Chronic pain and COVID-19: pathophysiological, clinical and organizational issues.

During the lockdown phase of the COVID-19 pandemic, a call not to neglect the continuum of care of patients who present with chronic diseases, including pain, was made. In the field of pain, COVID-19 had an impact both from a clinical (i.e., the influence of SARS-CoV-2 infection on pain) and organizational (i.e., how patients with chronic pain should be managed in the post-COVID-19 era) perspective. Furthermore, patients with chronic pain are also frequently frail subjects, affected from multiple comorbidities and hence are at increased risk of infection. On these bases, how the necessity to continue pain therapy will be pursued in the post-COVID-19 era? In this paper, we comment on the above-mentioned topics, on the basis of available data and our experience as pain therapists.

Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies.

OBJECTIVE: To compare the 2 most efficacious therapeutic regimens, intravenous immunoglobulin (IVIG) and anticoagulation with low molecular weight (LMW) heparin plus low-dose aspirin, in women with recurrent pregnancy loss associated with antiphospholipid antibodies (aPL). METHODS: We examined 40 women with recurrent abortion (at least 3 occurrences) and repeatedly positive test results for anticardiolipin or lupus anticoagulant. The subjects were randomly assigned to treatment with IVIG or LMW heparin plus low-dose aspirin. Both therapies were started when the women were pregnant as documented by a positive urine test. IVIG was stopped at the thirty-first week of gestation, aspirin at the thirty-fourth week, and heparin at the thirty-seventh week. The primary outcome of interest was the rate of live births with the 2 treatments. RESULTS: The characteristics of the 2 groups were similar at the time of randomization. The women treated with LMW heparin plus low-dose aspirin had a higher rate of live births (84%) than those treated with IVIG (57%). CONCLUSION: Treatment with LMW heparin plus low-dose aspirin should be considered as the standard therapy for recurrent pregnancy loss due to aPL.