Facing Chronic Pain and Coronavirus

If combined, chronic pain and coronavirus can be extra scary. But with a few simple precautions, you'll be prepared.

PPM is speaking to clinical experts about the unique situation that individuals living with chronic pain conditions, including rheumatologic diseases, may be facing as the country works to fight off the coronavirus. Here are a few tips from clinical pharmacist and editor-at-large of PPM, Dr. Jeffrey Fudin, as well as other members of our editorial advisory board. Check back for updates.

Certain rheumatic conditions can weaken the immune system and make individuals more susceptible to viruses in general. (Image: iStock)

Connect with your doctor from the comfort of your home

You may be concerned about getting an appointment to see your doctor for a prescription renewal, a procedure, or even just a follow-up. The good news is that many providers are taking advantage of telehealth (also called telemedicine, telecare, or virtual healthcare) and mobile apps to communicate with and monitor their patients. Rather than heading into a doctor’s office, you can share symptoms and ask questions via phone, chat, or video - all while reducing potential exposure to the coronavirus. Ask your provider if this is an option. And keep in mind that if you communicate with your doctor via email about health in any detail, be sure your messages are encrypted. Many telecare apps, as well as patient portals operated by doctors’ offices, include such software.

Talk to your pharmacy about home delivery and early refills

If you have any symptoms of coronavirus (the latest on testing state by state), have a weakened immune system, or are following guidelines to avoid public spaces, opt for your prescriptions to be delivered to your home. Many pharmacies are doing this, says Dr. Fudin, and if your pharmacy does not deliver, you can make a request to transfer your prescription to one that does. You can also inquire about your state’s particular contingency plans which were put into effect when the coronavirus was labeled a global pandemic. Many of these plans allow for prescription renewals, up to a certain percentage of medication prescribed, to be filled early.

In fact, if you are on chronic opioid therapy, you should be able to get your prescription filled or refilled via telemedicine. With the current coronavirus declared as a public health emergency, providers are able to prescribe controlled substances, including opioids, via telemedicine. The US DEA's Diversion Control Division (www.deadiversion.usdoj.gov/coronavirus.html) has reported that, "For as long as the Secretary's designation of a public emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided the following conditions are met:

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system; and
  • The practitioner is actin in accordance with applicable Federal and State laws."

Some additional things you can do if you are worried about getting prescriptions:

  • “Form a relationship with your pharmacist, and alert him/her when you will be needing to fill or refill your analgesic in case they need to order it,” advises Mary Lynn McPherson, PharmD, at the University of Maryland School of Pharmacy. “Always give 3 to 5 days’ notice so you won't run out of your medication.”
  • Ask for an electronic script, says Srinivas Nalamachu, MD, at the Mid America PolyClinic in Kansas. Dr. Nalamachu says he has been providing his patients with 1-week supply e-scripts to ensure their needs are being met if he cannot see them in person.

Be aware of pre-existing symptoms

If you have chronic pain conditions tied to back, neck or orofacial pain, excessive coughing caused by the coronavirus may worsen your pain, says Dr. Fudin. In these cases, it is best to work with your doctor on reducing your cough. For those who often experience joint or muscle pain, remember that the virus (just like the flu) may come with its own set of aches and pains as well. At the same time, noted Dr. Fudin, recognize that you will need to let the virus run its course.

For those patients on prescribed opioid therapy and who take their opioids via a transdermal patch (eg, buprenorphine or fentanyl), it is important to note that increased absorption may occur with a fever. Says Dr. Fudin, "This, coupled with a respiratory illness could potentially elevate the risk of opioid-induced respiratory depression and potentially be a very good reason to consider having emergency naloxone (for opioid overdose) available."

For those undergoing cancer treatment or who are immuno-suppressed due to certain rheumatological diseases such as Lupus or Rheumatoid Arthritis, "seek the help of infectious disease specialists and follow their guidelines," advises Gabriel Sella, MD, who has a master's of public health and works in preventive medicine at the Ohio Valley Medical Center. "Healthy lifestyle is the first defense including personal hygiene and avoidance of crowds." Stay 6 feet away from other individuals, keep your hands clean, and follow these basic care tips from Anita Gupta, DO, PharmD:

  • Wash hands often with soap and water for 20 seconds or more.
  • If soap and water is not available, use hand sanitizer with at least 60% alcohol (see below on how to make your own if necessary).
  • Avoid touching your eyes, nose or mouth.
  • Stay home if you are sick.
  • Avoid contact with people who are sick.
  • Cover your mouth and nose with a tissue when coughing or sneezing and then discard the tissue.
  • Clean and disinfect frequently touched objects and surfaces.

If you had a procedure scheduled, recognize that some treatments may be delayed if they are non-emergent and will need to be rescheduled for a later time.

If needed, make hand sanitizer at home

According to Dr. Fudin, you can use rubbing alcohol (or ethyl alcohol) and aloe vera (or a similar substitute) to make hand sanitizer in a pinch.

Mix a ratio of 2 parts rubbing alcohol to 1 part aloe vera. For instance, use 60 mL or 2 ounces of alcohol with 30 mL or 1 ounce of aloe vera.  Be sure that your rubbing alcohol is labeled as at least 70% alcohol; 90% or 91% are preferable. If you don’t have any rubbing alcohol, you can use ethyl alcohol (the type you drink), but it has to be high proof. Grain alcohol that is about 95% alcohol (190 proof or higher) is best. Use the same measurements noted above.

We actually go through a pandemic or epidemic about every 2 years. (Image: iStock)

Try to maintain perspective

Daniel Kirsch, PhD, president of The American Institute of Stress, shares that perspective is key. “I do not mean to diminish the threat or lives lost to coronavirus, or suggest we just ignore it,” he says, “but we actually go through this about every 2 years, as evidenced by the following table.”

Global Epidemics Virus Outbreaks

  • 2004 – SARS                                                                           
  • 2008 – Avian Flu
  • 2010 – Swine Flu
  • 2012 – MERS
  • 2014 – Ebola
  • 2016 – Zika Virus
  • 2018 – Ebola
  • 2020 – Coronavirus (Covid 19)

As of March 13, 2020, Johns Hopkins reported that there were 137,000 total confirmed cases of Covid-19 worldwide resulting in 3,300 deaths and 64,400 recoveries. Compare this to the annual flu virus, which has resulted in 36,000,000 – 51,000,000 cases, and 20,000 to 55,000 deaths between October 1, 2019 and March 7, 2020 in the United States alone (source: CDC).

“My wife had the flu this year. She was pretty sick for almost 2 weeks from it,” shares Dr. Kirsch. “I am a senior citizen who is not particularly healthy at this stage of my life. I sleep in the same bed as my wife and continued to do so throughout her illness. I just assumed I was already incubating it. I figured I would be down for a while, suffer some, and then most likely recover. But I never got sick. I took Vitamin C and avoided kissing the patient I was nursing but she breathed inches from my mouth all night.” 

Thus, he adds “I worry that people’s elevated stress levels may do them more harm than the potential of getting the coronavirus. People who try too hard to avoid being sick miss out on the challenges and joys of everyday life. Use sensible precautions and carry on. As many patients with chronic pain and chronic illness know, there is nothing that exacerbates pain more than stress.” Dr. Kirsch shares stress management tips and other resources at www.stress.org/

Remember that your mental health counts, too

If you have anxiety or your anxiety is on the up, be sure to loop in your mental health provider. Emotional and mental health are crucial to your overall pain care plan.

Says David Cosio, PhD, a pain psychologist at the Jesse Brown VA Medical Center, “What’s important is for everyone to remain calm. Try to keep to your routines as much as possible. Check on loved ones and continue to be social by other means of communication. Continue to practice yoga, mindfulness, or relaxation at home. Consider watching spiritual services on TV. Remember that social distancing is a precautionary but crucial measure to reduce the spread of the disease.”

 

Updated March 16, 2020.

Updated on: 03/31/20
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