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

The DOI matches its Crossref record; 86 of the 89 references it cites were found in a registry or an index.

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, Tracy, Lincoln M., Ashton-James, Claire E.·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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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).
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).CC BY-NC-ND · PubMed Central

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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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
  • Social Sciences › Sociology and Political Science › 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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