COVID-19 and impact on people living with persistent pain and distress

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

5C.5

Presenter:

Noureen Shivji

Twitter:

@noureenkaramali

Co-authors:

Hollie Birkinshaw, Adam Geraghty, Helen Johnson, Tamar Pincus, Paul Little, Michael Moore, Beth Stuart, Carolyn A. Chew-Graham

Author institutions:

School of Medicine Keele University, Department of Psychology, Royal Holloway, University of London, Faculty of Medicine, University of Southampton, Midlands Partnership NHS Foundation Trust , NIHR Applied Research Collaboration (ARC) West Midlands

Problem

Musculoskeletal pain impacts on people’s quality of life, and is a common problem brought by patients to primary care consultations. Low mood and distress are commonly reported by people who have persistent musculoskeletal pain and may be labelled as ‘depression’. Social restrictions, including the ‘lockdown’ and ‘stay-at-home’ guidance associated with the COVID-19 pandemic impacted on daily routines of people, and may have increased loneliness and social isolation. Social isolation increases the risk of depression, particularly in people living with persistent pain, as it is suggested that these people find it difficult to maintain their social relationships and activities, even in normal circumstances. We therefore, explored the impact of COVID-19 restrictions on the lives of people with persistent pain, their interactions with the health service and perspectives of GPs caring for this group of patients. This work is nested within a programme exploring how pain-related distress is conceptualised and managed by people with pain and general practitioners (GPs) in primary care consultations.

Approach

Qualitative methods with semi-structured interviews conducted via telephone or using virtual software (‘’Microsoft Teams’’), explored how people with pain and GPs perceive pain-related distress, whether this is different from ‘depression’ and how have these been affected by COVID-19 restrictions. Multiple methods of recruitment were utilised, interviews were digitally recorded, transcribed with consent, and analysed thematically using constant comparison techniques. A patient advisory group and a GP stakeholder group contributed to the study design and data analysis.

Findings

Perspectives on how COVID-19 had impacted on people living with persistent pain varied. People who had experienced helplessness and despair when living with persistent pain, pre-pandemic described how these feelings had been amplified during COVID-19 restrictions, particularly feelings of low mood and social isolation. Other people described that the restrictions had allowed them to pace themselves, and restrict activity, resulting reduction in pain and distress. GPs described the impact of remote consulting on consultations with this group of patients, highlighting the importance of continuity of care and establishing a patient-doctor relationship, particularly for those with complex needs. They specifically valued these aspects within a GP consultation, in promoting personalised and holistic care and suggested that remote consulting might be easier and more effective with this group of patients, once the relationship is already established.

Consequences

Findings related to the impact of COVID-19 restrictions on the lives of people with persistent pain imply that those people with a previous history of low mood and depression may require more help than they did before the pandemic to manage pain-related distress. There is a need to pay attention to the quality and accessibility of remote consulting within primary care keeping in mind the importance of relationship and continuity of care in those with long-term conditions.

Submitted by:

Noureen Shivji

Funding acknowledgement:

The De-STRESS pain study is funded by Versus Arthritis