Christopher Gharibo1, Amit Sharma2, Amol Soin3, Shalini Shah4, Sudhir Diwan5, Ricardo Buenaventura6, Devi E Nampiaparampil7, Steve Aydin8, Sanjay Bakshi9, Salahadin Abdi10, Sachin Sunny Jha11, Harold Cordner, Alan D Kaye12, Alaa Abd-Elsayed13, Kenneth D Candido14, Nebojsa Nick Knezevic15, Sairam Atluri16, Bradley W Wargo17, Mahendra R Sanapati18, Sukdeb Datta, Joshua A Hirsch19, Laxmaiah Manchikanti20, Kartic Rajput21. 1. Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, NY. 2. The American Society of Interventional Pain Physicians, Paducah, KY. 3. Ohio Pain Clinic. 4. University of California, Irvine, Department of Anesthesiology, Orange, CA. 5. Advanced Spine on Park Avenue. 6. Pain Relief of Dayton, Centerville, OH, and Clinical Associate Professor, Department of Surgery, Wright State University School of Medicine, Dayton, OH. 7. New York University School of Medicine, New York, NY. 8. Manhattan Spine and Pain Medicine, New York, NY, and Hofstra-North Shore/LIJ School of Medicine, New York, NY. 9. SurgiCare of Manhattan and Lenox Hill Hospital. 10. University of Texas, MD Anderson Cancer Center, Houston, TX. 11. University of Southern California, Department of Anesthesiology, Los Angeles, CA. 12. LSU Health Science Center, New Orleans. 13. Department of Anesthesiology University of Wisconsin, School of Medicine and Public Health, Madison, WI. 14. Department of Anesthesiology, Advocate Illinois Masonic Medical Center and Professor of Clinical Surgery and Anesthesia, University of Illinois College of Medicine. 15. Vice Chair for Research and Education, Department of Anesthesiology and Pain Management, Advocate Illinois Masonic Medical Center, Clinical Associate Professor of Anesthesiology and Surgery at University of Illinois, Chicago, IL. 16. Tri State Spine Care Institute. 17. Department of Interventional and Non-Interventional Pain Management, OrthoSouth Surgery Center. 18. Pain Management Centers of America, Evansville, IN. 19. Massachusetts General Hospital and Harvard Medical School, Boston, MA. 20. Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA. 21. Sutter Gould Medical Foundation, Stockton, CA.
Abstract
BACKGROUND: The COVID-19 pandemic has worsened the pain and suffering of chronic pain patients due to stoppage of "elective" interventional pain management and office visits across the United States. The reopening of America and restarting of interventional techniques and elective surgical procedures has started. Unfortunately, with resurgence in some states, restrictions are once again being imposed. In addition, even during the Phase II and III of reopening, chronic pain patients and interventional pain physicians have faced difficulties because of the priority selection of elective surgical procedures.Chronic pain patients require high intensity care, specifically during a pandemic such as COVID-19. Consequently, it has become necessary to provide guidance for triaging interventional pain procedures, or related elective surgery restrictions during a pandemic. OBJECTIVES: The aim of these guidelines is to provide education and guidance for physicians, healthcare administrators, the public and patients during the COVID-19 pandemic. Our goal is to restore the opportunity to receive appropriate care for our patients who may benefit from interventional techniques. METHODS: The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-19 Task Force in order to provide guidance for triaging interventional pain procedures or related elective surgery restrictions to provide appropriate access to interventional pain management (IPM) procedures in par with other elective surgical procedures. In developing the guidance, trustworthy standards and appropriate disclosures of conflicts of interest were applied with a section of a panel of experts from various regions, specialties, types of practices (private practice, community hospital and academic institutes) and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification was reviewed. The evidence -- informed with the incorporation of the best available research and practice knowledge was utilized, instead of a simplified evidence-based approach. Consequently, these guidelines are considered evidence-informed with the incorporation of the best available research and practice knowledge. RESULTS: The Task Force defined the medical urgency of a case and developed an IPM acuity scale for elective IPM procedures with 3 tiers. These included urgent, emergency, and elective procedures. Examples of urgent and emergency procedures included new onset or exacerbation of complex regional pain syndrome (CRPS), acute trauma or acute exacerbation of degenerative or neurological disease resulting in impaired mobility and inability to perform activities of daily living. Examples include painful rib fractures affecting oxygenation and post-dural puncture headaches limiting the ability to sit upright, stand and walk. In addition, emergency procedures include procedures to treat any severe or debilitating disease that prevents the patient from carrying out activities of daily living. Elective procedures were considered as any condition that is stable and can be safely managed with alternatives. LIMITATIONS: COVID-19 continues to be an ongoing pandemic. When these recommendations were developed, different stages of reopening based on geographical regulations were in process. The pandemic continues to be dynamic creating every changing evidence-based guidance. Consequently, we provided evidence-informed guidance. CONCLUSION: The COVID-19 pandemic has created unprecedented challenges in IPM creating needless suffering for pain patients. Many IPM procedures cannot be indefinitely postponed without adverse consequences. Chronic pain exacerbations are associated with marked functional declines and risks with alternative treatment modalities. They must be treated with the concern that they deserve. Clinicians must assess patients, local healthcare resources, and weigh the risks and benefits of a procedure against the risks of suffering from disabling pain and exposure to the COVID-19 virus.
BACKGROUND: The COVID-19 pandemic has worsened the pain and suffering of chronic painpatients due to stoppage of "elective" interventional pain management and office visits across the United States. The reopening of America and restarting of interventional techniques and elective surgical procedures has started. Unfortunately, with resurgence in some states, restrictions are once again being imposed. In addition, even during the Phase II and III of reopening, chronic painpatients and interventional pain physicians have faced difficulties because of the priority selection of elective surgical procedures.Chronic painpatients require high intensity care, specifically during a pandemic such as COVID-19. Consequently, it has become necessary to provide guidance for triaging interventional pain procedures, or related elective surgery restrictions during a pandemic. OBJECTIVES: The aim of these guidelines is to provide education and guidance for physicians, healthcare administrators, the public and patients during the COVID-19 pandemic. Our goal is to restore the opportunity to receive appropriate care for our patients who may benefit from interventional techniques. METHODS: The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-19 Task Force in order to provide guidance for triaging interventional pain procedures or related elective surgery restrictions to provide appropriate access to interventional pain management (IPM) procedures in par with other elective surgical procedures. In developing the guidance, trustworthy standards and appropriate disclosures of conflicts of interest were applied with a section of a panel of experts from various regions, specialties, types of practices (private practice, community hospital and academic institutes) and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification was reviewed. The evidence -- informed with the incorporation of the best available research and practice knowledge was utilized, instead of a simplified evidence-based approach. Consequently, these guidelines are considered evidence-informed with the incorporation of the best available research and practice knowledge. RESULTS: The Task Force defined the medical urgency of a case and developed an IPM acuity scale for elective IPM procedures with 3 tiers. These included urgent, emergency, and elective procedures. Examples of urgent and emergency procedures included new onset or exacerbation of complex regional pain syndrome (CRPS), acute trauma or acute exacerbation of degenerative or neurological disease resulting in impaired mobility and inability to perform activities of daily living. Examples include painful rib fractures affecting oxygenation and post-dural puncture headaches limiting the ability to sit upright, stand and walk. In addition, emergency procedures include procedures to treat any severe or debilitating disease that prevents the patient from carrying out activities of daily living. Elective procedures were considered as any condition that is stable and can be safely managed with alternatives. LIMITATIONS: COVID-19 continues to be an ongoing pandemic. When these recommendations were developed, different stages of reopening based on geographical regulations were in process. The pandemic continues to be dynamic creating every changing evidence-based guidance. Consequently, we provided evidence-informed guidance. CONCLUSION: The COVID-19 pandemic has created unprecedented challenges in IPM creating needless suffering for painpatients. Many IPM procedures cannot be indefinitely postponed without adverse consequences. Chronic pain exacerbations are associated with marked functional declines and risks with alternative treatment modalities. They must be treated with the concern that they deserve. Clinicians must assess patients, local healthcare resources, and weigh the risks and benefits of a procedure against the risks of suffering from disabling pain and exposure to the COVID-19 virus.
Authors: Rajesh N Janapala; Laxmaiah Manchikanti; Mahendra R Sanapati; Srinivasa Thota; Alaa Abd-Elsayed; Alan D Kaye; Joshua A Hirsch Journal: J Pain Res Date: 2021-09-10 Impact factor: 3.133
Authors: Marixa Guerrero; Pablo Castroman; Ovelio Quiroga; Maria Berenguel Cook; Marco Antonio Narvaez Tamayo; Lanfranco Venturoni; Joseph Pergolizzi; Martina Rekatsina; Giustino Varrassi Journal: Cureus Date: 2022-03-12
Authors: Marco Cascella; Luca Miceli; Francesco Cutugno; Giorgio Di Lorenzo; Alessandro Morabito; Alfonso Oriente; Giuseppe Massazza; Alberto Magni; Franco Marinangeli; Arturo Cuomo Journal: Int J Environ Res Public Health Date: 2021-12-19 Impact factor: 3.390