Policy briefing

Pain management: how to safely resume services

Guidance says risks related to COVID-19 must be weighed before some interventions

Guidance says risks related to COVID-19 must be weighed before some interventions

Picture: iStock Essential information

Pain is the most common reason for attending a GP practice and affects one in four people, according to the British Pain Society . The COVID-19 pandemic has led to significant changes in the delivery of pain medicine services nationally. A survey by the Faculty of Pain Medicine of the Royal College of Anaesthetists showed that the majority of services had reduced staffing during the pandemic, with major staff redeployment to help acute services.

Whats new

Safely resuming pain services disrupted and limited by COVID-19 is the focus of new guidance from the British Pain Society and the Faculty of Pain Medicine.

Patient and staff safety must be the priority,

Guidance says risks related to COVID-19 must be weighed before some interventions

Picture: iStock

Essential information

Pain is the most common reason for attending a GP practice and affects one in four people, according to the British Pain Society. The COVID-19 pandemic has led to significant changes in the delivery of pain medicine services nationally. A survey by the Faculty of Pain Medicine of the Royal College of Anaesthetists showed that the majority of services had reduced staffing during the pandemic, with major staff redeployment to help acute services.

What’s new

Safely resuming pain services disrupted and limited by COVID-19 is the focus of new guidance from the British Pain Society and the Faculty of Pain Medicine.

Patient and staff safety must be the priority, it says, with suitable measures such as personal protective equipment (PPE), extra time for cleaning, and social distancing arrangements in place.

All appropriate non-invasive treatments should be explored with patients before injection treatments are considered.

When it comes to resuming pain-relieving injections, services will need to consider local COVID-19 infection rates and the risk these pose to staff and patients.

A decision on whether to inject needs to be based on a balance of risks and benefits for individual patients.

When prioritising who should receive injections, staff should follow guidance published on the issue by the Faculty of Pain Medicine. This says the initial focus should be on urgent and time-critical work, including cancer-related pain, in-patient pain and clinic attendance to refill intrathecal pumps and manage malfunction of implantable devices.

As steroid injections may cause immunosuppression, steroid use should only be considered in certain circumstances and should use the minimum dose possible.

Consent discussions must include the risks a patient could face of exposure to COVID-19 if they visit a hospital, says the guidance from the British Pain Society and the Faculty of Pain Medicine.

An individualised treatment plan for difficult cases should be supported by the multidisciplinary team, with at least two clinicians involved.

The organisations are clear that the pandemic must not be used as an opportunity to decommission interventions or pain services.

Key points for nurses

To maintain staff safety:

  • Patients with active symptoms of COVID-19 infection should have their procedure deferred unless there is an overriding clinical priority.
  • Appropriate PPE must be available and social distancing protocols should be maintained except when actively imparting clinical care or monitoring.
  • Deep sedation requiring the potential need for airway support and subsequent aerosol generation should be avoided.
  • Time should be allowed for social distancing among patients and staff, and for cleaning after each case. This means any return to activity must factor in having fewer people in a patient list.

Expert comment

Karin Cannons, nurse consultant in pain management at Frimley Health NHS Foundation Trust

 

‘Chronic or persistent pain impacts the affected person's daily activities and quality of life. Pain services adopt a biopsychosocial approach that supports the whole person with pain. Pain services play a key role in supporting and augmenting people’s self-management strategies, which are the gold standard treatment.

‘COVID-19 has stalled some services completely. Many have been operating greatly reduced services, usually virtually. The result is a large backlog of cancelled appointments and procedures, as well as new referrals waiting to be seen.

‘Pain clinics have changed and will never be the same again’

‘This guidance document is useful for the whole multidisciplinary team as services restart. It stresses that safety is paramount.

‘Nurses will be key in facilitating patient and staff safety, ensuring services are delivered in a “COVID-19 safe” way. Although it is not mentioned in the document, I believe managing expectations of patients, referrers and colleagues will also be key. Pain clinics have changed and will never be the same again, but their role in supporting people living with pain can still be pivotal.’


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