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Sellinger JJ, Gilstad-Hayden K, Lazar C, Seal K, Purcell N, Burgess DJ, Martino S, Heapy A, Higgins D, Rosen MI. Impact of the COVID-19 pandemic on participants in pragmatic clinical trials for chronic pain: implications for trial outcomes and beyond. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:S17-S27. [PMID: 39514885 PMCID: PMC11548862 DOI: 10.1093/pm/pnae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVE The COVID-19 pandemic had profound effects on society, including those living with chronic pain. This study sought to examine pandemic impacts on individuals enrolled in pragmatic clinical trials focused on nonpharmacological treatments for chronic pain. METHODS We evaluated responses to a questionnaire on COVID-19 impacts that had been administered to participants (n=2024) during study enrollment in 3 pragmatic clinical trials for chronic pain treatment. All trials were part of the National Institutes of Health (NIH)-Department of Veterans Affairs (VA)-Department of Defense (DOD) Pain Management Collaboratory. COVID-19-related impacts on access to health care, mental health, finances, ability to meet basic needs, and social support were assessed. RESULTS Pandemic impacts were found in all domains assessed, including access to health care, mental and emotional health, ability to meet basic needs, finances, and social support. Impacts varied by demographic and clinical characteristics. The participants most negatively impacted by the pandemic were younger, Black or Latino, female, more educated, and unemployed and had screened positive for depression. No impact differences were found with regard to alcohol use disorder screenings or a prior history of COVID-19. Higher levels of pain were associated with worse pandemic impacts, and negative impacts declined over time. CONCLUSIONS Negative impacts of the pandemic on individuals living with chronic pain cut across aspects of life that are also central to effective pain management, including access to health care, social support, and mental and emotional health, with differential impacts found across key demographic and clinical factors. These findings should yield consideration of pandemic impacts in clinical practice and as moderating effects of treatment outcomes in clinical trials conducted during the pandemic.
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Affiliation(s)
- John J Sellinger
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Kathryn Gilstad-Hayden
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Christina Lazar
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Karen Seal
- San Francisco VA Healthcare System, Integrative Health Service San Francisco, San Francisco, CA 94121, United States
- University of California, San Francisco, San Francisco, CA 94158, United States
| | - Natalie Purcell
- San Francisco VA Healthcare System, Integrative Health Service San Francisco, San Francisco, CA 94121, United States
- University of California, San Francisco, San Francisco, CA 94158, United States
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States
- University of Minnesota Medical School, Minneapolis, MN 55455, United States
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Alicia Heapy
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
| | - Diana Higgins
- Durham VA Healthcare System, Durham, NC 27705, United States
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, United States
| | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven, CT 06516, United States
- Yale University School of Medicine, New Haven, CT 06504, United States
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Fatoye F, Fatoye C, Lawoe J, Mbada C, Gebrye T. Does COVID-19 Related Lockdown Restrictions Impact People With Musculoskeletal Disorders? A Systematic Review. Musculoskeletal Care 2024; 22:e1920. [PMID: 39126136 DOI: 10.1002/msc.1920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/04/2024] [Accepted: 07/14/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND As a result of coronavirus disease 2019 (COVID-19) related lockdown restrictions, people with musculoskeletal (MSK) disorders could be at increased risk of physical and psychological disabilities. This review aimed to summarise the impact of COVID-19 related lockdown restrictions on people with MSK disorders. METHODS Six electronic databases were searched for studies in the English language published until June 10, 2024. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify, select, and critically appraise relevant research. Two reviewers independently abstracted data from the included studies. Data were summarised using narrative synthesis, and the Newcastle-Ottawa Scale was used for quality assessment. RESULTS The search strategy identified 637 articles, 129 of which were removed as duplicates. Fifteen studies that met the inclusion criteria were analysed. The sample size the studies reviewed ranged from 40 to 1800. Having MSK disorders during COVID-19 related lockdown restrictions led to increased risk of pain, stress, depression, anxiety, MSK related injuries, decreased quality of life and increased use of emergency department. CONCLUSIONS This is the first study to report that COVID-19 related lockdown restrictions led to increased risk of pain, MSK injuries and healthcare resource utilisation as well as decreased quality of life among patients with MSK disorders. These results may help inform policy and management strategies in future for people with MSK disorders to mitigate the negative impact of pandemic.
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Affiliation(s)
- Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
- Lifestyle Diseases, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Clara Fatoye
- Department of Health and Social Care, University Campus Oldham, Manchester, UK
| | - Joyceline Lawoe
- Department of Visual and Industrial Art, Sunyani Technical University, Sunyani, Ghana
| | - Chidozie Mbada
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Tadesse Gebrye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Angarita-Fonseca A, Roy M, Lacasse A, Léonard G, Rainville P, Marin MF, Tufa I, Gentile EL, Pagé MG. Trajectories of pain and depressive symptoms among people living with low back pain during the COVID-19 pandemic: a 24-month longitudinal study. Pain Rep 2024; 9:e1165. [PMID: 38835744 PMCID: PMC11146579 DOI: 10.1097/pr9.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction: We explored trajectories of pain intensity and depressive symptoms over the first 24 months of the pandemic in people with low back pain. Methods: This longitudinal study was conducted alongside the Quebec Low Back Pain Study. Starting in April 2020 and every 3 months until July 2022, 291 participants completed an online survey. Group-based trajectory modeling was used to identify patterns of pain intensity and depressive symptoms. Onset outbreak characteristics were then put in relation with trajectory groups using multivariate logistic regression. Results: The analysis revealed 5 trajectories of pain intensity and depressive symptoms, respectively. The pain trajectories were stable mild (n = 17, 5.8%); stable moderate (n = 103, 35.4%); stable severe (n = 81, 27.8%); U-shape (n = 24, 8.3%), and inverted U-shape (n = 66, 22.7%). The trajectories of depressive symptoms were stable none (n = 58, 19.9%); stable very mild (n = 61, 21.0%); stable mild (n = 85, 29.2%); stable moderate (n = 59, 21.7%); and severe slightly improving (n = 24, 8.3%). Pre-COVID everyday/nearly everyday pain, average pain intensity, and widespread bodily pain were predictive of pain trajectory groups. Higher pre-COVID depression, acute stress disorder, and lockdown measures-related stress were associated with moderate/severe depressive trajectories. Discussion: Our findings indicated relative stability of pain and depressive symptoms among participants during the COVID-19 pandemic but also highlighted subgroups of people who experienced temporary deterioration or improvement over the first months of the pandemic that then reverted back to baseline levels. Modifiable risk factors were identified before the onset of the pandemic, which could give preventive measures in targeted populations.
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Affiliation(s)
- Adriana Angarita-Fonseca
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
- Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Guillaume Léonard
- Research Center on Aging, CIUSSS de l'Estrie-CHUS; School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pierre Rainville
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, QC, Canada
| | - Marie-France Marin
- Department of Psychology, Université de Québec à Montréal, Montreal, QC, Canada
| | - Iulia Tufa
- McGill University Health Center, Montreal, QC, Canada
- Quebec Pain Research Network, QC, Canada
| | - Erika L Gentile
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - M Gabrielle Pagé
- Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
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Krahé C, Brown C, Twiddy H, Frank B, Brian E, Nurmikko T, Stancak A, Fallon N. Effects of Lockdown Restrictions and Impact of Anxiety and Depression Symptoms in People With Chronic Pain During the Covid-19 Pandemic: A 13-Wave Longitudinal Study. THE JOURNAL OF PAIN 2024; 25:104437. [PMID: 38029948 DOI: 10.1016/j.jpain.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
In early 2020, countries across the world imposed lockdown restrictions to curb the spread of the Covid-19 coronavirus. Lockdown conditions, including social and physical distancing measures and recommended self-isolation for clinically vulnerable groups, were proposed to disproportionately affect those living with chronic pain, who already report reduced access to social support and increased isolation. Yet, empirical evidence from longitudinal studies tracking the effects of prolonged and fluctuating lockdown conditions, and potential psychological factors mediating the effects of such restrictions on outcomes in chronic pain populations, is lacking. Accordingly, in the present 13-wave longitudinal study, we surveyed pain intensity, pain interference, and tiredness in people with chronic pain over the course of 11 months of the Covid-19 pandemic (April 2020-March 2021). Of N = 431 participants at baseline, average completion rate was ∼50% of time points, and all available data points were included in linear mixed models. We examined the impact of varying levels of lockdown restrictions on these outcomes and investigated whether psychological distress levels mediated effects. We found that a full national lockdown was related to greater pain intensity, and these effects were partially mediated by depressive symptoms. No effects of lockdown level were found for pain interference and tiredness, which were instead predicted by higher levels of depression, anxiety, pain catastrophising, and reduced exercise. Our findings are relevant for improving patient care in current and future crises. Offering remote management options for low mood could be particularly beneficial for this vulnerable population in the event of future implementation of lockdown restrictions. PERSPECTIVE: This longitudinal study demonstrates the impact of Covid-19 lockdown restrictions on people with chronic pain. Findings suggest a complex interaction of psychosocial factors that impacted various aspects of pain experience in patients, which offer the potential to inform clinical strategies for remote medicine and future crises.
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Affiliation(s)
- Charlotte Krahé
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Christopher Brown
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Hannah Twiddy
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Bernhard Frank
- Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Eleanor Brian
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Turo Nurmikko
- Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrej Stancak
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
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Vowles KE, Knaggs RD, Palomares AC. Pandemic impact and adaptation to telehealth in chronic pain treatment providers across two COVID-19 pandemic years. Pain Pract 2024; 24:303-307. [PMID: 37877647 DOI: 10.1111/papr.13309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has had substantial impacts for both people using pain services and healthcare professionals delivering them. While the effects on service users have been studied, less is known about the effects for service providers. This study aimed to assess the impact of the pandemic on providers and the evolving role of telemedicine in treatment. DESIGN & METHODS An electronic survey was distributed to the professional membership of the European Pain Federation (EFIC). The survey evaluated impact and adjustment to the COVID-19 pandemic separately across two pandemic years (March 2020-February 2021 and March 2021 to February 2022) and assessed worry about COVID-19, disruption and adjustment of pain services, and use of telehealth services. The change between the first and second pandemic years and the degree to which telehealth services were adopted was evaluated. RESULTS From 149 respondents, 131 (88%) participants provided sufficient data to be included in the analysis. Both providers worry about the pandemic and service disruption decreased significantly from the first to the second year of the pandemic. Prior to the pandemic, only 30% of providers offered telehealth appointments but this increased to 64% and 83%, respectively, in the first and second years of the pandemic. CONCLUSIONS Although provider worry and disruption to delivery of pain services decreased during the second year of COVID-19 pandemic, waiting times for appointments continued to lengthen. The pandemic has hastened the adoption of telemedicine in pain services and plans to continue telehealth services seem common.
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Affiliation(s)
- Kevin E Vowles
- School of Psychology, Queen's University Belfast & Belfast Centre for Pain Rehabilitation, Belfast Health and Social Care NHS Trust, Belfast, UK
| | - Roger D Knaggs
- School of Pharmacy, University of Nottingham, and Primary Integrated Community Services, Nottingham, UK
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Kapos FP, Vandeleur DM, Tham SW, Palermo TM, Groenewald CB. Comparing the prevalence of chronic pain in school-aged children in the United States from 2019 to 2020: a nationally representative study examining differences associated with the COVID-19 pandemic. Pain 2024; 165:233-242. [PMID: 37556380 PMCID: PMC10841312 DOI: 10.1097/j.pain.0000000000003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/15/2023] [Indexed: 08/11/2023]
Abstract
ABSTRACT The coronavirus disease 19 (COVID-19) pandemic negatively affected children's health in the United States (US), with more severe disruption for marginalized groups. However, potential impact on pediatric chronic pain has not been assessed at the population level. This study aimed to (1) estimate differences in the US national prevalence of pediatric chronic pain during the first year of the COVID-19 pandemic (2020), relative to one year earlier (2019); (2) determine whether differences in prevalence varied across sociodemographic groups; and (3) explore changes in child, caregiver, and family factors associated with chronic pain prevalence. Using data of children 6 to 17 years from the National Survey of Children's Health 2019 and 2020 (n = 50,518), we compared weighted percentages of sample characteristics by year and conducted a series of directed-acyclic graph-informed survey-weighted Poisson regressions. The estimated national prevalence (95% CI) of pediatric chronic pain was 10.8% (9.9, 11.9%) in 2019, decreasing to 7.6% (6.9, 8.3%) in 2020. Contrary to hypotheses, the adjusted prevalence of chronic pain was 31% lower in 2020 than in 2019 (aPR = 0.69, 95% CI: 0.61, 0.79), adjusting for child age, sex, race or ethnicity, caregiver education, neighborhood park or playground, and census region. The 2019 to 2020 change in chronic pain prevalence was similar by age ( P = 0.34), sex ( P = 0.94), race or ethnicity ( P = 0.41), caregiver education ( P = 0.49), neighborhood park or playground ( P = 0.22), and census region ( P = 0.20). Exploratory analyses identified 3 potential contributors to the unexpected decrease in the national prevalence of pediatric chronic pain: lower prevalence of bullying, more frequent family meals, and higher family resilience.
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Affiliation(s)
- Flavia P. Kapos
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
| | - Daron M. Vandeleur
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - See Wan Tham
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Tonya M. Palermo
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Cornelius B. Groenewald
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
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Zgierska AE, Burzinski CA, Garland EL, Barrett B, Lennon RP, Brown RL, Schiefelbein AR, Nakamura Y, Stahlman B, Jamison RN, Edwards RR. Experiences of adults with opioid-treated chronic low back pain during the COVID-19 pandemic: A cross-sectional survey study. Medicine (Baltimore) 2023; 102:e34885. [PMID: 37832078 PMCID: PMC10578753 DOI: 10.1097/md.0000000000034885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/02/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to evaluate the impact of the COVID-19 pandemic on adults with opioid-treated chronic low back pain (CLBP), an understudied area. Participants in a "parent" clinical trial of non-pharmacologic treatments for CLBP were invited to complete a one-time survey on the perceived pandemic impact across several CLBP- and opioid therapy-related domains. Participant clinical and other characteristics were derived from the parent study's data. Descriptive statistics and latent class analysis analyzed quantitative data; qualitative thematic analysis was applied to qualitative data. The survey was completed by 480 respondents from June 2020 to August 2021. The majority reported a negative pandemic impact on their life (84.8%), with worsened enjoyment of life (74.6%), mental health (74.4%), pain (53.8%), pain-coping skills (49.7%), and finances (45.3%). One-fifth (19.4%) of respondents noted increased use of prescribed opioids; at the same time, decreased access to medication and overall healthcare was reported by 11.3% and 61.6% of respondents, respectively. Latent class analysis of the COVID-19 survey responses revealed 2 patterns of pandemic-related impact; those with worse pandemic-associated harms (n = 106) had an overall worse health profile compared to those with a lesser pandemic impact. The pandemic substantially affected all domains of relevant health-related outcomes as well as healthcare access, general wellbeing, and financial stability among adults with opioid-treated CLBP. A more nuanced evaluation revealed a heterogeneity of experiences, underscoring the need for both increased overall support for this population and for an individualized approach to mitigate harms induced by pandemic or similar crises.
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Affiliation(s)
- Aleksandra E. Zgierska
- Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Cindy A. Burzinski
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI
| | - Eric L. Garland
- University of Utah, College of Social Work, Salt Lake City, UT
| | - Bruce Barrett
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI
| | - Robert P. Lennon
- Department of Family and Community Medicine, and Law School, Pennsylvania State University College of Medicine, Hershey, PA
| | - Roger L. Brown
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | | | - Yoshio Nakamura
- Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, University of Utah School of Medicine, Salt Lake City, UT
| | - Barbara Stahlman
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Robert N. Jamison
- Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA
| | - Robert R. Edwards
- Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA
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Ziadni MS, Jaros S, Anderson SR, You DS, Darnall BD, Mackey SC. A Longitudinal Investigation of the Impact of COVID-19 on Patients With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:1830-1842. [PMID: 37225065 PMCID: PMC10201913 DOI: 10.1016/j.jpain.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
The COVID-19 pandemic prompted unexpected changes in the healthcare system. This current longitudinal study had 2 aims: 1) describe the trajectory of pandemic-associated stressors and patient-reported health outcomes among patients receiving treatment at a tertiary pain clinic over 2 years (May 2020 to June 2022); and 2) identify vulnerable subgroups. We assessed changes in pandemic-associated stressors and patient-reported health outcome measures. The study sample included 1270 adult patients who were predominantly female (74.6%), White (66.2%), non-Hispanic (80.6%), married (66.1%), not on disability (71.2%), college-educated (59.45%), and not currently working (57.9%). We conducted linear mixed effect modeling to examine the main effect of time with controlling for a random intercept. Findings revealed a significant main effect of time for all pandemic-associated stressors except financial impact. Over time, patients reported increased proximity to COVID-19, but decreased pandemic-associated stressors. A significant improvement was also observed in pain intensity, pain catastrophizing, and PROMIS-pain interference, sleep, anxiety, anger, and depression scores. Demographic-based subgroup analyses for pandemic-associated stressors revealed that younger adults, Hispanics, Asians, and patients receiving disability compensation were vulnerable groups either during the initial visit or follow-up visits. We observed additional differential pandemic effects between groups based on participant sex, education level, and working status. In conclusion, despite unanticipated changes in pain care services during the pandemic, patients receiving pain treatments adjusted to pandemic-related stressors and improved their health status over time. As the current study observed differential pandemic impacts on patient subgroups, future studies should investigate and address the unmet needs of vulnerable subgroups. PERSPECTIVE: Over a 2-year timeframe, the pandemic did not adversely influence physical and mental health among treatment-seeking patients with chronic pain. Patients reported small but significant improvements across indices of physical and psychosocial health. Differential impacts emerged among groups based on ethnicity, age, disability status, gender, education level, and working status.
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Affiliation(s)
- Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Sam Jaros
- Department of Epidemiology, Stanford University School of Medicine, Palo Alto, California
| | - Steven R Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California
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9
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Vargas-Schaffer G. Pharmacological Proposal Approach to Managing Chronic Pain Associated with COVID-19. Biomedicines 2023; 11:1812. [PMID: 37509450 PMCID: PMC10376228 DOI: 10.3390/biomedicines11071812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Post-COVID syndrome is widespread and chronic pain associated with this syndrome is increasingly being seen in pain clinics. Understanding and managing Chronic Post-COVID Pain (CPCoP) is essential in improving the quality of life of patients. Relevant sections: Identify the types of pain associated with post-COVID syndrome and look for ways to treat them. RESULTS AND DISCUSSION Based on our experience, we have identified five groups within CPCoP: (1) chronic pain post-hospitalization in intensive care or long hospitalizations, (2) pain associated with rehabilitation, (3) exacerbation of existing chronic pain pre-COVID-19 infection, (4) central and peripheral neuropathic pain post-COVID-19 infection, (5) chronic pain post vaccination. To fight against misinformation, we created an information capsule for doctors, nurses, and other health workers at a conference via the ECHO* program, delivered 2-3 times a year. CONCLUSIONS In pandemic and post-pandemic periods, it is important to determine the sequelae that a disease can leave in the general population, and to understand and treat them. The model proposed may serve as an inspiration to other pain centers to treat the increasing number of patients with CPCoP.
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Affiliation(s)
- Grisell Vargas-Schaffer
- Pain Center, Centre Hospitalier de l'Universitaire de l'Université de Montréal (CHUM), Montréal, QC H2X 3E4, Canada
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Booker SQ, Sowicz TJ, Knisely MR, Saravanan A, Bai J, St Marie B. Original Research: The Impact of COVID-19 on Pain Care Among Older Adults. Am J Nurs 2023; 123:26-36. [PMID: 37166166 DOI: 10.1097/01.naj.0000937180.48669.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE In this qualitative descriptive study, we sought to understand the professional experiences and perceptions of pain management nurses who cared for older adults in the United States during the height of the COVID-19 pandemic. METHODS Data were collected between July 2020 and July 2021 through individual, semistructured interviews with a nonprobability sample of 18 pain management nurses. An inductive content analysis approach, in which categories were derived from a coding process based on a close reading of data extracts from the interview transcripts, was used to reveal the major theme related to the study aim. RESULTS Notwithstanding the variable consequences of COVID-19 on patients' health, a single overarching theme was pronounced: "Pain management for older adults remained unchanged during the pandemic despite unpredictable survival, restrictions on human interactions, and communication challenges." This theme was supported by four categories that emerged from the data: unpredictable survival, restriction-induced isolation, perceived continuity and equality of pain management, and communication challenges. CONCLUSIONS During the COVID-19 pandemic, pain management nurses stepped in and joined interdisciplinary teams providing general and specialized pain care to ensure that older adults, whether inpatient or outpatient, continued to receive quality care. These study findings highlight the many challenges pain management nurses faced during this unprecedented public health crisis, as well as opportunities to improve the health system and enhance nursing practice to meet the needs of older patients.
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Affiliation(s)
- Staja Q Booker
- Staja Q. Booker is an assistant professor at the University of Florida College of Nursing in Gainesville. Timothy Joseph Sowicz is an assistant professor at the University of Arizona College of Nursing in Tucson. Mitchell R. Knisely is an associate professor at the Duke University School of Nursing in Durham, NC. Anitha Saravanan is an assistant professor at Northern Illinois University School of Nursing and Health Studies in DeKalb. Jinbing Bai is an assistant professor at the Emory University Nell Hodgson Woodruff School of Nursing in Atlanta. Barbara St. Marie is an associate professor at the University of Iowa College of Nursing in Iowa City. Contact author: Staja Q. Booker, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Chronic pain experience through COVID-19: a comparison of reports prior and during the early stages of the pandemic. Pain 2023; 164:435-442. [PMID: 36095051 DOI: 10.1097/j.pain.0000000000002724] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/29/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT The impacts of COVID-19 and imposed restrictions on individuals with chronic noncancer pain continue to emerge, varying across countries. More recent research (including with longitudinal designs) suggests that the pandemic may not have such a disproportionate effect on chronic noncancer pain and its management as first thought. This longitudinal study, with assessments before the pandemic (2019) and early during the pandemic (May-July 2020), examined changes in validated measures of pain severity, pain interference, prescription opioid misuse, and mental health symptoms. Patients (N = 236) self-reported significant improvements in pain severity, pain interference, pain self-efficacy, pain catastrophizing, prescription opioid misuse, depression, and anxiety symptoms over time. Approximately 30% and 33% of patients achieved minimally important reductions (10% change) in pain severity and pain interference, respectively. In follow-up exploratory analyses, prepandemic sociodemographic and psychological factors predictive of 10% improved (vs 10% worse) pain severity and interference were investigated in logistic regressions. Reduction in pain interference was predicted by current employment, older age, and higher pain self-efficacy. There were no significant predictors of reduction in pain severity. The impact of COVID-19 on patients' pain experience and mental health was negligible in the early stages of the pandemic, and findings suggest improvements through the period. Targeted interventions that promote the protective factor of pain self-efficacy and build resilience may buffer patients' future response to the pandemic because it evolves as a part of our new normal. Targeted social determinants of health interventions that direct resources toward maintaining employment could also be important.
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Tulinský L, Sengul I, Ihnát P, Mitták M, Toman D, Pelikán A, Martínek L, Sengul D. Impact of the coronavirus disease 2019 pandemic on the management of acute peptic ulcer perforation: to be reconsidered(?). REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:175-180. [PMID: 36629661 PMCID: PMC9937615 DOI: 10.1590/1806-9282.20221243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.
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Affiliation(s)
- Lubomír Tulinský
- Ostravská Univerzita, Department of General Surgery – Ostrava, Czech Republic.,Ostravská Univerzita, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Ilker Sengul
- Giresun University, Faculty of Medicine, Division of Endocrine Surgery – Giresun, Turkey.,Giresun University, Faculty of Medicine, Department of Surgery – Giresun, Turkey
| | - Peter Ihnát
- Ostravská Univerzita, Department of General Surgery – Ostrava, Czech Republic.,Ostravská Univerzita, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Marcel Mitták
- Ostravská Univerzita, Department of General Surgery – Ostrava, Czech Republic.,Ostravská Univerzita, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Daniel Toman
- Ostravská Univerzita, Department of General Surgery – Ostrava, Czech Republic.,Ostravská Univerzita, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Anton Pelikán
- Ostravská Univerzita, Department of General Surgery – Ostrava, Czech Republic.,Ostravská Univerzita, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic.,Univerzita Tomáše Bati ve Zlíně, Faculty of Humanities – Zlín, Czech Republic
| | - Lubomír Martínek
- Ostravská Univerzita, Department of General Surgery – Ostrava, Czech Republic.,Ostravská Univerzita, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Demet Sengul
- Giresun University, Faculty of Medicine, Department of Pathology – Giresun, Turkey.,Corresponding author:
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Offiah R, Aboulatta L, Peymani P, Aloud B, Kowalec K, Leong C, Delaney J, Falk J, Alessi-Severini S, Eltonsy S. Sex differences among users of NSAIDs and opioids during COVID-19 Pandemic. Int J Clin Pharm 2023; 45:233-239. [PMID: 36253662 PMCID: PMC9575648 DOI: 10.1007/s11096-022-01463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sex-based inequalities in healthcare have been exposed and amplified during the COVID-19 pandemic. However, few studies have reported sex differences in medication utilization and no studies have examined sex differences in prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and opioids utilization. AIM To compare the utilization patterns of prescribed NSAIDs and opioids between males and females in Manitoba, Canada during the COVID-19 pandemic. METHOD A cohort of incident and prevalent users of prescribed NSAIDs and opioids was created. Interrupted times series analysis using autoregressive models were used to evaluate the quarterly change in the prevalent and incident users before and after COVID-19 restrictions were applied (first quarter of 2020). RESULTS COVID-19 restrictions were associated with a significant decrease in the utilization of prescribed NSAIDs and opioids in all users, followed by a revert to the pre-pandemic trends. Among female prevalent and incident NSAIDs users, there was a significant change in trend after COVID-19 restrictions were introduced (β3 = 0.087 and 0.078, P = 0.023 and 0.028, respectively). However, there was non-significant change in trend among male prevalent and incident NSAIDs and opioids users during the pandemic. CONCLUSION In this study, a significant sharp decline in the use of prescribed NSAIDs and opioids was shown in both sexes at the onset of the pandemic. However, a significant upward trend is observed in female NSAIDs users as restrictions began to be lifted.
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Affiliation(s)
| | - Laila Aboulatta
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Payam Peymani
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Basma Aloud
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Kaarina Kowalec
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christine Leong
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
- Department of Psychiatry, Rady Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Joseph Delaney
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Jamie Falk
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Silvia Alessi-Severini
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Sherif Eltonsy
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
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Wan Tham S, Murray CB, Law EF, Slack KE, Palermo TM. The impact of the COVID-19 pandemic on pain and psychological functioning in young adults with chronic pain. Pain 2022; 163:e1095-e1101. [PMID: 35413028 PMCID: PMC9470785 DOI: 10.1097/j.pain.0000000000002618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Data are equivocal on the consequences of COVID-19 pandemic on pain and well-being for individuals with chronic pain. Furthermore, little is known regarding its impact on the health of young adults with chronic pain. We conducted a longitudinal study to compare pain, psychological functioning, and substance use before and during the pandemic of 196 young adults with chronic pain. Participants aged 18 to 24 years (M = 21.1 years; 79.6% females) reported on pain, anxiety, depression, and substance use before (October 2018-August 2019) and during the pandemic (October 2020-November 2020), in addition to the assessment of COVID-19 exposure and its impact. Before the pandemic, young adults experienced mild-to-moderate pain intensity (M = 3.75, SD = 2.33) and pain interference (M = 3.44, SD = 2.69). Findings were that pain intensity, pain interference, and depression symptoms remained stable during the pandemic. In contrast, anxiety symptoms increased significantly (M = 8.21, SD = 5.84 vs M = 8.89, SD = 5.95, P = 0.04). Tobacco, alcohol, and cannabis use were unchanged. Mixed linear models revealed that COVID-19 exposure and impact were not associated with changes in pain intensity or interference, with female sex associated with increased pain intensity (β = 0.86, P = 0.02) and pain interference (β = 0.87, P = 0.02). Our findings indicated relative stability of pain symptoms experienced by young adults with chronic pain. However, the increases in anxiety highlight the need to facilitate treatment access for mental health services to mitigate downstream impact.
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Affiliation(s)
- See Wan Tham
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, United States
| | - Caitlin B. Murray
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, United States
| | - Emily F. Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, United States
| | - Katherine E. Slack
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, United States
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States
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Krause-Parello CA, Flynn L, Hibler DA, Presciutti RE, Pratt BA, Walsh P, Garvin JT, Morse CY, Carter L, Moreno SJ. Social and Chronic Pain: Veterans Sharing a Path in Developing a Patient-Centered Response to the COVID-19 Pandemic. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i1.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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The Impact of the COVID-19 Pandemic on Youth with Chronic Pain and Their Parents: A Longitudinal Examination of Who Are Most at Risk. CHILDREN 2022; 9:children9050745. [PMID: 35626922 PMCID: PMC9139609 DOI: 10.3390/children9050745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/02/2022]
Abstract
Objectives: Chronic pain and mental illness in youth and parents are poised to reach new heights amidst the societal and healthcare impacts of the COVID-19 pandemic. Evidence from natural disasters (i.e., hurricanes) suggests that a degree of personal impact and individual personality may moderate the effects of high stress events, such as the COVID-19 pandemic, on mental health. Methods: In a pre-existing cohort of 84 youth with chronic pain (Mage = 14.39; 12–18 years; 67.8% female) and 90 parents (86.7% female), we examined changes in youth pain interference and youth and parent mental health (depression, anxiety) from before to during the first wave of the COVID-19 pandemic, and the influence of personal impact of the pandemic (i.e., financial, familial, health, social, occupational, and educational domains) and individual personality (neuroticism, conscientiousness, extroversion). Results: Overall, youth reported significantly lower pain interference and anxiety as compared to pre-pandemic; however, those more personally impacted by the pandemic reported worsening pain interference and anxiety symptoms. Overall, parents reported greater depressive symptoms as compared to pre-pandemic; however, those more personally impacted by the pandemic reported increased anxiety symptoms. Personality traits (high neuroticism, and low conscientiousness and extroversion) predicted worsened pain and mental health, and exacerbated effects of COVID-19-related personal impact on youth and parent anxiety symptoms. Discussion: Identifying risk and resilience profiles in youth and parents at high risk for worsening pain and mental health may better inform matching interventions to individual need.
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Quinlan-Colwell A, Schreier A. Pain Management during the COVID-19 Pandemic. Pain Manag Nurs 2022; 23:1-2. [PMID: 35093236 PMCID: PMC8790054 DOI: 10.1016/j.pmn.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
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