Pain Patients and COVID: How to Prepare for Potential Hospitalization

If you live with a chronic pain condition, you may be worried about potentially being admitted to the hospital with the coronavirus. An emergency medicine expert shares what to pack and what to expect for pain care.

Chronic pain so often means chronic planning. In the age of COVID, the need for planning is particularly true. As a member of the CDC Task Force creating emergency department (ED) coronavirus evaluation guidelines, here are some tips regarding what to expect in the ED, and how to plan if you are admitted for the coronavirus.

Image: iStock(BakiBG)When you talk to the emergency room staff, let them know about your chronic pain. Be prepared to advocate for yourself when it comes to an underlying pain condition, any additional risks you may have, and your need for pain management.

Deciding Whether to Go to the Hospital

The best option, of course, is to avoid emergency room exposure entirely, if possible (see our Action Plan for Pain Patients). Patients who need to be evaluated for the virus tend to have fever, cough, and body aches. While a loss of sense of smell is associated with coronavirus (and sore throat is not), simply wondering if you have COVID isn’t a good reason to go to the ED to be evaluated.

Those considered to be more at risk include people who are male, over age 60, obese, African American; those who have a history of chronic obstructive pulmonary disease (COPD), hypertension, kidney disease, diabetes, heart disease; and those who may be immunocompromised and use steroid treatments (not biologics). 

For patients with fever and difficulty breathing, an emergency center visit may be unavoidable. In these cases, your safest bet is to go.

If you are unsure about whether to head to the hospital, call - or have a caregiver call - your physician for instruction.
 

When You Arrive at the Hospital

Due to the way the novel coronavirus spreads, most hospital settings and even urgent care centers will require you to go in alone without a family member. So if someone drives you, let them know they may be waiting in a car. 

Your regular vital signs will be checked first. If you have two or more of the risk factors noted above, the ED staff will conduct a blood test to confirm whether you have the virus, regardless of your clinical presentation.

You may then be asked to do a physical exertion test. Since a drop in oxygen saturation after 1 minute of exercise is suggestive of worse outcomes with COVID-19, the emergency care team is likely to record your performance. In some hospitals, this means you may be asked to walk down an empty corridor or to march in place.

Tip: If you are able to optimize your pain levels to peak status before you get in the car (eg, take ibuprofen or your normally prescribed pain medication) so that you are capable of this physical exertion when you’re evaluated, do so. Just be sure to advise the ED staff that you took this medication before coming. And, if you are unable to stand due to your pain condition or disability, think about a way you can exert yourself using your upper body. The test is an important diagnostic tool.

Image: iStock (Mikeh57)Pack your medications in labeled pill box, along with the prescription bottles. Include supplements like Vitamin C, D, and Zinc, as well as magnesium for pain.

 

Have a Bag Ready: What to Pack

Because patients on the fence – meaning it’s unclear whether they have the virus -– can crash fast, emergency departments with capacity are being more careful about admitting patients when they can. If you are admitted, be prepared to take care of your own pain. You are very likely to be housed in a room alone and nurses are unlikely to enter your room for non-emergency situations.

I recommend having a bag ready to go with the items you need for pain management, just in case. This bag should include:

  • A list of the medications you take and the times you take them. Have a copy of this list in a packed bag and give another copy to a family member, friend, or caregiver for safe keeping.
  • The name and contact number for your primary care provider and/or pain specialist.
  • If and when you do head to the hospital, pack your medications in an actual week-long pill box with AM and PM slots if applicable, along with the prescription bottles.
  • Include supplements like Vitamin C, D, and Zinc (they may help reduce the severity of any virus) as well as magnesium for pain. Few hospitals will prescribe these.
  • Consider adding a card to the bag that says, "Please help me take my medicines at 9 am and 3 pm" written in big letters (plug in your personal medication details). This card can be placed in an isolation room window if you’ve been asked to lie on your stomach (this position can help lung function if you contract the virus), or in another visible spot in the room.
  • Physical items that help with your pain, such as a body pillow, portable pain-relieving devices, instant ice packs or hot packs. If you use reusable hot packs, you likely won’t be able to microwave them, so consider a hot pot if this is allowed.
  • A few pairs of disposable masks and gloves; these may not be needed but it won’t hurt to have them on hand.

If you go to the hospital, rather than schlep all these things in, just bring your medicines and list to start. Be sure to wear a mask and gloves as you enter. If you’re admitted, the hospital should allow your backup person/caregiver to bring in the things you need to care for your pain, but they may only be allowed to do so once.

 

How to Communicate Your Pain

When you talk to the emergency physician, let them know about your chronic pain and where you are in the cycle of coping. Their first concern will be treating you for the virus so you need to advocate for yourself when it comes to an underlying pain condition, any additional risks you may have, and your need for ongoing pain management.
 
If you anticipate that not being able to get a massage or a weekly adjustment will worsen your pain, let your admitting doctor know what usually works in case the team needs to escalate your pain relief. If there are foods, exercise equipment (eg, resistance bands), or self-care you do that requires equipment, pack it in advance just in case.

 

Other Things to Consider (and Pack)

One of the worst aspects of coronavirus admission I have seen to date is the boredom and loneliness that patients experience. Therefore, I suggest also packing mindfulness tapes, a phone charger, extra reading glasses if necessary, books, music, a yoga mat - anything you can bring to pass the time. 

Consider, too, a few portable phone-charging bricks if you fear having too much pain to get out of bed to charge your phone. And of course, be sure to pack any personal items such as a brush, toothbrush, underwear, change of clothes, and so forth.

Finally, another little tip I have learned: Current research suggests Sars-CoV-2 enters primarily through the nose. If you must be in public, food shopping, or waiting in line, consider wearing a swimmer’s nose clip in addition to the mask. While the mask affords some protection to you, it’s hard to remember to breathe with your mouth. A nose clip may feel weird out of the water, but at least you can hide it behind your mask to stay safe!

See Dr. Baxter's previous piece on how to communicate your pain in an ER setting.
Updated on: 06/03/20
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