COVID-19 and Chronic Pain: Challenges and Opportunities

The COVID-19 pandemic continues to impact the world with deaths in the hundreds of thousands and countless more having become ill. To reduce the risk of contagion and death, areas around the world maintain self-quarantining practices and have been doing so now for multiple months.

Sheltering-in-place, or self- quarantining, presents both challenges and opportunities for everyone, including those with persistent, or chronic, pain.

Challenges

While the COVID-19 pandemic presents multiple challenges to everyone, one of the most important of these challenges to those with chronic pain are the potential for vulnerabilities to developing serious complications if becoming ill with COVID-19. The coronavirus, which is the virus that causes COVID-19, leads to a wide range of symptoms for those who become infected. Some people don’t have any symptoms at all. Still others have mild to moderate degrees of symptoms. Still others have critical, life-threatening symptoms. These latter people with COVID-19 tend to become hospitalized and may even die.

The Centers for Disease Control (CDC) keep statistics on cases of COVID-19 worldwide and initially found that those who are most prone to developing critical, life-threatening forms of the illness are the elderly and those with certain pre-existing health conditions (April 3, 2020). Health conditions that are present at the time when another, unrelated health condition develops are called comorbid conditions. These conditions are high blood pressure (otherwise known as hypertension), high cholesterol (otherwise known as hyperlipidemia), diabetes, and chronic respiratory conditions, such as chronic obstructive pulmonary disease (COPD) and asthma.

In the United States, the CDC later found that African-Americans also have a greater risk of developing serious, life-threatening illness from COVID-19 (April 14, 2020). Indeed, in some states the majority of those who have died from COVID-19 are African-Americans, even though this group of people only makes up a minority of the population. While the cause(s) for this discrepancy is unknown at present, speculation is that the above-mentioned comorbidities as well as social and economic causes of poor health are the most likely culprits (Yancy, 2020).

It’s noteworthy that chronic pain syndromes are not one of the comorbidities that make people prone to critical, life-threatening progressions of COVID-19. With that said, however, the comorbidities listed above can occur in those with persistent pain. As such, it is important to take the threat of COVID-19 infection seriously for anyone with persistent pain whose health is additionally compromised by conditions such as heart disease, diabetes, COPD or asthma.

To reduce your risk of infection, it is important to follow the common guidelines advocated widely by governmental and healthcare institutions. Most everyone knows of them by now, but they bear repetition.

• Stay home as much as possible.
• Engage in distancing at least six feet, or 2 meters, (or more) from others, particularly when in public.
• Wear a mask when out in public or at home if you’re ill.
• Wear a mask if you are taking care of someone who is ill with COVID-19.
• Wash your hands often and for at least 20 seconds with soapy water, or use a hand sanitizer that is made up of at least 60% alcohol.
• Cover your cough or sneeze with your arm or a tissue.
• Don’t touch your eyes or face.
• Wash and disinfect common surfaces.

The CDC has a good webpage with more information here on this topic.

Opportunities

It may also be an opportunity for all of us to do what we can to become as healthy as possible. It’s all too easy for anyone of us to focus on the dangers of the illness, the disruptions of sheltering-in-place, and the economic stresses that are occurring as well. With all these problems, it’s easy to seek comfort in comfort foods, sleeping in late and staying up late, binge-watching TV, web surfing aimlessly for hours, or drinking alcohol (or using other drugs) more than you should. It’s all understandable, of course, so we shouldn’t judge ourselves or others when engaging in these behaviors, but when we do them we end up becoming unhealthier at a time when we need to be as healthy as possible.

Most of us while sheltering-in-place tend to have extra time on our hands and we could use this time to start a healthy behavior that we’ve always known we probably should do, but have never really gotten around to doing. As such, we could spend our extra time on ways to foster our health and overall well-being.

Maybe we could work at cooking from scratch more often, looking up some recipes and spending more time in the kitchen. We may come to enjoy cooking when done for pleasure as a pastime. We would also subsequently eat less processed foods and likely more fruits and vegetables. In doing so, we might even lose a bit of weight. In all, we might develop an enjoyable past time that is safe to do because we are also at home, while also eating healthier and possibly even losing some weight.

We could also start a gentle exercise routine.* Initially, it could be something quite modest, without rigor. You could use the motto of 'anything is better than nothing’ and so perhaps it is just walking a circle or two in your house or down to your mailbox and back. With time, you could extend it to walks outside each day or every other day. You could use the same approach if you have access to a treadmill, stationary bike, or other similar equipment. Notice it is gentle, yet something more than just stretching. It’s something that gets your heart rate up. It's a gentle or mild aerobic exercise and it makes us healthier when done over time.

We could get outside more often (while maintaining social distance) and spend time in green spaces.* Many parks remain open. Our grandmothers used to tell us to ‘go outside’ when we were kids because they knew it was good for us and they were right. Being among rocks and trees, with birds and scurrying little critters, and breathing fresh air improves our well-being. This link is a nice article that reviews the science proving that our grandmothers were right all along.

We could also do a stress management technique for a few minutes each day, such as diaphragmatic breathing, progressive muscle relaxation, meditation, yoga, or tai chi. Any of these contemplative practices are ways to develop the skill sets of calming yourself down and focusing your attention. We don’t tend to think of the abilities to calm yourself down and stay focused on things as skills that can be learned, but they are. They are like learning to play a sport or a musical instrument – the more you practice, the better you get at them. Simlarly, a contemplative practice like those listed above take practice to get good at them. With practice, however, you won’t have to resign yourself to being stressed and scattered. Instead, you could get good at becoming calm and focused. These skills sets can positively affect our health and well-being.

Any of these healthy behaviors bring about a greater sense of well-being, but are also apt to reduce factors associated with many of the comorbid conditions listed above that are associated with severity of COVID-19. They help to reduce blood pressure, lower cholesterol, reduce inflammation, lose weight, and lower blood sugars. They may even improve the functioning of the immune system.

Conclusion

Living and staying safe in the time of COVID-19 with its resultant economic uncertainties presents many challenges. It’s normal to be scared in the presence of danger. Sheltering-in-place, or self-quarantining, can also lead to persistent boredom and aimlessness. In response, it is common to seek comfort that temporarily provides relief, but in the end is actually unhealthy.

Now is the time, when we need to be as healthy as we can to fight off potential infection, to take active steps to improve our health. It’s a time to reset our priorities and stop putting off doing those things that we always knew we should do, but haven’t gotten around to it. Now, more than ever, is the time to become as healthy as possible.

*Please always follow the advice of your healthcare providers when starting a gentle exercise routine or going outside. Their recommendations should always supercede the informational content of this site. You may have unique aspects to your health that cannot be represented accurately with general, educational information as found on this site. Please also see Terms and Conditions of Use.

References

Centers for Disease Control (CDC), (April 3, 2020). Retrieved on April 20, 2020, fromhttps://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html

Centers for Disease Control (CDC), (April 14, 2020). Retrieved on April 20, 2020, fromhttps://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/

Guan, W., Liang, W., Zhao, Y., et al. (2020). Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. European Respiratory Journal, 55(4), 2000547. doi: 10.1138/139930003.00547-2020

Yancy, C. W. (2020). COVID-19 and African-Americans. JAMA, published online. doi: 10.1001/jama.2020.6548

Date of publication: April 23, 2020

Date of last modification: April 23, 2020

About the author: Dr. Murray J. McAllister is the editor at the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported and to make that empirically-supported pain management more publicly acessible. To achieve these ends, the ICP provides scientifically accurate information on pain that is approachable to patients and their families.