca e deli e y o ch onic pain
pa ien s.
Second, one aspec ha has become e iden du ing his c isis
is he need o adop a biopsychosocial app oach o p e en
unde mining he ca e o pa ien s wi h ch onic pain.
14,19
As
indica ed in one s udy, he emo ional impac o he pandemic and
i s e ec s on pain suppo he need o psychological moni o ing
o ch onic pain pa ien s du ing pe iods o heal h c isis.
4
This
should lead o he adop ion o a biopsychosocial app oach and
he inclusion o mul idisciplina y pain in e en ions, also a
necessa y esponse o adap o an aging popula ion and o a
p obably u u e inc ease in ch onic pain p oblems.
Telemedicine should be he hi d co ne s one o he u u e oad
map in ch onic pain managemen . The pandemic has b ough
elemedicine o he o e on o pa ien ca e and will ce ainly
boos he use o hese ins umen s. As in educa ion and
adminis a ion, eleheal h ools can mi iga e he impac o he
i al pandemic and con ibu e o imp o ing he well-being o he
ch onic pain popula ion. Pain specialis s should also be
ambi ious and unde s and ha eleheal h can in ol e much mo e
han phone consul a ions. I is impo an o expand he o ma s,
using speci ic pla o ms ha a e al eady a ailable (such as
elec onic medical eco ds and home eleca e pla o ms), and o
ex end he applica ion o hese ools o di e se aspec s o heal h
ca e (ie, o daily moni o ing o pa ien s, o emo e con ol o
ea men de ices such as neu omodula o y in e en ions, e-
habili a ion, and psychological in e en ions). To achie e his, i is
essen ial o ha e a common coo dina ed plan in ol ing all heal h
ca e agen s.
The COVID-19 pandemic has p esen ed unusual challenges
ha may change he heal h ca e sys em o e e . I has been
p esen ed as an oppo uni y o p o ide impe us o elemedicine
p ocedu es and pe haps as a p elude o a e olu ion in he
deli e y o heal h ca e in he u u e, including ca e o ch onic pain
pa ien s.
13
In he nex mon hs, we will see whe he he
oppo uni y ha he pandemic ep esen s o ha e olu ion has
been los o no .
Disclosu es
The au ho s ha e no con lic s o in e es o decla e.
Acknowledgmen s
The au ho s hank Bea iz Casal, in o ma ion specialis , o ad ice
on he bibliog aphic sea ch, and o D . Ca ina Fe nandes, D .
L´opez-Pa´
ıs and o D . M ´onica Moldes who p o ided inpu o a
i s d a o he a icle.
Funding: his s udy was unded by he Spanish Minis y o Science
and Inno a ion ( e e ence PID2019-107986RB-100).
A icle his o y:
Recei ed 21 Oc obe 2020
Recei ed in e ised o m 22 Decembe 2020
Accep ed 8 Janua y 2021
A ailable online 16 Feb ua y 2021
Re e ences
[1] Abej ´on D, Monz ´on EM, Dee T, Hagedo n JM, A aujo R, Abad C, Rios A,
Zamo a A, Vallejo R. How o es a he in e en ional ac i i y in he
COVID-19 e a: he expe ience o a p i a e pain uni in Spain. Pain P ac
2020;20:820–8.
[2] Alc ´an a a Mon e o A, Pacheco de Vasconcelos SR. COVID-19 and
ch onic pain: many ques ions and ew ce ain ies [in Spanish]. Seme gen
2020;46:365–7.
[3] Ande son S, Allen P, Peckham S, Goodwin N. Asking he igh ques ions:
scoping s udies in he commissioning o esea ch on he o ganisa ion and
deli e y o heal h se ices. Heal h Res Pol Sys 2008;6:7.
[4] Asensio-Sampe JM, Quesada-Ca ascosa M, De And ´es J. P ac ical
ecommenda ions o he managemen o he pa ien wi h ch onic pain
du ing he pandemic o COVID-19. Re Esp Anes esiol Reanim 2020. doi:
10.1016/j. eda .2020.08.005 [Epub ahead o p in ].
[5] Ba ios V, Cos´
ın-Sales J, B a o M, Escoba C, G ´amez JM, Huelmos A,
O iz Co ´es C, Egocheaga I, Ga c´
ıa-Pinilla JM, Jim ´enez-Candil J, L ´opez-
de-S ´a E, To es Lle go J, Obaya JC, Palla es-Ca a al ´a V, Sanma ´
ın M,
Vidal-P ´e ez R, Cequie ´
A. Telemedicine consul a ion o he clinical
ca diologis s in he e a o COVID-19: p esen and u u e. Consensus
documen o he Spanish Socie y o Ca diology. Re Esp Ca diol 2020;
73:910–18.
[6] B ocale o-Camacho A, P ´e ez-Bo ego YA, So o-Le ´on V, Rod iguez-
Ma as MJ, Fo ani G, Oli ie o A. E ec s o COVID-19 lockdown on
ch onic d ug- esis an pain pa ien s ea ed using b ain s imula ion
app oaches. B ain S imula ion 2020;13:1089–90.
[7] Chale J, Gil F aguas L, G ´omez Ga c´
ıa A, Laxe S, Luna Cab e a F,
Lla ona R, Miangola a Page JC, Del Pino Alga ada R, Sala e ´
ıa
Izagui e N, S ´anchez Ta i a P, San and Eu ME, Ga e a Figue a R. Impac
o Co ona i us disease 2019 ou b eak on ehabili a ion se ices and
physical ehabili a ion medicine and ehabili a ion physicians’ ac i i ies:
pe spec i es om he Spanish expe ience. Eu J Phys Rehabil Med 2020;
56:369–71.
[8] Cohen SP, Babe ZB, Bu anend an A, McLean BC, Chen Y, Hoo en WM,
Lake SR, Wasan AD, Kennedy DJ, Sandb ink F, King SA, Fowle IM,
S ojano ic MP, Hayek SM, Phillips CR. Pain managemen bes p ac ices
om mul ispecial y o ganiza ions du ing he COVID-19 pandemic and
public heal h c ises. Pain Med 2020;21:1331–46.
[9] Coma E, Mo a N, M ´endez L, Ben´
ı ez M, He mosilla E, F `ab egas M, Fina F,
Me cad ´e A, Flayeh S, Gui igue C, Ball ´o E, Ma inez Leon N, Mas A,
6 (2021) e899 www.pain epo sonline.com 5
Co dom´
ı S, Leja di Y, Medina M. P ima y ca e in he ime o COVID-19:
moni o ing he e ec o he pandemic and he lockdown measu es on 34
quali y o ca e indica o s calcula ed o 288 p ima y ca e p ac ices
co e ing abou 6 million people in Ca alonia. BMC Fam P ac 2020;21:
208.
[10] Co iula F, Pe ke A, Ba ole i M, Puglisi F, Helleday T. Managing COVID-
19 in he oncology clinic and a oiding he dis ac ion e ec . Ann Oncol
2020;31:553–5.
[11] Dee TR, Sayed D, Pope JE, Chak a a hy KV, Pe e sen E, Moeschle
SM, Abd-Elsayed A, Ami del an K, Mekhail N, Wo kg oup AC.
Eme gence om he COVID-19 pandemic and he ca e o ch onic pain:
guidance o he in e en ionalis . Anes h Analg 2020;131:387–94.
[12] Dejaco C, Alunno A, Bijlsma JW, Boonen A, Combe B, Finckh A,
Machado PM, Padjen I, Si e a F, S amm TA, Bu ge ei F. In luence o
COVID-19 pandemic on decisions o he managemen o people wi h
in lamma o y heuma ic and musculoskele al diseases: a su ey among
EULAR coun ies. Ann Rheum Dis 2020. doi: 10.1136/ann heumdis-
2020-218697 [Epub ahead o p in ].
[13] Eccles on C, Bly h FM, Dea BF, Fishe EA, Kee e FJ, Lynch ME, Pale mo
TM, Reid MC, Williams ACdC. Managing pa ien s wi h ch onic pain du ing
he COVID-19 ou b eak: conside a ions o he apid in oduc ion o
emo ely suppo ed (eHeal h) pain managemen se ices. PAIN 2020;
161:889–93.
[14] Failde Ma ´
ınez I. El uso de las nue as ecnolog´
ıas en los pacien es con
dolo c ´onico. Una ealidad que no se puede nega . Re is a de La
Sociedad Espan
˜ola Del Dolo 2019;26:259–60.
[15] L ´opez-B a o A, Ga c´
ıa-Azo ´
ın D, Bel ´
ıs R, Gonz ´alez-O ia C, La o e G,
San os-Lasaosa S, Gue e o-Pe al ´
AL. Impac o he COVID-19
pandemic on headache managemen in Spain: an analysis o he
cu en si ua ion and u u e pe spec i es. Neu ologia 2020;35:372–80.
[16] L ´opez-Medina C, Escude o A, Collan es-Es e ez E. COVID-19
pandemic: an oppo uni y o assess he u ili y o elemedicine in
pa ien s wi h heuma ic diseases. Ann Rheum Diseases doi: 10.1136/
ann heumdis-2020-218008 [Epub ahead o p in ].
[17] L ´opez-Medina C, Ladehesa-Pineda L, G ´omez-Ga c´
ıa I, ´
Angeles Puche-
La ubia M, Miguel Sequ´
ı-Saba e J, A men e os-O iz P, O ega-Cas o
R, Luis Ga ido-Cas o J, Escude o-Con e as A, Collan es-Es ´e ez E.
T ea men adhe ence du ing he COVID-19 pandemic and he impac o
con inemen on disease ac i i y and emo ional s a us: a su ey in 644
heuma ic pa ien s. Join Bone Spine 2020;88:105085.
[18] Mayo al Rojals V, P ´e ez He n ´andez C, P ´e ez Caja a ille J, Can ´os
Ve decho A. Sociedad Espan
˜ola del Dolo (SED). Recomendaciones
asis enciales pa a unidades de dolo an e la no malizaci ´on p og esi a de
la ac i idad du an e la pandemia po COVID-19. [Heal hca e
ecommenda ions o pain uni s in he ace o p og essi e no maliza ion
o ac i i y du ing he COVID-19 pandemic]. Re is a Soci Esp Dolo 2020;
27:192–215.
[19] Mic ´o JA. Co ona i us COVID-19 y dolo c ´onico: ince idumb es. Re is a
Soci Esp Dolo 2020;27:72–3.
[20] Minis e io de Sanidad. Ac ualizaci ´on nº 143. En e medad po el
co ona i us (COVID-19). 2020, Vol. 2020. A ailable a : h ps://www.
mscbs.gob.es/p o esionales/saludPublica/ccayes/ale asAc ual/nCo /
documen os/Ac ualizacion_143_COVID-19.pd . Accessed Decembe
16, 2020.
[21] Minis e io de Sanidad. Ac ualizaci ´on nº 272. En e medad po el
co ona i us (COVID-19). 2020, Vol. 2020. A ailable a : h ps://www.
mscbs.gob.es/p o esionales/saludPublica/ccayes/ale asAc ual/nCo /
documen os/Ac ualizacion_272_COVID-19.pd . Accessed Decembe
16, 2020.
[22] Minis e io de Sanidad, Ins i u o de Salud Ca los III. Es udio ENE-Co id19:
cua a onda. In: Es udio nacional de se o-epidemiolog´
ıa de la in ecci ´on
po SARS-Co -2 en Espan
˜a. In o me inal; 15 de diciemb e de 2020.
A ailable a : h ps://www.mscbs.gob.es/gabine eP ensa/no aP ensa/
pd /15.12151220163348113.pd . Accessed Decembe 16, 2020.
[23] Minis e io de Sanidad, Ins i u o de Salud Ca los III. Es udio ENE-Co id19:
p ime a onda. In: Es udio nacional de se o-epidemiolog´
ıa de la in ecci ´on
po SARS-Co -2 en Espan
˜a. Minis e io de Sanidad, Mad id: In o me inal;
6 de julio de 2020.
[24] Mo oll ´on N, Bel ´
ıs R, De Dios A, Pag `es N, Gonz ´alez-O ia C, La o e G,
San os-Lasaosa S. S anda d headache and neu algia ea men s and
SARS-CoV-2: opinion o he Spanish socie y o neu ology’s headache
s udy g oup. Neu ologia 2020;35:628–32.
[25] Munn Z, Pe e s MDJ, S e n C, Tu ana u C, McA hu A, A oma a is E.
Sys ema ic e iew o scoping e iew? Guidance o au ho s when
choosing be ween a sys ema ic o scoping e iew app oach. BMC Med
Res Me hodol 2018;18:143.
[26] Nie o R, Pa do R, So a B, Feliu-Sole A, Luciano JV. Impac o COVID-19
lockdown measu es on Spanish people wi h ch onic pain: an online s udy
su ey. J Clin Med 2020;9:3558.
[27] Obse a o io del dolo . Los e ec os del con inamien o en los abajado es
de la Uni e sidad de C ´adiz, 2020. A ailable a : h ps://
obse a o iodeldolo .com/2020/05/28/e ec os-del-con inamien o-en-
la-uca/. Accessed Decembe 16, 2020.
[28] Obse a o io 4D. Woman, pain, disabili y, disc imina ion, 2020. A ailable
a : h ps://www. ib odolo .o g/obse a o io-4d/. Accessed Decembe
16, 2020.
[29] Ouzzani M, Hammady H, Fedo owicz Z, Elmaga mid A. Rayyan—a web
and mobile app o sys ema ic e iews. Sys Re 2016;5:1–10.
[30] Se ano-Ib ´an
˜ez ER, Es e e R, Ram´
ı ez-Maes e C, Ruiz-P ´a aga GT,
L´opez-Ma ´
ınez AE. Ch onic pain in he ime o COVID-19: s ess
a e ma h and cen al sensi iza ion. B J Heal h Psychol 2020. doi:
10.1111/bjhp.12483 [Epub ahead o p in ].
[31] Shah S, Diwan S, Soin A, Rajpu K, Mahajan A, Manchikan i L, Kaye AD,
Hi sch JA, Gha ibo C. E idence-based isk mi iga ion and s a i ica ion
du ing COVID-19 o e u n o in e en ional pain p ac ice: Ame ican
socie y o in e en ional pain physicians (ASIPP) guidelines. Pain
Physician 2020;23:S161–s182.
[32] Sociedad Espan
˜ola de Reuma olog´
ıa. Documen o de posicionamien o
de la Sociedad Espan
˜ola de Reuma olog´
ıa sob e el uncionamien oy
es ablecimien o de la ac i idad de los se icios de euma olog´
ıa an e la
COVID-19, 2020. A ailable a : h ps://www.se .es/wp-con en /uploads/
2020/05/POSICIONAMIENTO-COVID19.pd Accessed Decembe 16,
2020.
[33] Sociedad Espan
˜ola del Dolo . Resul ado encues a pacien es dolo
c ´onico Co id-19, 2020. A ailable a : h ps://www.sedolo .es/download/
esul ado-encues a-pacien es-dolo -c onico-co id-19/.Accessed
Decembe 16, 2020.
[34] Vidal-Alaball J, Acos a-Roja R, Pas o He n ´andez N, Sanchez Luque U,
Mo ison D, Na ejos P ´e ez S, Pe ez-Llano J, Sal ado V `e ges A, L ´opez
Segu´
ı F. Telemedicine in he ace o he COVID-19 pandemic. A en
P ima ia 2020;52:418–22.
6M.T. Ca illo-de-la-Pen
˜a e al.·6 (2021) e899 PAIN Repo s
®
