Study Finds Chronic Pain Patients Used More Opioids For Pain Relief When COVID-19 Cancelled Elective Procedures

PainRelief.com Interview with:

Dr. Shantha Ganesan MD
 Pain Medicine Specialist
Kings County Hospital Center

David Kim, MD, PGY-2
SUNY Downstate Department of Anesthesiology 

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: The opioid epidemic is a serious national crisis that has detrimental impacts on both public health, and social and economic welfare. Therefore, any efforts to combat the opioid epidemic, including minimizing or weaning opioid prescriptions, and using other modes of analgesia when possible are undeniably necessary in this day and age. With the onset of Covid-19 pandemic, healthcare providers abruptly changed their care delivery. In-person clinic visits were changed to telemedicine, and elective cases were cancelled.

Due to a growing concern that chronic pain patients may have limited resources from this unprecedented time of social and economic shutdown, organizations such as American Medical Association and Drug Enforcement Administration have supported implementing measures to ensure these patients achieve adequate pain control by increasing access to pain medications, but at the cost of reducing barriers and restrictions to controlled substances. Given the cancellation of elective interventional pain management procedures and relaxed regulations on controlled substances during the Covid-19 pandemic, it is reasonable to suspect a dramatic increase in opioid prescription during this time.

PainRelief.com:  What is the purpose of this study?

Response: Our study focused on the change in opioid consumption in chronic pain patients who were unable to undergo their interventional pain procedure during the Covid-19 pandemic. The interventional pain procedures included in this study are lumbar epidural steroid injection, sacroiliac joint injection, and intra-articular facet joint injection. By demonstrating whether or not there has been a significant increase in opioid consumption in this patient population, we can

justify the efficacy and necessity of these procedures. A significant increase can also support the importance of creating protocols that allow for elective interventional pain procedures to continue during the next pandemic.

PainRelief.com: What are the main findings?

Response: The mean change in opioid consumption (MME/day) in all subjects showed a statistically significant increase. Subjects who received the same procedure in the past, on average, had a larger change in opioid consumption compared to those who were new to their scheduled procedure.

PainRelief.com: What should readers take away from your report?

Response: With the cancellation of elective interventional pain procedures due to the Covid-19 pandemic, there was a statistically significant increase in opioid consumption in chronic pain patients. The decision to cancel elective procedures may have been premature and possibly have contributed to a drastic worsening of the opioid epidemic. This may justify the need for a protocol that allows for elective interventional pain procedures to continue in a future pandemic.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: One of the goals of our study was to determine the mean change in opioid consumption stratified by scheduled procedure. This may help determine the efficacy of certain procedures. However, due to the small sample size of the study, no statistically significant results were obtained. An ongoing study involving a larger sample size may help address this. Now that elective procedures have resumed, it would be interesting to conduct a prospective study determining the change in opioid consumption for these patients before and after receiving their scheduled interventional pain procedure.

Citation: PainWeek 2020 abstract

The Effect of Covid-19 on the Opioid Epidemic: A retrospective review investigating the changes in opioid consumption in chronic pain patients unable to undergo their interventional pain procedure during the Covid-19 pandemic

David Kim1,2, Seth White1,2, Nelson Nwannunu1,2, Shantha Ganesan2

1State University of New York Downstate Medical Center, Brooklyn, NY, USA. 2NYC Health + Hospitals/Kings County Hospital Center, Brooklyn, NY, USA

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