The social threats of COVID for pain pateints

The social threats of COVID-19 for people with chronic pain – free full-text /PMC7382418/ – July 2020

The negative impact of social changes prompted by the COVID-19 crisis may disproportionately affect individuals living with long-term painful conditions.

Living with chronic pain can threaten an individuals’

• fundamental social needs for autonomy (agency or independence),
• belonging (social connection), and
• justice (fairness).

In turn, for some, experiencing heightened social threat can maintain and exacerbate chronic pain.  

In this review, we draw attention to the potential for social and systemic changes associated with attempts to contain the spread of COVID-19 to precipitate, maintain, and exacerbate pain by increasing the social threats faced by individuals with chronic pain.

We also suggest strategies for mitigating the social impact of COVID-19 on those living with chronic pain, for instance by learning from the resilience demonstrated by people in pain who have found ways to deal with social threat. Finally, we suggest several time-critical, high-impact research questions for further investigation.

Social threats posed by the COVID-19 pandemic

1.1 Social disconnection and loneliness

It is well known that spontaneous social interactions with others and participation in social roles can build and maintain

• a generalised sense of trust in others (social capital),
• promote feelings of wellbeing,
• provide protection from the harmful effects of stress,
• promote social connectedness, and
• reduce pain sensitivity.

Conversely, social isolation is associated with

• loneliness,
• higher levels of depression and anxiety,
• poorer health behaviours,
• poorer sleep,
• higher blood pressure,
• poorer immune function, and
• pain.

Indeed, disruption to social roles and relationships is one of the most distressing aspects of living with chronic pain.

People living with chronic pain, who may have entered the pandemic with fewer social resources than others, may be particularly vulnerable to feelings of loneliness and social disconnection at this time.

1.2 Risk of increased social proximity

The paradox of COVID-19 is that being physically isolated from one’s community can mean living in closer proximity to one’s household members.

People living with chronic pain conditions may benefit from more frequent contact with family members because closer proximity offers more opportunity to improve social bonds. However, enforced close-proximity living could also bring challenges to autonomy and independence.

There is also a risk that for people living with chronic pain, living in close proximity and enclosed environments could increase exposure to interpersonal conflict, which is known to amplify pain and disability.

1.3 Reduced access to high-quality pain management

Although pain management is a fundamental right,

Really?

Then again, they don’t specify whether you have a “fundamental right” to truly effective pain management or just the modalities that politicians and insurance companies are willing to embrace.

Pain management is no longer about people and their pain but has become a battlefield where those who need them for their pain struggle against anti-opioid zealots trying to restrict and even prevent our access to the medications our medical conditions require.

These days, you only have a “fundamental right” to receive whatever your doctor’s corporation (doctors are employees these days) has chosen to provide (usually ineffective alternative medicine treatments, highly dangerous epidural injections, non-opioid meds with horrible side effects), without any concern whether they are effective for you or not, and whether they’re backed by science or not.

…the health system responses to mitigate the impact of COVID-19 may significantly affect access for patients with complex medical conditions (eg, people with comorbid mental health conditions and addiction)

Furthermore, individual pain experiences may not be considered as immediately important when compared to the need to treat life-threatening symptoms associated with COVID-19, leading to less help-seeking and psychological distress.

Pain management during this pandemic for clinicians involves balancing access to care with minimising safety risk from exposure to COVID-19 for vulnerable patients and clinicians themselves

Although this may be deemed necessary in the context of the pandemic due to heightened needs from patients for pain relief, clinicians and patients may not agree on opioid prescription/deprescription.

This is because doctors and patients are motivated by different forces. Patients just want effective pain relief and opioids usually provide that. But doctors are just trying to save their careers/jobs.

They know that prescribing opioids brings them to the attention of the DEA. which has the power to take their license and even put them in jail with little provocation. (See DEA Raids Dr. Forest Tennant’s Pain Clinic)

Extreme events such as terrorist attacks and natural disasters are known to undermine the fundamental belief that the world is just, stable, orderly, and predictable, with ramifications for perceived life control, future prospects, and wellbeing.

If there was ever any doubt, those of us with chronic pain quickly learn that the world is NOT even close to “just, stable, orderly, and predictable” (it’s more like “nasty, brutish, and short”.) Such a childish belief is just wishful thinking that’s in no way justified by reality.

Once you’ve been forced to suffer constant pain because your doctors won’t prescribe opioids for effective relief, your world becomes unjust, unstable, disorderly, and not at all predictable. That is the reality we live in, not this naive fantasy of a “just world”.

Just-world hypothesis (from Wikipedia)

The just-world hypothesis or just-world fallacy is the cognitive bias (or assumption) that a person’s actions are inherently inclined to bring morally fair and fitting consequences to that person, to the end of all noble actions being eventually rewarded and all evil actions eventually punished.

This belief generally implies the existence of cosmic justice, destiny, divine providence, desert, stability, or order, and has high potential to result in fallacy, especially when used to rationalize people’s misfortune on the grounds that they “deserve” it.  (See also: What We Can and Cannot Control)

1.4. Exacerbation of social injustice and social inequalities

COVID-19 has disproportionately affected socially disadvantaged groups, and the ensuing global economic fallout could magnify these inequalities in pain further.

The concern is that the most economically disadvantaged will be most likely to be exposed to the hazard, most susceptible to harm from it, and most likely to experience negative outcomes from it.

Conclusions and future directions

To prevent a population-level increase in the severity and impact of chronic pain, it is critical to devote scientific attention to the assessment, mitigation, and prevention of sources of social threat for people with chronic pain.