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Cited by 149COVID-19 and Mental HealthMusculoskeletal pain and rehabilitationSocial impacts of COVID-19

The social threats of COVID-19 for people with chronic pain

Open access
Karos, Kai, McParland, Joanna L., Bunzli, Samantha, Devan, Hemakumar, Hirsh, Adam, Kapos, Flavia P., Keogh, Edmund, Moore, David +2 more·2020·Pain
DOI 10.1097/j.pain.0000000000002004PMC PMC7382418
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Abstract

1. Introduction The COVID-19 (SARS-CoV-2) pandemic has changed the social environment in which people live and work, as well as the social systems they rely on.39,88 To contain the spread of coronavirus and to prepare for a dramatic increase in demand for limited hospital/medical facilities and resources, societies have enforced physical distancing measures. Consequently, there have been limitations on the use of public transportation, public spaces, and work, education, and recreational facilities. Furthermore, access to vital, but nonurgent, healthcare services (including pain management services) has been restricted. These changes have affected the way people connect with each other, manage their health and wellbeing, and fulfil their social roles. For some, these changes may present opportunities (eg, increased time with family, normalisation of flexible working, and reduced demand for travel). For others, however, these social changes can also represent significant threats to health and wellbeing. 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.48 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 (Fig. 1). 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 (Fig. 1).Figure 1.: Schematic representation of how the COVID 19 pandemic (A) exacerbates existing levels of social threat (B), thereby inducing several social challenges (C) for people with chronic pain, and ultimately increasing the risk for the development, maintenance, and exacerbation of chronic pain complaints (D). Possible protecting processes and interventions countering the effects of the pandemic are portrayed as well (E).2. Social threats posed by the COVID-19 pandemic 1.1. Social disconnection and loneliness One of the most immediate effects of the pandemic on our social lives is the introduction of physical distancing measures and restriction of travel. 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,76 provide protection from the harmful effects of stress,95 promote social connectedness, and reduce pain sensitivity.91 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.40,42 Chronic pain conditions place individuals at an increased risk of social isolation, smaller social network size, and reduced social role functioning,37,38,78 all of which have negative implications for pain interference and pain intensity over time.7,31,47 Indeed, disruption to social roles and relationships is one of the most distressing aspects of living with chronic pain.81 Physical distance from others and reduced participation in work and social activities can cause people to feel lonely or socially distanced from others,73 and there are concerns that the COVID-19 pandemic will lead to a steep rise in the prevalence of loneliness.5,22,35,39 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. Unless individuals have the ability and means to maintain meaningful connections with others despite physical distancing measures, being physically isolated from others threatens to exacerbate pain and associated disability. 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. Although social support can help buffer against pain,14,15,18,56 an increase in solicitous behaviours in such close proximity might unintentionally contribute to the chronicity of pain.34,43,72 For examp

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  • Telerehabilitation appears as a key solution to counteract the burden of the COVID-19 pandemic on patients with persistent musculoskeletal pain.

    “In this context, telerehabilitation appears as a key solution to counteract the burden of the COVID-19 pandemic on patients with persistent musculoskeletal pain [1,4].”

    From Behavior Modification Techniques on Patients with Chronic Pain in the Context of COVID-19 Telerehabilitation: An Umbrella Review (2022) · cites this paper as [4]

    The section on reduced access to high-quality pain management says telehealth can maintain access to care for people with chronic pain during COVID-19. The section on responding to social threats describes online pain management as promising, but does not specifically identify telerehabilitation for persistent musculoskeletal pain as a key solution; it also cautions that no one response addresses all the pandemic’s social threats. (LLM, conf=0.84)

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  • The PAR framework provides a model for future studies codeveloping online solutions that can be scalable and potentially address the needs of high-risk populations, such as Indigenous and culturally and linguistically diverse communities.

    “Our PAR framework provides a model for future studies codeveloping online solutions that can be scalable and potentially address the needs of high-risk populations, such as Indigenous and culturally and linguistically diverse communities.29”

    From Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain - Protocol for a non-inferiority randomised controlled trial (iSelf-help trial) (2021) · cites this paper as [29]

    Section 3 says online technologies could provide relatively inexpensive, location-independent treatment and reduce disparities. Section 4 calls for research on access to online treatments for marginalized people with chronic pain. The paper does not address codeveloping scalable solutions or specifically identify Indigenous and culturally and linguistically diverse communities; the PAR framework is the citing authors’ own. (LLM, conf=0.85)

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  • Lack of person-centred collaboration can minimise the importance of values, such as those arising from culture and health beliefs, which form the basis of understanding the needs of individuals and families.

    “Lack of person-centred collaboration can minimise the importance of values,29 such as those arising from culture and health beliefs, which form the basis of understanding the needs of individuals and families.30–32”

    From Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain - Protocol for a non-inferiority randomised controlled trial (iSelf-help trial) (2021) · cites this paper as [29]

    The section on reduced access to high-quality pain management discusses barriers to care and possible disagreement between clinicians and patients, but does not say that a lack of person-centred collaboration diminishes the importance of patients’ values. Searches for person-centred collaboration, values, culture, and health beliefs found no passage making that connection. The later clause about culture and family needs carries separate citations (30–32). (LLM, conf=0.72)

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Research works printed but not linked: 3

  1. [1]Alon TM Doepke M Olmstead-Rumsey J Tertilt M The impact of COVID-19 on gender equality. Cambridge, 2020 Available at: https://www.nber.org/papers/w26947.
  2. [34]Fordyce WE Behavioral methods in chronic pain and illness. St Louis: Mosby, 1976.
  3. [49]Kite ME Whitley BE Jr Psychology of prejudice and discrimination. New York, NY: Psychology Press, 2016.

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Authors
Karos, K., McParland, J. L., Bunzli, S., Devan, H., Hirsh, A., Kapos, F. P., Keogh, E., Moore, D., Tracy, L. M., & Ashton-James, C. E.
Affiliations
  • Maastricht University (NL)
  • Glasgow Caledonian University (GB)
  • The University of Melbourne (AU)
  • University of Otago (NZ)
  • Indiana University – Purdue University Indianapolis (US)
  • University of Washington (US)
  • University of Bath (GB)
  • Liverpool John Moores University (GB)
  • Monash University (AU)
  • The University of Sydney (AU)
Corresponding author
Karos, Kai
ORCID
Venue
Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-07-13
Volume
161
Issue
10
Pages
2229-2235
ISSN
  • 0304-3959 (ISSN-L)
  • 1872-6623
DOI
10.1097/j.pain.0000000000002004
PMC
PMC7382418
OpenAlex
W3045169510
Cited by
149
References
89
Citations by year
2026: 5 · 2025: 10 · 2024: 21 · 2023: 16 · 2022: 48 · 2021: 38 · 2020: 11
FWCI
2.22
Type
journal article
Language
en
Open access
Licence
Locations
  • Pain (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by-nc-nd)
  • DSpace (Open University in the Netherlands) (publishedVersion, cc-by-nc-nd)
  • ResearchOnline (Glasgow Caledonian University) (acceptedVersion, cc-by-nc-nd)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-nd)
  • Lirias (submittedVersion, other-oa)
  • Liverpool John Moores University (submittedVersion)
  • Purdue University Indianapolis (Indiana University) (submittedVersion, cc-by-nc-nd)
  • Pure (University of Bath) (submittedVersion, cc-by-nc)
  • IUScholarWorks (Indiana University) (submittedVersion, cc-by-nc-nd)
  • The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
  • DSpace (Open University in the Netherlands) (submittedVersion, cc-by-nc-nd)
  • Research Publications (Maastricht University) (submittedVersion, cc-by-nc-nd)
Funders
  • University of Otago
  • Philanthropic Educational Organization
  • Vlaamse regering
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Social Sciences › Safety Research › Social impacts of COVID-19
Keywords
COVID-19 pandemic, chronic pain, social danger, social disconnection, loneliness, social distancing, social isolation, pain exacerbation, social belonging, autonomy, resilience, healthcare access restrictions, well-being, coping strategies, flexible work arrangements, research priorities
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Communicable Disease Control, Delivery of Health Care, Health Services Accessibility, Humans, Loneliness, Pneumonia, Viral, Public Policy, Role, Social Environment, Social Isolation, Social Justice, Socioeconomic Factors, Telemedicine, Coronavirus Infections, Disease Progression, Pain Clinics, Resilience, Psychological, Pandemics, Chronic Pain, Pain Management, Social Determinants of Health

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