How to safely resume disrupted pain management services
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How to safely resume disrupted pain management services

Erin Dean Health journalist

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

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 (BPS).

Nursing Standard. 35, 9, 67-68. doi: 10.7748/ns.35.9.67.s20

Published: 02 September 2020

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Picture credit: iStock

COVID-19 has led to significant changes in the delivery of pain medicine services nationally. A survey by the Faculty of Pain Medicine (FPM) of the Royal College of Anaesthetists showed that the majority of services had reduced staffing during the pandemic, with significant staff redeployment to assist in the delivery of acute services.

What’s new

The safe resumption of pain services that have been disrupted by the COVID-19 pandemic 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, the guidance says, with suitable measures such as use of personal protective equipment (PPE), ensuring extra time for cleaning, and social distancing arrangements all in place.

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.

‘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.’

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

Key points for nurses

To maintain staff safety:

  • » Patients with active COVID-19 symptoms should have their procedure deferred unless there is an overriding clinical priority

  • » Appropriate personal protective equipment must be available and social distancing protocols should be maintained, except during active clinical care or monitoring

  • » Deep sedation, which may require airway support, should be avoided

  • » Time should be allowed to maintain social distancing among patients and staff, and for cleaning after each individual is seen. This means any return to activity must factor in having fewer people in a patient list

When it comes to pain-relieving injections, services will need to consider local COVID-19 infection rates and the risk to staff and patients, it says. A decision on whether to inject should be based on a balance of risks and benefits.

When prioritising who should receive injections, staff should follow guidance published on the issue by the FPM. This says the initial focus should be on urgent and time-critical work, including cancer-related pain, inpatient pain, refilling intrathecal pumps and managing malfunctioning implantable devices.

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

Discussions regarding consent must include the risks of exposure to COVID-19 if patients visit a hospital, the guidance says.

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 services.

Find out more

British Pain Society and Faculty of Pain Medicine, Royal College of Anaesthetists: Joint Guidance on Pain Interventions During the COVID-19 Recovery Phase

British Pain Society: Pain:less campaign

More essential policy briefings rcni.com/policy-briefing

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