ABSTRACT
Introduction: Chronic pain is more prevalent in military Veterans than in the general population. The extent to which the COVID-19 pandemic has affected Canadian Armed Forces (CAF) Veterans living with chronic pain is unknown. This study compared the impact of the pandemic and public health measures on Canadian Veterans and non-Veterans. Methods: An online cross-sectional study was conducted across Canada. Participants (n = 3,159) were adults with chronic pain recruited from April to May 2020. Seventy-six participants reported having formerly served in the CAF and were pair-matched with non-Veterans. Results: CAF Veteran participants' mean age was 55.1 (standard deviation = 9.6) years;50.0% were female. Over 60% lived with chronic pain for > 10 years. Two thirds of Veterans (67.1%) reported worsened pain since pandemic onset, and 44.7% experienced moderate to severe psychological distress. This was comparable to the non-Veteran group (63.2%, p = 0.61;35.5%, p = 0.25), and no differences were found between female and male Veterans (p = 0.22, p = 0.36). Percentages of participants reporting changes in pharmacological pain treatments because of the pandemic were similar in CAF Veterans (14.9%) and non-Veterans (13.3%) (p = 0.68). Over 50% of Veterans modified their physical/psychological pain treatments due to the pandemic, compared with 45.3% of non-Veterans (p = 0.24). Discussion: Pain deterioration, psychological distress, and pain treatment changes were observed in CAF Veterans living with chronic pain during the COVID-19 pandemic, as was the case in non-Veterans. These results will help develop interventions to adequately face pandemic waves to come and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) Introduction : La prevalence de la douleur chronique est plus elevee chez les veterans que dans la population en general. La mesure dans laquelle la pandemie de COVID-19 a touche les veterans des Forces armees canadiennes (FAC) souffrant de douleur chronique n'est pas connue. La presente etude compare l'impact de la pandemie et des mesures de sante publique chez des veterans et des non-veterans canadiens. Methodologie : Une etude transversale en ligne a ete effectuee partout au Canada. Les participants (n = 3 159) etaient des adultes vivant avec de la douleur chronique, recrutes en avril et en mai 2020. Soizante-seize participants ont indique avoir servi dans les FAC et ont ete apparies avec des non-veterans. Resultats : L'age moyen des participants veterans FAC etait de 55,1 ans (ecart-type = 9,6);50 % etaient des femmes. Plus de 60 % d'entre eux vivaient avec de la douleur chronique depuis plus de 10 ans. Deux tiers des veterans (67,1 %) ont indique que leur douleur s'etait aggravee depuis le debut de la pandemie et 44,7 % ont ressenti de la detresse psychologique moderee a grave. Ces pourcentages sont comparables a ceux observes chez le groupe de non-veterans (63,2 %, p =0,61 ;35,5 %, p = 0,25) et aucune difference n'a ete notee entre les veterans masculins et feminins (p = 0,22, p = 0,36). Les pourcentages de participants rapportant des changements dans leurs traitements pharmacologiques pour la douleur, en raison de la pandemie, etaient semblables chez les veterans des FAC (14,9 %) et les non-veterans (13,3 %) (p = 0,68). Plus de 50 % des veterans ont modifie leurs traitements physiques/psychologiques pour la douleur en raison de la pandemie, comparativement a 45,3 % des non-veterans (p = 0,24). Discussion : Une intensification de la douleur, de la detresse psychologique et des modifications apportees aux traitements de la douleur ont ete observees pendant la pandemie de COVID-19 chez les veterans des FAC qui vivent avec la douleur chronique comme c'etait le cas chez les non-veterans. Ces resultats aideront a mettre au point des interventions qui permettront de faire face de facon adequate aux prochaines vagues de la pandemie et a de futures crises sanitaires. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement Chronic pain is more frequent in military Veterans than in the general population. The objective of this study was to assess whether the COVID-19 pandemic has had a greater impact on Canadian Armed Forces (CAF) Veterans who live with chronic pain compared to non-Veterans. An online survey of Canadian adults with chronic pain was conducted between April and May 2020;76 respondents reported having formerly served in the CAF and were compared with 76 similar non-Veterans. About two thirds of the Veterans had been living with chronic pain for longer than 10 years. Two thirds reported worsened pain since the pandemic began. Nearly half experienced moderate to severe psychological distress. These changes were similar to those in non-Veterans with chronic pain. A significant number of Veterans and non-Veterans changed their pain treatments due to the pandemic. In summary, the COVID-19 pandemic and associated restriction measures did not have a greater impact in CAF Veterans with chronic pain compared with non-Veterans. However, changes in chronic pain supports are needed to be better prepared for COVID-19 waves to come and future health crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
INTRODUCTION: Multimodal treatment is recognized as the optimal paradigm for the management of chronic pain (CP). Careful balance between pharmacological and physical/psychological approaches is thus desirable but can be easily disrupted. OBJECTIVES: This study aimed at exploring the impact of the COVID-19 pandemic on pharmacological and physical/psychological treatments of CP. METHODS: A Pan-Canadian cross-sectional web-based study was conducted between April 16th and May 31st 2020 among adults living with CP when the country was in the ascending slope of the first COVID-19 pandemic wave. RESULTS: A total of 2864 participants shared their treatment experience (mean age: 49.7 years and women: 83.5%). Among medication users (n = 2533), 38.3% reported changes in their pharmacological pain treatment. The main reasons were as follows: (1) changes in pain symptoms, (2) lack of access to prescribers/cancellation of medical appointments, and (3) increased medication intake in compensation for stopping physical/psychological treatments because of the pandemic. Among participants who used physical/psychological pain management approaches before the pandemic (n = 2467), 68.3% had to modify their treatments or self-management strategies. Common reasons were lack of access to clinics/exercise facilities and the need to compensate for having to stop another type of physical/psychological treatment because of the pandemic-related public health safety measures. CONCLUSIONS: Our study underlines the negative impact of the COVID-19 pandemic on access to pain relief, which is considered a fundamental human right. Results will help to justify resource allocation and inform the development of interventions to be better prepared for waves to come and future health crises.
ABSTRACT
Introduction. La pandémie de COVID-19 a eu un impact disproportionné sur les populations vulnérables, notamment les personnes atteintes de douleur chronique. Nous avons examiné les associations entre les variations géographiques des taux d’infection par le coronavirus, le stress et l’intensité de la douleur et nous avons étudié les facteurs associés à l’évolution de la douleur et à la détresse psychologique chez les personnes atteintes de douleur chronique pendant la pandémie. Méthodologie. Cette analyse s’inscrit dans le cadre d’une initiative plus vaste, l’étude pancanadienne « Douleur chronique et COVID-19 », qui emploie une méthode de recherche transversale observationnelle. Au total, 3 159 personnes atteintes de douleur chronique ont répondu à une enquête quantitative entre le 16 avril et le 31 mai 2020. Résultats. Les deux tiers (68,1 %) des participants avaient entre 40 et 69 ans, et 83,5 % étaient des femmes. Les deux tiers (68,9 %) des répondants ont signalé une aggravation de leur douleur depuis le début de la pandémie. Un niveau élevé de risques perçus liés à la pandémie (rapport de cotes ajusté : 1,27 %;intervalle de confiance [IC] à 95 % : 1,03 à 1,56), un niveau élevé de stress (1,21;IC à 95 % : 1,05 à 1,41), la modification des traitements de la douleur pharmacologiques (3,17;IC à 95 % : 2,49 à 4,05) et physiques/psychologiques (2,04;IC à 95 % : 1,62 à 2,58) et enfin le fait d’occuper un emploi au début de la pandémie (1,42;IC à 95 % : 1,09 à 1,86) étaient associés à une probabilité accrue de déclarer une aggravation de la douleur. La perte d’emploi (34,9 % des personnes travaillaient avant la pandémie) a été associée à une probabilité inférieure (0,67;IC à 95 % : 0,48 à 0,94) de déclarer une aggravation de la douleur. Près de la moitié (43,2 %) des personnes ont indiqué une détresse psychologique d’intensité modérée ou grave. Les émotions négatives à l’égard de la pandémie (2,14;IC à 95 % : 1,78 à 2,57) et le stress global (1,43;IC à 95 % : 1,36 à 1,50) ont été associés à une détresse psychologique modérée ou grave. Conclusion. Les résultats de l’étude ont permis de cerner, outre les facteurs biomédicaux, plusieurs facteurs psychosociaux à prendre en compte pour surveiller l’état des patients atteints de douleur chronique et faciliter leur accès aux traitements pendant une pandémie.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has had a disproportionate impact on vulnerable populations, including individuals with chronic pain. We examined associations between geographical variations in COVID-19 infection rates, stress and pain severity, and investigated factors associated with changes in pain status and psychological distress among individuals living with chronic pain during the pandemic. METHODS: This investigation is part of a larger initiative, the Chronic Pain & COVID-19 Pan-Canadian Study, which adopted a cross-sectional observational design. A total of 3159 individuals living with chronic pain completed a quantitative survey between 16 April and 31 May 2020. RESULTS: Two-thirds (68.1%) of participants were between 40 and 69 years old, and 83.5% were women. Two-thirds (68.9%) of individuals reported worsened pain since pandemic onset. Higher levels of perceived pandemic-related risks (adjusted odds ratio: 1.27; 95% confidence interval: 1.03-1.56) and stress (1.21; 1.05-1.41), changes in pharmacological (3.17; 2.49-4.05) and physical/psychological (2.04; 1.62-2.58) pain treatments and being employed at the beginning of the pandemic (1.42; 1.09-1.86) were associated with increased likelihood of reporting worsened pain. Job loss (34.9% of individuals were employed pre-pandemic) was associated with lower likelihood (0.67; 0.48-0.94) of reporting worsened pain. Almost half (43.2%) of individuals reported moderate/severe levels of psychological distress. Negative emotions toward the pandemic (2.14; 1.78-2.57) and overall stress (1.43; 1.36-1.50) were associated with moderate/severe psychological distress. CONCLUSIONS: Study results identified psychosocial factors to consider in addition to biomedical factors in monitoring patients' status and facilitating treatment access for chronic pain patients during a pandemic.
Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Chronic Pain/psychology , Psychological Distress , Stress, Psychological/epidemiology , Adult , Aged , COVID-19/prevention & control , Canada , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Self Concept , Socioeconomic FactorsABSTRACT
BACKGROUND: Chronic pain affects about 20 % of the Canadian population and can lead to physical, psychological and social vulnerabilities. However, this condition remains poorly recognized and undertreated. During 2020, as the COVID-19 pandemic disrupted daily living and health care systems, the situation of people with chronic pain has drawn little public attention. METHODS: This qualitative study was part of a pan-Canadian mixed-methods project and aimed to understand the experiences and challenges of people living with chronic pain during the COVID-19 pandemic in Canada. Between May and August 2020, we conducted in-depth semi-structured interviews with 22 individuals living with chronic pain across the country. We used reflexive thematic analysis to interpret data. RESULTS: Our findings underscored four dimensions of the chronic pain experience during the pandemic: (1) Reinforced vulnerability due to uncertainties regarding pain and its management; (2) Social network as a determinant of pain and psychological condition; (3) Increasing systemic inequities intermingling with the chronic pain experience; (4) More viable living conditions due to confinement measures. Though several participants reported improvements in their quality of life and reduced social pressure in the context of stay-at-home orders, participants from socio-economically deprived groups and minorities reported more challenges in accessing pain relief, health care services, and psychosocial support. CONCLUSIONS: The COVID-19 pandemic has revealed and intensified pre-existing disparities and challenges among people living with chronic pain in terms of material resources, psychosocial condition, social support, and access to care. In post-pandemic times, it will be essential to address flaws in health and welfare policies to foster equity and social inclusiveness of people with chronic pain.