Giuliano Lo Bianco1,2, Alfonso Papa3, Michael E Schatman4,5, Andrea Tinnirello6, Gaetano Terranova7, Matteo Luigi Giuseppe Leoni8, Hannah Shapiro9, Sebastiano Mercadante10. 1. Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy. 2. Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy. 3. Pain Department, AO "Ospedali dei Colli", Monaldi Hospital, 80131 Naples, Italy. 4. Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA. 5. Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA. 6. Anesthesiology and Pain Management Unit, Azienda Socio Sanitaria Territoriale della Franciacorta, 25032 Chiari, Italy. 7. Anaesthesia and Intensive Care Department, Asst Gaetano Pini, 20122 Milano, Italy. 8. Unit of Interventional Pain Management, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy. 9. Division of Alcohol, Drugs, and Addiction, McLean Hospital, Harvard Medical School, Boston, MA 02115, USA. 10. Pain Relief and Supportive Care, Private Hospital La Maddalena, 90100 Palermo, Italy.
Abstract
BACKGROUND: Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients. METHODS: Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19 patients. RESULTS: Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.
BACKGROUND: Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients. METHODS: Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19patients. RESULTS: Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.
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